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1.
Cochrane Database Syst Rev ; 5: CD002785, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32367513

RESUMO

BACKGROUND: Chelation therapy is promoted and practiced around the world as a form of alternative medicine in the treatment of atherosclerotic cardiovascular disease. It has been suggested as a safe, relatively inexpensive, non-surgical method of restoring blood flow in atherosclerotic vessels. However, there is currently limited high-quality, adequately-powered research informing evidence-based medicine on the topic, specifically regarding clinical outcomes. Due to this limited evidence, the benefit of chelation therapy remains controversial at present. This is an update of a review first published in 2002. OBJECTIVES: To assess the effects of ethylene diamine tetra-acetic acid (EDTA) chelation therapy versus placebo or no treatment on clinical outcomes among people with atherosclerotic cardiovascular disease. SEARCH METHODS: For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials register to 6 August 2019. We searched the bibliographies of the studies retrieved by the literature searches for further trials. SELECTION CRITERIA: We included studies if they were randomised controlled trials of EDTA chelation therapy versus placebo or no treatment in participants with atherosclerotic cardiovascular disease. The main outcome measures we considered include all-cause or cause-specific mortality, non-fatal cardiovascular events, direct or indirect measurement of disease severity, and subjective measures of improvement or adverse events. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality using standard Cochrane procedures. A third author considered any unresolved issues, and we discussed any discrepancies until a consensus was reached. We contacted study authors for additional information. MAIN RESULTS: We included five studies with a total of 1993 randomised participants. Three studies enrolled participants with peripheral vascular disease and two studies included participants with coronary artery disease, one of which specifically recruited people who had had a myocardial infarction. The number of participants in each study varied widely (from 10 to 1708 participants), but all studies compared EDTA chelation to a placebo. Risk of bias for the included studies was generally moderate to low, but one study had high risk of bias because the study investigators broke their randomisation code halfway through the study and rolled the placebo participants over to active treatment. Certainty of the evidence, as assessed by GRADE, was generally low to very low, which was mostly due to a paucity of data in each outcome's meta-analysis. This limited our ability to draw any strong conclusions. We also had concerns about one study's risk of bias regarding blinding and outcome assessment that may have biased the results. Two studies with coronary artery disease participants reported no evidence of a difference in all-cause mortality between chelation therapy and placebo (risk ratio (RR) 0.97, 95% CI 0.73 to 1.28; 1792 participants; low-certainty). One study with coronary artery disease participants reported no evidence of a difference in coronary heart disease deaths between chelation therapy and placebo (RR 1.02, 95% CI 0.70 to 1.48; 1708 participants; very low-certainty). Two studies with coronary artery disease participants reported no evidence of a difference in myocardial infarction (RR 0.81, 95% CI 0.57 to 1.14; 1792 participants; moderate-certainty), angina (RR 0.95, 95% CI 0.55 to 1.67; 1792 participants; very low-certainty), and coronary revascularisation (RR 0.46, 95% CI 0.07 to 3.25; 1792 participants). Two studies (one with coronary artery disease participants and one with peripheral vascular disease participants) reported no evidence of a difference in stroke (RR 0.88, 95% CI 0.40 to 1.92; 1867 participants; low-certainty). Ankle-brachial pressure index (ABPI; also known as ankle brachial index) was measured in three studies, all including participants with peripheral vascular disease; two studies found no evidence of a difference in the treatment groups after three months after treatment (mean difference (MD) 0.02, 95% CI -0.03 to 0.06; 181 participants; low-certainty). A third study reported an improvement in ABPI in the EDTA chelation group, but this study was at high risk of bias. Meta-analysis of maximum and pain-free walking distances three months after treatment included participants with peripheral vascular disease and showed no evidence of a difference between the treatment groups (MD -31.46, 95% CI -87.63 to 24.71; 165 participants; 2 studies; low-certainty). Quality of life outcomes were reported by two studies that included participants with coronary artery disease, but we were unable to pool the data due to different methods of reporting and varied criteria. However, there did not appear to be any major differences between the treatment groups. None of the included studies reported on vascular deaths. Overall, there was no evidence of major or minor adverse events associated with EDTA chelation treatment. AUTHORS' CONCLUSIONS: There is currently insufficient evidence to determine the effectiveness or ineffectiveness of chelation therapy in improving clinical outcomes of people with atherosclerotic cardiovascular disease. More high-quality, randomised controlled trials are needed that assess the effects of chelation therapy on longevity and quality of life among people with atherosclerotic cardiovascular disease.


