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

Adults with hypopituitarism die prematurely, and the excess mortality is from vascular disease. On echocardiography we have demonstrated abnormalities of myocardial diastolic function in hypopituitary adults, indicating possible early ischaemic change. Peripheral arterial disease is evident on ultrasonography. Vascular risk factors have also been examined. Impaired glucose tolerance and unrecognized diabetes are common in hypopituitary adults. Total cholesterol levels are elevated, particularly in hypopituitary women. The role of growth hormone (GH) deficiency in the vascular disease and in the vascular-risk-factor abnormalities is unknown at present. Prolonged GH therapy causes a decrease in the levels of fasting total cholesterol, without any adverse effects on glucose homeostasis. GH therapy trials in adults will clarify the role of GH in the excess vascular risk of hypopituitarism. Prolonged GH therapy will be necessary for the vascular effects to be defined.
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PMID:Metabolic changes and vascular risk factors in hypopituitarism. 129 16

Peripheral arterial disease has received less attention from epidemiologists than coronary and cerebrovascular disease. Prevalence and incidence data typically show that peripheral arterial disease increases with age, is more common in men than women, and that symptomatic disease is only the tip of the iceberg. Studies concerning the prevalence of peripheral arterial disease rely mainly on the Rose questionnaire, which is used to screen for intermittent claudication, and on the ankle/brachial index, used to detect asymptomatic disease. Although there is a certain parallel between the 2 sets of data, the figures for asymptomatic disease consistently surpass those for clinical disease, and there is a wide variation between frequencies obtained in individual studies. In general, the prevalence of peripheral arterial disease is estimated to be under 2% for men aged less than 50 years, increasing to over 5% in those aged more than 70 years. Women reach these rates almost 10 years after men, although this gender difference decreases with increasing age. Figures for incidence follow a similar trend. The incidence of chronic critical ischaemia is estimated to be between 0.05% and 0.1% of the population. Asymptomatic disease detected with noninvasive tests is 3 to 4 times more frequent than intermittent claudication: its prevalence increases from under 5% for individuals aged less than 50 years to over 20% for individuals aged more than 70 years. The classical risk factors for atherosclerosis also apply to peripheral arterial disease, although their order of importance may be different from that for coronary and carotid disease. Several studies have shown that peripheral arterial disease correlates most strongly with cigarette smoking. Smoking is also the single greatest predictor of the progression of peripheral arterial disease. Other risk factors include hypertension, raised lipid levels (cholesterol and triglycerides for severe disease), diabetes, increased plasma viscosity, fibrinogen and homocysteine levels. Divergent views have been expressed in individual epidemiological studies with regard to the respective contribution of these risk factors to the development and progression of peripheral arterial disease. The natural history of peripheral arterial disease is characterised by a relatively benign local evolution. It can be estimated that, in general, 3 of 4 men presenting with intermittent claudication will never have a serious problem necessitating vascular intervention, and that no more than 5% are ever likely to require a major amputation. However, the underlying atherosclerotic pathology progresses with time: nondiseased arteries become obliterated and disease with an initially unilateral pattern frequently progresses to become bilateral. In addition, the few patients who do progress to critical ischaemia are at a significantly higher risk of amputation. The general prognosis for patients with peripheral arterial disease is particularly negative. There is a high prevalence of coronary heart disease and cerebrovascular disease in such patients, although the exact percentages depend on the patient population selected and on the method used for their evaluation. Coronary heart disease is detected in 40 to 60% of patients through a medical history combined with electrocardiography, while systematic coronary angiography detects coronary heart disease in 90% of those undergoing surgery. Although few patients with peripheral arterial disease have a history of stroke, in studies of surgical patients almost 30% appear to have significant extracranial disease. Patients with peripheral arterial disease have a poor life expectancy: the mortality rate is 3 to 5% per year in those with intermittent claudication and 20% per year in those with critical ischaemia. Coronary heart disease accounts for half of the total mortality, while vascular disease in general accounts for almost two-thirds.
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PMID:[Epidemiology and prognosis of peripheral obliterative arteriopathy]. 984 97

