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PubMed2004

The spectrum of cardiovascular disease in children with predialysis chronic kidney disease.

Cardiovascular disease is the major cause of mortality in adults and children on chronic dialysis and in adults after kidney transplantation. Cardiovascular disease burden and cardiovascular mortality are high in adults with chronic kidney disease. The early development of cardiovascular disease risk factors, some of which are modifiable, largely explain this phenomenon. Limited data are available on the prevalence of chronic kidney disease in children, the prevalence of cardiovascular disease in children with chronic kidney disease, and the prevalence of cardiovascular disease risk factors in these patients. This article summarizes the current knowledge of the prevalence of cardiovascular disease and of cardiovascular disease risk factors in pediatric patients with predialysis chronic kidney disease. Long-term prospective studies are needed to determine the impact of early identification and treatment of cardiovascular disease and its risk factors on the natural history of cardiovascular disease in children with chronic kidney disease.

Anemia↗

PubMed2000

Selected topics related to occupational exposures. Part V. Occupational cardiovascular disease

Cardiovascular disease is common in the United States. Several occupational exposures, such as carbon disulfide and organic nitrates, are believed to cause occupational cardiovascular disease. In addition some other agents, such as lead and cadmium, may indirectly cause cardiovascular disease through their effects on blood pressure. For other agents (ie, carbon monoxide, solvents, and chlorofluorocarbons), acute exposure and high levels may cause cardiovascular disease but may not cause cardiovascular disease through long-term or low levels. A primary care physician who has a patient with a new or unstable cardiovascular disease should obtain an occupational history to assess whether occupational exposures may be playing a role. An occupational history may indicate potential cardiovascular risks. Such risks can include exposure to certain chemicals and metals, physical factors, exertion, or psychological stress. The primary care physician should be able to assess the situation and advise the patient, as well as the employer, about restrictions or accommodations that may need to be made.

Journal Article↗

PubMed2006

Oxidative stress in renal transplant patients who develop cardiovascular disease.

Cardiovascular disease limits life expectancy of successful renal transplant patients. Reactive oxygen species have been implicated in the development of atherosclerosis, and high levels could be due to increased production or a decrease in antioxidant reserve. Cardiovascular disease in renal transplant recipients could be due to elevated levels of malondialdehyde (an index of levels of reactive oxygen species) and homocysteine and reduced levels of glutathione. Renal transplant recipients with and without cardiovascular disease were studied along with healthy controls. Serum malondialdehyde, plasma homocysteine, and red blood cell glutathione were measured. The results suggest that levels of serum malondialdehyde and plasma homocysteine were higher in patients with or without cardiovascular disease compared with controls; however, the values were similar in both groups of transplant patients. Glutathione levels in red blood cells were similar in all 3 groups. Renal transplant recipients without cardiovascular disease have high levels of oxidative stress and may develop cardiovascular disease with time.

Adult↗

PubMed1993

Hormone replacement therapy and cardiovascular disease.

Cardiovascular disease is the chief cause of death among women in industrialized countries. Even breast cancer deaths, at 100/100,000 annually, are only 20% those from cardiovascular disease. However, the research effort in the area of cardiovascular disease among postmenopausal women is far smaller than those for osteoporosis or cancer. In postmenopausal women, the risk of cardiovascular disease rises dramatically, and among the elderly exceeds that of males. Although there is overwhelming evidence that HRT reduces the incidence, many physicians assume that it may cause hypertension and thrombosis, perhaps under the mistaken impression that HRT has the same side effects as the first generation of steroid contraceptives. A number of studies have demonstrated that cardiovascular mortality of postmenopausal women on HRT decreases by approximately one-half. The main epidemiologic evidence for this is a series of case-control and prospective (cohort) studies. Some 20 studies over the last 15 years could be briefly summarized by saying that approximately one third found cardiovascular risk among HRT users to be reduced by > 50% compared with non-users; one third found risk reductions < 50%; and one third found increased risks. HRT appears to affect a large number of risk factors associated with cardiovascular disease; but many formerly thought to be of significance have little clinical relevance, whereas some factors, such as peripheral vascular resistance and certain prostanoids, are apparently much benefited. The benefits of HRT for lipid factors (HDL-cholesterol, LDL-cholesterol, etc.) are well known, but recent evidence indicates that changes in these lipids account for only 20-25% of the cardiovascular benefits of HRT.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular Diseases↗

PubMed2006

Diabetes mellitus and cardiovascular disease.

