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

The frequency of cardiovascular disease associated with metabolic disorder is increasing rapidly worldwide. The metabolic syndrome, a concurrence of glucose intolerance, obesity, dyslipidemia, and hypertension that are risk factors for atherosclerosis, accounts for a large proportion of cardiovascular morbidity and mortality. Exceeding energy intake coupled with high fat diet, sedentary lifestyle, and multiple genetic factors interact to produce the metabolic syndrome, and insulin resistance and visceral adiposity have been suggested to be the common pathophysiological basis of the metabolic syndrome. Adiposity is correlated with altered production of so-called adipocytokines that play a role on the atherosclerotic angiopathy. At the cellular level, excess insulin is involved in VLDL-triglycerides production, decreased HDL, and various elements of atherogenesis. Detecting the metabolic syndrome and implementing preventive lifestyle interventions--diet education, physical activity, and weight control--is a high clinical priority.
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PMID:[The metabolic syndrome and insulin resistance]. 1610 Dec 44

Type 2 diabetes mellitus is increasing globally and is an established risk factor for the development of atherosclerotic vascular disease. Insulin resistance is the hallmark feature of type 2 diabetes and is also an important component of the metabolic syndrome. There is evidence to suggest that testosterone is an important regulator of insulin sensitivity in men. Observational studies have shown that testosterone levels are low in men with diabetes, visceral obesity (which is strongly associated with insulin resistance), coronary artery disease and metabolic syndrome. Short-term interventional studies have also demonstrated that testosterone replacement therapy produces an improvement in insulin sensitivity in men. Thus hypotestosteronaemia may have a role in the pathogenesis of insulin-resistant states and androgen replacement therapy could be a potential treatment that could be offered for improvements in glycaemic control and reduction in cardiovascular risk, particularly in diabetic men.
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PMID:Androgens, insulin resistance and vascular disease in men. 1611 8

Interest in insulin resistance as a candidate pathway in the pathogenesis of vascular disease continues to grow, in part fuelled by the rapidly increasing rates of obesity worldwide which drives insulin resistance in susceptible individuals. Insulin resistance is associated with a range of metabolic perturbances and many of these can accelerate the atherogenic process. There is thus considerable clinical interest in assessing the degree of insulin resistance in subjects at risk for vascular disease. Direct measurements of insulin resistance are generally unsuitable for widespread clinical use. Rather metabolic syndrome criteria based on readily measured factors associated insulin resistance have been proposed by the World Health Organisation and the National Cholesterol Education Panel. Although such criteria predict coronary heart disease events and more strongly type 2 diabetes, their clinical applicability requires much more study. One recent benefit, however, is that vascular risk physicians now more frequently document obesity and glucose concentrations in their patients, and more commonly consider lifestyle interventions. Ongoing clinical trials will further determine the value of lifestyle factors and insulin sensitising agents in reducing risk of vascular and metabolic disease in high risk subjects.
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PMID:Insulin resistance and the metabolic syndrome as predictors of cardiovascular risk: where are we now? 1620 4

The metabolic syndrome describes the clustering of dyslipidaemia, glucose intolerance and hypertension with central adiposity. The syndrome is increasing in prevalence worldwide as a consequence of increasing obesity prevalence. It will have global effects on the prevalence of cardiovascular disease. This review summarises current knowledge of the syndrome with special emphasis on the aetiology and pathogenesis and examines the clinical consequences of occlusive vascular disease and non alcoholic steatohepatitis. The roles of nutrition, exercise and pharmacological treatments of the syndrome are discussed.
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PMID:The metabolic syndrome and type 2 diabetes. 1620 5

The incidence of type-2 diabetes is increasing throughout the world. By 2010, 350 million people will have this disease. Microalbuminuria is present in more than one third, for some at diabetes diagnosis. Rather than a complication, it is an indication of a vascular disorder that is part of the metabolic syndrome. 25% will develop end-stage kidney failure. Several studies have identified microalbuminuria or proteinuria as an independent cardiovascular risk factor. Others have shown that antihypertensive treatments acting on the renin-angiotensin system (ACE inhibitors, ARBs agents) can reduce the progression of nephropathy in people with hypertension, type 2 diabetes and microalbuminuria. The "nephroprotective" effects of these drug classes, beyond their role in blood-pressure reduction, are suggested by modifications in renal structure and protein expression. But no study has so far examined their value in primary prevention in persons with type 2 diabetes without--but at risk of developing--microalbuminuria. The Roadmap study (Randomized Olmesartan And Diabetes Microalbuminuria Prevention Study) of primary prevention has as its objective measurement of the impact of ARBs (olmesartan 40 mg/d) treatment on renal outcome in 4400 patients with type 2 diabetes without microalbuminuria. Follow-up of this placebo-controlled study will last for 5 years. Conducted in 200 European centers, its results are expected for 2012.
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PMID:[Primary cardiorenal prevention in patients with type-2 diabetes. The Roadmap study]. 1626 93