Peripheral arterial disease (PAD) is a clinical condition that has often been neglected. The clinical diagnosis of PAD may be made on the basis of an accurate history by using the WHO/Rose Questionnaire or the Edinburgh Questionnaire. From a clinical point of view, PAD may be classified into four stages. The PARTNERS Programme (PAD Awareness, Risk and Treatment: NEw Resources for Survival) is a recent study based on a partnership to improve PAD care. In this population, the prevalence of patients who were PAD+/CVD- was approximately 12% in males and 15% in females; PAD+/CVD+ approximately 18% in males and 14% in females; PAD-/CVD+ 28% in males and 17% in females; and finally, patients without vascular disease (PAD-/CVD-) 42% in males and 54% in females. The lessons derived from the PARTNERS Programme Study were informative; PAD is detectable in routine practice, using a simple, inexpensive, always available, clinical test such as calculation of the ankle-brachial pressure index (ABPI). Fewer than half of individuals with PAD are aware of their condition, while physicians are unaware of the presence of PAD in 70% of their patients with the condition. Diabetics and smokers are at high risk for PAD. Diabetes is present in about 41% of patients with PAD and a history of smoking (> 10 pack for year) is present in over 63% of patients with PAD. Antiplatelet therapy is taken by only about half of patients with PAD. Finally, the lack of diagnosis and treatment means that PAD patients remain at elevated risk of heart attack and stroke. Efforts must be made to diffuse this information to improve the diagnosis and treatment of PAD to reduce the risk of future fatal and nonfatal cardiac and cerebrovascular events.
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PMID:Classification, epidemiology, risk factors, and natural history of peripheral arterial disease. 1218 Mar 52

Peripheral arterial disease, which is caused by atherosclerotic stenosis or occlusion of the leg arteries, is an important manifestation of systemic atherosclerosis. The age-adjusted prevalence of symptomatic and asymptomatic peripheral arterial disease is approximately 12% in the general population. The overall prevalence and incidence of the disease is likely to increase with the aging of the population. Peripheral arterial disease is a relatively benign condition in terms of local disease. Five years after the diagnosis, 75% of the patients remain clinically stable. On the contrary, life expectancy, even in the absence of any history of myocardial infarction or ischemic stroke, has decreased by 10 years. These patients have approximately the same relative risk of death from cardiovascular causes as do patients with history of coronary or cerebrovascular disease. Moreover, the severity of peripheral arterial disease is closely associated with the risk of myocardial infarction and death from vascular disease. The lower the ankle-brachial index, the greater the risk of cardiovascular events. Furthermore, peripheral arterial disease is a significant independent predictor for cardiovascular mortality also in coronary patients. The risk factors associated with peripheral arterial disease are essentially the same as for coronary heart disease: older age, cigarette smoking, diabetes mellitus, hypertension, and hyperlipidemia. The excess morbidity and mortality for cardiovascular disease in these patients has not been fully explained. Patients with peripheral arterial disease show a systemic endothelial dysfunction and an increase in the serum concentration of activated white blood cells, endothelin, and C-reactive protein that may trigger acute coronary syndromes. In peripheral arterial disease the functional status is often severely impaired. Peak exercise performance has decreased to about 50% of that of age-matched controls, equivalent to moderate-severe heart failure. Epidemiological studies support the concept that patients affected by peripheral arterial disease, without established coronary heart disease, have a coronary heart disease high risk equivalent. In spite of this, peripheral arterial disease remains an underdiagnosed and undertreated disease. As the role of cardiologists is expanding, the purpose of this review was to awaken the clinician to the significance of lower limb atherosclerotic occlusive diseases.
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PMID:[Why are cardiologists to be concerned about obliterating arterial disease of the lower leg?]. 1278 66

Advances in vascular biology and drug development, as well as improved interventional techniques, are yielding multiple new treatments for patients with venous and/or arterial thrombosis. Hematologists who are providing consultations for these patients often participate in a multidisciplinary approach to provide optimal care. New anticoagulants, simplified and validated tests for detecting vascular disease, and improved interventional procedures can all reduce the morbidity and mortality that result from venous and arterial thrombosis. In this chapter, different aspects of the diagnosis and treatment of these disorders are addressed by a hematologist, an expert in vascular medicine, and a vascular surgeon. The key to the prevention and treatment of venous and arterial thrombosis is anticoagulant and antiplatelet therapy. In Section I, Dr. Charles Francis, a hematologist with expertise in thrombosis and hemostasis, describes the clinical trials that have resulted in the approval of newer anticoagulants such as fondaparinux and the thrombin- specific inhibitors. He also reviews the clinical trials that have shown the efficacy of the new oral anticoagulant ximelagatran. Although currently under study primarily for the prevention and treatment of venous thrombosis, these anticoagulants are likely to undergo evaluation for use in arterial thrombosis. Peripheral arterial disease (PAD), which affects as many as 12% of individuals over the age of 65 years, provides a diagnostic and therapeutic challenge to physicians across multiple subspecialties. Dr. William Hiatt, a specialist in vascular medicine, discusses in Section II the epidemiology and manifestations of PAD, the best ways in which to diagnose this disorder and determine its severity, and the most appropriate pharmacologic treatment. In Section III, Dr. Mark Jackson, a vascular surgeon, describes interventional procedures that have been developed or are under development to treat arterial thrombosis. He also reviews the status of inferior vena caval filters that are retrievable.
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PMID:Consultations on patients with venous or arterial diseases. 1463 98

