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PubMed1983

[Echocardiography in coronary heart disease].

Coronary heart disease can be detected via echocardiography, if myocardial ischemia or infarction are present leading to segmental abnormalities of left ventricular function. The capability to demonstrate these regional changes is limited as far as TM echocardiography is concerned, whereas 2D echocardiography is more reliable. For this purpose, cross-sectional imaging of all segments in several planes is necessary. The complex mosaic of findings obtained in this way is best documented by means of a segmental scheme of representative sections. Infarct size then can be estimated by a segmental score. Depressed wall motion and systolic wall thickening are used as criteria for ischaemia and infarction. In the chronic phase, morphological changes can be identified additionally: Thinning, expansion and increased reflectivity of the infarcted areas. In acute myocardial infarction, echocardiography is mainly used if the course is complicated, in the chronic phase, if ECG-changes are questionable, or to evaluate residual ventricular function after large infarcts. Even the TM echocardiogram reliably estimates the ventricular damage caused by the infarct in the chronic phase.

Cardiomegaly↗

PubMed2004

Genetics of familial combined hyperlipidemia and risk of coronary heart disease.

Coronary heart disease is the leading cause of death in developed countries. This alarming statistic is partly attributable to lifestyle, and partly due to the genetic factors that make humans highly susceptible to atherosclerotic vascular disease. The principal metabolic causes of atherosclerosis include hyperlipidemia, hypertension, obesity, insulin resistance and diabetes mellitus. Here we discuss the aetiology of familial combined hyperlipidemia (FCHL), a highly atherogenic disorder affecting 1-2% of the Western world. Genome-wide linkage studies indicate that more than three genes contribute to the pernicious lipid profile of FCHL, and that these genes reside within the 1q21-23, 11p14.1-q12.1 and 16q22-24.1 chromosomal regions. Other loci include 1p31, 6q16.1-16.3 and 8p23.3-22, but the linkage data for these are not yet persuasive. Combined linkage and association analyses provide compelling evidence for the involvement of two distinct alleles at the APOA1/C3/A4/A5 gene cluster in the transmission of FCHL. An important lesson arising from the study of a complex genetic disorder, such as FCHL, that lacks a consensus on diagnostic criteria, is that an understanding of complex genetic disorders can derive from comparative analyses of genome-wide linkage data generated from conditions that share phenotypic overlap. The identification of potential genetic overlap between FCHL and the Metabolic Syndrome, which is estimated to affect 47 million Americans, promises to deliver new targets for reducing the risk of important conditions such as cardiovascular disease and stroke.

Alleles↗

PubMed2001

With increasing ageing in Western populations, what are the prospects for lowering the incidence of coronary heart disease?

Coronary heart disease (CHD), rare in the early 1900s, in the 1970s was responsible for almost a third of deaths in Western populations. Although its mortality rate has fallen in the last 20 years, considerably in certain populations, it remains the leading cause of death, and there is little evidence of any fall in its incidence rate. The primary risk factors, which include pattern of diet, smoking practice, and level of physical activity, are well known, but explain only approximately 50% of variation in its occurrence. Despite the numerous health improvement recommendations made, alterations in diet have been relatively slight. Although smoking practice has halved in some populations, its prevalence is now rising in the young. The extent of physical activity is low, compared with that in the past, and may even be decreasing in the young. With the general ageing of populations, the near absence of strong encouragement from the state, and individuals' general failure to reduce risk factors significantly, the chances of decreases in the incidence of CHD appear remote.

Coronary Disease↗

PubMed2001

Women and coronary heart disease.

Coronary heart disease (CHD) is the leading cause of death in men and women in the United States. The incidence of CHD during midlife is lower in women than men, but the gap narrows with each decade. Because women have a longer life span than men, the absolute numbers of CHD deaths are roughly equal. Effective diagnosis of CHD in women requires the recognition of gender differences in presentation and pathogenesis. Women present with atypical symptoms and are less likely to have adequate primary prevention. This article discusses the differences between men and women in CHD and examines the assessment, diagnosis, and clinical management of CHD in women.

Clinical Trials as Topic↗

PubMedDate not supplied

Clopidogrel in the management of ischemic heart disease.

