[Physical trainings in peripheral atherosclerosis: problems and ways of solution].

Physical trainings (PT) in patients with peripheral atherosclerosis (PA) improve quality of life and the prognosis. They are accompanied and followed by favourable shifts in metabolism of peripheral tissues. The currently existing guidelines are unequivocally in favour of the necessity of physical trainings in patients with signs of intermittent claudication (class I, level A evidence). However, there is a considerable gap between efficacy of regular physical exercises and readiness of patients to participate in them, with only a sparse number of patients with PA actually performing these programmes. The review gives a detailed consideration of both subjective and objective factors limiting the participation of PA patients in PT programmes. New approaches for solving this problem have recently been proposed. In order to prevent the development of painful sensations during PT, they propose to use low-intensity loads, also performing training of other muscular groups, integral trainings, including those using electrostimulation of skeletal muscles. Mention should be made of the beginning of PT in patients with subclinical manifestations of PA, behavioural therapy in PA patients. Revealing early forms of PA and carrying out active rehabilitative measures are more convenient to be performed by physicians specializing in neurosurgery, thus requiring new organizational approaches.

Surgical aspects of the diabetic foot.

A comprehensive review of the literature relating to the pathology and management of the diabetic foot is presented. This should provide a guide for the treatment of ulcers, Charcot neuro-arthropathy and fractures involving the foot and ankle in diabetic patients.

[Arterial media calcification in patients with type 2 diabetes mellitus]. / Calcificarile vasculare mediale la pacientii cu diabet zaharat tip 2.

Arterial calcification was previously viewed as an inevitable, passive, and degenerative process that occurred at the end stages of atherosclerosis. Recent studies, however, have demonstrated that calcification of arteries is a complex and regulated process. It may occur in conjunction with atherosclerosis or in an isolated form that is commonly associated with diabetes and renal failure. Higher artery calcium scores are associated with increased cardiovascular events, and some aspects of arterial calcification are similar to the biology of forming bone. Arterial calcification can thus be viewed as a distinct inflammatory arteriopathy, much like atherosclerosis and aneurysms, with its own contribution to cardiovascular morbidity and mortality. Current research involves efforts to define the complex interactions between cellular and molecular mediators of arterial calcification and, in particular, the role of endogenous calcification inhibitors. This review discusses the clinical relevance, cellular events, and suspected molecular pathways that control arterial calcification.

Antioxidant plasma concentration and supplementation in carotid intima media thickness.

Cerebrovascular diseases represent a major problem in Western countries. Oxidative stress, an important condition of increased amounts of reactive oxygen species, is now recognized to be a prominent feature of many acute and chronic diseases, and even of the normal aging process. Carotid intima media thickness is an important marker of atherosclerosis that correlates with established coronary heart disease. Changes in carotid intima media thickness, measured by B-mode high-resolution carotid ultrasonography, represent an important and early step in carotid plaque formation and progression and are the most common currently used marker to evaluate the progression of atherosclerotic processes. Several therapeutic strategies have been adopted to slow the early atherosclerotic process in asymptomatic subjects in order to reduce the risk of cardiovascular events. An additional step to slow the atherosclerotic process may include interventions to decrease newly emerging coronary risk factors, such as oxidative stress and inflammation. Consuming a diet rich in fruits and vegetables will provide antioxidant vitamins, and carotenoids, which are believed to inhibit tissue damage derived from oxidative processes and may slow the progression of early atherosclerosis, modify the increase in carotid intima media thickness and, consequently, reduce cardiovascular events. This review synthesizes the published literature regarding antioxidant vitamins plasma concentration and supplementation and carotid intima media thickness.

Vaccines for the prevention of cardiovascular disease.

