Coronary vascular disease, association

Hypertension, whether labile or fixed, borderline or definite, casual or basal, systolic or diastolic, at any age regardless of gender is the most common and a powerful contributor to atherosclerotic coronary vascular disease. Morbidity and mortality increase progressively with the degree of elevation of either systolic or diastolic pressure and pulse pressure, and no discernible critical value exists (see Chap. 13). Numerous trials have documented the reduction in risk associated with blood pressure lowering however, most of these studies show that mortality and morbidity reduction is a result of fewer strokes and... 

The incidence of type 2 (noninsulin-dependent) diabetes mellitus continues to increase in the United States (1). Consequently, the associated morbid and mortal events from the associated microvascular and macrovascular complications of this disease have also risen (1). The preponderance of research toward the understanding of vascular disease in diabetes has been directed toward the delineation of end organ injury from microvascular disease. Consequently, the focus on macrovascular peripheral vascular disease has been relatively ignored. However, several studies have elucidated both the incidence and prevalence of peripheral vascular disease associated with both type 1 (insulin-dependent) and type 2 diabetes mellitus. In general, these studies have found that the duration of diabetes is perhaps the best correlate to predict the development of coronary artery and renal disease, as well as other associated end organ injuries that have not consistently correlated with the development of peripheral vascular disease. 

Prolonged exposure to elevated GH and IGP-Is can lead to serious complications in patients with acromegaly. Aggressively manage comorbid conditions such as hypertension, diabetes, arrhythmias, coronary artery disease and heart failure to prevent vascular and neuropathic complications. It is critical to monitor patients indefinitely for management of the comorbidities associated with acromegaly8 (Table 43-4). 

As the prevalence of obesity increases worldwide, so does the prevalence of associated co-morbidities type-2 diabetes, chronic obstructive sleep apnoea, cardiovascular disease (hyper-tension, coronary artery disease and congestive heart failure, stroke and peripheral vascular disease), fatty liver disease, various malignancies (Table 7.2), gallstones, subfertility, musculo-skeletal problems and depression. 

Lowering cholesterol levels can arrest or reverse atherosclerosis in all vascular beds and can significantly decrease the morbidity and mortality associated with atherosclerosis. Each 10% reduction in cholesterol levels is associated with an approximately 20% to 30% reduction in the incidence of coronary heart disease. Hyperlipidemia, particularly elevated serum cholesterol and low density lipoprotein (LDL) levels, is a risk factor in the development of atherosclerotic cardiovascular disease. 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

Clearly, the addictive power of cigarettes is directly related to their nicotine content. It is not known to what extent nicotine per se contributes to the other well-documented adverse effects of chronic tobacco use. It appears highly probable that nicotine contributes to the increased risk of vascular disease and sudden coronary death associated with smoking. Also, nicotine probably contributes to the high incidence of ulcer recurrences in smokers with peptic ulcer. 

Cardiovascular diseases, such as hypertension, coronary heart disease (CHD), and atherosclerosis, are associated with increased oxidative stress and are more common in men than in premenopausal women of similar age, with the incidence of CHD increasing significantly after menopause, with loss of cardiovascular protection attributed to estrogen deficiency [Forte et al., 1998]. Differences in the regulation of blood pressure and vascular function between males and females have been investigated extensively over the past... 

The risk of embolism associated with mechanical heart valves is 2 to 6% per patient per year despite anticoagulation and is highest with valves in the mitral position. Warfarin therapy (INR 2.5 to 3.5) is recommended in these patients. The addition of enteric-coated aspirin (100 mg/d) to warfarin (INR 3.0 to 4.5) in high-risk patients (preoperative atrial fibrillation, coronary artery disease, history of thromboembolism) with mechanical valves decreases the incidence of systemic embolism and death from vascular causes (1.9 vs. 8.5% per year), but increases the risk of bleeding. 

Coronary heart disease is associated with ischemic stroke in postmortem (Stemmermann et al. 1984), twin (Brass et al. 1996), case-control (Feigin et al. 1998) and cohort studies (Harmsen et al. 1990 Shaper et al. 1991 Wolf et al. 1991b Touze et al. 2006) as are electrocardiographic abnormalities, cardiac failure, left ventricular hypertrophy, claudication and asymptomatic peripheral vascular disease (Leys et al. 2006). 

Danesh J, Whincup P, Walker M et al. (2000). Chlamydia pneumoniae IgG litres and coronary heart disease prospective study and metaanalysis. British Medical Journal 321 208-213 Danesh J, Whincup P, Walker M (2003). Chlamydia pneumoniae IgA litres and coronary heart disease prospective study and meta-analysis. European Heart Journal 24 881 Danesh J, Lewington S, Thompson SG et al. (2005). Plasma fibrinogen level and the risk of major cardiovascular diseases and non-vascular mortality an individual participant meta-analysis. Journal of American Medical Association 294 1799-1809 Diabetes Control and Complications Trial/ Epidemiology of Diabetes Interventions and Complications Research Group (2003). 

Communities (ARIC) Study. Journal of the American Medical Association 279 119-124 Huxley R, Lewington S, Clarke R (2002). Cholesterol, coronary heart disease and stroke a review of puhhshed evidence from observational studies and randomized controlled trials. Seminars in Vascular Medicine 2 315-323... 

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