Ischemic heart disease (IHD) represents a pathophysiologic continuum consisting of stable angina, unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction. Patients who develop a change in their usual stable pattern of ischemia are classified as having an acute coronary syndrome, which includes patients with unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction. Such progression from a stable to an unstable state is believed to result from disruption of an atherosclerotic plaque with subsequent platelet aggregation and thrombus formation. This, in turn, leads to the clinical manifestations of unstable angina, MI or death. Because platelets play a central role in the thrombotic complications of atherosclerosis, antiplatelet agents have been the cornerstone of the therapy for IHD. Aspirin has been the traditional antiplatelet agent, and remains the mainstay of treatment for all forms of IHD. However, aspirin is a weak antiplatelet agent and is often poorly tolerated by many patients. Clopidogrel is a new antiplatelet agent of the thienopyridine class. Clopidogrel, when used alone, and especially in combination with aspirin, has been shown to improve outcomes in patients with IHD across a variety of syndromes. However, combination therapy with aspirin and clopidogrel has been associated with an increased risk of bleeding. Therefore, despite improved outcomes, further studies are required to determine the optimal duration and dosage regimen of such combination therapy to maximize its risk-benefit ratio.

Angioplasty, Balloon, Coronary↗

PubMed2006

Role of computed tomography in risk assessment for coronary heart disease.

Coronary heart disease is the most common cause of death in Western countries, with a rising incidence in developing countries. It is part of the spectrum of cardiovascular diseases that have common end points of myocardial infarction, stroke and death. As these end points often occur suddenly and often in those with no known disease, identification of those people at high risk is important. Besides the known traditional risk factors, direct imaging of the calcified plaque as a marker for atherosclerotic disease has been extensively studied with electron beam computed tomography and now with multislice computed tomography. This review discusses the role of computed tomography in assessment of cardiovascular risk in both people with or without symptoms.

Calcinosis↗

PubMed2004

Shear stress insensitivity of endothelial nitric oxide synthase expression as a genetic risk factor for coronary heart disease.

Coronary heart disease (CHD) is based on the development of atherosclerosis in coronary arteries. Shear stress-induced endothelial nitric oxide (NO) release not only contributes to local blood pressure control but also effectively helps to retard atherosclerosis. Therefore, functionally relevant polymorphisms in the endothelial NO synthase (NOS-3) gene may contribute to the development of CHD. NOS-3 expression was analyzed in endothelial cells isolated from umbilical cords genotyped for the -786C/T single nucleotide polymorphism (SNP) of the human nos-3 gene. Moreover, NO-dependent relaxation was examined in segments of saphenous vein isolated from genotyped patients undergoing aortocoronary bypass surgery, and patients subjected to quantitative coronary angiography were genotyped to verify an association between this SNP and CHD. Shear stress-induced NOS-3 mRNA and protein expression was present in TT and CT genotype cells but absent in cells with CC genotype. Pretreatment of these cells with a decoy oligonucleotide comprising position -800 to -779 of the C-type nos-3 promoter reconstituted shear stress-induced NOS-3 expression. These results were confirmed by reporter gene analysis with the corresponding nos-3 promoter luciferase constructs. In addition, the NO-mediated relaxant response of vein grafts from CC genotype patients was significantly attenuated as compared with the CT or TT genotype, and in CHD-positive patients, the CC genotype was significantly more frequent (19.0%) than in CHD-negative patients (4.4%). The -786C/T SNP of the nos-3 gene thus constitutes a genetic risk factor for CHD, presumably due to binding of an inhibitory transcription factor to the C-type promoter blocking shear stress-dependent maintenance of NOS-3 expression.

Adult↗

PubMed2001

Cardiovascular risk factors associated with insulin resistance cluster in families with early-onset coronary heart disease.

Coronary heart disease (CHD) is a multifactorial disease caused by environmental and genetic factors. CHD clusters in families, but it is not known whether susceptibility to early-onset CHD is associated with the clustering of cardiovascular risk factors. Therefore, we determined the levels of cardiovascular risk factors among siblings with and without severe early-onset CHD drawn from 101 Finnish families. Probands with CHD, compared with their siblings without CHD, had, respectively, higher 2-hour insulin levels (475.7 versus 331.8 pmol/L, P=0.011) and 2-hour insulin areas (796.2 versus 640.4 pmol/L per hour, P=0.031) in an oral glucose tolerance test, lower high density lipoprotein cholesterol levels (1.22 versus 1.42 mmol/L, P=0.001), higher total triglyceride levels (1.91 versus 1.68 mmol/L, P=0.018), higher very low density lipoprotein triglyceride levels (1.25 versus 1.06 mmol/L, P=0.011), and higher fibrinogen levels (3.8 versus 3.4 g/L, P= 0.008). No significant differences were found in cardiovascular risk factors between affected siblings and probands with CHD. Environmental or lifestyle factors did not differ between siblings with or without early-onset CHD. We conclude that cardiovascular risk factors associated with the insulin resistance syndrome (hyperinsulinemia, low high density lipoprotein cholesterol, high total and very low density lipoprotein triglycerides, and high fibrinogen) are likely to contribute indirectly to early-onset CHD.

