Cardiovascular disease infarction

Other Cardiovascular Agents Effecting Atherosclerosis. A large amount of clinical data is available concerning semm Upid profiles in patients subjected to dmg therapy for other cardiovascular diseases. Atheroma, for example, may be the underlying cause of hypertension and myocardial infarction. There are on the order of 1.5 million heart attacks pet year in the United States (155). 

Everybody suffers some intellectual and memory impairment with age. If it becomes very marked or occurs earlier in life (40+) it is known as dementia. Although it may be caused by alcoholism, cardiovascular disease such as multiple infarcts, and is often seen in the later stages of Parkinsonism, the most common cause is a neurodegenerative one, namely, Alzheimer s disease (AzD). In fact this is the primary and sole cause in over half the cases of dementia and is a contributory cause in a further quarter and the younger the patient, the more likely is the dementia to be of the Alzheimer type. 

Inverse association. + = Positive association. 0 = No association. CHD = coronary heart disease. CVD = cardiovascular disease. Ml = myocardial infarction. IMT = intima media thickness. CCA-IMT = common carotid artery intima media thickness. LDL = low-density lipoprotein. 

Carotenoids and cardiovascular diseases — Numerous epidemiological studies aimed to study the relationship of carotenoids and cardiovascular diseases (CVDs) including coronary accident risk and stroke. It appeared then that observational studies, namely prospective and case-control studies, pointed to a protective effect of carotenoids on myocardial infarct and stroke, but also on some atherosclerosis markers such as intima media thickness (IMT) of the common carotid artery (CCA) and atheromatous plaque formation. 

The vascular endothelium produces a number of substances that are released basally into the blood vessel wall to alter vascular smooth muscle tone. One such substance is endothelin (ET-1). Endothelin exerts its effects throughout the body, causing vasoconstriction as well as positive inotropic and chronotropic effects on the heart. The resulting increases in TPR and CO contribute to an increase in MAP. Synthesis of endothelin appears to be enhanced by many stimuli, including Ag II, vasopressin, and the mechanical stress of blood flow on the endothelium. Synthesis is inhibited by vasodilator substances such as prostacyclin, nitric oxide, and atrial natriuretic peptide. There is evidence that endothelin is involved with the pathophysiology of many cardiovascular diseases, including hypertension, heart failure, and myocardial infarction. Endothelin receptor antagonists are currently available for research use only. 

Hypertension is the most common cardiovascular disease in fact, nearly 25% of adults in the U.S. are considered hypertensive. Hypertension is defined as a consistent elevation in blood pressure such that systolic/diastolic pressures are >140/90 mmHg. Over time, chronic hypertension can cause pathological changes in the vasculature and in the heart. As a result, hypertensive patients are at increased risk for atherosclerosis, aneurysm, stroke, myocardial infarction, heart failure, and kidney failure. There are several categories of antihypertensive agents ... 

Low risk Has asymptomatic cardiovascular disease with <3 risk factors for cardiovascular disease Has well-controlled hypertension Has mild, stable angina Has mild congestive heart failure (NYHA class 1) Has mild valvular heart disease Had a myocardial infarction >6 weeks ago Patient can be started on phosphodiesterase inhibitor... 

Many studies have shown that ginseng has a protective effect on the development of atherosclerosis that may lead to myocardial infarction and other cardiovascular diseases. The preventive effects on cardiovascular diseases of ginseng include its potential antihypertensive and antiatherosclerotic effects. Ginsenosides are likely to be responsible for some of these effects as they have been shown to have inhibitory effects on platelet aggregation and to suppress thrombin formation as well as an effect on blood vessel contraction. 

Associations have also been made between areca and cardiovascular disease, diabetes, and asthma (Winstock et al. in press). Areca may affect cardiovascular disease by increasing homocysteine concentrations and/or through areca copper concentrations and interaction with the lysyl oxidase enzyme (Trivedy et al. 1999). Areca chewing has been associated with cardiac dysrhythmias in a few cases and a case of myocardial infarction was temporally associated with areca use (Hung and Deng 1998 Chiang etal. 1998). 

