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)

Cardiovascular disease is the leading cause of death in patients with end-stage renal disease. In addition, abnormalities of coagulation and fibrinolysis have been reported in patients with uremia. However, whether these hemostatic abnormalities lead to cardiovascular disease in dialysis patients is currently unknown. Therefore, we investigated the association of hemostatic factors with ischemic heart disease (IHD) in patients on peritoneal dialysis and hemodialysis. The study patients comprised 30 continuous ambulatory peritoneal dialysis patients and 18 hemodialysis patients. Twenty healthy subjects served as controls. We evaluated each subject's hemostatic factors, including factor VII, factor XII, thrombin-antithrombin III complex (TAT), fibrinogen, plasmin-antiplasmin complex (PIC), plasminogen activator inhibitor (PAI-1), and D-dimer. In dialysis patients, IHD was diagnosed by documented myocardial infarction or positive result on coronary angiogram or by positive thallium myocardial scintigraphy. Factor VII, fibrinogen, PIC, and D-dimer levels were significantly higher in the two dialysis groups than in controls. All hemostatic variables were similar between the two dialysis groups. Subject age (p = 0.005), PIC (p = 0.005), and D-dimer level (p = 0.003) were significantly higher in patients with IHD than in patients without IHD in the dialysis groups. Multiple logistic regression analysis showed that only patient age and D-dimer levels were independent predictors of IHD. Adjusted odds ratio for IHD was 1.06 for each 10 ng/mL increase of D-dimer (p = 0.06). In CAPD patients, only D-dimer was independently associated with IHD (odds ratio: 1.06, p = 0.03). We conclude that multiple hemostatic abnormalities are present in dialysis patients and that elevated D-dimer levels are independently associated with prevalent IHD.
Adv Perit Dial 2000
PMID:Coagulation and fibrinolysis factors in dialysis patients with and without ischemic heart disease. 1104 82

End-stage renal disease (ESRD) patients frequently have multiple comorbidities, and cardiovascular disease remains the leading cause of death in these patients. The objectives of the present study were (1) to characterize the number and severity of cardiovascular comorbidities at the start of peritoneal dialysis (PD), and (2) to determine the impact of these comorbidities on mortality. We retrospectively studied all ESRD patients starting peritoneal dialysis at our center between 1990 and 1999. The baseline cardiovascular comorbid factors were categorized as ischemic heart disease, congestive heart failure, arrhythmia, peripheral vascular disease, and cerebrovascular disease. The severity of each factor was scored from 0 to 3. The number of comorbidities and the total cardiovascular comorbidity severity scores were determined for each patient. Cardiovascular deaths included those attributed to sudden death, cardiac disease, cerebrovascular disease, and complications of peripheral vascular disease. Of the 191 patients, 105 were men, and 105 (55%) had diabetes mellitus. The mean age was 60.8 +/- 13.3 years and the mean time on PD was 18.8 +/- 16.3 months. As the number of cardiovascular comorbidities increased, the proportion of patients who died of cardiovascular causes increased eighteen-fold. At each level of cardiovascular comorbidity, diabetic patients starting dialysis were younger, and their survival time was shorter as compared with non diabetic patients. Baseline comorbidity determination is important, as comorbidities are prognostic harbingers of eventual complications.
Adv Perit Dial 2001
PMID:Cardiovascular comorbidity and mortality in patients starting peritoneal dialysis: an American midwestern center experience. 1151 Feb 63

Cardiovascular disease is the major cause of death among patients with end-stage renal disease, accounting for almost half of all fatalities. In recent years much progress has been made in understanding the pathogenesis of cardiovascular disease in the uraemic population. Anaemia is a consistent finding in chronic renal disease, affecting up to 90% of patients, and the central role of anaemia in the development of cardiovascular dysfunction is now well established. A significant proportion of patients have established cardiovascular complications on initiation of dialysis, raising the possibility of early correction of anaemia as a strategy for preventing cardiovascular co-morbidities among renal patients. Randomized, controlled trials have shown that normalization of haemoglobin (Hb) with recombinant erythropoietin (rh-Epo) is of no cardiovascular benefit in haemodialysis patients with symptomatic heart failure, ischaemic heart disease, or severe left ventricular dilatation, although suggestive evidence exists for benefits at earlier stages of cardiac disease. Results from large-scale clinical trials are required to clarify the effects of early anaemia correction on mortality and cardiovascular function, as well as appropriate treatment targets in different patient populations. The potential exists for higher Hb levels to extend patient survival through cardioprotective effects.
Nephrol Dial Transplant 2001
PMID:Anaemia in chronic renal disease: lessons learned since Seville 1994. 1159 Feb 56