Atherosclerosis, especially coronary heart disease (CHD), remains a most significant global public health problem. Highly effective LDL-lowering therapies have gained widespread adoption in the United States and throughout the developed world, but therapeutic options for raising low HDL, a key independent risk factor for CHD, remain limited. We are developing a vaccine approach to raising HDL, by inducing an immune response to endogenous cholesteryl ester transfer protein (CETP), and have demonstrated proof of principle in preclinical and clinical models. This vaccine approach may offer the opportunity to address low HDL with a cost-effective semi-annual injection.

Predictores de mortalidad por cardiopatía isquémica en un hospital de Asturias / Predictors of mortality by ischemia cardiophaty at a hospital in Asturias

Objetivos: La mortalidad por cardiopatía isquémica es una de las principales causas de muerte en nuestro país, a pesar de su descenso. Quisimos identificar los factores pronósticos de mortalidad en los pacientes ingresados por isquemia miocárdica en un hospital de Asturias. Métodos: Estudio retrospectivo de 484 pacientes con cardiopatía isquémica que fueron admitidos en el Hospital Álvarez Buylla del 1/1/1999 al 31/12/2001. Fueron analizados: sexo, edad, vivir solo, factores de riesgo cardiovascular, pruebas complementarias y mortalidad. Se realizó tanto análisis univariante como multivariante. Resultados: De los pacientes del estudio, la mortalidad fue el 10,5% (51). Los fallecidos presentaban con mayor frecuencia que los supervivientes las siguientes variables: edad > 60 años, ACV, diabetes e hiperglucemia, insuficiencia renal crónica, creatinina alta (> 1,2 mg/dl), ácido úrico (> 7,2 mg/dl) y fibrinógeno (> 600 mg/dl). Fue más frecuente ser fumador entre los supervivientes que en los fallecidos. En el análisis multivariante las variables predictoras de mortalidad fueron vivir solo y la tensión arterial sistólica. Conclusiones: La mortalidad fue mayor en los ancianos, diabéticos, pacientes con IRC, ACV, hiperglucemia y elevación de creatinina, ácido úrico y fibrinógeno. Y en la regresión logística los factores independientes de mortalidad fueron: vivir solo y la tensión arterial sistólica (AU)

Aim: The mortality by ischemic cardiophaty is one of the mean causes of mortality in our country in spite of its decrease. We want to identify the prognostic factors of mortality of myocardial ischemia in patients admitted at a hospital in Asturias. Methods: A retrospective study of 484 patients with ischemic cardiophaty who were admitted to the Hospital Álvarez Buylla from 1/1/1999 to 31/12/2001. They were analyzed regarding: sex, age, to live along, cardiovascular risk factors, complementary tests and mortality. They were studied and analyzed by univariate and multivariate techniques. Results: Of the study patients, mortality was 10, 5% (51). The dead patients had a greater proportion of the following parameters as compared with survivors: age > 60 years, stroke, diabetes and hyperglycaemia, chronic renal failure, high creatinina (>1.2 mg/dl), uric acid (> 7.2 mg/dl) and fibrinogen (> 600 mg/dl). To smoke were more frequent in the survivors than in the dead. In the multivariate analysis the predictors of mortality were: to live along and systolic blood pressure. Conclusions: The mortality was higher in elderly, diabetics, stroke, chronic renal failure, hyperglycaemia, high creatinina, uric acid and fibrinogen. In logistic regression independent factors for death were: to live along and systolic blood pressure (AU)

The homeopathic preparation Vertigoheel versus Ginkgo biloba in the treatment of vertigo in an elderly population: a double-blinded, randomized, controlled clinical trial.