Assuntos
Arteriosclerose/terapia , Quelantes/uso terapêutico , Terapia por Quelação/métodos , Ácido Edético/uso terapêutico , Doenças Vasculares Periféricas/terapia , Angina Pectoris/epidemiologia , Arteriosclerose/mortalidade , Causas de Morte , Terapia por Quelação/mortalidade , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/terapia , Humanos , Infarto do Miocárdio/epidemiologia , Doenças Vasculares Periféricas/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/epidemiologia
2.
Adv Exp Med Biol ; 1228: 181-193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32342458

RESUMO

Adaptation of a healthy lifestyle including adequate daily physical activity is shown to reduce 80% of cardiovascular mortality and 40% of cancer-related deaths. A large body of evidence exists proving that this relationship is dose dependent, and even half of the recommended normal physical activity yields significant risk reduction. There has been no medical therapy that would provide such high percentages of reduction in mortality to date. The World Health Organization, therefore, has started an initiative to implement exercise into daily life as a primary prevention measure. Herein, we will focus on the effects of exercise on the vasculature, mainly the peripheral vasculature, in the context of atherosclerotic disease. Exercise has a fundamental role in the pathogenesis, diagnosis, and treatment of atherosclerotic vascular disease. It exerts a protective effect against the development of atherosclerosis irrespective of other cardiovascular risk factors. Additionally, exercise induces changes in vascular hemodynamics helping us to elucidate the presence of obscure vascular involvement. Once again, exercise is the main treatment modality in peripheral arterial disease with accumulating evidence to reduce symptoms and improve both exercise capacity and cardiovascular symptoms.


Assuntos
Arteriosclerose , Exercício Físico , Doença Arterial Periférica , Arteriosclerose/prevenção & controle , Arteriosclerose/terapia , Terapia por Exercício , Humanos , Doença Arterial Periférica/prevenção & controle , Doença Arterial Periférica/terapia , Comportamento de Redução do Risco
3.
PLoS One ; 14(10): e0224026, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31626662

RESUMO

In-stent restenosis remains a major problem of arteriosclerosis treatment by stenting. Expansion-optimized stents could reduce this problem. With numerical simulations, stent designs/ expansion behaviours can be effectively analyzed. For reasons of efficiency, simplified models of balloon-expandable stents are often used, but their accuracy must be challenged due to insufficient experimental validation. In this work, a realistic stent life-cycle simulation has been performed including balloon folding, stent crimping and free expansion of the balloon-stent-system. The successful simulation and validation of two stent designs with homogenous and heterogeneous stent stiffness and an asymmetrically positioned stent on the balloon catheter confirm the universal applicability of the simulation approach. Dogboning ratio, as well as the final dimensions of the folded balloon, the crimped and expanded stent, correspond well to the experimental dimensions with only slight deviations. In contrast to the detailed stent life-cycle simulation, a displacement-controlled simulation can not predict the transient stent expansion, but is suitable to reproduce the final expanded stent shape and the associated stress states. The detailed stent life-cycle simulation is thus essential for stent expansion analysis/optimization, whereas for reasons of computational efficiency, the displacement-controlled approach can be considered in the context of pure stress analysis.


Assuntos
Desenho de Prótese , Stents , Angioplastia Coronária com Balão , Arteriosclerose/terapia , Simulação por Computador , Humanos , Modelos Cardiovasculares
4.
Circ Res ; 125(2): 223-241, 2019 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-31079549

RESUMO

RATIONALE: Transplantation-accelerated arteriosclerosis is one of the major challenges for long-term survival of patients with solid organ transplantation. Although stem/progenitor cells have been implicated to participate in this process, the cells of origin and underlying mechanisms have not been fully defined. OBJECTIVE: The objective of our study was to investigate the role of c-Kit lineage cells in allograft-induced neointima formation and to explore the mechanisms underlying this process. METHODS AND RESULTS: Using an inducible lineage tracing Kit-CreER;Rosa26-tdTomato mouse model, we observed that c-Kit is expressed in multiple cell types in the blood vessels, rather than a specific stem/progenitor cell marker. We performed allograft transplantation between different donor and recipient mice, as well as bone marrow transplantation experiments, demonstrating that recipient c-Kit+ cells repopulate neointimal smooth muscle cells (SMCs) and leukocytes, and contribute to neointima formation in an allograft transplantation model. c-Kit-derived SMCs originate from nonbone marrow tissues, whereas bone marrow-derived c-Kit+ cells mainly generate CD45+ leukocytes. However, the exact identity of c-Kit lineage cells contributing to neointimal SMCs remains unclear. ACK2 (anti-c-Kit antibody), which specifically binds and blocks c-Kit function, ameliorates allograft-induced arteriosclerosis. Stem cell factor and TGF (transforming growth factor)-ß1 levels were significantly increased in blood and neointimal lesions after allograft transplantation, by which stem cell factor facilitated c-Kit+ cell migration through the stem cell factor/c-Kit axis and downstream activation of small GTPases, MEK (mitogen-activated protein kinase kinase)/ERK (extracellular signal-regulated kinase)/MLC (myosin light chain), and JNK (c-Jun N-terminal kinase)/c-Jun signaling pathways, whereas TGF-ß1 induces c-Kit+ cell differentiation into SMCs via HK (hexokinase)-1-dependent metabolic reprogramming and a possible downstream O-GlcNAcylation of myocardin and serum response factor. CONCLUSIONS: Our findings provide evidence that recipient c-Kit lineage cells contribute to vascular remodeling in an allograft transplantation model, in which the stem cell factor/c-Kit axis is responsible for cell migration and HK-1-dependent metabolic reprogramming for SMC differentiation.


