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 13,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetes mellitus (DM) in adults is a global health problem, although its prevalence varies widely between different populations and the rate has generally increased worldwide. In Taiwan, the mortality rate from DM has almost doubled over the past 10 years. The prevalence of DM in Taiwan was established between 1985 and 1996 and the rates were between 4.9 and 9.2%. The prevalence of impaired glucose tolerance (IGT) was 15.5% (men 15% and women 15.9%). The prevalence of DM and IGT increased significantly with age for both genders. The significant factors associated with newly diagnosed DM were age, BMI, family history of DM, systolic blood pressure (hypertension), physical activity and serum triglyceride levels. The prevalence of large vessel disease (LVD) in DM and non-diabetic subjects were 20.0 and 12.9%, respectively. Among diabetics, 15.8% had ischemic heart disease (IHD), 1.7% leg vessel disease (leg VD), and 2.5% stroke. In non-diabetics, the prevalence of the aforementioned macroangiopathies were 11.5, 0.2 and 1.2%, respectively. The diabetics had a significantly higher prevalence of macrovascular disease than non-diabetic subjects. The most significantly associated with the LVD was serum cholesterol levels. Serum cholesterol and HbA1(c) were significantly associated with the development of IHD. Cigarette smoking and female gender were significantly associated with the leg VD. The prevalence of diabetic retinopathy (DR) was 35.0%. (background DR 30%, preproliferative DR 2.8% and proliferative DR 2.2%, respectively.) The prevalence of DR for previously and newly diagnosed diabetics were 45.2 and 28.3% (men 42.8 vs. 33.3% and women 47.5 vs. 24.8%), respectively. From multiple logistic regression analysis, duration of DM was the most important risk factor related to DR. Diabetic subjects treated with insulin had a higher risk of developing retinopathy than those treated with dietary control. The prevalence of nephropathy and neuropathy were 12.9 and 23.5%, respectively. For those patients with and those without nephropathy and neuropathy, the duration of DM, percentage of insulin treatment, percentage of hypertension, and fasting plasma glucose were significantly different. Diabetic duration, hypertension, insulin treatment and glycemic control consistently correlated with nephropathy and neuropathy. In conclusion, the prevalence of DM in Taiwan was between 4.9 and 9.2%, and the prevalence of IGT was 15.5%. The possible risk factors of newly diagnosed diabetes were age, family history of DM, BMI, SBP (hypertension), physical activity and triglyceride levels. Diabetes in Chinese subjects share many characteristics similar to other Asian populations. The burden imposed by the chronic complications of diabetes is massive. In Taiwan, the mortality rates from DM have increased greatly over the past 10 years. Reduction of the modificable risk factors such as BMI, hypertenion and dyslipidemia, and increase of physical activity and good glycemic control through public health efforts may help to reduce the risk of DM and its chronic complications.
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PMID:Epidemiologic study of type 2 diabetes in Taiwan. 1102 84

Cardiovascular illness is an important contributor to the morbidity of kidney disease. The spectrum of cardiovascular disease (CVD) in patients with chronic renal insufficiency (CRI) includes left ventricular hypertrophy (LVH) and dilatation, ischemic heart disease, and peripheral vascular disease. Both "traditional" and "uremia-specific" factors contribute to the occurrence and progression of cardiac disease in renal patients. A growing body of recent evidence indicates that the processes contributing to CVD commence early in CRI, leading to concentric LVH, left ventricular dilatation, congestive heart failure, and ischemic heart disease. Many of the coexisting conditions that have been identified consistently as contributing to the burden of cardiovascular illness in renal populations can be modified through medical interventions. Specific therapies exist for hypertension, anemia, hyperparathyroidism, and dyslipidemia. Studies to date have demonstrated that treatment of many of these factors-such as anemia and hypertension during end-stage renal disease-appear to benefit the cardiovascular system. Earlier intervention may offer the best opportunity to reduce the burden of illness in all groups of CRI patients. Identification of patients at the onset of kidney disease and attention to the known traditional and "uremic" risk factors are emerging as promising strategies. Long-term interventional studies are needed to determine costs, benefits, and risks of such strategies.
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PMID:Cardiovascular disease in chronic renal insufficiency. 1111 55