Cardiac disease is the major cause of death in patients with end-stage renal disease (ESRD), accounting for about 45% of all deaths. In dialysis patients about 20% of cardiac deaths are attributed to acute myocardial infarction (AMI). The survival of dialysis patients after AMI is poor, with nearly three-quarters of patients dead at 2 years after AMI. The definition of AMI is based on symptoms, electrocardiography, and cardiac biomarkers. In the non-ESRD population, it has been recognized that sensitive markers of myocardial injury (cardiac troponin I and troponin T) define a group of patients who are increased risk for adverse cardiac outcomes and who are more likely to benefit from treatment. Elevated cardiac troponin levels in nonhospitalized ESRD patients without other evidence of ongoing myocardial ischemia may also prospectively identify a subgroup of ESRD patients at increased risk for death. This editorial is an overview of cardiac biomarkers (specifically troponin I and troponin T) in the management of acute coronary syndromes in ESRD patients. A potential role of cardiac troponin testing for risk stratification in the outpatient dialysis unit is also presented.
Semin Dial
PMID:Cardiac biomarkers in the new millennium. 1167 96

Cardiovascular complications are a major cause of morbidity and the leading cause of mortality in renal transplant recipients. Multiple cardiovascular risk factors are often present before transplantation. Prior ischaemic heart disease, cerebrovascular disease and peripheral vascular disease predict post-transplantation mortality, as do older age, diabetes mellitus, smoking and length of time on dialysis. After transplantation, immunosuppressive agents and/or graft dysfunction may increase cardiovascular risk by causing hypertension, hyperlipidaemia and diabetes mellitus or glucose intolerance. Graft dysfunction may also contribute to cardiovascular risk by causing anaemia or hyperhomocysteinaemia. To assess the relative importance of potential cardiovascular risk factors in renal transplant recipients, a retrospective analysis has been performed on data from 911 patients at the Ospedale Maggiore, Milan, Italy. Preliminary findings confirm that cardiovascular complications are the leading cause of death in renal transplant recipients, accounting for 32% of all deaths. Other major factors predicting post-transplantation cardiovascular events include pre-transplant cardiovascular events, age, smoking, diabetes mellitus (often acquired after transplantation) and hypertension. Careful selection and adequate preparation of patients in addition to appropriate treatment of cardiovascular risk factors are needed before transplantation to reduce the risk of post-transplantation cardiovascular events. After transplantation, appropriate treatment of diabetes, hypertension and hyperlipidaemia, as well as avoidance of smoking, obesity and physical inactivity may reduce the risk of cardiovascular complications further.
Nephrol Dial Transplant 2002
PMID:Role of anaemia in cardiovascular mortality and morbidity in transplant patients. 1181 11

Cardiomyopathy and IHD are important morbid complications among renal transplant recipients. Age, diabetes, and sex remain important markers of risk. Smoking, hyperlipidemia, and hypertension appear to be the major reversible risk factors for IHD. Anemia and hypertension predict CHF. Definitive evidence on optimal intervention is lacking. Similarities in the renal transplant recipients to CRI patients with respect to cardiomyopathy and to the general population with respect to IHD suggest that extrapolation from those groups is reasonable in the interim.
Perit Dial Int 2001
PMID:Factors governing cardiovascular risk in the patient with a failing renal transplant. 1188 35

Despite the use of recombinant human erythropoietin (rh-EPO, epoetin) for more than a decade in treating renal anaemia, there is still considerable debate over optimal target haemoglobin (Hb) levels. Current European and North American guidelines that are based on decade-old trials aim for partial anaemia correction, with a subnormal target Hb concentration. More recent randomized clinical trials examining the effect of normalizing Hb levels have produced conflicting results. A study in the USA, in patients with existing congestive heart failure or ischaemic heart disease, showed an unexpected rise in cardiac mortality and haemodialysis access failure with higher Hb levels. In contrast, three other studies (in Australia, Spain and Canada) that normalized Hb levels in healthier dialysis patients observed improvements in quality of life and exercise capacity and a slower progression of left ventricular dilatation, without an unacceptable increase in the incidence of adverse effects. These studies indicate that, while higher Hb levels may be detrimental to patients with pre-existing cardiac disease, healthier patients benefit from normalized Hb levels. Thus, there is no clear scientific rationale for setting a single Hb target for all patients, and individualized treatment targets would appear to be a more logical and patient-centred approach.
Nephrol Dial Transplant 2002
PMID:A rationale for an individualized haemoglobin target. 1209 94