Assuntos
Arteriosclerose/terapia , Movimento Celular , Miócitos de Músculo Liso/fisiologia , Animais , Aorta/fisiologia , Aorta/transplante , Células Cultivadas , Reprogramação Celular , Camundongos , Camundongos Endogâmicos C57BL , Miócitos de Músculo Liso/citologia , Miócitos de Músculo Liso/metabolismo , Proteínas Proto-Oncogênicas c-kit/genética , Proteínas Proto-Oncogênicas c-kit/metabolismo , Regeneração , Fator de Células-Tronco/metabolismo , Túnica Íntima/citologia , Túnica Íntima/fisiologia
5.
Dtsch Med Wochenschr ; 144(5): 329-333, 2019 03.
Artigo em Alemão | MEDLINE | ID: mdl-30836404

RESUMO

Early Vascular Aging, a concept describing pathophysiologic and clinical aspects of premature arterial stiffness and arteriosclerosis, has attracted attention in recent years. Early diagnosis and intervention is essential for prevention and postponing cardiovascular events.


Assuntos
Envelhecimento , Arteriosclerose , Rigidez Vascular , Arteriosclerose/diagnóstico , Arteriosclerose/prevenção & controle , Arteriosclerose/terapia , Humanos
6.
Pediatr Nephrol ; 34(5): 819-821, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30406368
7.
PLoS One ; 13(8): e0201496, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30106971

RESUMO

BACKGROUND: Hospitalisation for atherothrombotic disease (ATD) is expected to rise in coming decades. However, increasingly, associated comorbidities impose challenges in managing patients and deciding appropriate secondary prevention. We investigated the prevalence and pattern of multimorbidity (presence of two or more chronic conditions) in Aboriginal and non-Aboriginal Western Australian residents with ATDs. METHODS AND FINDINGS: We used population-based de-identified linked administrative health data from 1 January 2000 to 30 June 2014 to identify a cohort of patients aged 25-59 years admitted to Western Australian hospitals with a discharge diagnosis of ATD. The prevalence of common chronic diseases in these patients was estimated and the patterns of comorbidities and multimorbidities empirically explored using two different approaches: identification of the most commonly occurring pairs and triplets of comorbid diseases, and through latent class analysis (LCA). Half of the cohort had multimorbidity, although this was much higher in Aboriginal people (Aboriginal: 79.2% vs. non-Aboriginal: 39.3%). Only a quarter were without any documented comorbidities. Hypertension, diabetes, alcohol abuse disorders and acid peptic diseases were the leading comorbidities in the major comorbid combinations across both Aboriginal and non-Aboriginal cohorts. The LCA identified four and six distinct clinically meaningful classes of multimorbidity for Aboriginal and non-Aboriginal patients, respectively. Out of the six groups in non-Aboriginal patients, four were similar to the groups identified in Aboriginal patients. The largest proportion of patients (33% in Aboriginal and 66% in non-Aboriginal) was assigned to the "minimally diseased" (or relatively healthy) group, with most patients having less than two conditions. Other groups showed variability in degree and pattern of multimorbidity. CONCLUSION: Multimorbidity is common in ATD patients and the comorbidities tend to interact and cluster together. Physicians need to consider these in their clinical practice. Different treatment and secondary prevention strategies are likely to be useful for management in these cluster groups.


