Aggression risk factors

The treatment of claudication due to LEAD is multifacted aggressive risk factor modification, regression therapy of the atheromas, pharmacotherapy, exercise therapy, endovascular transcatheter therapeutic interventions, angiogenesis, and vascular graft procedures. 

Aggressive Risk Factor Modihcation Extra-Low LDL Cholesterol Antiplatelet Therapy References... 

Criteria for initiation of drug treatment now take into consideration total cardiovascular risk rather than blood pressure alone, such that treatment is now recommended for persons whose blood pressure is in the normal range but still bear a heavy burden of cardiovascular risk factors. Thus, the role of simultaneous reduction of multiple cardiovascular risk factors in improving prognosis in hypertensive patients is stressed. In addition, more aggressive blood pressure goals are recommended for hypertensive patients with comorbid conditions such as diabetes mellitus or renal insufficiency. 

Early detection and aggressive modification of risk factors is one of the primary strategies for delaying ischemic heart disease progression and preventing ischemic heart disease-related events including death. 

Like dyslipidemia, hypertension is a major, modifiable risk factor for the development of IHD and related complications. Unfortunately, awareness, treatment, and control of blood pressure are not nearly enough.30 Aggressive identification and control of hypertension is warranted in patients with IHD to minimize the risk of major adverse cardiac events. Goal blood pressure in patients with IHD is less than 140/90 mm Hg or less than 130/80 mm Hg in patients with diabetes. Because of their cardioprotective benefits, 3-blockers and ACE inhibitors (or ARBs in ACE-inhibitor-intolerant patients), either alone or in combination, are appropriate for most patients with both hypertension and IHD. 

Given that VTE can be debilitating or fatal, it is important to treat it quickly and aggressively.8 On the other hand, because major bleeding induced by antithrombotic drugs can be equally harmful, it is important to avoid treatment when the diagnosis is not reasonably certain. Assessment of the patient s status should focus on the search for risk factors in the patient s medical history... 

Near-normal glycemia reduces the risk of microvascular disease complications, but aggressive management of traditional cardiovascular risk factors (i.e., smoking cessation, treatment of dyslipidemia, intensive blood pressure control, antiplatelet therapy) is needed to reduce macrovascular disease risk. 

An involuntary weight loss of more than 10% is a major risk factor for survival. This is due to a high rate of secretion of cytokines, especially from aggressive tumours. 

The (outdated) classical view was of perturbed balance between acid-peptic aggression and mucosal resistance. Helicobacter pylori infection and nonsteroidal anti-inflammatory drug use, are now recognized as the major risk factors. H. pylori infection alone appears insufficient and other influences, notably smoking appear necessary associates. 

Environmental stimuli and context are relevant to the occurrence of aggression. The interaction between environment and genetic risk factors may offer new opportunities for intervention. For example, individuals with family histories of suicide are at increased risk for suicide. However, even individuals with low levels of 5-HI A A generally do not make daily or even monthly attempts—so what is it that relates to an attempt happening on one day and not another Maes et al. (1995)... 

For a summary of individual and environmental risk factors and protective factors in aggressive behavior in youth, see Tables 50.02a and 50.2b. 

TABLE 50.2a Risk Factors and Protective Factors for Aggressive Behavior in Youth Individual Factors... 

Incarcerated individuals have a two to four fold greater prevalence of epilepsy, however, a relationship between criminal acts and seizure activity is seldom demonstrated (Marsh and Krauss, 2000). Aggression in seizure-disordered patients is often directed in nature, occurring during the interictal period, in response to a social context, likely related to general brain dysfunction rather than to seizure activity. Therefore, consideration of the social context in which the behavior occurs and of the sociological and biological risk factors is important. 

In the assessment of risk for violence one needs to take into consideration the risk factors outlined in Table 50.1. Most aggressive youths are impulsive and non-compliant, often continuing to be at risk despite active treatment. 

Beck et al. (38) reported that hopelessness in the context of major depression was the MDD symptom most often associated with suicide. This finding was replicated by Fawcett et al. (39), who found that hopelessness with anhedonia, mood cycling within an episode, loss of mood reactivity, and psychotic delusions were high-risk factors for a subsequent suicide. Soloff and associates ( 40) also found that hopelessness and impulse aggression independently increased the risk of suicidal behavior in patients with borderline personality disorder and in patients with major depression. Negative life events (e.g., the death of a loved one or humiliating events such as financial ruin) often precede suicide. 

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