Oxidized low-density lipoprotein (Ox-LDL) has been related with progression of atherosclerosis. Some studies reported increased Ox-LDL levels in hemodialysis (HD) patients. The levels of Ox-LDL in peritoneal dialysis (PD) patients have not yet been clarified. We measured Ox-LDL in PD patients and investigated the related factors. We measured plasma Ox-LDL, total cholesterol (TC), triglycerides (TG), and LDL-cholesterol (LDL-c) levels in 18 PD patients (mean age: 55.5 +/- 9.8 years; mean duration of dialysis: 2.7 +/- 1.4 years) and in 24 HD patients as controls. We compared Ox-LDL levels in patients with diabetes mellitus (DM) and ischemic heart disease (IHD). And we looked at the correlation between Ox-LDL levels and adequacy of PD. Levels of Ox-LDL were significantly higher in the PD patients (2.24 +/- 1.14 ng/microgram LDL protein) than in the HD patients (1.43 +/- 0.90 ng/microgram LDL protein), and other lipids were higher in the PD patients. The Ox-LDL did not correlate with other lipids. The Ox-LDL levels of the PD patients with DM or IHD were higher than those of non DM or non IHD patients. The adequacy of PD did not correlate with Ox-LDL. Patients on PD, especially those with DM or IHD, showed elevated Ox-LDL levels. Special attention should be paid to the level of Ox-LDL and atherosclerosis in PD patients.
Adv Perit Dial 2002
PMID:Correlation between oxidized low-density lipoprotein and other factors in patients on peritoneal dialysis. 1240 17

Cardiovascular complications are the leading cause of mortality in patients with end-stage renal disease (ESRD). The excess cardiovascular risk and mortality is already demonstrable in early renal disease and in patients with chronic renal failure (CRF), with the highest relative risk of mortality in the youngest patients. The high risk for cardiovascular disease (CVD) results from the additive effect of multiple factors, including hemodynamic overload and several metabolic and endocrine abnormalities more or less specific to uremia. CVD includes disorders of the heart (left ventricular hypertrophy [LVH], cardiomyopathy) and disorders of the vascular system (atherosclerosis, arteriosclerosis), these two disorders being usually associated and interrelated. LVH is the most frequent cardiac alteration in ESRD, resulting from a combined pressure and volume overload. LVH in general is an ominous prognostic sign and an independent risk factor for arrhythmias, sudden death, heart failure, and myocardial ischemia. Regression of LVH needs a combined intervention to reduce hemodynamic overload and is associated with improved prognosis and survival. Clinical studies have shown that damage of large conduit arteries is a major contributing factor for the high incidence of congestive heart failure (CHF), LVH, ischemic heart disease (IHD), sudden death, cerebrovascular accidents, and peripheral artery diseases. Damage to large conduit arteries is principally related to highly calcified occlusive atherosclerotic lesions and to stiffening of large capacitive arteries. These two complications are independent risk factors for survival, and improvement of arterial stiffness is associated with better prognosis and survival. The present review summarizes the most recent works dealing with the pathophysiology of CVD and some aspects of the therapeutic approach.
Semin Dial
PMID:Cardiovascular disease in chronic renal failure: pathophysiologic aspects. 1264 70

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Both in dialysis and in transplant patients, CVD remains the leading cause of death. There is accumulating evidence that the increase in CVD burden is present in patients prior to dialysis, due to both conventional risk factors as well as those specific to kidney disease. Of importance is that even in patients with mild kidney disease, the risk of cardiovascular events and death is increased relative to patients without evidence of kidney disease. The new classification system proposed by the National Kidney Foundation as part of the Dialysis Outcomes Quality Initiative (DOQI) process describes the five stages of kidney disease, as well as those complications associated with chronic kidney disease (CKD), in particular cardiovascular risk factors and disease. Patients with kidney disease are deemed to be at highest cardiovascular risk. CVD, defined as the presence of either congestive heart failure (CHF), ischemic heart disease (IHD), or left ventricular hypertrophy (LVH), is prevalent in cohorts with established CKD (8-40%). The prevalence of hypertension, a major risk factor for coronary artery disease (CAD) and LVH is high in patients with CKD (87-90%). At least 35% of patients with CKD have evidence of an ischemic event (myocardial infarction or angina) at the time of presentation to a nephrologist. The prevalence of LVH increases at each stage of CKD, reaching 75% at the time of dialysis initiation, and the modifiable risk factors for LVH include anemia and systolic blood pressure, which are also worse at each stage of kidney disease. Even under the care of nephrologists, a change in cardiac status (worsening of heart failure or anginal symptoms) occurs in 20% of patients. The presence of CVD predicts a faster decline of kidney function and the need for dialysis, after controlling for all other factors including glomerular filtration rate (GFR), age, and the presence of LVH. This article describes the new classification system for staging of CKD, defines and describes CVD in CKD, and reviews the evidence and its limitations with respect to the current understanding of CKD and CVD. Specifically, methodologic issues related to survival and referral bias limit our current understanding of the complex interaction of conventional and nonconventional kidney disease-specific risk factors. We identify the importance of well-conducted studies of patient groups with and without CVD, with and without CKD, in order to better understand the complex physiology so that treatment strategies can be appropriately applied.
Semin Dial
PMID:Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. 1264 72


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