Assuntos
Arteriosclerose/epidemiologia , Análise de Dados , Hospitalização/estatística & dados numéricos , Web Semântica/estatística & dados numéricos , Tromboembolia/epidemiologia , Adulto , Fatores Etários , Arteriosclerose/terapia , Doença Crônica/epidemiologia , Doença Crônica/terapia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade/tendências , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Prevalência , Prevenção Secundária/métodos , Tromboembolia/terapia , Austrália Ocidental/epidemiologia
8.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 34(2): 145-149, 2018 Feb 08.
Artigo em Chinês | MEDLINE | ID: mdl-29926679

RESUMO

OBJECTIVES: To investigate the interventional effects of 16-week aerobic exercises on the elderly's arteriosclerosis and its mechanism. METHODS: Twenty-seven elderly people with the average age of 62. 70 ±3. 26 joined a 16-week square dance/taijiquan exercise program that conducted 60 minutes each time, six times per week. Arterial stiffness and its related indexes such as systolic pressure(SBP), diastolic pressure(DBP), left brachial-ankle pulse wave velocity (L-baPWV), right brachial-ankle pulse wave velocity(R-baPWV), left ankle brachial index (L-ABI), right ankle brachial index(R-ABI), serum triglyceride(TG), total cholesterol(TC), high density lipoprotein cholesterol(HDL-c), low density lipoprotein cholesterol(LDL-c), superoxide dismutase(SOD), malondialdehyde(MDA) and glutathione peroxidase (GSH-Px) were detected at 3 time points including before exercise program, by the end of exercise for 8 weeks and 16 weeks. RESULTS: ① Compared with pre-exercise, the R-baPWV and R-ABI of the elderly people were decreased at the end of the 8th week, and the L-baPWV, RbaPWV, R-ABI and L-ABI were decreased significantly at the end of the 16th week. ②Compared with pre-exercise, SBP and DBP were declined markedly (P<0.01, P<0.05) at the end of the 8th week, SBP, DBP and pulse pressure were decreased significantly (P<0.01, P<0.05) at the end of the 16th week. ③Compared with pre-exercise, TC and LDL-c were declined markedly (P<0.01) at the end of the 8th and the 16th week, and there was no difference of the level of TG and LDL-c between pre-exercise and post-exercise. ④There was no evident difference of serum level of SOD, GSH-Px, MDA between pre-exercise and post-exercise at the end of the 8th week. Compared with pre-exercise, the level of serum SOD, GSH-Px was increased evidently while the content of serum MDA was decreased significantly (P<0.01). CONCLUSIONS: Sixteen-week aerobic exercises could reduce baPWV and ABI levels, regulate blood pressure, blood lipids and lipid peroxides levels of the elderly evidently, thus improve the controlling quality of atherosclerosis.


Assuntos
Índice Tornozelo-Braço , Pressão Sanguínea , Exercício Físico , Análise de Onda de Pulso , Idoso , Tornozelo , Arteriosclerose/terapia , Colesterol/sangue , Glutationa Peroxidase/sangue , Humanos , Malondialdeído/sangue , Pessoa de Meia-Idade , Superóxido Dismutase/sangue , Triglicerídeos/sangue
9.
J Vasc Interv Radiol ; 29(7): 966-970, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29843995

RESUMO

PURPOSE: To perform a post-hoc analysis of the Nephropathy Ischemic Therapy (NITER) trial, which enrolled patients with atherosclerotic renal artery stenosis, to evaluate whether medical therapy plus stent placement is superior to medical therapy alone in patients without elevated albuminuria. MATERIALS AND METHODS: Data from 51 patients were analyzed and stratified into 2 cohorts by median urinary albumin (UAlb) levels: cohort 1 ("low albuminuria," UAlb ≤0.04 g/24h) and cohort 2 ("high albuminuria," UAlb >0.04g/24h). Interaction effect between treatment arms and UAlb cohorts was calculated using Cox regression analysis. Survival analysis was followed by test for effect size, power analysis, and construction of a Kaplan-Meier survival table. RESULTS: At study completion, 13 patients had an outcome event: 6 (23%) from cohort 1 and 7 (28%) from cohort 2. Patients in cohort 1 had event-free survival of 83% at 3.9 ± 0.3 years from the primary endpoints of all-cause mortality, dialysis, and cardiovascular events when treated with interventional therapy, compared to 45% when treated with medical therapy alone (P = .501), which showed a 62% treatment effect for stent placement. In cohort 2, event-free survival rates were 64% for medical therapy versus 52% for medical plus interventional therapy (P = .64). Using Cox regression analysis, the interaction effect between treatment arms and UAlb cohorts was not significant (P = .32). The power of the study to detect an interaction effect, if one existed, was only 15%. CONCLUSIONS: Inference cannot be drawn for similar populations because of inadequate sample size, but, in this sample, patients treated with stent placement who had low albuminuria had better outcomes than patients treated with medical therapy alone.


