Cardiovascular disease myocardial infarction

In the case of aspirin, there are numerous reports of beneficial effects of low-dose aspirin in the secondary prophylaxis of cardiovascular disease (myocardial infarction and stroke). Aspirin clearly reduces the risk of myocardial infarction and stroke among patients who already have manifestations of cardiovascular disease. 

Tight control of diabetes, with reduction of HbAic from 9.1% to 7%, was shown to reduce the risk of microvascular complications overall compared with that achieved with conventional therapy (mostly diet alone, which decreased HbAic to 7.9%). Cardiovascular complications were not noted for any particular therapy metformin treatment alone reduced the risk of macrovascular disease (myocardial infarction, stroke). Epidemiologic analysis of the study suggested that every 1% decrease in the Aic achieved an estimated risk reduction of 37% for microvascular complications, 21% for any diabetes-related endpoint and death related to diabetes, and 14% for myocardial infarction. 

In the Heart Outcomes Prevention Evaluation 2 (HOPE-2) study, 5522 patients aged 55 or older with vascular disease or diabetes were randomized to treatment with either placebo or a combination 2, 5 mg of folic acid, 50 mg vitamin B6, and I mg vitamin B 2, for an average of five years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, and stroke. Mean plasma homocysteine levels decreased by 2.4 jimol/L in the treatment group and increased by 0.8 jimol/L in the placebo group. The primary outcome occurred in 18.8% of patients assigned to active therapy and in 19.8% of those assigned to placebo (relative risk = 0.95 95% Cl = 0.84-1.07 P = 0.41) (68). 

The long-term safety of dihydropyridine calcium channel blockers has been extensively debated since 1995, with reports of conflicting results from observational and randomized clinical studies about possible increases in cardiovascular mortality, myocardial infarction, and neoplastic diseases (SEDA-22, 214). Two studies have contributed to this controversy. 

The natural history of the disease is determined by the onset and extent of chronic diabetic complications. Microangiopathic changes are diabetes-specific, causing retinopathy, nephropathy and alterations in the peripheral and autonomous nervous system. Macroangiopathy, which is more typical for Type-II diabetes, leads predominantly to cardiovascular complications with coronary heart disease, myocardial infarction and peripheral vascular occlusion. 

Observational studies have indicated that cardiovascular disease occurs at an early stage m CKD. Thus among middle-aged men, a moderate increase in plasma creatinine concentration [>1.5mg/dL (>130pmol/L)] was associated with an age-adjusted relative risk of 1.5 for coronary disease and 3.0 for stroke. Reduction of GFR is associated with increased risk of composite end-points of cardiovascular death, myocardial infarction, and strokeMicroalbuminuria and proteinuria have also been shown to be associated... 

Modern oral contraceptives can contribute to the incidence and severity of certain diseases if other risk factors are present. The following conditions are considered absolute contraindications for combination oral contraceptives the presence or history of thromboembolic disease, cerebrovascular disease, myocardial infarction, coronary artery disease, or congenital hyperlipidemia known or suspected carcinoma of the breast, carcinoma of the female reproductive tract, or other hormone-dependent/responsive neoplasias abnormal undiagnosed vaginal bleeding known or suspected pregnancy and past or present liver tumors or impaired liver function. The risk of serious cardiovascular side effects is particularly marked in women over 35 years of age who smoke heavily (e.g., >15 cigarettes/day) even low-dose oral contraceptives are contraindicated in such patients. 

Coexisting diseases precipitate DKA and DKA precipitates coexisting disease. Most often patients with DKA suffer from infectious disease and signs of infection should be vigorously sought for and treatment should be instituted on wide indications. Other prominent co-morbidities include cardiovascular events (myocardial infarction, stroke, thrombophlebitis, pulmonary embolism), acute gastrointestinal disorders and a variety of intoxications. 

Five patients (aged 23 to 58) treated for germ cell tumours died from unexpected acute life-threatening vascular events (myocardial infarction, rectal infarction, cerebrovascular accident) after treatment with VBP (vinblastine, bleomycin, cisplatin). A survey of the literature by the authors of this paper revealed 14 other cases of both acute and long-term cardiovascular problems (myocardial infarction, coronary heart disease, cerebrovascular accident) in patients given VBP. ... 

The root of Salvia miltiorrhiza has been used as Chinese folk medicine for the treatment of cardiovascular diseases, such as ischemia, angina pectoris, coronary heart disease, myocardial infarction, and hypertension. Many studies on the secondary metabolites from Salvia miltiorrhiza revealed that tanshinones were a group of compounds responsible for these biological activities, especially for the treatment of coronary artery disease and h5 rtension. 

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). 

It is well accepted that hypertension is a multifactorial disease. Only about 10% of the hypertensive patients have secondary hypertension for which causes, ie, partial coarctation of the renal artery, pheochromacytoma, aldosteronism, hormonal imbalances, etc, are known. The hallmark of hypertension is an abnormally elevated total peripheral resistance. In most patients hypertension produces no serious symptoms particularly in the early phase of the disease. This is why hypertension is called a silent killer. However, prolonged suffering of high arterial blood pressure leads to end organ damage, causing stroke, myocardial infarction, and heart failure, etc. Adequate treatment of hypertension has been proven to decrease the incidence of cardiovascular morbidity and mortaUty and therefore prolong life (176—183). 

A third study (85) enrolled 7825 hypertensive patients (55% males and 45% females) having diastoHc blood pressures (DBP) of 99—104 mm Hg (13—14 Pa) there were no placebo controls. Forty-six percent of the patients were assigned to SC antihypertensive dmg therapy, ie, step 1, chlorthaUdone step 2, reserpine [50-55-5] or methyldopa [555-30-6], and step 3, hydralazine [86-54-4]. Fifty-four percent of the patients were assigned to the usual care (UC) sources in the community. Significant reductions in DBP and in cardiovascular and noncardiovascular deaths were noted in both groups. In the SC group, deaths from ischemic heart disease increased 9%, and deaths from coronary heart disease (CHD) and acute myocardial infarctions were reduced 20 and 46%, respectively. 

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. 

Moderate risk Has three or more risk factors for coronary artery disease Has moderate, stable angina Had a recent myocardial infarction or stroke within the past 6 weeks Has moderate congestive heart failure (NYHA Class 2) Fbtient should undergo a complete cardiovascular work-up and treadmill stress testing to determine tolerance to increased myocardial energy consumption associated with increased sexual activity... 

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