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

Twenty of approximately 1000 patients attending the arteriosclerosis clinic at MIT during a 13 year period were treated simultaneously with aspirin and warfarin for symptomatic atherosclerotic (19) or rheumatic (1) heart or vascular disease. The average duration of therapy was 5.8 years. Thirteen patients suffered from familial hyperlipoproteinemia; only one patient had none of the major risk factors for arteriosclerosis. Refractory symptoms were related to the central nervous system in 13, peripheral vascular system in 5 and the heart in 2. All twenty patients became asymptomatic or showed marked clinical improvement on aspirin plus warfarin therapy. While on this therapy, complications, both thrombotic and hemorrhagic, occurred in 7 of the 20 patients (graft embolus in 1, and bleeding in 6; with one death as a result of intracranial bleeding) and sudden death, probably from acute myocardial ischemia, in a further 2 patients. We conclude that when alternative therapies are impossible or have proven to be of no avail in patients suffering from the complications of advanced atherosclerosis, the simultaneous administration of aspirin and warfarin may be a therapeutic alternative, although very close and careful followup of the patients' prothrombin times and clinical status is essential.
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PMID:Simultaneous therapy with antiplatelet and anticoagulant drugs in symptomatic cardiovascular disease. 387 67

Data concerning circulating immune complexes were obtained for women who had had a pulmonary embolism, myocardial infarction, or cerebral thrombosis, and for 224 healthy controls. In women with pulmonary embolism who had used oral contraceptives (OCs) concentrations of circulating immune complexes were significantly higher than in healthy controls (regardless of OC use), or in those with pulmonary embolism who had never used these preparations. Concentrations of circulating immune complexes were not raised in myocardial infarction, but these women had major risk factors for ischemic heart disease. The group of patients with cerebral thrombosis without risk factors tended to have high concentrations of circulating immune complexes. The data provide some confirmation that immunological mechanisms may play a role in thrombotic episodes associated with OCs, especially when they occur in the absence of risk factors for vascular disease.
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PMID:Immunogenicity and the vascular risk of oral contraceptives. 399 71

Primary hyperbetalipoproteinemia (type II hyperlipoproteinemia) is a common disorder associated with premature vascular disease. It is frequently due to genetic abnormalities, some of which are expressed in childhood. We have examined the manner in which that form of hyperbetalipoproteinemia known as familial hypercholesterolemia may be expressed in 236 children aged 1-19 born of 90 matings in which one parent had hyperbetalipoproteinemia of this variety and one parent did not.Two Gaussian populations were fitted to the distribution of both low density lipoprotein cholesterol (C(LDL)) and plasma cholesterol (C) in these children and a likelihood ratio test strongly favored a two over a one population model for both C(LDL) (X(2) = 18.41, P < 0.0005) and C (X(2) = 7.81, P < 0.025). 45% of the children were in the population identified as affected; their mean C(LDL) was 229. The remaining 55% were in the normal population with a mean C(LDL) of 110 which was indistinguishable from that of an unrelated control population, aged 1-19. On the basis of an assumed frequency of hyperbetalipoproteinemia in the general population of 5%, the Edwards' test indicated that a polygenic model of inheritance was highly unlikely (expected, 22%; observed, 45%). The segregation ratio obtained from the derived intersection between the two population curves (C(LDL), 164 mg/100 ml; C, 235 mg/100 ml) was 45/55 (abnormal/normal). The percentage of abnormal children in the first decade (52%) significantly exceeded that in the second (39%) (P < 0.01). The ratios (II/N) were 50/47 and 55/84 in the offspring of affected female and male parents, respectively (X(2) = 3.819, 0.05 < P < 0.10). Only 10% of hyperbetalipoproteinemic children were considered to have hyperglyceridemia. These children, frequently, but not invariably, had a parent with hyperglyceridemia in addition to hyperbetalipoproteinemia (P < 0.05). None of the affected children who were examined had ischemic heart disease (IHD) and 7% had tendon xanthomas. Half of the parents (mean age, 37.4 yr) who were examined had IHD and three-quarters had xanthomas. The data agree well with the hypothesis that hyperbetalipoproteinemia is inherited as a monogenic trait with early expression in these children. More than one genetic defect within the group is not excluded, but retrospective analyses of the 345 first-degree adult relatives of the affected parents indicated that most of the abnormal parents probably represented familial hypercholesterolemia, rather than combined hyperlipidemia, the other most generally recognized form of familial hyperbetalipoproteinemia.
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PMID:Familial hypercholesterolemia (one form of familial type II hyperlipoproteinemia). A study of its biochemical, genetic and clinical presentation in childhood. 436 6