Assuntos
Albuminúria/etiologia , Angioplastia com Balão , Arteriosclerose/terapia , Obstrução da Artéria Renal/terapia , Idoso , Idoso de 80 Anos ou mais , Albuminúria/diagnóstico , Albuminúria/mortalidade , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Angioplastia com Balão/mortalidade , Arteriosclerose/complicações , Arteriosclerose/diagnóstico por imagem , Arteriosclerose/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Itália , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/mortalidade , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
11.
Stem Cell Res Ther ; 9(1): 85, 2018 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-29615103

RESUMO

BACKGROUND: Mesenchymal stem cell (MSC) transplantation shows promise for treating transplant arteriosclerosis, at least partly via promoting endothelial regeneration. However, the efficacy and safety are still under investigation especially regarding recent findings that neointimal smooth muscle cells are derived from MSC-like cells. The high mobility group box 1 (HMGB1)/receptor for advanced glycation end-product (RAGE) axis is involved in regulating proliferation, migration, and differentiation of MSCs, and therefore it can be presumably applied to improve the outcome of cell therapy. The aim of the current study was to investigate this hypothesis. METHODS: Rat MSCs were treated with HMGB1 or modified with HMGB1 vectors to activate the HMGB1/RAGE axis. RAGE was targeted and inhibited by specific short hairpin RNA vectors. We assessed the capacity for cell proliferation, migration, and differentiation after vector transfection in vitro and in a rat model of transplant arteriosclerosis. The expression of CD31 and α-smooth muscle actin (αSMA) was determined to evaluate the differentiation of MSCs to endothelial cells and smooth muscle cells. RESULTS: Exogenous HMGB1 treatment and transfection with HMGB1 vectors promoted MSC migration and vascular endothelial growth factor (VEGF)-induced differentiation to CD31+ cells while inhibiting their proliferation and platelet-derived growth factor (PDGF)-induced differentiation to αSMA+ cells. Such an effect was blocked by RAGE knockdown. HMGB1-modified cells preferably migrated to graft neointima and differentiated to CD31+ cells along with significant relief of transplant arteriosclerosis and inhibition of HMGB1 and RAGE expression in graft vessels. RAGE knockdown inhibited cell migration to graft vessels. CONCLUSIONS: HMGB1 stimulated MSCs to migrate and differentiate to endothelial cells via RAGE signaling, which we translated to successful application in cell therapy for transplant arteriosclerosis.


Assuntos
Arteriosclerose/terapia , Diferenciação Celular , Células Endoteliais/citologia , Proteína HMGB1/genética , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Miócitos de Músculo Liso/citologia , Actinas/genética , Actinas/metabolismo , Animais , Células Endoteliais/metabolismo , Endotélio Vascular/citologia , Produtos Finais de Glicação Avançada/metabolismo , Proteína HMGB1/metabolismo , Células-Tronco Mesenquimais/metabolismo , Músculo Liso Vascular/citologia , Miócitos de Músculo Liso/metabolismo , Molécula-1 de Adesão Celular Endotelial a Plaquetas/genética , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Ratos , Ratos Endogâmicos F344
12.
Clin Investig Arterioscler ; 29(5): 218-223, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28844490

RESUMO

Therapeutic inertia (TI) is defined as the failure of the physician to initiate or intensify a treatment when the therapeutic goal has not been achieved. TI can be of 2types: inertia due to lack of prescription of drugs and inertia in the absence of control of a risk factor. The consequences of TI are poor control of risk factors, an increase in potentially preventable events and an increase in costs. There are factors of the doctor himself, the patient and the care organization that determine the presence of TI. Ten measures are proposed to reduce TI: to promote continuing education, to define clearly therapeutic objectives, to establish audits, to implement computerized medical records with alerts, to encourage research in this field, to disseminate clinical practice guidelines, to create motivational incentives, to organize care, to improve the doctor-patient relationship and to involve other health care providers.


Assuntos
Arteriosclerose/terapia , Relações Médico-Paciente , Médicos/organização & administração , Guias de Prática Clínica como Assunto , Arteriosclerose/etiologia , Humanos , Médicos/normas , Fatores de Risco , Sociedades Médicas , Espanha
13.
J Atheroscler Thromb ; 24(8): 765-778, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28603219

