Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cerebrovascular disease mortality trends in England and Wales are discussed, concentrating on data relating to years after 1968. Cerebrovascular disease deaths have been found to comprise a decreasing proportion of all deaths and of all cardiovascular disease deaths. For ages under 85 the mortality rates have generally fallen for cerebrovascular disease, with females experiencing the greater improvement. Concerning the main diagnostic categories, the rates for cerebral haemorrhage and thrombosis have fallen, and have risen for subarachnoid haemorrhage and the vague rubrics (436, 437). Possible explanations for these trends are proposed including relationships to other cardiovascular diseases. In particular, the downward trend in cerebral haemorrhage mortality rates is found to be positively correlated at a significant level with that due to hypertensive disease. However, the trends in cerebral thrombosis and ischaemic heart disease mortality rates are found to be in opposite directions--a phenomenon which contradicts the widely-held view that these diseases have a common aetiology.
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PMID:The changing mortality of cerebrovascular disease. 67 51

By summing up a series of epidemiological evidence a continuous elevation of total serum cholesterol, especially LDL-cholesterol, leads atherosclerosis and causes the narrowing or occlusion of coronary artery which introduces acute myocardial infarction or angina pectoris in the heart. In the brain, it is a risk factor for cerebral thrombosis. On the other hand, a lower level, 160 mg/dl or less of total serum cholesterol relates with the higher incidence of cerebral hemorrhage or subarachnoid hemorrhage, but still with the lower incidence of ischemic heart disease. It is concluded that the higher the total serum cholesterol level and the longer the period of continuous elevation is, the higher the incidence of ischemic heart disease. And there is a U-shape relationship between the level of serum cholesterol and cerebrovascular disease as a whole with a nadir around 160 to 200 mg/dl which means an optimal range of total serum cholesterol. A subject with total serum cholesterol over the optimal level may need some sort of modification in his daily life, in eating or physical exercise but not necessarily requires any pharmacological therapy.
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PMID:[Serum cholesterol levels as a risk factor of cardiovascular disease]. 207 72

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

The risk of thromboembolism in oral contraceptive (OC) users is evaluated based on findings of major cohort studies conducted in England, the US, and Denmark. Since approximately 25% of Danish Women aged 15-45 use OCs, such an assessment is timely and critical. A study by the Royal College of General Practitioners (RCGP) found a slightly higher risk of venous thrombosis and pulmonary embolism, especially postoperatively (deep venous thrombosis). Major risk was found only with the use of high estrogen-content pills. No connection between OC use and subarachnoidal bleeding could be established according to the latest studies. In a US study examining 182 cases of apoplexy cerebri of thrombotic origin in comparison with 98 controls, the risk was 9.5 times higher on OC users. However, 74% of the patients with cerebral thrombosis were smokers vs. 43% of controls. The high gestagen component of pills was implicated in the increased risk. In a case control study, the risk of myocardial infarct was found 4 times higher in OC users and 20 times higher in smokers who used OCs. Another study of the RCGP supported these findings: myocardial infarct was .3/1000 women per year in pill users vs. .15 in nonusers, and the risk of death from ischemic heart disease was 6.4 times higher among users. These risk factors were also borne out by Danish data: the number of women aged 35-39 and 40-45 dying of ischemic heart disease between 1951-1981 rose slightly, but there was no significant increase after 1967, when low-dose OCs were introduced; in recent years there has been a decline. To establish a firm link between the use of the estrogen and gestagen components of OCs and thromboembolic disease, further investigations must be conducted in view of recently introduced low-dose pills.
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PMID:[The pill and thrombosis]. 651 90

During 1968-69, 23,000 women taking oral contraceptives (OCs) and an equal number of controls were recruited by 1400 general practitioners (GPs) throughout the UK. Every 6 months the GPs report on the health and OC use of women in the continuing study. To determine the incidence of arterial disease the number of reports of initial vascular illnesses in each OC-usage group is divided by the calendar months of observation for women in that group. The standardized incidence rate (number of cases) of ischemic heart disease was 0.77 for current OC users, 0.63 for former users, and 0.54 for controls and of cerebrovascular disease for OC users was 0.62 for current users, 0.50 for former users, and 0.20 for controls. The only subcategory for which current users had a significantly increased relative risk was acute myocardial infarction (2.0). Current users also had increased risk of cerebral thrombosis, cerebral embolism, and transient ischemic attacks. Women aged 35 years and over had higher rates of arterial disease than did younger women and cigarette smoking increased the risk for older women in each OC usage group, having little effect on women under 35 years of age. Women over 35 who smoked had a 3.1 times greater risk of developing arterial disease than did nonsmokers. Neither ischemic heart disease nor peripheral vascular disease was shown to be associated with duration of OC use. It was also found that women who smoked and had used OCs had case-fatality rates 2-3 times greater than women in other groups. General conclusions are: 1) the relative risks of OC use are lower for the incidence of 1st events of arterial disease than for deaths, and 2) for cerebrovascular disease there is an increased risk in former users which remains high for over 6 years after stopping OCs.
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PMID:Incidence of arterial disease among oral contraceptive users. Royal College of General Practitioners' Oral Contraception Study. 686 38

The present level of understanding of the known risks of oral contraceptive (OC) use are summarized. The findings of many investigations in the late 1960s and early 1970s may no longer be totally appropriate because OCs available then had higher dosages than today. Also, early studies enrolled predominantly women in their 20s, who are now almost all more than 35 years old. Thus, the risks observed in these studies may not be applicable to younger women using OCs today. Another consideration has been underscored by the results of the Walnut Creek Study. Behavioral characteristics such as smoking, drinking, and sexual activity are factors which can strongly confound risks of OC use and must be considered when assessing current and future investigations. Many studies have clearly shown that the most serious life threatening danger associated with OC use is that of cardiovascular complications arising from the interaction of OC use and smoking. The increased risks attributable to smoking while using OCs account for a substantial number of the deaths recorded. The Walnut Creek Study showed a somewhat different outcome. Its data suggest no significant risk of myocardial infarction (MI), ischemic heart disease, cerebral thrombosis, or ischemic cerebrovascular disease associated with OC use, but there were nonsignificant increases noted in some cardiovascular diseases which appeared to be explained by a synergism between current use and heavy smoking. Age also has a strong influence on risk for cardiovascular disease. The results of earlier studies seem to indicate that OC use is associated with a risk of subarachnoid hemorrhage. The Walnut Creek Study also noted an increased risk of subarachnoid hemorrhage associated with OC use and found that risk increased with use. Several studies have shown that the incidence of venous thrombosis seems dependent on the dosage of the OC used. An overwhelming majority of studies on the carcinogenicity of OCs have found no increased incidence of cancer of the ovaries, uterus, or breast among users. In regard to both ovaries and endometrium, there is some evidence that OCs may be protective. Several studies have concluded that OC users have a slightly increased risk of developing malignant melanoma. The results of the Oxford/Family Planning Study show that although previous use of OC by nulliparous women may delay future childbearing by several months, it does not impair longterm potential for pregnancy. No increase in risk of clinically apparent diabetes mellitus has been reported in users. In addition to their possible protection against ovarian and endometrial cancer, OCs may reduce the risk of at least 5 other diseases: benign breast disease; deficiency anemia; arthritis, pelvic inflammatory disease; and ovarian cysts.
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PMID:The pill: an evaluation of recent studies. 704 36

To evaluate the cardiac dysfunction of the cerebral infarction (cerebral thrombosis) patients in the chronic period, non-invasive studies were performed on 45 cerebral infarction patients (CI group: 25 males and 16 females, mean age 64.1 y). Forty hospitalized patient without cerebral infarction served as controls (non-CI group: 23 males and 19 females, mean age 64.8 y). The CI and non-CI group were divided into two sub-groups: patients with a past history of hypertension (HT) and without (NT). In each sub-group, the cardiac functions were compared between CI and non-CI by M-mode and Doppler echocardiography. In echocardiography, research based on the premise that the function of the left ventricle can be divided into preload (EDVi), afterload (SVR), contractility (EF, mVcf, SBP/ESV) and distensibility (E/A). On results show that there were no significant differences in preload, afterload and contractility of the left ventricle between CI and non-CI group in each HT and NT sub group. However, a significant difference was demonstrated in the diastolic function the left ventricle between the two groups in the HT (p = 0.007) and NT (p = 0.04) sub-groups. In conclusion, left ventricle diastolic function was deteriorated in cerebral infarction patients although systolic function not deteriorated. Because diastolic dysfunction may be caused by existing latent heart failure and/or silent myocardial ischemia, echocardiographic study is useful for early detection of left ventricle impairments in cerebral infarction patients.
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PMID:[Study of left ventricular function in cerebral thrombosis with pulsed Doppler echocardiography]. 811 52

More than 50 randomized trials have documented the efficacy and safety of aspirin as an antiplatelet agent and a cardiovascular drug. However, the optimal dose for preventing coronary and cerebral thrombosis has long been a cause of debate. For patients with ischaemic heart disease the range recommended for the prevention of a secondary event, based on strong clinical evidence, is 75-160 mg aspirin/day. For patients with cerebrovascular disease, recommendations range from 30-1300 mg/day. If these patients require a higher dose of aspirin it suggests that a different mechanism of action is involved. This paper considers hypotheses and reports the findings of recent clinical trials. The SALT study compared aspirin with placebo in 1360 patients with TIA or minor ischaemic stroke. It showed an 18% reduction in the risk of stroke or death in patients receiving 75 mg aspirin/day. Five other trials of 55,000 patients with ischaemic cerebrovascular disease compared the protective effect of aspirin (range 30-300 mg/day) with placebo, clopidogrel, or oral anticoagulants. Aspirin was better than placebo, safer than oral anticoagulants, and no different from clopidogrel. The implications of these findings are discussed. Mechanistic studies and randomized clinical trials strongly suggest that the mechanism of action and dose requirement of the antithrombotic effect of aspirin in patients with cerebrovascular disease is the same as that for ischaemic heart disease.
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PMID:Prevention of myocardial infarction and stroke by aspirin: different mechanisms? Different dosage? 978 31

Small amounts of alcohol were held to be beneficial in the 19th century, but the idea died out. Scientific evidence that moderate amounts prolonged life, published in 1926, was ignored. Further evidence accumulated from the early 1950s but the belief that alcohol was only harmful had become so ingrained that the idea has been taken seriously only since the early 1980s. Now, the evidence that small amounts reduce the risk of vascular disease by about a third and reduce total mortality in middle and old age is massive. Alternative explanations for the observed inverse relationships have been ruled out and beneficial effects have been shown to be biologically plausible. The reduction in mortality is mainly attributable to ischaemic heart disease and cerebral thrombosis, but some other diseases may also contribute to it. The increasing mortality with larger amounts is attributable to many causes that have long been recognized. The optimum level varies with sex and age and may be zero under about age 45 years. The benefit is directly due to ethanol and the extra benefit attributed to wine is due to the pattern of drinking. Public policy needs to take account of medical and social effects other than mortality and will vary in different communities depending on background patterns of injury and disease.
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PMID:The benefit of alcohol in moderation. 1620 3