OBJECTIVE: Alternative medical practices are common in the treatment of vertigo. This study compared the effects of Ginkgo biloba treatment with the homeopathic remedy Vertigoheel (Biologische Heilmittel Heel GmbH, Baden-Baden, Germany). DESIGN: Randomized, double-blinded, parallel group study. SUBJECTS: One hundred and seventy (170) patients, ages 60-80 years, with atherosclerosis-related vertigo. INTERVENTIONS: Patients were randomly allocated to receive treatment with either Vertigoheel (n = 87) or G. biloba (n = 83). OUTCOME MEASURES: The results were analyzed for the non-inferiority of Vertigoheel to G. biloba on the combined endpoint of changes from baseline to week 6 in dizziness score (assessed by questionnaire), frequency, duration, and intensity of vertigo episodes (recorded in patient diaries). RESULTS: Both treatments improved vertigo status. From a baseline mean value of 26.1 +/- 5.2 (on a 50-point scale) in the Vertigoheel group, the dizziness questionnaire score improved by -10.6 +/- 10.0, and by -10.7 +/- 9.0 from 25.8 - 4.7 in the G. biloba group. Statistical analysis of this endpoint showed that Vertigoheel was not inferior to G. biloba. The 95% confidence interval for the difference between treatment did not reach the inferiority threshold of 0.36 at any of the time points tested. The results were supported by the results of a line walking test, Unterberger's stepping test, and patient and physician global assessments of therapeutic effect. Both treatments were well tolerated. CONCLUSIONS: Vertigoheel is an appealing alternative to established G. biloba therapy for atherosclerosis-related vertigo.

Ácidos grasos trans, cops y lops: evidencia actual de su influencia sobre la salud infantil / Trans fatty acids, cholesterol oxidation products and lipid oxidation products: current evidence of their influence on the health of children

Una de las preocupaciones del pediatra es la prevención de la enfermedad del adulto a través de la nutrición del niño. La aterosclerosis, una de las principales causas de morbimortalidad actual, se origina ya en la infancia, y uno de sus factores predisponentes es la dieta. En ella, se encuentran algunos productos grasos menos conocidos, como son los ácidos grasos trans, así como los productos de oxidación del colesterol y otros lípidos, que parecen tener efectos nocivos importantes sobre el organismo, y cuyo consumo debería limitarse ya desde la infancia precoz

The prevention of adult disease through childhood nutrition is one of the aims of the paediatrician. It is well known that atherosclerosis is among the major causes of morbidity and mortality, and nutrition is one of its etiologic factors. Our daily diet provides certain lesser known fat products, such as trans fatty acids, cholesterol oxidation products and other lipid oxidation products, that may have detrimental effects on the human body, and their intake through the diet should be limited from early childhood

Medial arterial calcification mimicking temporal arteritis.

Medial arterial calcification, which has been increasingly recognized in end-stage renal disease (ESRD) patients, has been associated with acutely symptomatic vascular complications including calcific uremic arteriolopathy (calciphylaxis) and ischemic changes in the extremities. This report describes a 50-year-old ESRD patient on maintenance hemodialysis in whom medial arterial calcification developed with features mimicking the findings of temporal arteritis. He complained of persistent bilateral temporal area headaches with associated symptoms of blurred vision; pain in his shoulders, hips, and knees; and intermittent symptoms consistent with jaw claudication. He was not receiving calcium or vitamin D supplements. Superficial temporal arteries were dilated, tortuous, nodular, and tender to palpation. Ophthalmologic examination was unremarkable, except for the presence of peripapillary atrophy. Temporal artery biopsy results showed medial arterial calcification with mild inflammatory changes. No giant cells were identified. Additional long-term complications of medial arterial calcification have included the development of painful ischemic ulceration of the glans penis and extensive mitral annulus calcification detected by echocardiography. The findings in this patient show that clinical manifestations of medial artery calcification associated with ESRD can mimic those seen with other vascular diseases.

Supplementary taurine may stabilize atheromatous plaque by antagonizing the activation of metalloproteinases by hypochlorous acid.