RESUMO

Arteriosclerosis, particularly aortosclerosis, is the most critical risk factor associated with cardiovascular, cerebrovascular, and renal diseases. The pulsatile hemodynamics in the central aorta consists of blood pressure, flow, and stiffness and substantially differs from the peripheral hemodynamics in muscular arteries. Arteriosclerotic changes with age appear earlier in the elastic aorta, and age-dependent increases in central pulse pressure are more marked than those apparent from brachial pressure measurement. Central pressure can be affected by lifestyle habits, metabolic disorders, and endocrine and inflammatory diseases in a manner different from brachial pressure. Central pulse pressure widening due to aortic stiffening increases left ventricular afterload in systole and reduces coronary artery flow in diastole, predisposing aortosclerotic patients to myocardial hypertrophy and ischemia. The widened pulse pressure is also transmitted deep into low-impedance organs such as the brain and kidney, causing microvascular damage responsible for lacunar stroke and albuminuria. In addition, aortic stiffening increases aortic blood flow reversal, which can lead to retrograde embolic stroke and renal function deterioration. Central pressure has been shown to predict cardiovascular events in most previous studies and potentially serves as a surrogate marker for intervention. Quantitative and comprehensive evaluation of central hemodynamics is now available through various noninvasive pressure/flow measurement modalities. This review will focus on the clinical usefulness and mechanistic rationale of central hemodynamic measurements for cardiovascular risk management.


Assuntos
Arteriosclerose/terapia , Hemodinâmica , Gerenciamento Clínico , Humanos
15.
Cir. Esp. (Ed. impr.) ; 94(5): 266-273, mayo 2016. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-151409

RESUMO

La claudicación intermitente, estación evolutiva intermedia de la enfermedad arterial periférica, se ha considerado tradicionalmente como un estadio benigno, atendiendo al hecho exclusivo de la clínica de dolor que se produce durante la marcha. En este artículo pretendemos llamar la atención sobre las posibles consecuencias asociadas al dolor isquémico y el consiguiente estrés oxidativo desencadenado por su «sombra», el fenómeno isquemia/reperfusión. Durante el mismo se produce deficiente manejo del calcio y aparición incontrolada de radicales libres de oxígeno, con daño mitocondrial y aumento del fenómeno inflamatorio que podría estar asociado a una progresión acelerada de la arteriosclerosis sistémica con aumento del riesgo cardiovascular, directamente proporcional a la disminución del índice tobillo/brazo. Ante estos acontecimientos, proponemos una nueva clasificación integradora de las actuales de Fontaine y Rutherford, que considera las posibles consecuencias sistémicas expuestas y sirva para modificar nuestro manejo tradicional de la enfermedad arterial periférica


Clasically, intermittent claudication, an intermediate stage in peripheral arterial disease, has been considered as a benign condition when considering only the muscular pain on walking. In this paper our aim is to attract attention about the effects linked to ischemic pain and the oxidative injury resulting from episodes of ischemia/reperfusion. Throughout this process alterations in calcium homeostasis as well as uncontrolled generation of reactive oxygen species, in association with the mitochondrial dysfunction and inflammatory phenomena, could lead to accelerate atherosclerosis, with an increased cardiovascular risk stated by means of a reduced ankle-brachial index. Taking this idea into account we propose a possible new classification for the management of the peripheral arterial disease, combining the Fontaine and Rutherford classifications and thinking about the described systemic effects in order to change the traditional management of peripheral arterial disease


Assuntos
Humanos , Masculino , Feminino , Doença Arterial Periférica/classificação , Doença Arterial Periférica/complicações , Doença Arterial Periférica/diagnóstico , Isquemia/diagnóstico , Isquemia/patologia , Reperfusão/instrumentação , Reperfusão/métodos , Reperfusão , Claudicação Intermitente/classificação , Claudicação Intermitente/patologia , Claudicação Intermitente/terapia , Arteriosclerose/complicações , Arteriosclerose/diagnóstico , Arteriosclerose/terapia , Doenças Cardiovasculares
16.
Med. clín (Ed. impr.) ; 146(4): 172-177, feb. 2016. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-147842

RESUMO

Una alta proporción de pacientes de alto riesgo cardiovascular no alcanzan los objetivos terapéuticos del c-LDL. Ello se debe a un uso inadecuado o insuficiente de los fármacos hipolipidemiantes por parte de los facultativos, y también a una mala tolerancia o al incumplimiento terapéutico por parte de los pacientes. Sin embargo, otra causa de esta situación es la potencia insuficiente de los fármacos actuales para disminuir el colesterol, incluyendo las estatinas y la ezetimiba. Entre los nuevos agentes hipocolesteremiantes, los inhibidores de la proproteína convertasa subtilisina/kexina tipo 9 se están mostrando como unos agentes seguros y con una alta eficacia para disminuir el c-LDL en los numerosos ensayos clínicos que se han realizado o están en curso, y nos permitirán lograr el control óptimo de la hipercolesterolemia en la gran mayoría de los pacientes. Los fármacos que inhiben la síntesis de apolipoproteína B y los inhibidores de la proteína microsómica transferidora son otros fármacos que aportan un nuevo potencial de disminuir el colesterol en los pacientes con hipercolesterolemias graves y, en particular, en la hipercolesterolemia familiar homocigótica. Por último, los inhibidores de la proteína transferidora de esteres de colesterol han mostrado potentes efectos sobre el c-HDL y el c-LDL, pero su eficacia en prevención cardiovascular y su seguridad aún no han sido probadas. En este artículo se sintetizan las principales características de los fármacos para el tratamiento de la hipercolesterolemia que han sido recientemente aprobados o que están en fase avanzada de investigación (AU)