Cardiovascular diseases include hypertension, coronary heart disease, acute myocardial infarction, heart failure, sudden death, peripheral vascular disease, and stroke. The high risk of cardiovascular disease in individuals with diabetes was recognized more than 30 years ago. Appreciation of the multiple risk factors and complex pathophysiologic process responsible for cardiovascular disease in individuals with both type 1 and 2 diabetes is critical for the prevention, early detection, and management of cardiovascular disease in this population. The focus of this article is on the acute and chronic manifestations of coronary heart disease.

Cardiovascular Diseases↗

PubMed2004

Erectile dysfunction and cardiovascular disease.

Cardiovascular disease and erectile dysfunction (ED) are closely interrelated disease processes. Erectile dysfunction reportedly affects 10 million to 20 million men in the United States and more than 100 million men worldwide. Each year, about 500,000 persons in the United States survive a myocardial infarction, and an estimated 11 million have existing cardiovascular disease, making the issue of sexual function and cardiac disease relevant to many patients. We explore the relationship between ED and the presence of cardiovascular disease in the general population. We also review the prevalence and pathophysiological associations of ED and cardiovascular disease. The risks of sexual activity for patients with cardiovascular disease are discussed, as are prevention and treatment strategies for ED in this patient population.

Cardiovascular Diseases↗

PubMed1994

Theoretical rationale of community intervention for the prevention and control of cardiovascular disease.

Cardiovascular disease is the leading cause of death and disability in the developed world, accounting for slightly more than 40% of all mortality. Along with the resultant disability of those who survive with the disease it costs the health care system in Canada approximately $17 billion on an annual basis. The known risk factors for cardiovascular disease are widespread within the population; in Canada, approximately 70% of individuals have one or more of the major risk factors. Research over the past 25 years has disclosed that a significant proportion of the cause of heart disease and its risk factors are rooted in the unhealthy habits of average living in conjunction with unfavorable physical, economic and psychosocial environments. The primary prevention of cardiovascular disease has focused on individual risk factor change combined with approaches to community organization in an effort to produce a more conducive environment for behavior change to be carried out. First-generation community programs for cardiovascular disease prevention, as illustrated by the North Karelia Project, Stanford Five City Project and others in the United States, have relied heavily on social learning theory as advanced by Bandura, from Stanford University. Second-generation prevention programs, such as the Nova Scotia Heart Health Program, have relied on these theories as well as theories of participation and community development in the prevention of major noncommunicable diseases. This paper gives an overview of the theoretical basis of community intervention programs for cardiovascular disease. Included will be a discussion of some of the various theoretical approaches used in Canada and the United States and elsewhere over the past 25 years.

Canada↗

PubMed2004

Dietary intake of children at high risk for cardiovascular disease.

Cardiovascular disease and obesity begin in childhood, and dietary interventions to prevent them should be initiated then. We hypothesized that children who were at high risk for cardiovascular disease based on family history would have diets that were different than those of children from low-risk families. Two hundred ninety-seven children were screened for family history of early cardiovascular disease; had height, weight, and finger-stick total cholesterol measured; and filled out food frequency questionnaires. Sixty-eight (23%) children were at risk for cardiovascular disease. Cholesterol was significantly higher compared with those not at risk (4.71+/-0.93 mmol/L vs 4.35+/-0.92 mmol/L, P=.005). Intakes of energy, fat, fiber, and cholesterol were similar between groups. Children at high risk for cardiovascular disease were no more likely to meet guidelines for heart-healthy diets than were children at low risk. Families need guidance to change dietary patterns to prevent future disease.

Cardiovascular Diseases↗

PubMed2006

Endotoxin, TLR4 signaling and vascular inflammation: potential therapeutic targets in cardiovascular disease.

Cardiovascular disease ranks among the leading causes of morbidity and mortality in adult populations in the Western world. Significant progress in understanding the etiology of cardiovascular disease has come from recent recognition that chronic inflammation plays a key role in its development. The principal mediators of this inflammatory response, and the mechanisms by which they work, however, are incompletely understood. Moreover, the complex nature of the inflammatory response poses significant challenges to the development of effective and targeted treatments. Potentially promising targets to reduce inflammation in atherosclerosis include Toll-like receptor (TLR) pathways and anti-inflammatory factors that modulate TLR signaling. In this review, we outline studies that provide insight into the links between cardiovascular disease and inflammation, focusing on innate immunity and endotoxin/TLR4 signaling. We also discuss the contribution of specific host immune/inflammatory responses to atherogenesis, and describe cellular signaling pathways (lipopolysaccharide-binding protein [LBP], CD14, MD-2, TLR4, MyD88, and NF-kappaB, among others) that play key roles in innate immune signaling. Finally, we discuss the therapeutic potential of modulating these cellular signaling pathways as future strategies for the prevention and treatment of cardiovascular disease, including such approaches as specific targeting of the TLR4 signaling pathway, antibiotic therapy, drug classes with broad anti-inflammatory activity (statins, thiazolidinediones), and the potential of vaccine development. Because of the complexity of the links between low-level chronic infections, inflammation, and atherosclerosis, treatment and prevention of cardiovascular disease will likely require an integrated approach that utilizes a combination of these strategies to target the underlying inflammatory processes.

