Vascular endothelium summary statement II: Cardiovascular disease prevention and control.

The prevention and control of cardiovascular disease (CVD), principally ischemic heart disease and stroke, are a major clinical and public health challenge. Worldwide, CVD accounts for substantial morbidity and mortality. The major modifiable CVD risk factors are known and all of them cause endothelial activation and dysfunction. Preventing and controlling the established risk factors are associated with preserved endothelial function and reduced risk of CVD. Research advances that improve our understanding of strategies to preserve endothelial function or make the endothelial cells resilient to environmental insults may help improve our preventive interventions. This summary statement addresses the current state of the science with respect to endothelial dysfunction and CVD pathogenesis, diagnostic evaluation, and suggested strategies for public health practice and research.

Cardiovascular disease 2005--the global picture.

Although the past twenty years have seen a remarkable decline in the death rates of heart disease and stroke in the United States and several countries of western Europe, a reverse trend is occurring in other parts of the world. This is especially true in sub-Saharan Africa, India, China and Russia. World-wide, deaths from cardiovascular disease exceed those caused by cancer, infectious disease and trauma, constituting a deadly epidemic. Yet, in 1996 the Victoria Declaration stated that the world has the knowledge to eliminate cardiovascular disease as a major illness. Defeating such an initiative are other priorities such as education, housing, transportation, defense, as well as ignorance. The Earth Institute has labeled the needed effort, "A Race Against Time".

Venous volume displacement plethysmography: Its diagnostic value in deep venous thrombosis as determined by receiver operator characteristic curves.

The pitfall of several reviews of noninvasive venous assessment has been the expression of the test data solely in terms of diagnostic accuracy (the number of correct tests in ratio to all tests performed), where results of a test will vary according to disease prevalence. The advantages of receiver operator characteristic curve analysis are twofold: (1) it describes the dynamic relationship between sensitivity (the ratio of the number of true positive tests to the patients with deep venous thrombosis) and specificity (the ratio of true negative tests to the number of patients with no deep venous thrombosis) independent of disease prevalence; and (2) the threshold criteria that defines a positive test can be set by the best balance between sensitivity and specificity and then applied to a given patient population for its diagnostic accuracy. Venous volume plethysmography is a widely used, simple and rapid method. It was compared to the "gold standard" of phlebography in a prospective blind study of 70 limbs that were clinically suspect of having deep venous thrombosis (DVT). Venous volume displacement plethysmography was defined objectively by three quantitative parameters: (1) maximum venous outflow, (2) integer ratio, and (3) segmental venous capacitance ratio. The DVT (22 to 70 positive phlebograms) was divided by anatomic location into either calf vein DVT or proximal DVT (popliteal vein or above). By combining these three parameters, a balance between sensitivity and specificity was obtained to provide a rapid, objective method for screening patients with suspected DVT.