Adult↗

PubMed2002

Lycopene, tomatoes, and the prevention of coronary heart disease.

Coronary heart disease (CHD) is one of the primary causes of death in the Western world. The emphasis so far has been on the relationship between serum cholesterol levels and the risk of CHD. More recently, oxidative stress induced by reactive oxygen species (ROS) is also considered to play an important part in the etiology of this disease. Oxidation of the circulating low-density lipoprotein (LDL(ox)) is thought to play a key role in the pathogenesis of atherosclerosis and CHD. According to this hypothesis, macrophages inside the arterial wall take up the LDL(ox) and initiate the process of plaque formation. Dietary antioxidants such as vitamin E and beta-carotene have been shown in in vitro studies to prevent the formation of LDL(ox) and their uptake by microphages. In a recent study, healthy human subjects ingesting lycopene, a carotenoid antioxidant, in the form of tomato juice, tomato sauce, and oleoresin soft gel capsules for 1 week had significantly lower levels of LDL(ox) compared with controls. The antioxidant effects of lycopene have also been shown in four other human trials, including one where lycopene consumption reduced the levels of breath pentane. However, in one recent study, dietary supplementation with beta-carotene but not with lycopene was shown to inhibit LDL oxidation. The sources of lycopene used in most of these studies were either tomato products or lycopene extracted from tomatoes containing other carotenoids in various proportions. Therefore, it is not possible to attribute the effects solely to lycopene. Mechanisms other than the antioxidant properties of lycopene have also been shown to reduce the risk of CHD. Lycopene was shown to inhibit the activity of an essential enzyme involved in cholesterol synthesis in an in vitro and a small clinical study suggesting a hypocholesterolemic effect. Other possible mechanisms include enhanced LDL degradation, LDL particle size and composition, plaque rupture, and altered endothelial functions. Recent epidemiological studies have also shown an inverse relationship between tissue and serum levels of lycopene and mortality from CHD, cerebrovascular disease, and myocardial infraction. However, the most impressive population-based evidence comes from a multicenter case-control study where subjects from 10 European countries were evaluated for relationship between antioxidant status and acute myocardial infarctions. After adjusting for a range of dietary variables, only lycopene levels but not beta-carotene were found to be protective. At present, the role of lycopene in the prevention of CHD is strongly suggestive. Although the antioxidant property of lycopene may be one of the principal mechanism for its effect, other mechanisms may also be responsible. Controlled clinical and dietary intervention studies using well-defined subject populations and disease end points must be undertaken in the future to provide definitive evidence for the role of lycopene in the prevention of CHD. Mechanistic studies must also be initiated to understand the mode of lycopene action.

Antioxidants↗

PubMed2003

[Relationship between the subendocardial viability ratio and risk factors for ischemic heart disease].

Ischemic heart disease is one of the major causes of sudden death in Japanese workers. Hypercholesteremia, hypertension, obesity, and the smoking habit are considered to be risk factors for cardiovascular events. Generally the subendocardium is thought to be more sensitive to a shortage of blood supply than the subepicardium. Buckberg et al. have demonstrated that the ratio of the area of the diastolic phase (diastolic pressure time index: DPTI) to that of the systolic phase (time tension index: TTI) in the central aortic profile has a close correlation with the blood supply to the subendocardium. This ratio was designated as the subendocardial viability ratio: SEVR (DPTI/TTI). We examined the relationships between the SEVR, as measured by SphygmoCor (AtCor Medical Ltd.), and the data from the health examination of 178 males working for a steel company. A significantly low SEVR was observed in people with the smoking habit, a high pulse rate, obesity, abnormality of blood fat components, or hyperglycemia. Employees in the normal SEVR group (SEVR: 140% or more) n = 120 and low SEVR group (SEVR: 139% or less) n = 58 were compared. The results suggested that employees with low SEVR were older and had a higher BMI, higher pulse rate, higher total cholesterol, higher triglyceride, and higher fasting plasma glucose. They also had lower HDL-cholesterol. In the low SEVR group, the percentage of employees with hyperlipidemia or hyperglucosemia was significantly higher than that in the normal SEVR group. Results of stepwise regression analysis indicated that the pulse rate and age were significant and independent predictive factors for SEVR. These data on SEVR calculated from the wave pattern of the central artery are considered to be useful parameters for evaluating the risk of myocardial ischemia and for guiding health promotion.

Adult↗

PubMed2006

The gut microbiota and lipid metabolism: implications for human health and coronary heart disease.