An elevated proportion of high cardiovascular risk patients do not achieve the therapeutic c-LDL goals. This owes to physicians’ inappropriate or insufficient use of cholesterol lowering medications or to patients’ bad tolerance or therapeutic compliance. Another cause is an insufficient efficacy of current cholesterol lowering drugs including statins and ezetimibe. In addition, proprotein convertase subtilisin kexin type 9 inhibitors are a new cholesterol lowering medications showing safety and high efficacy to reduce c-LDL in numerous already performed or underway clinical trials, potentially allowing an optimal control of hypercholesterolemia in most patients. Agents inhibiting apolipoprotein B synthesis and microsomal transfer protein are also providing a new potential to decrease cholesterol in patients with severe hypercholesterolemia and in particular in homozygote familial hypercholesterolemia. Last, cholesteryl ester transfer protein inhibitors have shown powerful effects on c-HDL and c-LDL, although their efficacy in cardiovascular prevention and safety has not been demonstrated yet. We provide in this article an overview of the main characteristics of therapeutic agents for hypercholesterolemia, which have been recently approved or in an advanced research stage (AU)


Assuntos
Humanos , Masculino , Feminino , Hipercolesterolemia/terapia , Arteriosclerose/epidemiologia , Arteriosclerose/terapia , Hipolipemiantes/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Ésteres do Colesterol/imunologia , Ésteres do Colesterol/uso terapêutico , Metabolismo dos Lipídeos , Metabolismo dos Lipídeos/imunologia , Metabolismo dos Lipídeos/fisiologia , Hipolipemiantes/imunologia , Hipolipemiantes/metabolismo
17.
Voen Med Zh ; 337(9): 32-37, 2016 09.
Artigo em Russo | MEDLINE | ID: mdl-30592829

RESUMO

Assessment of the influence of the balneo-physiotherapeutic procedures on microcirculatory blood flow in patients with occlusive diseases of the great arteries. A comprehensive program of rehabilitation treatment of patients with atherosclerosis of the arteries of the lower extremities, including over venous laser light, gradient magnetic field on the collar region and calf muscles, dry carbon dioxide baths alternating with baths with horse chestnut. The program is pathogenetically justified the use of its high-performance, regardless of the predominance of a clinical syndrome. This allows recommending it for widespread use in clinical practice, including sanatorium conditions. Some methods that are included in a comprehensive program, in accordance with the proposed algorithm can be used in patients with atherosclerosis of the arteries of the lower extremities with the predominance of individual symptom complex.


Assuntos
Arteriosclerose , Balneologia/métodos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/fisiopatologia , Microcirculação , Adulto , Arteriosclerose/fisiopatologia , Arteriosclerose/terapia , Velocidade do Fluxo Sanguíneo , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia
18.
Artigo em Espanhol | IBECS | ID: ibc-142037