Cardiovascular Diseases↗

PubMed2003

Targeting the cell cycle machinery for the treatment of cardiovascular disease.

Cardiovascular disease represents a major clinical problem affecting a significant proportion of the world's population and remains the main cause of death in the UK. The majority of therapies currently available for the treatment of cardiovascular disease do not cure the problem but merely treat the symptoms. Furthermore, many cardioactive drugs have serious side effects and have narrow therapeutic windows that can limit their usefulness in the clinic. Thus, the development of more selective and highly effective therapeutic strategies that could cure specific cardiovascular diseases would be of enormous benefit both to the patient and to those countries where healthcare systems are responsible for an increasing number of patients. In this review, we discuss the evidence that suggests that targeting the cell cycle machinery in cardiovascular cells provides a novel strategy for the treatment of certain cardiovascular diseases. Those cell cycle molecules that are important for regulating terminal differentiation of cardiac myocytes and whether they can be targeted to reinitiate cell division and myocardial repair will be discussed as will the molecules that control vascular smooth muscle cell (VSMC) and endothelial cell proliferation in disorders such as atherosclerosis and restenosis. The main approaches currently used to target the cell cycle machinery in cardiovascular disease have employed gene therapy techniques. We will overview the different methods and routes of gene delivery to the cardiovascular system and describe possible future drug therapies for these disorders. Although the majority of the published data comes from animal studies, there are several instances where potential therapies have moved into the clinical setting with promising results.

Animals↗

PubMed1997

A multicultural perspective of cardiovascular disease.

Cardiovascular disease constitutes an emerging public health problem in most countries, even though morbidity and mortality profiles vary according to inherent risk factors. Urbanization and adoption of Western life style appear to predispose populations of all countries to greater risks for coronary heart disease and related conditions. The cultural composition of the United States is rapidly changing due to immigration. This growing ethnic diversity has placed new demands on the health care system for providing culturally sensitive care. In the United States, no ethnic group appears to be immune to cardiovascular disease. Cardiovascular risk factors of major American ethnic populations are discussed, and cultural beliefs that stress implications for nursing care of multicultural patients are introduced.

Adolescent↗

PubMedDate not supplied

[Depression in patients with cardiovascular disease].

Cardiovascular disease and depression, which is frequently encountered in developed countries, are unexpectedly linked and someway interdependent. Although it has been proven that major depression is a risk factor for cardiovascular disease, it is also true that cardiovascular disease may often cause depression. This article provides epidemiological data regarding this phenomenon and focuses on the mechanisms and causes that link these apparently unrelated pathologies. The diagnosis of depression and the difficulty in recognizing it as such are reviewed and several tests useful for this purpose are presented. Finally, the most common antidepressants particularly suitable for cardiac patients are examined along with any possible interactions between these drugs and those currently used for treatment of cardiovascular disease.

Cardiovascular Diseases↗

PubMed1999

Plasminogen activator inhibitor type-1 (PAI-1) and its role in cardiovascular disease.

Cardiovascular disease is responsible for approximately 50% of total mortality in Europe, the USA and Japan. Established risk factors including smoking, hypercholesterolemia, and hypertension explain about half of the incidence of cardiovascular disease only. Reduced endogenous fibrinolytic activity secondary to increased plasma activity of plasminogen activator inhibitor type-1 (PAI-1) is now considered as a new cardiovascular risk factor. In this review, evidence is gathered for the notion that PAI-1 constitutes a predictor of cardiovascular disease and also contributes to the development of cardiovascular disease as a pathogenetic factor. The review will focus on experimental studies modulating PAI-1 activity and clinical studies addressing coronary heart disease, myocardial infarction, restenosis after coronary angioplasty, and graft occlusion after coronary artery bypass grafting.

Animals↗

PubMed2004

Expression profiling of cardiovascular disease.