The rupture of atherosclerotic plaque, responsible for triggering the majority of myocardial infarctions, presumably requires proteolysis of collagen fibers and other protein components of the intercellular matrix. This is achieved by activated matrix metalloproteases (MMPs) secreted by intimal macrophages and foam cells. MMPs are synthesized as inactive pro-enzymes in which coordinate binding of the thiol group of a key cysteine residue to the active-site zinc atom blocks proteolytic activity. Physiological activation of MMPs is mediated, in large measure, by phagocyte-derived hypochlorous acid (HOCL), which can oxidize the zinc-bound thiol to sulfinic acid, thus freeing the active-site zinc. HOCL also encourages proteolysis of ground substance by inactivating proteins such as TIMP-1 that are physiological inhibitors of MMPs. In vivo, the unrestrained oxidant activity of HOCL is opposed by taurine, which reacts spontaneously with HOCL to generate taurine chloramine, much more stable than HOCL. Taurine chloramine has less impact than HOCL on MMP activation, and does not impair the activity of TIMP-1. Since tissue levels of taurine can be boosted via supplementation, taurine may thus have potential for stabilizing plaque and thereby warding off infarction--an effect that should be reinforced by taurine's platelet-stabilizing activity. In light of recent epidemiological evidence that increased expression of myeloperoxidase - the enzyme which generates HOCL--is an important risk factor for coronary disease, supplemental taurine may indeed have broader utility for suppressing both the genesis and the rupture of atherosclerotic plaque.

Hypercholesterolemia and endothelium dysfunction: role of dietary supplementation as vascular protective agents.

There is increasing evidence that dietary supplementation, such as L-arginine, anti-oxidant vitamins, soy phytoestrogens, flavonoids and omega-3 fatty acids exert vascular protective benefits particularly in terms of restoring endothelial function in cardiovascular disease states. The endothelium has been a major focus over the past 20 years as being a primary site at which dysfunction occurs in association with, and contributing to, vascular pathologies. Such states include mild compromise of the cardiovascular system as observed in smokers, hypercholesterolemics and hypertensives, through to end-point heart failure. This review will focus on the experimental and clinical evidence examining the effect of nutriceuticals on vascular function, in particular endothelium-derived factors, and argues that there is a role for nutriceuticals in the clinical management of the cardiovascular compromised individual.

[Relationship between pathological development of phlegm-stasis and expression of actin in vascular smooth muscle cell in atherosclerosis rat model].

OBJECTIVE: To explore the dynamic change of Phlegm-stasis in the rat atherosclerotic model as the time goes on. METHODS: Adopting high fat forage fed to develop the atherosclerotic model in rats, and the changes of blood lipid, hemorrheology, blood glucose, insulin and vascular smooth muscle cell (VSMC) actin expression were detected by biochemical and immunohistochemical assay at various time points after modeling. RESULTS: The expression of VSMC actin gradually increased along with the change of model rats' Syndrome from Phlegm to stasis, i.e., the change of parameters, including blood lipid, hemorrheologic parameters, blood glucose, insulin and insulin sensitive indexes along with the aggravation of disease. CONCLUSION: The expression of VSMC actin could be the molecular mechanism for the Syndrome developing from Phlegm to stasis in atherosclerotic rats.

Spinal cord stimulation in the treatment of peripheral vascular disease: results of a single-center study of 258 patients.

This report is of a retrospective study of data from 258 patients who received spinal cord stimulation (SCS) for the treatment of peripheral vascular disease as a result of arteriosclerosis. The patients' clinical outcomes were monitored over a period of 18 months. In patients with a low baseline transcutaneous oxygen pressure (TcPO(2)) value of <10 mm Hg, limb survival at 18 months of follow-up (estimated by use of Kaplan-Meier survival analysis) was 77.8%, and this was even higher, at 89.5%, in patients with a medium baseline TcPO(2) value of 10-30 mm Hg. This successful treatment was accompanied by a sustained increase in TcPO(2) values to approximately 30 mm Hg in both of these groups. In looking at diabetic and nondiabetic patients, there is no difference in limb survival as a result of the treatment. It is concluded that SCS is an effective therapy in improving limb survival in patients with peripheral vascular disease. In addition, TcPO(2) values at baseline may be a useful predictor of treatment outcome.