摘要:

&NA;Recent evidence indicates that infections or a pathogen burden contribute to the development and progression of atherosclerosis. While the mechanism of infection contributing to the pathogenesis is not fully elucidated, I hypothesize that heat shock proteins may be a link between infections and atherosclerosis. Heat shock proteins are a highly conserved family of proteins expressed in most cell types and have been shown to play a general role in protecting cells in response to stress. It has been demonstrated thatChlamydiaand human HSP60 coexist in atherosclerotic lesions. Bacterial and human heat shock proteins have been found in soluble form in the general circulation of patients with atherosclerosis. Both heat shock proteins can stimulate cells to express adhesion molecules and proinflammatory cytokines. Certain organisms synthesize heat shock proteins that have close structural homology with human heat shock proteins. Because of the immunologic molecular mimicry between bacterial and human HSP60, it could be an autoantigen involved in eliciting cell‐mediated and humoral immune responses that cause vessel injury leading to atherosclerosis. The aim of this review is to provide an update overview on the involvement of heat shock proteins in the pathogenesis of atherosclerosis in response to infections.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Arterial hypertension is a major risk factor for the clinical syndrome of angina pectoris, in which the ECG is abnormal but the coronary arteries are normal. Structural and functional abnormalities in coronary circulation as well as extravascular factors (eg, left‐ventricular hypertrophy, fibrosis with diastolic dysfunction) compromise the adequate ratio of coronary blood flow to oxygen demand causing angina, dyspnea, and major cardiac events. Recent studies stress the importance to functional disturbances of coronary microvasculature leading to profound morphologic changes associated with impaired coronary conductance. In patients without epicardial coronary stenosis hypertensive microvascular disease can be qualitatively assessed by noninvasive diagnostic approaches based on new Doppler echocardiography techniques and may also be monitored by widely available stress tests. For ultimate quantitative assessment, invasive procedures are still required. Beyond guidelines to control blood pressure in hypertensive individuals, restoration of functional and structural integrity of the coronary microvasculature represents the ultimate therapeutic goal in hypertensive patients with coronary insufficiency and without angiographic evidence of atherosclerosis. Concomitant factors reducing coronary conductance such as left‐ventricular hypertrophy and diastolic dysfunction should be reversed in parallel. Currently, therapeutic intervention in the renin‐aldosterone‐angiotensin‐II‐system using ACE inhibitors, angiotensin receptor blockers, and low doses of aldosterone antagonists represent the most promising strategy to achieve these goals. Using the knowledge of these recent results we should refine the overall management of our hypertensive patients with coronary insufficiency but without atherosclerosis.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Treating patients with renovascular disease is complex, particularly as imaging and medical techniques become more effective. Atherosclerotic renal artery disease is present in 7% of the general population above age 65 and in 20 to 45% of patients with coronary disease or aortoiliac disease. Most patients are treated medically, but when progressive hypertension, renal insufficiency, or circulatory congestion develops, revascularization should be considered. Endovascular procedures with arterial stents are now widely employed. These procedures sometimes offer major benefits in blood pressure control and stabilization of renal function. Stent procedures continue to entail hazards, including atheroemboli, arterial dissections, and thrombosis, in addition to restenosis rates of 14 to 20%. Small, randomized trials to date demonstrate no survival benefit to either endovascular or surgical revascularization as compared with medical management. Recognizing renal artery disease and directing revascularization procedures to those with the most benefit remains a premier challenge for the clinician.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Despite clear guidelines and an array of available antihypertensive medications, patients with hypertension and coronary artery disease are often inadequately treated. New data from HOPE, LIFE, and ALLHAT underscores the importance of blood pressure reduction for patients with coronary artery disease. Despite our improved understanding of the mechanism by which the various classes of antihypertensive medications achieve their effect, it remains the case that blood pressure reduction remains more important than the medication used to achieve the reduction. For most patients with coronary artery disease, combination therapy will be required to achieve a target blood pressure of less than 140/80. When tolerated, this therapy should include a &bgr;‐blocker and ACE inhibitor, both of which are of prognostic benefit for patients with coronary artery disease. There are also attractions in choosing calcium antagonists because of their efficacy in controlling anginal symptoms (Dihydropyridine calcium channel blockers if already on a &bgr;‐blocking agent and rate‐limiting calcium channel blockers if &bgr; blockers are contraindicated). Thiazide diuretics have proven themselves effective again in the ALLHAT study and are likely to be an integral part of treatment for the great majority of patients with coronary artery disease.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Diastolic dysfunction is a poorly understood pathophysiological entity; its importance is magnified by the increasing prevalence of diastolic heart failure. Forty‐six million people in the US are experiencing heart failure and 550,000 new cases are diagnosed annually. A large percentage of these patients with heart failure have a normal or nearly normal left‐ventricular ejection fraction. Isolated diastolic dysfunction may be associated with an increased mortality. One of the major causes of diastolic dysfunction is hypertension. Advances in diagnosis and treatment strategies may improve the clinical outcome for patients with diastolic dysfunction.