Calcium cardiovascular risk

Patients with diabetes and hypertension should initially be treated with either P-blockers, ACE inhibitors, ARBs, diuretics, or calcium channel blockers. There is a general consensus that therapy focused on RAAS inhibition by ACE inhibitors or ARBs may be optimal if the patient has additional cardiovascular risk factors such as left ventricular hypertrophy or chronic kidney disease.2,3,59,67... 

Obviously, the effects of tamoxifen and derivatives and of raloxifene on L-type calcium channels from aortic and other blood vessels would reduce vascular smooth muscle contractility. This action, in synergy with the aforementioned effect on BK channels, would reduce blood peripheral resistance and blood pressure, which may partially account for the reduction in cardiovascular risk (Da Costa et al. 2004 Trump et al. 1992) (Fig. 4.1). 

Structure/function claims state that a product may affect the structure or function of the body (e.g., calcium builds strong bones, antioxidants maintain cell integrity, fiber maintains bowel regularity), but may not claim that a therapy can prevent or cure a disease (e.g., alleviates constipation). Traditional nutrients refers to vitamins and minerals considered essential to the diet and/or to correct a classical nutritional deficiency disease. For example, foods containing vitamin C to correct scurvy or vitamin D to alleviate rickets are not functional foods. However, soy, w hich contains soy protein and is associated with a reduced cardiovascular risk, is a functional food. 

Johnson, A J., Hsu, Ai., Song, X., Lin, H.P., and Chen, C.S. (2002) The Cyclooxygenase-2 Inhibitor Celecoxib Perturbs Intracellular Calcium by Inhibiting Endoplasmic Reticulum Ca -ATPases. A Plausible Link with Its Antitumor Effect and Cardiovascular Risks, Biochem J. 366 (Pt 3), 831 37. 

Savica V, Bellinghieri G, Monardo P, Miuaca U, Santoro D. An update on calcium metabolism alterations and cardiovascular risk in patients with chronic kidney disease questions, myths and facts. J Nephrol 2013 26(3) 456-64. 

The term chronic kidney disease-mineral and bone disorder (CKD-MBD) was introduced in a position statement by the Kidney Disease Foundation. According to the guidelines, CKD-MBD is a systemic disorder and patients with vascular or valvular calcification should be included in the group with the greatest cardiovascular risk. Therefore, the presence or absence of calcification is a key factor in strategy decisions for such patients. In particular, it is recommended that the use of calcium-based phosphate binders should be restricted in patients with hypercalcaemia, vascular calcification, low levels of parathyroid hormone or adynamic bone disease. 

Patients with end-stage renal disease hyperphosphatemia ineffectively filter excess phosphate that enters the body in the normal diet.278 Elevated phosphate produces the bone disorder renal osteodystrophy. Skeletal deformity may occur, possibly associated with cardiovascular disease. Calcium deposits may further build up around the body and in blood vessels creating further health risks. The use of lanthanum carbonate is being promoted as an alternative to aluminum-based therapies.279,280 Systemic absorption, and cost have produced a clinical candidate, Fosrenol (AnorMED), an intriguing use of a lanthanide compound in therapy. 

Data on the effect of calcium antagonists on cardiovascular disease risks in patients with hypertension are available from one moderate-to-large scale randomized, placebo-controlled trial. In the Systolic Hypertension in Europe (Syst-Eur) trial, nitrendipine-based therapy produced an approximate 10/5 mmHg reduction in SBP-DBP in patients with systolic hypertension and a 42% reduction in the risk of stroke. Similar results were observed in two large, nonrandomized, placebo-controlled trials (with alternate treatment assignment), i.e. the Shanghai Trial of Nifedipine in the Elderly and the Systolic Hypertension in China (Syst-China) trial. 

Epidemiologic, experimental, and in vitro mechanistic data indicate that lead exposure elevates blood pressure in susceptible individuals. In populations with environmental or occupational lead exposure, blood lead concentration is linked with increases in systolic and diastolic blood pressure. Studies of middle-aged and elderly men and women have identified relatively low levels of lead exposure sustained by the general population to be an independent risk factor for hypertension. In addition, epidemiologic studies suggest that low to moderate levels of lead exposure are risk factors for increased cardiovascular mortality. Lead can also elevate blood pressure in experimental animals. The pressor effect of lead may be mediated by an interaction with calcium mediated contraction of vascular smooth muscle, as well as generation of oxidative stress and an associated interference in nitric oxide signaling pathways. 

Antihypertensive Agents. Hypertension (high blood pressure) is a significant risk factor for cardiovascular diseases such as angina heart attacks, and strokes. /(-Adrenoceptor (adrenergic nervous system receptors of the /(-type) antagonists (/(-blockers), calcium channel blockers, angiotensinconverting enzyme (ACE) inhibitors, and potassium channel activators... 

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