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)

We assessed the prevalence of conventional risk factors for ischaemic heart disease in patients with peripheral vascular disease, and the scope for preventative treatment with lipid-lowering therapy in this group, by retrospectively reviewing 299 patients who had undergone peripheral angiography in 1996. A total of 278 patients had severe peripheral vascular disease; 44% were current smokers at the time of their angiogram, and 36% had a history of coronary artery disease (either myocardial infarction, coronary artery bypass surgery, coronary angioplasty or angina). Cholesterol had been measured in 80 (27%) patients, of whom 26 (9%) were receiving treatment for hypercholesterolaemia. Patients with a history of ischaemic heart disease were more likely to have had their cholesterol measured (50% vs. 15%; p < 0.001). Hypertension (defined as systolic > 160 mmHg or diastolic > 90 mmHg) was present in 44%. There was no difference in the distribution of risk factors between those with and those without known ischaemic heart disease. There is a high prevalence of modifiable risk factors for coronary disease in patients with severe peripheral vascular disease. Effective prevention is available for coronary artery disease, but we found low levels of treatment. There is considerable scope for intervention to reduce the risk of coronary disease in such patients.
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PMID:Cholesterol in peripheral vascular disease--a suitable case for treatment? 1039 10

The recent clinical trials of lipid lowering have established the benefit of this therapy in men and women with, or at high risk for, cardiovascular disease. It is now thought that most of the reduction in the risk of clinical events is due to functional rather than anatomic changes in atherosclerotic arteries. Cholesterol-lowering drugs improve endothelial vasomotor function and vascular nitric oxide in patients with coronary artery disease over several months. These changes in vasomotor function may reflect other beneficial changes that are regulated by nitric oxide such as the reduced recruitment and activation of inflammatory cells and a shift in the coagulation balance to favor thrombolysis. These mechanisms may contribute to the reduction in myocardial ischemia and clinical events observed with lipid lowering in patients with vascular disease. Lipid-lowering therapy decreases cardiovascular events and is an important adjunct to coronary revascularization most likely because an improvement in endothelial function prevents the development and destabilization of new atherosclerotic lesions and subsequent ischemic events.
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PMID:Effect of lipid-lowering therapy on vasomotion and endothelial function. 1098 Aug 48

Cardiovascular disease (CVD) is the leading cause of death and disability in the United States and in most industrialized nations. Major breakthroughs to modern day cardiovascular/lipid research have been attributed to the findings of the Framingham Heart Study and Gofman and colleagues who made associations between lipoprotein levels (LDL, VLDL and HDL) and CVD. Unfortunately, half of all CVD patients have none of the established coronary risk factors (hypertension, hypercholesterolemia, cigarette smoking, diabetes mellitus, obesity) and new strategies for identifying patients need be considered. Although there remains little disagreement regarding the necessity to lower elevated plasma cholesterol levels, there remains much controversy regarding appropriate dietary means of accomplish this goal. The National Cholesterol Education Program (1993) proposed a dietary reduction (Step I and Step II diets) to the percent saturated fat and cholesterol consumed by at-risk patients. Many currently question about the effectiveness of these diets and an alternative diet, replacing saturated fats by monounsaturated fats (olive oil), has attracted recent attention. While diet modification is considered the foundation of primary treatment, other interventions are frequently required. Although early drug trials demonstrated that agents such as nicotinic acid, clofibrate, gemfibrozil, bile acid-binding resins generally slowed progression of atherosclerotic lesions, lowered plasma cholesterol levels and decreased mortality from CVD, the greatest advance to current drug therapy involved the discovery of the "statins" (HMG-CoA reductase inhibitors). In the current work, mechanisms for vascular dysfunction resulting in myocardial ischemia were explored and potential nutritional (dietary) and pharmacologic interventions were reviewed.
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PMID:Cardiovascular disease: a historic perspective. 1123 77

Pre- and postmenopausal cholesterol (mg/dl), body mass index (BMI; kg/m(2)), and systolic blood pressure (SBP; mmHg) levels were compared in three age-at-time-of-menopause (ATM) groups to examine the relationship between the three risk factors and age ATM. Cholesterol, BMI, and SBP levels recorded 4 years prior to and 8 years after menopause were examined and increases in these risk factors between the two measurements were noted. The three age groups were: group A (n=49; age ATM [44+/-1]<45), group B (n=395; 45< or =age ATM [48+/-1]<50), and group C (n=578; age ATM [52+/-2]> or =50). Cholesterol levels in premenopausal groups A (169+/-31 mg/dl, 40 years) and B (174+/-31, 44 years) were lower than those in group C (179+/-30, 48 years) (0.05< or =P<0.1 and P<0.05). Because, the increases in cholesterol were greater in group A (41+/-28 mg/dl) than in groups B (32+/-28) and C (29+/-28) (0.05< or =P<0.1 and P<0.05), cholesterol levels were identical among groups despite age differences upon reaching the postmenopause phase: group A (210+/-34, 51 years), group B (206+/-35, 56 years) and group C (208+/-35, 60 years). BMI and SBP increases were not different in groups A, B, and C. Differences in BMI and SBP levels among groups in order of premenopausal age were still observed after menopause. These data suggest that the greater increase in cholesterol associated with early menopause may be related to a higher prevalence of ischemic heart disease (IHD) in younger menopausal women.
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PMID:Effects of age at menopause on serum cholesterol, body mass index, and blood pressure. 1136 9