With the advent of more effective therapies for human immunodeficiency virus (HIV) infection, HIV-infected patients are living longer and cardiovascular disease is becoming more obvious in this population. Patients with HIV infection represent one of the most rapidly developing groups with cardiovascular disease globally. Cardiovascular disease complicating HIV infection is likely to contribute to burgeoning healthcare costs. Pericarditis, myocarditis, cardiomyopathy, atherosclerotic coronary vasculopathy, arterial aneurysms, pulmonary hypertension, and endocarditis occur with increased frequency in these patients. Pericardial tamponade, dilated cardiomyopathy, endocarditis, and vasculopathy can lead to fatal outcomes in this population. The advent of cardiomyopathy heralds a very poor prognosis in patients infected with HIV. Coronary vasculopathy without obvious risk factors can lead to myocardial ischemia in young patients infected with the virus. Moreover, the protease inhibitors used to treat HIV infection induce a syndrome of lipodystrophy and dyslipidemia that may be associated with accelerated atherosclerosis as well as insulin resistance. All these factors contribute to increased cardiovascular morbidity and mortality in the HIV-infected population. HIV infection, opportunistic infections, secreted viral proteins such as gp120 (envelope protein) or Tat (transactivator of viral transcription), and cytokines elaborated during the course of HIV infection of the immune system all contribute to pathogenesis of these disorders. Further basic and clinical studies are required to understand the pathogenesis of cardiovascular complications and develop appropriate management strategies for these patients.
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PMID:The cardiovascular and metabolic complications of HIV infection. 1117 4

Lipid peroxidation, cell stability, lipid spectrum, conjunctival microcirculation, levels of ceruloplasmin and myoglobin were studied in 107 males with ischemic heart disease before and after coronaroangiography by M. Judkins (CAG). It was found that CAG provokes oxidative stress, promotes membranodestructive processes, dyslipidemia and circulation disorders in the bulbar conjunctive. Preventive (3 days before CAG) administration of alpha-tocopherol or emoxipin proved cardioprotective. The highest cytoprotective effect was produced by trimetasidine given 10 days before the procedure.
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PMID:[Use of antioxidants and trimetazidine in preparation of patients with ischemic heart disease for coronary angiography]. 1123 63

As a result of increased recognition of elevated LDL-cholesterol (LDL-C) as a risk for ischemic heart disease, the necessity for LDL-C measurement emerged in clinical laboratories. Consequently various LDL-C measurement methods were developed. The objective of the present review article is to compare and to evaluate the characteristics of various methods for LDL-C measurement. Because LDL is a particle defined by its density, ultracentrifugation method; beta-quantification is currently considered the reference method, but it is a time-consuming and expensive technique. The evaluation by Friedewald's equation is simple and applicable to the vast majority of normolipidemic samples. LDL-C measurement by electrophoresis provides an evaluation of LDL along with other lipoproteins. Homogeneous assays have the advantage of obviating the need for pretreatment of samples, and this is suitable for online performance, requiring only a few microliters of sample. Generally, there is little disagreement between methods in LDL-C data of normolipidemic samples. However, when the sample is from patients with dyslipidemia, there may be disagreement in LDL-C results between methods and the reason for this phenomena has been discussed. At the moment, the method for LDL-C measurement at each clinical laboratory has to be selected by adequately balancing demands, costs and benefits.
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PMID:[Evaluation of LDL-cholesterol measurement]. 1198 50

The authors draw attention to the important role played by menopause in the onset of arterial hypertension, enhanced coronary risk and dyslipidemia, for which a particularly useful association has been found to be estrogens, only if administered by mouth (alone or with progestins), and statins. The authors review numerous studies for or against the use of estrogens as a means of reducing arterial hypertension and the incidence of myocardial ischemia in menopausal women. In order to ensure therapeutic efficacy, replacement estrogen therapy should not be started at not too late an age, but instead as young as possible (the first 5 years after the start of menopause are optimal), namely before levels of endothelial estrogen receptors start to fall. Moreover, therapy should not be continued for more than 5 years in order to avoid the risk of breast cancer and endometrial carcinoma. With regard to myocardial infarction, it is worth noting that women show a higher frequency of silent and atypical infarction leading to a late diagnosis and therefore the arrival in the coronary unit half an hour or an hour later than men. Together with the onset of myocardial infarction at an older age in women compared to men (5-10 years), and the fact that diagnosis is less accurate in women and treatment less sophisticated, this accounts for the higher immediate and medium-term mortality figures in women following myocardial infarction. However, at least in America studies have shown that the less aggressive diagnostic and therapeutic management of myocardial infarction in women compared to men is not sufficient to cause a significant difference in mortality between men and women 30 days after the event. Turning to arrhythmia, it is worth recalling that supraventricular tachycardia with close rapid complexes, caused by return in the atrioventricular node is more frequent in females and in the second lutein or progestin phase of the menstrual cycle, thus demonstrating the protective role of estrogens against the onset of arrhythmia. The authors also point out the frequent association between ischemic ictus and chronic non-valvular atrial fibrillation in women aged over 75 since they present a very high risk (94%) of death by ischemic ictus. On the one hand, the guidelines recommend the use of anticoagulating therapy in these patients, but on the other there is a very high risk of hemorrhage which acts as a major constraint. Lastly, pregnancy is mentioned as a condition that facilitates the onset of arrhythmia; for example, orthodromic supraventricular tachycardia in Wolf Parkinson White and ventricular tachycardia which usually regresses post-partum.
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PMID:[Women and cardiovascular diseases]. 1203 64