Coronary heart disease (CHD) is the leading cause of mortality in Western societies, affecting about one third of the population before their seventieth year. Over the past decades modifiable risk factors of CHD have been identified, including smoking and diet. These factors when altered can have a significant impact on an individuals' risk of developing CHD, their overall health and quality of life. There is strong evidence suggesting that dietary intake of plant foods rich in fibre and polyphenolic compounds, effectively lowers the risk of developing CHD. However, the efficacy of these foods often appears to be greater than the sum of their recognised biologically active parts. Here we discuss the hypothesis that beneficial metabolic and vascular effects of dietary fibre and plant polyphenols are due to an up regulation of the colon-systemic metabolic axis by these compounds. Fibres and many polyphenols are converted into biologically active compounds by the colonic microbiota. This microbiota imparts great metabolic versatility and dynamism, with many of their reductive or hydrolytic activities appearing complementary to oxidative or conjugative human metabolism. Understanding these microbial activities is central to determining the role of different dietary components in preventing or beneficially impacting on the impaired lipid metabolism and vascular dysfunction that typifies CHD and type II diabetes. This approach lays the foundation for rational selection of health promoting foods, rational target driven design of functional foods, and provides an essential thus-far, overlooked, dynamic to our understanding of how foods recognised as "healthy" impact on the human metabonome.

Biomarkers↗

PubMed2003

The significance of autoimmunity in the pathogenesis of Chagas heart disease.

Chagas heart disease develops in approximately one-third of individuals infected with the protozoan parasite Trypanosoma cruzi. Among the many possible mechanisms responsible for this illness, an autoimmune mechanism has received much experimental support during the past several decades. Initial observations of the absence or near absence of parasites from the inflamed tissues suggested the autoimmunity hypothesis, and the finding of measurable autoimmune responses in humans and experimental animals has bolstered this idea. The rigorous testing of the hypothesis has been difficult, primarily because other mechanisms are likely to play a role during active infection, particularly immunity to parasite antigens that may persist in the infected animal. While the role autoimmunity plays in disease pathogenesis is not known, it is clear that autoimmune responses are induced during infection of some humans and animals. A number of mechanisms may explain the induction of autoimmunity during T. cruzi infection, including parasite-induced polyclonal lymphocyte activation, molecular mimicry, bystander activation, and presentation of cryptic self epitopes. The genetic makeup of both the parasite and host are also critical to the outcome of infection. The autoimmune hypothesis deserves further exploration, while public health interventions should focus on control of the insects that transmit the parasite, development of parasiticidal drugs and vaccines, and testing of blood products, which have become an important threat of new infections.

Animals↗

PubMed1999

Hypertensive heart disease.

Hypertensive heart disease (HHD) is a common problem in clinical practice. Left ventricular hypertrophy (LVH) is pathognomonic of HHD. Echo-Doppler study is the modality of choice to document cardiac involvement in hypertension. 'Radiology of chest and electrocardiography (ECG) are highly insensitive. Magnetic resonance imaging (MRI) produces similar results like echo but is not cost-effective. LVH is not merely related to haemodynamic load but several other factors are also involved in its genesis. LVH is a powerful and independent prognostic determinant for future cardiovascular and coronary events. LVH can be regressed by drugs but the aim in future should be prevention of LVH rather than its regression.

Calcium Channel Blockers↗

PubMedDate not supplied

Role of magnetic resonance imaging in coronary heart disease.

Coronary heart disease (CHD) is the number one cause of morbidity and mortality in the developed countries. CHD involves a very broad clinical spectrum, ranging from stable angina pectoris to sudden cardiac death. Despite a huge improvement in treatment in the last 3 decades, significantly reducing the death rate, the prevalence of CHD will increase in the coming years due to an improved survival after a first acute myocardial infarction and due to an overall increased longevity, fueled by an epidemic of type-2 diabetes and obesity. This increased prevalence of cardiovascular disease will greatly impact the cost of health care. Moreover, new but often expensive imaging technologies are appealing for more accurate clinical and preclinical detection of CHD. Among these techniques, magnetic resonance imaging (MRI) is certainly one of the most promising. In this review we would like to highlight its potential in diagnosing CHD, against the background of a steadily increasing cost in health care and the need to choose the most cost-effective technique.

Belgium↗

PubMed2004

Evaluation of spleen in children with heterotaxia and congenital heart disease.

