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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study was designed to investigate potential factors involved in the disruption of the circadian blood pressure (BP) pattern in diabetes mellitus, as well as the relation between BP, cardiac autonomic neuropathy, and estimated cardiovascular risk. We studied 101 diabetic patients (58% with type 2 diabetes; 59% men), age 21-65 yrs, evaluated by 48 h BP monitoring. We performed three autonomic tests in a single session: deep breathing, Valsalva maneuver, and standing up from a seated position. Patients were classified according to the number of abnormal tests and their 10 yr risk of coronary heart disease or stroke. The prevalence of non-dipping 24 h patterning ranged from 47.6% in type 1 to 42.4% in type 2 diabetes. The awake/asleep ratio of systolic BP (SBP) was comparable between patients with or without abnormal autonomic tests. Pulse pressure (PP) was significantly higher in patients with > or =1 abnormal autonomic test (p < 0.001). Ambulatory SBP was significantly elevated in the group with higher risk of coronary heart disease (p < 0.001). Patients with higher stroke-risk had higher SBP but lower diastolic BP, and thus an elevated ambulatory PP by 9 mmHg, compared to those with lower risk (p < 0.001). Cardiac autonomic neuropathy is not the main causal-factor for the non-dipper BP pattern in diabetes mellitus. The most significant finding from this study is the high ambulatory PP found in patients with either cardiac autonomic dysfunction or high risk for coronary heart disease or stroke. After correcting for age, this elevated PP level emerged as the main cardiovascular risk factor in diabetes mellitus.
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PMID:Cardiac autonomic neuropathy, estimated cardiovascular risk, and circadian blood pressure pattern in diabetes mellitus. 1963 52

Hyperhomocysteinemia is an independent cardiovascular risk factor, according to most observational studies and to studies using the Mendelian randomization approach, utilizing the common polymorphism C677T of methylene tetrahydrofolate reductase. In contrast, the most recent secondary preventive intervention studies, in the general population and in chronic kidney disease (CKD) and uremia, which are all negative (with the possible notable exception of stroke), point to other directions. However, all trials use folic acid in various dosages as a means to reduce homocysteine levels, with the addition of vitamins B6 and B12. It is possible that folic acid has negative effects, which offset the benefits; alternatively, homocysteine could be an innocent by-stander, or a surrogate of the real culprit. The latter possibility leads us to the search for potential candidates. First, the accumulation of homocysteine in blood leads to an intracellular increase of S-adenosylhomocysteine (AdoHcy), a powerful competitive methyltransferase inhibitor, which by itself is considered a predictor of cardiovascular events. DNA methyltransferases are among the principal targets of hyperhomocysteinemia, as studies in several cell culture and animal models, as well as in humans, show. In CKD and in uremia, hyperhomocysteinemia and high intracellular AdoHcy are present and are associated with abnormal allelic expression of genes regulated through methylation, such as imprinted genes, and pseudoautosomal genes, thus pointing to epigenetic dysregulation. These alterations are susceptible to reversal upon homocysteine-lowering therapy obtained through folate administration. Second, it has to be kept in mind that homocysteine is mainly protein-bound, and its effects could be linked therefore to protein homocysteinylation. In this respect, increased protein homocysteinylation has been found in uremia, leading to alterations in protein function.
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PMID:Hyperhomocysteinemia in uremia--a red flag in a disrupted circuit. 1970 80

Diabetes mellitus (DM) is an independent risk factor for coronary heart disease, stroke, peripheral arterial disease and heart failure, which are the main causes of death in these patients. Moreover, patients with DM and cardiovascular disease have a worse prognosis than nondiabetics, present lower short-term survival, higher risk of recurrence of the disease and a worse response to the treatments proposed. In the last decades, diagnostic and therapeutic progress had already shown benefits concerning cardiovascular risk reduction in these patients, but their absolute mortality risk is still twice that of non-diabetic patients. Because of this, the adoption of intensive treatment, with strict cardiovascular risk factor control, is a priority. The present study presents the main clinical characteristics and also the practical approach for screening, diagnosis and treatment of patients with diabetic macrovascular disease.
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PMID:[Macrovascular diabetic complications: clinical characteristics, diagnosis and management]. 1989 11