Cardiovascular disease is a major cause of morbidity and mortality in dialysis patients. Vascular disease develops before the initiation of dialysis, and it is now recognized that chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease. Death from cardiovascular disease is a more common endpoint of CKD than progression to dialysis. There are multiple mechanisms that contribute to the increased vascular risk of CKD, one of which is the presence of insulin resistance (IR). CKD is characterised by many features of the metabolic syndrome, and features of IR are also observed in dialysis and transplant patients. IR may be quantified by several different methods. One such method is homeostatic model assessment (HOMA) technique, which derives a measurement of IR from fasting plasma glucose and insulin concentrations. The HOMA index has been demonstrated to be an independent predictor of survival in dialysis patients. CKD is characterised by a chronic inflammatory response and abnormalities in the production and regulation of adipose tissue derived proteins, which may contribute to the development of IR. There are a range of interventions including diet and exercise programmes or medications that may influence IR; however, the impact of these interventions in the context of CKD has not been systematically evaluated.
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PMID:Should we quantify insulin resistance in patients with renal disease? 1635 44

Metabolic syndrome points out numerous vascular risk factors clustering together, due to a common mechanistic substratum, visceral obesity and insulin resistance. The definitions of the syndrome allow to identify individuals at risk of vascular disease and diabetes but actually do not add anything to the predictive value of the individual components of the syndrome. Metabolic syndrome could become a target for some specific therapeutic interventions.
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PMID:[Metabolic syndrome and cardiovascular risk]. 1636 26

Our knowledge and understanding of the role played by peroxisome proliferator-activated gamma receptors in physiology and pathophysiology has expanded dramatically over the past 5 years. Originally described as having important functions in adipogenesis and glucose homeostasis, their pharmacologic agonists, the thiazolidinediones, were introduced as antihyperglycemic, insulin-sensitizing agents for the management of type 2 diabetes mellitus. However, it was to some degree inevitable that the thiazolidinediones would be rapidly recognized as having vasculoprotective properties beyond glycemic control that might also be beneficial. First, diabetic complications are vascular in nature, the earliest feature of these is endothelial dysfunction. Second, it is being increasingly appreciated that these complications develop through inflammatory and procoagulant pathways in which increased oxidative stress is considered a major etiologic mechanism, and which are closely linked to the presence of insulin resistance, visceral obesity, and hyperglycemia. Early appreciation that the thiazolidinediones have antioxidant, anti-inflammatory, anti-procoagulant, and antiproliferative properties in addition to their insulin-sensitizing, anti-lipotoxic properties created a marriage of investigative pathways that has not only led to a very large body of literature on the pleiotropic effects of thiazolidinediones, but also to the development of new understandings of the connections between insulin resistance, obesity, and hyperglycemia and the onset of vascular disease. Understandably, most of the focus has been directed at the macrovascular complications of diabetes, since these are the major causes of morbidity and mortality in this population. However, there is evidence that these agents may have benefits for the microvascular complications as well, and their potential role for cardiovascular disease prevention in non-diabetic patients with the metabolic syndrome is a logical extension of the work performed in diabetes. The recently reported results of the effects of pioglitazone versus placebo on cardiovascular events in patients with type 2 diabetes support the contention that these agents have vasculoprotective effects.
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PMID:Thiazolidinediones : beyond glycemic control. 1639 16

Coronary heart disease is still highly prevalent worldwide, and stable angina pectoris is one of its more common presentations. Three major controversies are risk factor management, drug therapy, and intervention. As well as the major risk factors stated by the Framingham study and European guidelines, other factors include abdominal obesity, metabolic syndrome, and psychological stress. How should these additional factors be rated? With respect to drug therapy, apart from aspirin, all patients with stable angina should be assessed for statin treatment. Although statins will reduce coronary events by about one third in patients with vascular disease, the absolute benefit depends on the absolute risk. Non-controversially, all patients should be considered for angiotensin-converting-enzyme inhibitors. The concept that beta blockers are protective from future coronary events can be disputed. Percutaneous coronary intervention can relieve symptoms without extending lifespan beyond medical therapy. However, strong mortality data favour coronary-artery bypass grafting in individuals with triple-vessel or even double-vessel disease. Thus, effort angina needs comprehensive assessment, lifestyle changes, and treatment tailored to the individual patient.
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PMID:Controversies in stable coronary artery disease. 1663 2

Diabetes mellitus with its increasing prevalence is a major global health problem in United States. Macrovascular complications, especially atherosclerosis, are the major cause of morbidity and mortality in patients with type 2 diabetes mellitus. Metabolic syndrome is considered to be a metabolic precursor of type 2 diabetes mellitus and is an independent risk factor in the pathogenesis of atherosclerosis. It is a constellation of proatherogenic metabolic abnormalities, which include obesity, hypertension, characteristic dyslipidemia, hyperglycemia, insulin resistance, and compensatory hyperinsulinemia. Recent epidemiological data have demonstrated a strong causal association between insulin resistance and coronary vascular disease independent of hyperglycemia associated with type 2 diabetes mellitus. Given the high prevalence of metabolic syndrome in the general population and its role in the pathogenesis of atherosclerosis, every attempt should be made to recognize early the metabolic syndrome and to modify the associated proatherogenic metabolic abnormalities. Management of atherosclerosis in insulin-resistant states like metabolic syndrome and type 2 diabetes is a multifactorial process involving nonpharmacological interventions like exercise, diet control, and pharmacological therapy directed at hypertension, hyperglycemia, and dyslipidemia. Further research is warranted to demonstrate the effects of these interventions unequivocally in preventing the progression of metabolic syndrome to overt type 2 diabetes mellitus with its associated macrovascular complications.
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PMID:Managing atherosclerosis in patients with type 2 diabetes mellitus and metabolic syndrome. 1642 24


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