The principal causes of death for persons aged between 55 and 64 years are identified from Australian mortality data for 1966 and 1977. Four conditions--ischaemic heart disease, cerebrovascular disease, bronchial carcinoma, and chronic airways disease--account for 62% of deaths in this age group, with 36% of deaths being attributed to ischaemic heart disease. Changes in age-specific mortality rates during the period from 1966 to 1977 are described for each of these four conditions. There have been substantial reductions in mortality from vascular disease in both sexes, and this trend has accelerated since 1974. A recent fall in mortality from bronchial carcinoma and chronic airways disease is indicated for males, while death rates from these disorders continue to increase rapidly for females. The introduction of beta-blockade in the treatment of vascular disease, and changes in the pattern of cigarette smoking are discussed in relation to these mortality trends.
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PMID:The changing face of death: recent trends in Australian mortality. 610 14

An analysis has been made of the 249 deaths which were reported during the course of the Royal College of General Practitioners' prospective study of the health associations of (OC) oral contraception. As in the past, women who had used the pill were reported to have a 40% higher death rate than women who had never taken OCs. Virtually all excess mortality was due to diseases of the circulatory system. Women who had used OCs had a relative risk of 4.3 for deaths attributed to vascular diseases. Most of these were from ischemic heart disease (relative risk 4.1) and subarachnoid hemorrhage (relative risk 4.0). The larger number of cases now reported has permitted greater discrimination than was possible earlier between subjects with high and low risks. There were few deaths under 35 years of age and the excess annual death rates of 1/77,000 women in nonsmokers and 1/10,000 women in smokers have wide confidence limits, and could have arisen by chance. For women aged 35-44 years, the excess annual death rate was 1/6700 women in nonsmokers and 1/2000 women in smokers; at 45 years and above the risks were 1 in 2500 and 1 in 500, respectively. There is now no evidence that the risk is associated with duration of OC use. The demonstrated positive association of risk with parity in pill users needs confirmation. Former users were noted to have an increased risk of death from vascular disease, but it was not possible to determine whether this represents a residual effect of OCs on the vascular system.
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PMID:Further analyses of mortality in oral contraceptive users. Royal College of General Practitioners' Oral Contraception Study. 611 42

The scientific basis for the statement that cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive (OC) use is reviewed. The published literature and the new statistical analyses of the data are examined. Attention is directed to 3 broad categories of relevant vascular disease--deep vein thrombosis and pulmonary embolism, stroke--both occlusive and hemorrhagic, and ischemic heart disease. Within each category, the epidemiologic relationship of cigarette smoking alone, of OC use, and of a combination of the 2 is addressed. This review of smoking and OC use as risk factors for major classes of cardiovascular disease reveals little convincing evidence for an interaction of the smoking and OC use. Essentially all of the data have been interpreted to indicate that OC use is a risk factor for cardiovascular disorders derive from retrospective case-control studies, which continue to be a subject of controversy. The role of smoking as a risk factor appears to be little questioned in the case of myocardial infarction, and the evidence suggests that it may also be a factor in hemorrhagic stroke. There is little evidence to implicate smoking in the pathogenesis of thrombotic stroke in young women, and several publications suggest that it has a protective effect for deep vein thrombosis. In sum, evidence for an interaction of smoking and OC use has been reported but is deemed to be weak. A major existing difficulty is the methodological problems that are inherent in epidemiologic investigations, both retrospective and prospective. While conservatism could thus withhold needed and effective contraception, the recommendation is for the OC user to forego smoking.
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PMID:Smoking, oral contraceptives, and thromboembolic disease. 612 53

