Cardiovascular system clinical therapy

A number of other processes are in continuous development. Clinical applications of these therapies in the urogenital and cardiovascular systems, in peripheral and central nervous systems, pancreas, joint cartilage restoration, etc., are being studied. However, almost all procedures suffer from a common limitation the availability of donor cells. Cell therapies have to begin with a relatively high number of cells, and stem cells, irrespective of their origin, are always a minor subpopulation in tissues. 

Cardiovascular System In women, estrogen protects against cardiovascular disease. The protective cardiovascular effects of estrogen include decreased serum LDL cholesterol and increased HDL cholesterol levels, va-sodilatory effect, and antioxidation of LDL cholesterol (Chapter 20). Extensive clinical trials have shown that estrogen replacement therapy of postmenopausal women reduces the risk of heart disease. 

In the last decade, an expectation of coronary benefit had been a major reason for postmenopausal hormone use because observational studies indicated that women who use hormone therapy have a 35% to 50% lower risk of coronary heart disease than nonusers. In addition, previous studies have shown that estrogen exerts protective effects on the cardiovascular system, including lipid-lowering,antioxidant, and vasodilating effects. Nevertheless, recent randomized clinical trials have provided no evidence of cardiovascular disease protection and even some evidence of harm with hormone therapy " (Table 80-8). 

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. 

More important than numerical data are the clinical implications of differences between the two countries. The largest differences have narrowed since the previous study, but important categories in which the U.S. still lagged behind Britain in December 1976 included cardiovascular drugs, peptic ulcer treatment, and central nervous system drugs—including therapies for depression, epilepsy, and migraine. 

The clinical manifestations of PAD are associated with reduction in functional capacity and quality of life, but because of the systemic nature of the atherosclerotic process there is a strong association with coronary and carotid artery disease. Consequently, patients with PAD have an increased risk of cardiovascular and cerebrovascular ischemic events [myocardial infarction (Ml), ischemic stroke, and death] compared to the general population (4,5). In addition, these cardiovascular ischemic events are more frequent than ischemic limb events in any lower extremity PAD cohort, whether individuals present without symptoms or with atypical leg pain, classic claudication, or critical limb ischemia (6). Therefore, aggressive treatment of known risk factors for progression of atherosclerosis is warranted. In addition to tobacco cessation, encouragement of daily exercise and use of a low cholesterol, low salt diet, PAD patients should be offered therapies to reduce lipid levels, control blood pressure, control blood glucose in patients with diabetes mellitus, and offer other effective antiatherosclerotic strategies. A recent position paper... 

A confluence of scientific, technical, and medical advancements has made genetic therapeutics for cardiovascular disease a promising and exciting field. The molecular mechanisms of major cardiovascular disorders such as atherosclerosis, ischemic heart disease, and myocardial failure have been well characterized. Sophisticated surgical and catheter-based systems that can enable the delivery of therapeutic genes or cells in vivo are in clinical use, and clinical therapeutic end-points for the evaluation of treatment efficacy have been clearly defined. Simultaneously, gene therapy has evolved from a modality restricted to the potential cure of monogenetic diseases to a therapeutic platform that enables cus-... 

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