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;The Adult Treatment Panel III report reemphasized the importance of reducing elevated levels of low‐density lipoprotein cholesterol as the most efficacious treatment target to reducing coronary heart disease morbidity and mortality, which is the leading cause of disability and death in the United States. Although the etiologic role of elevated levels of low‐density lipoprotein cholesterol in atherosclerosis is well established, treatment with statins still leaves a large proportion of patients vulnerable to cardiovascular events. The role of high‐density lipoprotein cholesterol in atherosclerosis is increasingly recognized because of its strong inverse association with coronary heart disease in epidemiologic studies, and the observed high prevalence of low high‐density lipoprotein cholesterol that occurs in populations with coronary heart disease, with or without elevated low‐density lipoprotein cholesterol, especially among patients with diabetes and metabolic syndrome. This report highlights some of the therapeutic implications of the Adult Treatment Panel III report and various therapeutic approaches to both lowering elevated low‐density lipoprotein cholesterol and triglycerides as well as increasing low levels of high‐density lipoprotein cholesterol to optimize clinical event rate reduction in patients with coronary heart disease. Among available dyslipidemic therapies, although statins remain the mainstay for lowering low‐density lipoprotein cholesterol and clinical events, niacin is currently the most effective agent for increasing low high‐density lipoprotein cholesterol levels. The importance of combination dyslipidemic therapy, such as a statin plus niacin, in treating more optimally the entire lipid profile has been demonstrated not only to decrease progression and increase regression of atherosclerotic lesions, but to enhance event‐free survival compared with statin monotherapy. Combination dyslipidemic therapy affords the most efficacious approach to controlling the multiple lipid abnormalities associated with atherosclerotic cardiovascular disease and optimizing cardiovascular event rate reduction in patients with coronary heart disease.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Cardiovascular disease is the principal cause of death in industrialized countries. Hyperlipidemia, with high low‐density lipoprotein cholesterol and triglycerides, and low high‐density lipoprotein cholesterol levels (<40mg/dL in men and <45 mg/dL in women), is a known major cardiovascular risk factor. Statins are considered the most potent and effective agents to reduce low‐density lipoprotein cholesterol, but they have a variable effect on high‐density lipoprotein cholesterol and triglycerides. Different clinical trials with statins have shown a decrease in low‐density lipoprotein cholesterol by 35% and a reduction of the incidence of coronary events by as much as 30%. However, 60 to 70% of events still occur, despite remarkable reduction of low‐density lipoprotein cholesterol concentration. Recent National Cholesterol Education Program guidelines highlighted the importance of high‐density lipoprotein cholesterol concentration in the prevention and treatment of cardiovascular disease. High‐density lipoprotein cholesterol is considered an independent risk factor and has an inverse relation with coronary events. The association of low levels of high‐density lipoprotein cholesterol with an increased incidence of cardiovascular events implies a critical role of high‐density lipoprotein in the protection against atherosclerotic disease and in the progression of coronary atherosclerotic disease. High‐density lipoprotein cholesterol appears to exert this protective effect through multiple mechanisms. High‐density lipoprotein is not only involved in reverse cholesterol transport, but also prevents endothelial dysfunction; inhibits the homing of monocytes, apoptosis, platelet activation, and factor X activation; and has antioxidant properties. In this article the authors review the available experimental and clinical evidence supporting the importance of high‐density lipoprotein cholesterol as a protective factor in coronary artery disease, and the strategies developed to increase high‐density lipoprotein cholesterol.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Cholesterol plays an important role in atherogenesis. Oxidized low‐density lipoprotein cholesterol is harmful to arteries whereas high‐density lipoprotein cholesterol appears to have beneficial properties on vascular function. There is increasing evidence that inflammation is also involved in the atherogenic process. Inflammation accelerates atherosclerosis and promotes thrombogenesis, and inflammatory biomarkers have been correlated with cardiovascular risk. There is now evidence that lowering low‐density lipoprotein and raising high‐density lipoprotein cholesterol have beneficial effects on inflammation that might contribute to the reduction in clinical cardiovascular events with currently available lipid‐altering therapies. New therapeutic strategies are being designed to inhibit specific aspects of the inflammatory system that contribute to the initiation and progression of atherosclerosis.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Type 2 diabetes mellitus and the closely related metabolic syndrome are associated with significant risk for cardiovascular disease. Recent evidence suggests that both conditions are increasing in epidemic proportions. Dyslipidemia is characterized by increased triglyceride‐rich lipoproteins; low high‐density lipoprotein cholesterol; small, dense low‐density lipoprotein particles; increased postprandial lipemia; and abnormal apolipoprotein A1 and B metabolism. All these lipoprotein disturbances accelerate atherosclerosis in these patients. It is likely that many patients will need combinations of lipid‐modifying therapy to achieve American Diabetes Association (ADA), Adult Treatment Panel III, and American Heart Association (AHA)/American College of Cardiology (ACC) guidelines to help prevent cardiovascular disease and death.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID