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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In three different studies we tested the hypothesis that early-onset vascular disease is associated with impaired homocysteine metabolism which could contribute to the development of arteriosclerosis and thrombosis. In patients with occlusive vascular disease before the age of 60, a post-methionine load increase of plasma homocysteine exceeding the highest value for comparable healthy control subjects was found in 1 of 21 with myocardial infarction (5%), 14 of 37 with aorto-iliac disease (38%), and 17 of 53 with cerebrovascular disease (32%). This might indicate heterozygosity for homocystinuria due to cystathionine beta-synthase deficiency. Concentrations of serum vitamin B12 and red cell folate had an important modulating effect on plasma homocysteine concentrations in the fasting state.
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PMID:Plasma homocysteine and methionine tolerance in early-onset vascular disease. 268 Aug 11

Sulfur amino acids have been implicated in the pathogenesis of thromboembolic vascular disease, and observations of patients with several inborn errors of metabolism have led to the 'homocysteine theory of arteriosclerosis'. Homocysteine is an intermediate in the transsulfuration pathway and it enters into several other reactions, some of which involve transfer of methyl groups. An abnormally high concentration of homocysteine in the blood causes homocystinuria. Deficiency of cystathionine beta-synthase is the most frequent cause of homocystinuria. Patients with this disorder are at risk for early vascular occlusions. Treatment with vitamin B6 of patients who are biochemically responsive to this vitamin reduces the risk of thromboembolism. Clinical or pathologic evidence of early vascular disease has also been provided in patients with homocysteinemia due to deficient (re)methylation of homocysteine to methionine. This may be caused by a deficiency of 5,10-methylenetetrahydrofolate reductase or by a deficient synthesis of cobalamins.
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PMID:Inborn errors of metabolism causing homocysteinemia and related vascular involvement. 268 Aug 12

Predominance of analysis over synthesis, lack of integrative perception and inadequate consideration of regulatory mechanisms, insufficient understanding of the dialectical relationship between animal and man as well as of human individuality, these are considered to be the most severe limitations on scientific cognition today. This appraisal fully applies to arteriosclerosis, as well. More attention ought to be given to its peculiarities as a chronic disease, to the role played by so-called risk factors and their causative implications as well as to the impact of senescence on chronic pathological alterations. Our present knowledge on the causative correlations implied is not sufficient for adequate prevention of the arteriosclerotic vascular disease. Nevertheless, it would make sense to reduce those factors which have been identified as risk-boosting, although only limited consequences can be expected from such an approach.
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PMID:[Arteriosclerosis as the reflected image of current problems of medical science]. 268 95

Few studies have presented a thorough analysis of young adults with symptoms of arterial occlusive disease. To learn more about the possible risk factors of vascular disease playing a role in these young patients, we have reviewed all patients of 45 years of age and younger with symptoms of arterial occlusive disease who had been referred to our department between 1978 and 1987. Thirty-seven patients (28 males and 9 females) were included in the study. The mean age at which the first symptoms occurred was 34 years. Most patients presented with chronic arterial obliterations of the lower extremities (31/37, 84%). In addition, 4 patients showed signs of ischaemic heart disease. A strongly positive family history of arteriosclerosis was obtained from 13 patients (35%). Hypertension was present in 7 patients (19%), diabetes in three (8%) and nicotine abuse was found in 27 patients (73%). Fifty-four percent of the patients (20/37) had undergone vascular reconstructive surgery, 19% (7/37) underwent transluminal dilatation, and 3 had had subsequent treatment of newly developed lesions. For this study, all patients were recalled to the outpatient clinic. A complete case history was taken followed by a physical examination and ECG. Laboratory examinations were performed to analyse parameters of: (a) coagulation; (b) fibrinolysis; (c) fat- and (d) methionine metabolism. Clear-cut laboratory abnormalities were found in 33 patients (33/37, 89%). Coagulation parameters were abnormal in 11 patients (30%) (protein S deficiency: 3 pts). Fibrinolysis was impaired in 15 patients (40%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A prospective survey of risk factors in young adults with arterial occlusive disease. 274 53

Carriers of the apolipoprotein A-IMilano (apo A-IM) variant represent a selected group of subjects showing low levels of high density lipoprotein (HDL), variable hypertriglyceridemia, and low prevalence of atherosclerotic vascular disease. The distribution of HDL subfractions and the correlation with abnormalities in triglyceride transport were determined in these subjects. Sera from 24 apo A-IM carriers (A-IM+ and from age- and sex-matched normolipidemic controls (A-IM-) were analyzed by rate zonal ultracentrifugation. The A-IM+ subjects showed a marked decrease of HDL3 mass with reduced flotation rates and major compositional alterations; the HDL2 were nearly absent. The HDL subclasses from 10 A-IM+ subjects were resolved according to particle size by gradient gel electrophoresis (GGE). The HDL patterns detected in the carriers were unique in exhibiting a distinct peak in the (HDL3b)gge interval, undetectable in the controls. Three patterns reflecting the relative contributions of smaller (HDL3b)gge and larger (HDL3a)gge particles could be distinguished in the carriers, and these were clearly related to different triglyceride and HDL cholesterol levels in plasma. These findings in a highly selected group of subjects with generally low HDL levels and quite variable triglyceridemia confirmed the existence of relationships between alterations in triglyceride transport and abnormalities in the HDL subclass distribution, possibly reflecting the variable atherosclerotic risk in hypertriglyceridemic subjects.
Arteriosclerosis
PMID:Apolipoprotein A-IMilano. Correlation between high density lipoprotein subclass distribution and triglyceridemia. 311 56

A thorough knowledge of the normal changes that occur in the brain with age is critical before abnormal findings are analyzed. Magnetic resonance (MR) imaging improves the ability to distinguish normal and abnormal findings in the brain. The major changes that may occur in elderly individuals without neurologic deficits include enlargement of the ventricles, cortical sulci, and vermian subarachnoid spaces; multifocal areas of hyperintensity in the white matter and basal ganglia; a progressive prominence of hypointensity on T2-weighted images of the putamen, almost equal to that of the globus pallidus; an increase in the oxygen extraction ratio with normal or mildly decreased neuron metabolism; arteriosclerosis in large and small arteries and amyloid angiopathy in leptomeningeal cortical vessels; and decreased dopamine receptor binding in the corpus striatum. Since approximately half of the elderly population exhibits only negligible brain alterations, MR imaging may facilitate the distinction between usual (no neurologic dysfunction) and successful (no brain or vascular changes) aging.
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PMID:Imaging of the aging brain. Part I. Normal findings. 327 47

The prevalence of atherosclerotic vascular disease (ASVD) and its risk factors were investigated in 263 insulin-treated diabetic patients, ages 45 to 64 years, who were older than 30 years when their diabetes was diagnosed. The patients were divided into two groups based on the degree of endogenous insulin secretion capacity: Group A: glucagon-stimulated plasma C-peptide less than 0.20 nmol/l and Group B: C-peptide greater than or equal to 0.20 nmol/l. The age-adjusted prevalence of definite myocardial infarction was significantly higher in Group B than in Group A (16.8% vs. 5.2%, p less than 0.01). A similar difference between Groups A and B was found for definite or possible coronary heart disease (54.6% vs. 32.9%, p less than 0.001) and stroke (9.3% vs. 2.0%, p less than 0.05). In multivariate analysis, high glucagon-stimulated plasma C-peptide level (greater than or equal to 0.20 nmol/l) was positively associated with definite or possible coronary heart disease independently of other cardiovascular risk factors. Our results indicate that among insulin-treated patients with a late onset of diabetes, the prevalence of ASVD is markedly higher in those with persistent endogenous insulin secretion (noninsulin-dependent diabetes) than in those with low or no insulin secretion (insulin-dependent diabetes).
Arteriosclerosis
PMID:Atherosclerotic vascular disease in middle-aged, insulin-treated, diabetic patients. Association with endogenous insulin secretion capacity. 328 22

Using TOSHIBA Digiformer X, digital subtraction angiography (DSA) was performed in 286 patients, in whom 229 patients of cerebro-spinal vascular disease was included. The authors emphasize the usefulness of DSA in cerebro-spinal vascular disease in relation to conventional angiography. DSA taken by single small dose injection of contrast medium into the ascending aorta clearly demonstrates not only aortic arch and thoracic major vessels, but also cervical vessels and all intracranial vessels. Therefore, we could rapidly understand gross dynamics of the circulation and obtain useful informations prior to catheterization to the selective artery. This advantage of DSA was particularly useful for occlusive vascular diseases. Gradual injection of small dose of contrast medium obviously reduced recoiling of the catheter tip, which enabled the selective angiography with setting of the tip of the catheter at the entrance of cervical major vessels without its sufficient insertion into the selective vessels. This advantage is particularly beneficial for the patients with severe arteriosclerosis who was found to be difficult for selective catheterization. In our experience, demonstration of a presence of aneurysm by DSA was possible in almost all cases of subarachnoid hemorrhage, although spatial resolution of DSA is said to be inferior to the conventional angiography. Real time display of DSA decreased the time required for examination and enabled repeated angiography. This advantage of DSA is especially useful for the patients with spinal arterio-venous malformation and thoracic outlet syndrome.
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PMID:[Diagnostic value of digital subtraction angiography (DSA) using Toshiba Digiformer X in the cerebrospinal vascular diseases]. 330 13

A large and rapidly growing quantity of information gained from both clinical and experimental observation strongly indicate that perturbations of the immune system can contribute to the pathogenesis of vessel injury and thrombosis. This is, in part, because the immune system functions to amplify and diversify the host response to a given stimulus often resulting in activation of associated pathways such as the hemostatic system and modulation of endothelial cell function. Studying the pathogenesis of arteriosclerosis and its complications, as well as other vascular disease, from an immunologic or immunopathologic perspective may provide a better understanding of why some some individuals appear to be at greater risk of cardiovascular disease than others, a more precise identification of the mechanisms leading to the expression of increased risk, and because of the structural specificity implicit in immunologic reactions, identification of those environmental factors responsible for inciting such immunologic perturbation. It is conceivable that identification of at least some of the risk factors associated with the 50% of deaths from heart attack that are not associated with known risk factors may be achieved through a consideration of the role of immunologic mechanisms in the pathogenesis cardiovascular disease.
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PMID:Immunologic aspects of vessel injury and thrombosis. 331 May 35

Marine lipids containing omega-3 fatty acids (chiefly, eicosapentanoic acid [EPA] and docosahexanoic acid [DHA]) may inhibit the development of atherosclerotic vascular disease, but the mechanisms responsible for this putative beneficial effect are unknown. We investigated the effects of EPA and DHA in a canine model of accelerated vein graft arteriosclerosis during a 3-month period. Twenty-five dogs were divided into three dietary groups: group I (control), group II (2.5% cholesterol), and group III (2.5% cholesterol plus 2 gm EPA/day [as MaxEPA]). The effects of EPA on vein graft intimal thickening, platelet and vascular prostaglandin metabolism, lipid and lipoprotein receptor metabolism, and hematologic parameters were assessed. Cholesterol feeding caused a significant 54% increase in graft intimal thickness compared with control animals (124.9 +/- 50.4 vs 81.2 +/- 32.4 micron; p = 0.013), which was prevented by supplementation with EPA in group III (56.9 +/- 30.0 micron; p = 0.001 vs group II). Intimal thickness in group III was not significantly different from that of control. EPA supplementation was also associated with a 38% decline in serum thromboxane levels from 457.0 +/- 129.3 pg/0.1 ml in group II to 283.5 +/- 96.9 pg/0.1 ml in group III (p = 0.007). The alterations in lipoprotein metabolism associated with cholesterol feeding were not affected by EPA: in both groups II and III, serum cholesterol and high-density lipoproteins and liver cholesterol content were elevated and hepatic low-density lipoproteins (LDL) receptor content was reduced. There were no differences between the three groups in terms of vein graft or native vessel prostacyclin production, hematocrit, platelet count, or coagulation parameters. In this canine model, dietary supplementation with marine omega-3 fatty acids reduced the extent and magnitude of accelerated vein graft intimal thickening induced by hypercholesterolemia; moreover, this beneficial effect was associated with lower serum thromboxane production and appeared to be independent of alterations in lipoprotein metabolism or LDL receptor density.
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PMID:Inhibition of vein graft intimal thickening by eicosapentanoic acid: reduced thromboxane production without change in lipoprotein levels or low-density lipoprotein receptor density. 333 17


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