We are presenting a review of Isolated Systolic Hypertension (ISH) as a cardiovascular risk factor with emphasis on the perioperative period.Isolated systolic hypertension is associated with aging and is the most frequent subtype (65%) among patients with uncontrolled hypertension. ISH is strongly associated with increased risks of cardiac and cerebrovascular events exceeding those in comparably aged individuals with diastolic hypertension. Patients with ISH show an increase in left ventricular (LV) mass and an increase in the prevalence of left ventricular hypertrophy (LVH). These LV changes increase cardiovascular events and frequently lead to diastolic dysfunction (DD). Treatment to reduce elevated systolic blood pressure has been shown to reduce the risk of cardiovascular events.In the perioperative setting, essential hypertension has not been found to be a significant risk factor for cardiac complications. Most of the studies were based on the definition of essential hypertension and underpowered in sample size. The significance of perioperative ISH, however, is not well studied, partly due to its recognition only fairly recently as a cardiovascular risk factor in the non-surgical setting, and partly due to the evolving definition of ISH.Perioperative cardiac complications remain a significant problem to the healthcare system and to the patient. Although the incidence of perioperative cardiac complications is prominent in high-risk patients as defined by the Revised Cardiac Risk Index (RCRI), the bulk of the cardiac complications actually occur in low-risk group. Currently, little understanding exists on the occurrence of perioperative cardiac complications in low- risk patients. A factor such as ISH, with its known pathophysiological changes, is a potential perioperative risk factor.We believe ISH is an under-recognized perioperative risk factor and deserves further studying. Our research group has recently been funded by the Heart Stroke Foundation (HSF) to examine ISH as a perioperative risk factor (PROMISE Study).
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PMID:Is Peri-Operative Isolated Systolic Hypertension (ISH) a Cardiac Risk Factor? 1992 74

Cardiovascular disease is the leading cause of death in Western countries. Since 1969, homocysteine has been implicated in the atherosclerotic process, and numerous observational studies have suggested that hyperhomocysteinaemia should be considered as an independent cardiovascular risk factor. B-vitamins, particularly folic acid, reduce homocysteine levels effectively; it was suggested, therefore, that supplementation with these vitamins might decrease cardiovascular risk and reduce the morbidity and mortality associated with stroke, coronary heart disease and peripheral artery disease. However, the results of clinical trials conducted to investigate this issue have been inconsistent. This review discusses the findings of these trials and provides an updated overview on the 'homocysteine hypothesis'.
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PMID:The controversial role of B-vitamins in cardiovascular risk: An update. 1996 94

The obstructive sleep apnoea syndrome (OSAS) is a highly prevalent sleep related breathing disorder associated with hypopnoea/apnoea, arousals and increased daytime sleepiness. OSAS has been shown to have damaging acute effects on the cardiovascular system and thus has been postulated to represent an independent cardiovascular risk factor. A causal relationship between OSAS and cardiovascular disease has currently only been established for hypertension and heart failure. Evidence that OSAS indeed plays a key role in the pathogenesis of heart attacks and stroke and that therapy of OSAS reduces cardiovascular morbidity and mortality is currently limited. The results of multiple ongoing international multi-centre studies investigating the effects of OSAS therapy on cardiovascular event rate and mortality are thus anxiously awaited.
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PMID:[Cardiovascular consequences of obstructive sleep apnoea syndrome]. 2008 31

Patients with metabolic syndrome have a 1.5- to 3-fold increase in the risk of coronary heart disease and stroke. The association between metabolic syndrome and cardiovascular diseases raises important questions about the underlying pathological processes, especially for designing targeted therapeutic interventions. Cardiovascular risk reduction in individuals with metabolic syndrome should include at least three levels of interventions: 1) control of obesity, unhealthy diet and lack of physical activity; 2) control of the individual components of metabolic syndrome, especially atherogenic dyslipidaemia, hypertension, dysglycaemia and prothrombotic state; and 3) control of insulin resistance, a defect closely linked to metabolic syndrome. Metabolic syndrome generally precedes and is often associated with type 2 diabetes. Because of this intimate relationship, appropriate management of metabolic syndrome should be able to prevent the progression from impaired glucose tolerance to frank diabetes and thus to prevent type 2 diabetes, another important cardiovascular risk factor. The importance of prevention of diabetes in high-risk individuals (such as people with metabolic syndrome are) is highlighted by the substantial and worldwide increase in the prevalence of type 2 diabetes in recent years. Owing to the complex pathophysiology and phenotypic expression of metabolic syndrome, lifestyle changes are crucial as they are able to positively and simultaneously influence almost all components of the syndrome. If such measures are not sufficient or not adequately followed, a pharmacological intervention may be considered. However, no official guidelines are available yet concerning the pharmacological management of individuals with metabolic syndrome.
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PMID:Management of metabolic syndrome and associated cardiovascular risk factors. 2069 May 66