Specific features of lipid plasma spectrum and principal parameters of red cell membranes are characterized in patients with metabolic syndrome (MS) and chronic stable ischemic heart disease (IHD). 109 patients with metabolic syndrome (diabetes mellitus type 2, arterial hypertension, abdominal obesity and dyslipidemia) were divided into 2 groups: with and without IHD. MS patients with IHD had marked defects of lipid metabolism with hypercholesterolemia, high levels of triglycerides, LDLP cholesterol, low level of HDLP cholesterol. Lipid plasma spectrum in MS patients with IHD vs those without coronary atherosclerosis was characterized by a significantly lower level of apo A1. In red cell membranes these patients had lower fractions of esterified cholesterol combined with high intensity of lipid peroxidation.
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PMID:[Analysis of lipid plasma spectrum and basic parameters of red cell membranes in patients with metabolic syndrome and ischemic heart disease]. 1208 82

Aspirin has been used for more than 100 years, but its mechanisms of action have only been understood in the past 20 years. Aspirin interferes with arachidonic acid metabolism in platelets and endothelial cells and thereby reduces thromboxane A2 and prostacyclin. It also has other mechanisms of action, including anti-inflammatory roles, protection from oxidative stress, enhancement of fibrinolysis, and suppression of plasma coagulation and platelet-dependent inhibition of thrombin generation. It has been used for primary and secondary prevention of myocardial ischemia, and for primary and secondary prevention of cerebrovascular ischemia. We review the 5 pivotal studies relating to primary prevention for cardiovascular risk and the many studies relating to secondary prevention of myocardial ischemia. We also review the utility of aspirin in primary prevention of myocardial infarction and stroke. We conclude that aspirin is one of the most potent drugs ever discovered and that its effects extend well beyond those of cycloxoxygenase enzyme inhibition. Aspirin treatment does not preclude control of underlying and comorbid conditions such as diabetes mellitus, hypertension, and dyslipidemia. For most patients, a daily dose of 325 mg is optimal. Patients must understand the potential for gastrointestinal upset and hemorrhagic complications. The utility of aspirin is greater in coronary artery disease prevention than in cerebrovascular prevention.
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PMID:Aspirin in the prophylaxis of coronary artery disease. 1235 34

Platelet activation, impairment of fibrinolysis, activation of the coagulation pathway, and dyslipidemia are important factors in the pathogenesis and progression of ischemic heart disease, and patients generally need to use an antiplatelet agent. Lipid-lowering cerivastatin, a novel 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, was administered to 20 patients with primary mixed hyperlipidemia for the assessment of the effect of cerivastatin on lipid levels, plasma fibrinogen concentration, factor VII, VIII, and X levels, plasminogen and antiplasmin concentrations, platelet count, and aggregation (adenosine diphosphate [ADP], collagen, and epinephrine induced). Assessments were made immediately after 2 months of a standard lipid-lowering diet, 4 weeks of placebo administration, and 4 weeks of cerivastatin treatment. Cerivastatin achieved significant reductions in triglyceride, total cholesterol, and low-density lipoprotein cholesterol levels. The significant improvement of the lipid profile was associated with platelet aggregation reduction in vitro stimulated by ADP, collagen, and epinephrine (P < .05, P = .05, P < .005, respectively). Significantly lower levels of factor VII and fibrinogen were observed (P = .001, P < .0001) immediately after cerivastatin treatment. No significant differences were detected in factor VIII level, plasminogen and antiplasmin concentrations, and platelet count after cerivastatin treatment. It was concluded that cerivastatin in mixed hyperlipidemia can exert beneficial changes on specific hemostatic variables and platelet aggregation in addition to its positive effects on plasma lipid values.
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PMID:Treatment with cerivastatin in primary mixed hyperlipidemia induces changes in platelet aggregation and coagulation system components. 1241 40

According to results of recent prospective studies depression is an independent risk factor of ischemic heart disease and should be considered together with such acknowledged risk factors as dyslipidemia, hypertension and smoking. Possible pathophysiological mechanisms of relationship between depression and ischemic heart disease are lowered heart rate variability and defects of physiological characteristics of platelets, depression also influences compliance to treatment and physicians recommendations. Depression negatively affects prognosis: mortality after myocardial infarction of patients with depression is 3-6 time higher than of those without depression. Incidence of depression is rather high and special investigation reveals its clinically significant symptoms in every fifth patient. Depression worsens clinical course of ischemic heart disease. Timely detection of depression is very important.
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PMID:[Depression--a novel risk factor of ischemic heart disease and predictor of coronary death]. 1249 75


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