Peripheral arterial disease (PAD) due to atherosclerosis, although frequently ignored in clinical practice, results in significant cardiovascular morbidity and mortality and may progress due to uncontrolled atherosclerotic risk factors. Although treatment of claudication symptoms is important for improved lifestyle, treatment of risk factors will prolong life. Smoking cessation, blood pressure control, lipid modification and strict control of diabetes mellitus will reduce the risk of both macro and micro vascular disease progression. Risk factor modification in conjunction with antiplatelet treatment results in decreased heart attack, stroke and peripheral vascular events in patients with PAD.
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PMID:The effect of risk factor changes on peripheral arterial disease and cardiovascular risk. 1537 18

Peripheral arterial disease (PAD) is increasingly recognized as a strong predictor of mortality and morbidity from atherosclerotic events, especially from coronary heart disease. Since vascular disease remains the most common cause of death in the world, the substantial prevalence, ease of diagnosis, and ominous prognosis have increased interest in PAD among the prevention community. The association with coronary heart disease is strong enough that for prevention purposes, PAD should be considered a high-risk condition that demands aggressive therapy to reduce incident vascular events. Unlike other forms of atherosclerotic disease, PAD is easily diagnosed in the outpatient clinic noninvasively, using the ankle brachial index. Because its diagnosis can thus be seamlessly integrated into the routine clinical encounter, the ankle brachial index has emerged as a tool for global risk assessment. This article will review the relationship between PAD and other vascular disease, emphasizing the role of PAD in prevention efforts.
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PMID:The unsung perils of peripheral arterial disease: a malady in search of a patient. 1586 Sep 87

Peripheral arterial disease (PAD) is a common, progressive manifestation of atherothrombotic vascular disease, which should be managed no different to cardiac disease. Indeed, there is growing evidence that PAD patients are a high risk group, although still relatively under-detected and under treated. This is despite the fact that PAD patients are an increased mortality rate comparable to those with pre-existing or established cardiovascular disease [myocardial infarction, stroke]. With a holistic approach to atherothrombotic vascular disease, our management of PAD can only get better.
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PMID:Peripheral arterial disease: a high risk - but neglected - disease population. 1597 99

Management of advanced obstructive vascular disease affecting the extremities poses tremendous challenges for physicians and patients. Peripheral arterial disease is often a consequence of obstructive atherosclerosis affecting the ileofemoral circulation but is also rarely a result of nonatherosclerotic conditions such as thromboangiitis obliterans (Buerger's disease). Consequences range from the presence of asymptomatic obstruction to intermittent claudication, development of rest pain, ulceration, gangrene, and amputation. A relatively new and promising approach using cell therapy has recently been developed to treat intractable symptoms related to ischemia in subjects with peripheral arterial disease in whom conventional medical therapy and revascularization modalities have been exhausted.
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PMID:Cell therapy in peripheral arterial disease. 1881 33

Peripheral arterial disease (PAD) is a common but frequently overlooked vascular disease, often affecting the lower extremities. The prevalence of PAD increases exponentially with age, and this is of particular concern among the elderly population because this condition frequently signals disease in other vascular beds, including the coronary arteries and/or cerebral vasculature. In addition to the increased risk of cardiovascular disease and stroke, patients with PAD may also experience functional impairment and decreased quality of life. The ankle-brachial index is the most effective and widely used screening tool for detecting PAD and should be performed when PAD is suspected, based on the medical history or physical examination. Current treatment guidelines recommend risk factor modification, including exercise therapy and smoking cessation interventions, combined with pharmacologic measures for secondary prevention and management of symptoms of PAD. Antiplatelet therapy is an integral component of global cardiovascular risk reduction strategies in patients with PAD.Current guidelines provide a significant opportunity for practitioners to detect and treat patients with PAD in a timely and effective manner, thereby improving the overall mortality, morbidity, and quality of life associated with this disease.
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PMID:Peripheral arterial disease in the elderly: recognition and management. 1915 22


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