RESUMO

Fundamento: El exceso de riesgo de muerte por cualquier causa (MCC) o de causa cardiovascular (MCV) según los niveles de control glucémico es desconocido entre los pacientes con diabetes tipo 1 (DM1). Por ello se realizó un estudio observacional de base poblacional con la que determinar el exceso de riesgo de muerte según los niveles de control glucémico en la población de Suecia en pacientes con DM1. Métodos: Se incluyeron en el estudio los pacientes con DM1 registrados en el Swedish National Diabetes Register después del 1 de enero del 1998. Por cada paciente se eligieron 5 controles aleatorizados de la población general aparejados según edad, sexo y lugar de residencia. Los pacientes y controles fueron seguidos hasta el 31 de diciembre del 2011 a través del registro de mortalidad por causas específicas de Suecia. Se evaluaron a 33.915 pacientes con DM1 y a 162.249 controles. La MCC y la MCV se evaluaron según las categorías de la HBA1c media que se compararon con la MCC y la MCV de los controles. Resultados: Según los grupos, la edad media fue de 35,8 años en el grupo de DM1 y de 35,7 años en los controles, y el 45,1% de cada uno de los grupos fueron mujeres. El seguimiento medio de los grupos fue de 8 y 8,3 años, respectivamente. Globalmente, 2.701 de los 33.915 pacientes con DM1 (8%) murieron, frente a 4.835 de los 169.249 controles (2,9%), el hazard ratio (HR) ajustado fue de 3,52 (IC 95%: 3,06-4,04). Las tasas de MCV fueron del 2,7% para el grupo de DM1 y del 0,9% en los controles, HR: 4,60 (IC 95%: 3,47-6,10). Según un análisis multivariante los HR para MCC según los niveles de HbA1c de los pacientes con DM1 frente a los controles fue de 2,36 (IC 95%: 1,97-2,83) en HbA1c 6,9% o menor; un HR de 2,38 (IC 95%: 2,02-2,80) entre 7,0-7,8%; un HR de 3,11 (IC 95%: 2,66-3,62) entre 7,9-8,7%; un HR de 3,65 (IC 95%: 3,11-4,30) entre 8,8-9,6%; y de 8,51 (IC 95%, 7,24-10,01) en niveles de 9,7% o superiores. Según MCV, los HR fueron de 2,92 (IC 95%: 2,07-4,13), 3,39 (IC 95%: 2,49-4,61), 4,44 (IC 95%: 3,32-5,96), 5,35 (IC 95%: 3,94-7,26), y de 10,46 (IC 95%: 7,62-14,37), respectivamente. Conclusión: El estudio concluye que según un estudio observacional en función de un registro poblacional de pacientes con DM1, los pacientes con DM1 aún teniendo niveles de HbA1c iguales o inferiores a 6,9% el riesgo de MCC y MCV es 2 veces más alto que el riesgo de MCC y MCV de los controles no diabéticos. Sin embargo, cuanto peor es el control mayor es el riesgo de MCC y MCV (AU)


No disponible


Assuntos
Adulto , Feminino , Humanos , Masculino , Índice Glicêmico/fisiologia , Glicemia/análise , Diabetes Mellitus Tipo 1/mortalidade , Fatores de Risco , Arteriosclerose/complicações , Arteriosclerose/terapia , Diabetes Mellitus Tipo 1/sangue , Estudos de Casos e Controles , Análise Multivariada , Indicadores de Morbimortalidade , Doenças de Pequenos Vasos Cerebrais/complicações
19.
Saudi J Kidney Dis Transpl ; 26(5): 987-91, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26354575

RESUMO

Schimke immune-osseous dysplasia (SIOD) is a rare autosomal recessive disorder characterized by spondylo-epiphyseal dysplasia (SED), progressive renal insufficiency beginning as steroid-resistant nephrotic syndrome (SRNS) and defective cellular immunity. This article reports a case from Egypt with a mild form of SIOD. A 14.5-year-old male patient presented with disproportionate short stature, SRNS (focal and segmental glomerulosclerosis), laboratory evidence of cellular immune deficiency and radiologic characteristics of SED. He died at the age of 16.5 years with bone marrow failure and severe pneumonia. To the best of our knowledge, this is the first case of SIOD to be reported from Egypt.


Assuntos
Arteriosclerose , Síndromes de Imunodeficiência , Síndrome Nefrótica , Osteocondrodisplasias , Embolia Pulmonar , Adolescente , Arteriosclerose/diagnóstico , Arteriosclerose/genética , Arteriosclerose/terapia , Progressão da Doença , Egito , Evolução Fatal , Humanos , Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/genética , Síndromes de Imunodeficiência/terapia , Masculino , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/genética , Síndrome Nefrótica/terapia , Osteocondrodisplasias/diagnóstico , Osteocondrodisplasias/genética , Osteocondrodisplasias/terapia , Doenças da Imunodeficiência Primária , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/genética , Embolia Pulmonar/terapia , Fatores de Tempo
20.
Cardiovasc Pathol ; 24(6): 335-42, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26365806

RESUMO

Arterial vascular diseases comprise the leading cause of death in the industrialized world. Every physician learns about the pathology of these diseases in medical school. All pathologists evaluate arterial disease in surgical pathology and/or autopsy specimens. All clinicians encounter patients with clinical manifestations of these diseases. With such a common and clinically-important group of entities one would think there would be a general understanding of the "known" information that exists. That is, physicians and scientists should be able to separate what is fact and what is fancy. This review article is intended to generate thought in this regard.


Assuntos
Artérias/patologia , Arteriosclerose/patologia , Esclerose Calcificante da Média de Monckeberg/patologia , Placa Aterosclerótica , Arteriosclerose/classificação , Arteriosclerose/epidemiologia , Arteriosclerose/terapia , Biópsia , Humanos , Esclerose Calcificante da Média de Monckeberg/classificação , Esclerose Calcificante da Média de Monckeberg/epidemiologia , Esclerose Calcificante da Média de Monckeberg/terapia , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Ruptura Espontânea , Índice de Gravidade de Doença , Terminologia como Assunto
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