Hypertension is a common problem in the elderly. Its prevalence is currently 60%-80%, but it is estimated that it will increase with the projected population growth of older people aged more than 65 years. Hypertension is a major cardiovascular risk factor due to the well-known continuous relationship between high blood pressure, stroke and cardiovascular (CV) mortality in all age groups. Because of the expected increasing proportion of older people, a further increase in CV and renal complications of hypertension in the next few decades can be predicted. In the elderly, systolic blood pressure increases because of arterial stiffness produced by structural alterations of arterial wall occurring with aging. On the other hand, in people aged 60 years and over, diastolic blood pressure remains unchanged or decreases. Isolated systolic hypertension and high pulse pressure are thus prevalent, and are important risk factors for stroke, coronary heart disease and all-cause mortality in the elderly and very elderly. The efficacy of therapy in older patients with systolic and diastolic hypertension or with isolated systolic hypertension, in terms of reduction of cardiovascular morbility and mortality, have been widely confirmed by many controlled and randomized clinical trials.
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PMID:Hypertension in the elderly. 2087 73

The eight papers included in this doctoral thesis were made during my position as a clinical research assistant at the Department of Neurology, Bispebjerg Hospital. All papers are based on the Copenhagen Stroke Study, which comprises a cohort of 1197 patients with acute stroke admitted to a single stroke unit and recruited from a well-defined area in Copenhagen, Denmark. This thesis focuses on the survival after stroke in relation to several baseline clinical characteristics and risk factors for cardiovascular disease. The thesis comes in three sections with regard to whether factors or clinical characteristics are permanent, potentially modifiable, or possible to change. The relative importance of the factors and clinical characteristics are discussed in relation to short-, intermediate-, and long-term survival after stroke. The results from the Copenhagen Stroke Study are compared to the results from other community-based or population-based studies. The two most prominent factors that determine both short- and long-term survival after stroke are age and stroke severity at onset. Advancing age and increasing severity are perceptively negatively correlated to survival. In some cases emerging therapies such as thrombolytic therapy and hypothermia may alleviate the burden of stroke severity, but this is not the case for the majority of stroke patients. The necessity to measure stroke severity with a validated stroke scale when comparing stroke patients in randomized clinical trials or population-based surveys is emphasized. For factors such as sex, and most cardiovascular risk factors further studies are necessary to clarify the relation to survival because studies disagree. Conclusions from studies of the relation between survival and alcohol intake are still debatable, mostly because of diverging definitions of the intensity of exposure. Smoking is uniformly associated with a poorer survival after stroke. Stroke unit treatment improves both short- and longterm survival regardless of stroke type, severity, age, and cardiovascular risk factor profile.
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PMID:Survival after stroke. Risk factors and determinants in the Copenhagen Stroke Study. 2104 Jun 87

The role of statins in the treatment and prevention of cardiovascular diseases, such as coronary artery disease, acute coronary syndromes, diabetes, or stroke, is well established. However, there are still some questions regarding the role of statins in patients with chronic kidney disease (CKD). Dyslipidemia is a known cardiovascular risk factor in individuals without CKD. In these patients, however, the relation of dyslipidemia to cardiovascular risk is complex, and the underlying pathobiological mechanisms are complex. Statins have proven to be highly effective in patients with initial stages of CKD; however, their effects in patients with advanced-stage CKD have been neutral despite a low-density lipoprotein cholesterol-lowering effect. In this review, we summarize the findings of the recent clinical trials of statins in renal disease and make recommendations for our patients.
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PMID:Statins and renal disease: friend or foe? 2105 7


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