Cardiovascular disease is the most important cause of morbidity and mortality in developed countries, causing twice as many deaths as cancer in the USA. The major cardiovascular diseases, including coronary artery disease (CAD), myocardial infarction (MI), congestive heart failure (CHF) and common congenital heart disease (CHD), are caused by multiple genetic and environmental factors, as well as the interactions between them. The underlying molecular pathogenic mechanisms for these disorders are still largely unknown, but gene expression may play a central role in the development and progression of cardiovascular disease. Microarrays are high-throughput genomic tools that allow the comparison of global expression changes in thousands of genes between normal and diseased cells/tissues. Microarrays have recently been applied to CAD/MI, CHF and CHD to profile changes in gene expression patterns in diseased and non-diseased patients. This same technology has also been used to characterise endothelial cells, vascular smooth muscle cells and inflammatory cells, with or without various treatments that mimic disease processes involved in CAD/MI. These studies have led to the identification of unique subsets of genes associated with specific diseases and disease processes. Ongoing microarray studies in the field will provide insights into the molecular mechanism of cardiovascular disease and may generate new diagnostic and therapeutic markers.

Animals↗

PubMed2003

The emerging role of gene therapy in the treatment of cardiovascular diseases.

Cardiovascular disease is the number one source of morbidity and mortality in the United States. Therapies directed at a variety of cardiovascular diseases have blossomed over the last several decades. The advent of gene therapy, first as an intriguing tool, and subsequently with the early successes of gene trials involving the treatment of SCID, led to the development of gene therapy as a potentially exciting and viable therapy in cardiovascular diseases. A variety of novel vector technologies and delivery systems have been developed to more efficiently deliver the gene product to the desired organ or tissue bed. Early clinical trials focused on stimulating angiogenesis. Subsequently, a number of other aspects of cardiovascular disease have been identified as potential targets for gene therapy, including the prevention of restenosis, the prevention and treatment of thrombosis, and the prevention of transplant vasculopathy. With over forty clinical human trials either completed or currently enrolling, cardiovascular gene therapy has proven to be safe and initial results suggest its efficacy.

Animals↗

PubMed2000

Antioxidants and vitamins to reduce cardiovascular disease.

Cardiovascular disease is the leading cause of morbidity and mortality in Western populations. Several lines of evidence support the role of oxidative stress in atherogenesis. Dietary micronutrients with antioxidant properties and vitamins have also been shown to have a benefit with regards to cardiovascular disease. The most persuasive evidence relates to alpha tocopherol and folate and vitamin B(12). Although the evidence is mounting for supplementation with alpha tocopherol and folate and B(12) for secondary prevention of cardiovascular disease, no clear consensus can be reached for primary prevention of cardiovascular disease. This will have to await results of ongoing clinical trials.

Animals↗

PubMed2006

Epidemiology of non-dialysis-requiring chronic kidney disease and cardiovascular disease.

PURPOSE OF REVIEW: To review recent literature about the relationship between non-dialysis-requiring chronic kidney disease and cardiovascular disease as well as possible explanatory factors. RECENT FINDINGS: Reduced estimated glomerular filtration rate below 60 ml/min/1.73 m independently predicts the risk of death and cardiovascular events in persons with or without known cardiovascular disease as well as those undergoing coronary or peripheral arterial revascularization. This risk is not linearly associated with level of kidney function. Chronic kidney disease is associated with a larger burden of traditional vascular risk factors but is also linked to abnormalities in a variety of nontraditional pathways such as dysregulation of mineral metabolism and arterial calcification, vessel stiffness and endothelial dysfunction, insulin resistance, inflammation, malnutrition, and anemia, among others. Other novel kidney-specific proteins (e.g. renalase) may play direct mediating roles. The relative contribution of these factors to excess cardiovascular disease in chronic kidney disease remains unclear. SUMMARY: Recent evidence demonstrates the importance of non-dialysis-requiring chronic kidney disease as a potent predictor of cardiovascular disease and its complications. Randomized trials should be performed to determine whether modification of traditional and nontraditional risk factors can reduce incident cardiovascular disease as well as which interventions can optimize treatment outcomes in persons with chronic kidney disease and cardiovascular disease.

Cardiovascular Diseases↗

PubMed2000

Women and cardiovascular disease.

Cardiovascular disease remains the number one killer in the United States. The face of the person with cardiovascular disease is changing. No longer is the middle-aged man at highest risk. Current data reveal that women, especially postmenopausal women, are at highest risk for cardiovascular disease. This article identifies the differences noted between men and women with cardiovascular disease, including effects in presentation, identification, and treatment.

Clinical Trials as Topic↗