The plasma concentration of beta-thromboglobulin (BTG), a platelet-specific protein released during platelet aggregation, is considered a sensitive marker of in vivo platelet activity. The mean plasma level in 133 asymptomatic individuals was 32.3 +/- 1.1 ng/ml, and there was no difference between those with no risk factors (32.2 +/- 1.2 ng/ml, n = 56), those who smoked (31.8 +/- 1.8 ng/ml, n = 45), those with hyperlipidemia (32.8 +/- 1.7 ng/ml, n = 15), and those exposed to both of these risk factors (34.1 +/- 2.7 ng/ml, n = 17). The mean plasma BTG level in 104 patients with symptomatic ischemic heart disease was significantly elevated (40.9 +/- 1.4 ng/ml, p less than 0.01), but there was considerable overlap with normal levels. Although no difference was found between patients with no risk factors (38.1 +/- 4.0 ng/ml, n = 13) and those with only 1 risk factor (37.0 +/- 1.8 ng/ml, n = 44), patients with 2 or more risk factors ahd a significantly elevated plasma BTG level (45.2 +/- 2.2 ng/nl, n = 47, p less than 0.01). It is concluded that risk factors themselves do not increase platelet activity, but that patients with vascular disease have activated platelets that may contribute to the progression of the disease. Plasma BTG was also measured serially for 10 days in 29 patients after hospitalization with acute ischemic cardiac pain. Although the median plasma level was elevated above normal there were no acute changes in plasma BTG after either acute infarction (n = 22) or acute ischemia (n = 7), except in 2 patients in whom pericardial friction rubs developed. Thus, measurement of systemic plasma BTG did not detect platelet involvement in acute coronary occlusion or acute ischemia.
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PMID:Plasma beta-thromboglobulin as a measure of platelet activity. Effect of risk factors and findings in ischemic heart disease and after acute myocardial infarction. 618 69

In the past years, the structure and function of the plasma lipoproteins and apolipoproteins have been elucidated. The biochemical defect of several genetic lipoprotein disorders and their role in the development of atherosclerosis are now well understood. Electrophoretic separation of lipoproteins in polyacrylamide gradient gel gives an acurate characterization of the different lipoproteins and allows the phenotyping of hyperlipoproteinemia. Abnormal concentrations of plasma lipoproteins have been known for many years to be a major risk factor in the development of premature ischemic heart disease. Although large-scale epidemiological studies have focused attention on the association between above-normal concentrations of plasma lipids and coronary atherosclerosis, recent findings have shown that quantitative lipoprotein and apoprotein determination may be a more nearly accurate predictor in the recognition of atherosclerosis. The risk for vascular disease seems to be particularly associated with an increase in the concentrations of apolipoprotein B (apo B), the major protein moiety of low density lipoproteins and a decrease in apolipoprotein Al, the major polypeptide of high-density lipoproteins.
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PMID:[Methods of biochemical analysis in hyperliproproteinemias]. 640 90

A Bulgarian team, within the frames of a multinational study on diabetic vascular disease, sponsored by WHO, studied a group of 473 diabetic patients by the inquiry method and by the determination of blood cholesterin and creatinine and urine albumin. The results were compared with those of the whole group (6695 patients from 14 countries) and with each national group separately. A higher percentage of insulin-treated patients was established in the Bulgarian group as compared with the whole group, fewer hypertonics, lower mean cholesterol values, a little higher average body weight and considerably lower percentages of smokers. The various forms of macroangiopathy among the Bulgarian group proved to be in percentages, approaching the average percentages for the whole group or little lower than them (e.g. for the category "probable infarctions" and "cerebral hemorrhages"). Only for the category "IHD" the affection percentage among the Bulgarian group significantly surpassed that of the whole group. Since the Bulgarian group, as regards the possible risk factors, is in a more favourable condition, the higher IHD percentage is admitted to be due to the circumstances that patients with graver states have been included in the group. That is suggested by the higher percentage of patients (52%), insulin-treated. The severity of diabetes is concluded to be a significant factor in the development of macroangiopathy.
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PMID:[Comparison between the incidence of diabetic macroangiopathy in a group of diabetics from Bulgaria and from 13 other countries]. 646 38

A prospective study was made of the morbidity and mortality from ischemic heart disease in 390 patients with focal TIA caused by atherosclerotic vascular disease. The 5-year cumulative rate of myocardial infarction or sudden death in these patients was 21.0%, a rate only slightly less than that of fatal or nonfatal cerebral infarction (22.7%). Risk factors including diabetes, angina, and ECG abnormalities were associated with an increase in morbidity and mortality from ischemic heart disease. A major factor associated with these cardiac events was the presence of atherosclerotic obstructive or ulcerative lesions in the carotid arteries. These observations indicate that focal TIA caused by carotid atherosclerosis is a predictor not only of cerebral infarction, but also of serious cardiac disease and death.
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PMID:Risk of ischemic heart disease in patients with TIA. 653 54


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