Accumulation of homocystine in blood is associated with cardiovascular disease deep vein thrombosis, thromboembolism, and stroke dislocation of the lens (ectopic lens) and mental retardation. Homocystinemia caused by an enzyme deficiency is a rare, but severe, condition in which atherosclerosis in childhood is a prominent finding. These children often have myocardial infarctions before 20 years of age. Ail patients excrete high levels of homocystine in the urine. Treatment includes a diet low in methionine. The two major enzyme deficiencies producing homocystinemia are ... 

Cardiovascular disease Cardiomyopathy Congestive heart failure Myocardial infarction (heart attack)... 

Statistical surveys provide an impressive correlation between the number of cigarettes smoked a day and the risk of death from coronary disease or lung cancer. Statistics also show that, on cessation of smoking, the increased risk of death from coronary infarction or other cardiovascular disease declines over 5-10 years almost to the level of non-smokers. Similarly, the risk of developing bronchial carcinoma is reduced. 

The results of several large clinical trials using the statin drugs (discussed later) show that the tested drugs decreased the risk of both primary and secondary cardiovascular events. The incidence of myocardial infarction and death from cardiovascular disease was reduced in patients with hypercholesterolemia who never had a... 

There have been reports associating the use of phenylephrine HCl 10% ophthalmic solutions with the development of serious cardiovascular reactions, including ventricular arrhythmias and myocardial infarctions. These episodes, some ending fatally, have usually occurred in patients with preexisting cardiovascular diseases. 

Aspirin (acetylsalicylic acid, Figure 7.9) is a derivative of salicyclic acid, which was first used in 1875 as an antipyretic and antirheumatic. The usual dose for mild pain is 300-600 mg orally. In the treatment of rheumatic diseases, larger doses, 5-8 g daily, are often required. Aspirin is rapidly hydrolysed in the plasma, liver and eiythrocytes to salicylate, which is responsible for some, but not all, of the analgesic activity. Both aspirin and salicylate are excreted in the urine. Excretion is facilitated by alkalinisation of the urine. Metabolism is normally very rapid, but the liver enzymes responsible for metabolism are easily saturated and after multiple doses the terminal half-life may increase from the normal 2-3 h to 10 h. A soluble salt, lysine acetylsalicylic acid, with similar pharmacological properties to aspirin, has been used by parenteral administration for postoperative pain. Aspirin in low doses (80-160 mg daily) is widely used in patients with cardiovascular disease to reduce the incidence of myocardial infarction and strokes. The prophylaxis against thromboembolic disease by low-dose aspirin is due to inhibition of COX-1-generated thromboxane A2 production. Because platelets do not form new enzymes, and COX-1 is irreversibly inhibited by aspirin, inhibition of platelet function lasts for the lifetime of a platelet (8-10 days). 

Increased production of ET-1 has been implicated in a variety of cardiovascular diseases, including hypertension, cardiac hypertrophy, heart failure, atherosclerosis, coronary artery disease, and myocardial infarction. ET-1 also participates in pulmonary diseases, including asthma and pulmonary hypertension, as well as in several renal diseases. 

Estrogens with or without progestins should not be used for the prevention of cardiovascular disease. The Women s Health Initiative (WHI) study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 19 years of age) during 5 years of treatment with oral conjugated estrogens (0.625 mg) combined with medroxyprogesterone acetate (2.5 mg) relative to placebo.62... 

In large series, sulprostone has had good tolerability with a very low complication rate. The most severe complication is myocardial infarction secondary to coronary spasm, with a frequency of one in 20 000, usually in smokers and women over 35 years of age with cardiovascular disease (SEDA-23, 436). 

There was a background history of cardiovascular disease in 40% of the patients at baseline, and myocardial infarction was reported in 1.5% of those who took finasteride and 0.5% of those who took placebo, a significant difference. 

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