Cerebrovascular disease is the leading cause of disability in Western societies. In the United States, it has been estimated that a stroke occurs every 53 seconds. Consequently, the societal costs attributable to cerebrovascular disease are immense and encourage the medical community to seek new therapies that can reduce stroke's frequency and impact. Although serum lipid levels have not been shown to act as a surrogate marker for stroke, in landmark lipid-lowering trials, statin therapy has been associated with reductions in the incidence of ischemic stroke in patient populations with manifest ischemic heart disease. This observation is supported by a recently published meta-analysis of statin trials that reported an average reduction of about 30% in the incidence of cerebrovascular disease. However, to date, statin studies have only been conducted in patients with, or at high risk for coronary artery disease, who are not truly representative of the overall stroke population. The ongoing Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL) trial has been designed to prospectively evaluate the benefits of aggressive lipid-lowering therapy on cerebrovascular events in patients who have had a previous stroke or transient ischemic attack, but who have no prior history of coronary artery disease.
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PMID:Cerebrovascular disease and statins: a potential addition to the therapeutic armamentarium for stroke prevention. 1159 97

Remarkable therapeutic advances in the treatment of acute coronary syndromes (ACS) have been made with antiplatelet and antithrombotic therapy. However, these therapies alone do not appear to completely stabilize culprit lesions. Evidence from a variety of sources suggests that intensive cholesterol lowering with statins favorably influences culprit lesion stabilization in patients with ACS. Potential mechanisms of benefit include improvements in endothelial function, decreased propensity for platelet thrombus formation, and reduction in inflammation at the site of the lesion. The Myocardial Ischemia with Aggressive Cholesterol Lowering (MIRACL) study is the first large-scale clinical trial to examine whether these mechanisms translate into clinical-event reduction in patients with ACS as well as the substantial proved benefits in the chronic coronary syndromes. In this trial, early initiation of atorvastatin after an episode of unstable angina or non-Q-wave myocardial infarction reduced events over the ensuing 16 weeks. It is hoped that a growing awareness of the benefits of early statin therapy to stabilize culprit lesions in ACS will lead to an increase in the proportion of coronary patients who will receive this beneficial therapy.
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PMID:Early pharmacologic intervention and plaque stability in acute coronary syndromes. 1169 17

The highest risk of a recurrent event in patients with acute coronary syndromes (ACS) occurs in the first month, with the rates of reported events ranging from 10% to 25%. Statins are the cornerstone of lipid-lowering therapy for the long-term care of patients with stable atherosclerotic disease. More recent accumulated data from several trials now show that statin therapy can also help reduce cardiovascular risk in unstable disease. These studies evaluated the effects of statin therapy begun before discharge, with the Myocardial Ischemia with Aggressive Cholesterol Lowering (MIRACL) trial showing that therapy could be started as early as 24 hours after onset with measurable clinical benefit. Registry data also suggest that long-term compliance may be improved in patients with a predischarge statin prescription compared with a postdischarge statin prescription. This is because many patients discharged without a statin prescription are either lost to further medical follow-up or do not receive a statin prescription from their primary care provider. The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III), which constitutes the updated clinical guidelines of the National Cholesterol Education Program (NCEP), recommends that lipid-lowering drug therapy be initiated at hospital discharge. ATP III also provides important information on the goals of lipid-lowering therapy in patients after ACS. The challenge for the specialist is to establish a predischarge plan that includes maximal dosing to achieve aggressive target goals and to work with the patient's primary care provider to maintain these goals long-term.
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PMID:Postdischarge lipid management of coronary artery disease patients according to the new National Cholesterol Education Program guidelines. 1169 18

Three-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors (statins) reduce coronary events and death in both primary and secondary prevention trials. In these trials benefit did not appear for years after randomization. It is noteworthy that these trials did not include patients with recent myocardial infarctions or unstable angina. It is well known that mortality and recurrent ischemic events rates are the highest in the early period after acute coronary syndromes. Favorable physiologic effects of statins have been described within a few weeks of exposure to the statin in a number of experimental studies. The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study was designed to bridge the gap between primary and secondary prevention trials and specifically included patients with unstable angina or non-ST elevation myocardial infarction.
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PMID:Acute statin treatment in reducing risk after acute coronary syndrome: the MIRACL (Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering) Trial. 1170 11

Educational messages directed at the public to prevent ischemic heart disease (IHD) are generally based on cholesterol-reduction. However, IHD has multiple risk factors, and a study was performed to help determine whether or not the allocation of educational messages among risk factors is appropriate: The severity of high cholesterol was compared with the severity of multiple other major risk factors for IHD, and the beneficial effects of cholesterol-reduction was compared with the benefits of multiple other major preventative factors for IHD. It was found that high cholesterol levels, and multiple other risk factors, generally give a risk of around 2.0 for developing IHD. Cholesterol-reduction by statins, and multiple other factors which prevent IHD, generally reduce the risk of IHD by about 30-40%. It was concluded that the allocation of educational messages to reduce the incidence of IHD should significantly increase discussions of non-cholesterol risk and preventative factors.
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PMID:Cholesterol: an important but relatively overemphasized risk factor for ischemic heart disease. 1173 17

The Myocardial Ischemia Reduction with Acute Cholesterol Lowering (MIRACL) Trial tested the hypothesis that intensive lowering of cholesterol with atorvastatin (80 mg/day) initiated 24-96 h after an acute coronary syndrome would, over 4 months, reduce the incidence of the composite endpoint of death, nonfatal infarction, resuscitated cardiac arrest, and recurrent symptomatic myocardial ischemia with new objective symptoms requiring emergency rehospitalization. This primary composite endpoint was reduced from 17.4% to 14.8% (P = 0.048) among the 3086 patients enrolled. The results of MIRACL suggest that patients with acute coronary syndromes should begin to receive this treatment before leaving hospital, irrespective of baseline levels of low-density lipoprotein-cholesterol.
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PMID:The Myocardial Ischemia Reduction with Acute Cholesterol Lowering (MIRACL) trial: a new frontier for statins? 1180 82


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