Congenital heart disease (CHD) affects 8 to 10 children out of every 1,000 live births. Of these, 2.2% have an abnormality associated with the spleen. Many previous studies have associated CHD and asplenia or polysplenia syndrome. We report a case of a 12-year-old girl with complex CHD who was noted to have Howell-Jolly bodies on her peripheral blood smear at birth, but disappeared at 2 months of age and radiographic evidence of splenic tissue with situs inversus. Unfortunately, she presented with overwhelming sepsis at 20 months of age. In this paper, we discuss multiple tests available for evaluating splenic function in children with CHD and heterotaxia. Hepatoiminodiacetic acid (HIDA) scan in conjunction with radiocolloid scan is the best available choice today to document the presence or absence of a functional spleen in children with heterotaxia and CHD.

Child↗

PubMed2005

[Ischemic heart disease].

Ischemic heart disease is one of the leading causes of death in Japan. Acute coronary syndrome (ACS) most commonly begins with atherosclerotic plaque rupture and intracoronary thrombus formation. Therefore, the primary goal of treatment of acute coronary occlusion is the achievement of early and complete reperfusion. To achieve this goal, detection of atherosclerosis and/or myocardial necrosis by imaging and serologic tests is important. Original diagnosis of acute myocardial infarction (AMI) was made from typical symptoms, characteristic rises in serum enzyme levels, and an atypical electrocardiographic pattern. Increasingly sensitive and specific tests have been developed in recent years and have been rapidly adopted into clinical practice. Rapid developments in technology in the field of serum biomarkers have redefined the diagnosis of AMI. The new ESC/ACC criteria place increased emphasis on cardiac biomarkers, especially troponins. However, the electrocardiogram still remains significant in the diagnosis of AMI and the ability to identify high risk subgroups by admission electrocardiogram is necessary to estimate the severity of AMI. Current practice guidelines recognize the importance of promptly restoring normal epicardial blood flow, but blood flow to the ischemic tissue may still be impeded after relief of the occlusion; a phenomenon known as no reflow. Myocardial scintigraphy is one of the methods for defining coronary microvascular injury in the acute phase of AMI. Prompt assessment of coronary perfusion and detection of coronary microvascular injury may aid in making decisions concerning the use of drugs to improve microvascular function and left ventricular function after primary coronary angioplasty.

Humans↗

PubMed1994

Genetic markers in coronary heart disease.

Coronary heart disease (CHD) was found to aggregate in families. So the present study aimed at studying certain genetic markers (lipoproteins, ABO blood groups and dermatoglyphics), in a group of 60 patients with CHD and a control group to detect any significant association between such genetics markers in this disorder. This can throw light on its genetics. The study revealed significant and marked association of CHD with low alpha-lipoprotein, high pre-beta and beta-lipoproteins. No significant association wa detected with ABO phenotypes. Definite significant association was also detected between CHD and certain dermatoglyphics phenotypes including FTP, T-D count and palm patterns. These significant associations of CHD and these genetic markers "which are genetically determined" denoted strongly genetic etiology or at least genetic predisposition of CHD. Detection of such genetic markers may help in determination of risky individuals in population and families of CHD patients. This can help in prevention by proper genetic counseling.

Adult↗

PubMed1989

[Effects of kuo guan powder on immunologic functions in patients with ben-xu biao-shi syndrome in ischemic heart disease].

Ischemic heart disease (IHD) is correlated with the Immunodisturbances. In this study, the immunological effects of Kuo Guan No 1, a powder for aiding Qi and activating the blood, in 17 cases of Qi Yang Xu Xue Yu (QYXXY, ) syndrome, Kuo Guan No 2, powder for nourishing the Yin and activating the blood, in 14 cases of Yin-Xu Xue-Yu (YXXY, ) syndrome had been observed in one month treatment. After treatment with both powder of Kuo Guan No 1 and Kuo Guan No 2, the increased levels of IgG, CIC, IC-IgG and IC-C3 in serum and the numbers of B cells in peripheral blood lymphocyte (PBL) of the patients with Ben-Xu Biao-Shi (BXBS, ) syndrome of IHD angina were markedly decreased and showed no significant difference while compared with the normal controls (P greater than 0.05); the numbers of OKT+3, OKT+4 and OKT+8 cells in PBL, which were lower before treatment in both groups, were obviously increased and showed no marked difference with the controls (P greater than 0.05); the higher ratio of T4/T8 was lowered in group of YXXY syndrome, and showed no difference while compared with the controls (P greater than 0.05), but the ratio in QYXXY syndrome group was lowered than that in the controls (P less than 0.05). After the treatment with Kuo Guan No 1, the increased level of C3 in serum in QYXXY group was lowered down to that of the controls (P greater than 0.05). The results indicated that it is reasonable to consider that "Kuo Guan" powder is an immunoregulative preparation for patients with BXBS syndrome of IHD angina.

Adult↗