Risk factors myocardial infarction

Some prospective and case-control studies also investigated the relationship of carotenoids and the evolution of CCA-IMT. Although the EVA study showed no association between total carotenoids and IMT, others like the ARIC study, the Los Angeles Atherosclerosis Study, " and the Kuopio Ischaemic Heart Disease Risk Factor Study demonstrated the protective role of isolated carotenoids such as lycopene, lutein, zeaxanthin, and P-cryptoxanthin on IMT. Thus, findings from prospective and case-control studies have suggested that some carotenoids such as lycopene and P-carotene may present protective effects against CVD and particularly myocardial infarcts and intima media thickness, a marker of atherosclerosis. 

Street, D.A. et al.. Serum antioxidants and myocardial infarction are low levels of carotenoids and alpha-tocopherol risk factors for myocardial infarction Circulation, 90, 1154, 1994. 

To control risk factors and prevent major adverse cardiac events, statin therapy should be considered in all patients with ischemic heart disease, particularly in those with elevated low-density lipoprotein cholesterol. In the absence of contraindications, angiotensin-converting enzyme inhibitors should be considered in ischemic heart disease patients who also have diabetes melli-tus, left ventricular dysfunction, history of myocardial infarction, or any combination of these. Angiotensin receptor blockers... 

Devise a pharmacotherapy and risk-factor modification treatment plan for secondary prevention of coronary heart disease events in a patient following myocardial infarction. 

Moderate Major or minor surgery, age 40-60 years, and no clinical risk factors Major surgery, age less than 40 years, and no clinical risk factors Minor surgery, with clinical risk factor(s) Acutely ill (e.g., myocardial infarction, ischemic stroke, heart failure exacerbation), and no clinical risk factors 10-20 1-2 I o UFH 5000 units SC every 12 hours Dalteparin 2500 units SC every 24 hours Enoxaparin 40 mg SC every 24 hours Tinzaparin 3500 units SC every 24 hours IPC Graduated compression stockings... 

As of 1995, almost 38% of all women 50 to 75 years of age were using HRT.1 It was in 1996 that the United States Preventive Services Task Force (USPSTF) first published its recommendations that not all postmenopausal women should be prescribed HRT, but rather, therapy should be individualized based on risk factors. This recommendation was further supported with publication of the Heart and Estrogen/Progestin Replacement Study (HERS) in 1998, which demonstrated that women who had established CHD were at an increased risk of experiencing a myocardial infarction within the first year of HRT use compared with a similar group of women without CHD risk factors. As a result, the authors concluded that HRT is not recommended for the secondary prevention of CHD.2 Then, in 2002, the Women s Health Initiative (WHI) report was published. This trial demonstrated that HRT was not protective against CHD but... 

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... 

Cambien F, Poirier O, Lecerf L, Alun E, Jean-Pierre C, Dominique A, Gerald L, Jean-Marie B, Lucienne B, Syl-vain R, Laurence T, Philippe A, Francois AG, Florent S. Deletion polymorphism in the angiotensin I-convert-ing enzyme is a potent risk factor for myocardial infarction. Nature 1992 359 641-644. 

The response-to-injury hypothesis states that risk factors such as oxidized LDL, mechanical injury to the endothelium, excessive homocysteine, immunologic attack, or infection-induced changes in endothelial and intimal function lead to endothelial dysfunction and a series of cellular interactions that culminate in atherosclerosis. The eventual clinical outcomes may include angina, myocardial infarction, arrhythmias, stroke, peripheral arterial disease, abdominal aortic aneurysm, and sudden death. 

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... 

Ridker PM, Rifai N, Pfeffer M, Sacks F, Lepage S, Braunwald E (2000) Elevation of tumor necrosis factor-alpha and increased risk of recurrent coronary events after myocardial infarction. Circulation 101 2149-2153... 

When Rosengren et al. (R14) showed in their prospective analysis that men with myocardial infarction had significantly higher levels of Lp(a), it was firmly established that Lp(a) is an independent risk factor for CHD. 

Sandkamp, M., Funke, H., Schulte, H., Kohler, E., and Assmann, G., Lipoprotein(a) is an independent risk factor for myocardial infarction at a young age. Clin. Chem. (Winston-Salem. NC) 36, 20-23 (1990). 

Synthesized conclusions of the lARC monograph on smokeless tobacco (lARC 2007) and the opinion of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) on the health effects of smokeless tobacco SCENIHR (2008) can be summarized as follows (a) all forms of ST are potentially addictive (b) all forms of ST are carcinogenic (c) there are probable reproductive health effects (d) there are probable risk factors for myocardial infarction (e) there is limited... 

Figure 22.6 How various factors increase the risk of atherosclerosis, thrombosis and myocardial infarction. The diagram provides suggestions as to how various factors increase the risk of development of the trio of cardiovascular problems. The factors include an excessive intake of total fat, which increases activity of clotting factors, especially factor VIII an excessive intake of saturated or trans fatty acids that change the structure of the plasma membrane of cells, such as endothelial cells, which increases the risk of platelet aggregation or susceptibility of the membrane to injury excessive intake of salt - which increases blood pressure, as does smoking and low physical activity a high intake of fat or cholesterol or a low intake of antioxidants, vitamin 6 2 and folic acid, which can lead either to direct chemical damage (e.g. oxidation) to the structure of LDL or an increase in the serum level of LDL, which also increases the risk of chemical damage to LDL. A low intake of folate and vitamin B12 also decreases metabolism of homocysteine, so that the plasma concentration increases, which can damage the endothelial membrane due to formation of thiolactone.

Cardiovascular (CV) risk NSAIDs may cause an increased risk of serious CV thrombotic events, myocardial infarction (Ml), and stroke, which can be fatal. This risk may increase with duration of use. Patients with CV disease or risk factors for CV disease may be at higher risk. 

Currently, the only clinically useful risk factors for SCD are the presence of CAD, previous myocardial infarction (MI), and depressed left ventricular (LV) function. While these factors account for the patients with the highest risk of SCD, they do not account for the majority of patients who have SCD (from the perspective of the total number of SCD patients) [5]. Most SCDs occur in the larger, lower risk subgroups, i.e., those who... 

Atrial fibrillation is commonly associated with heart failure, and the prevalence of atrial fibrillation is related to the severity of heart failure, with less than 5% affected with very mild heart failure to nearly 50% affected with advanced heart failure [66]. Heart failure and atrial fibrillation are both common cardiovascular disorders and share the same demographic risk factors, including age, history of hypertension, prior myocardial infarction, and valvular heart disease [67, 68]. Further, the incidence of heart failure increases dramatically after the diagnosis of atrial fibrillation [69]. Progression of LV dysfunction can clearly be associated with rapid ventricular rates [70-76]. Conversely, conversion to normal sinus rhythm or control of ventricular response in atrial fibrillation can improve LV function [71-74, 77]. Accordingly, rate control becomes very important in patients with heart failure and dilated cardiomyopathy, and likely even more so when ischemia from rapid rates complicate the patient s course. 

Cumulative cardiovascular risk factor score Myocardial infarction... 

Prevention of heart failure through identification and management of risk factors in the preclinical phase of the disease is a priority. The concept of primary prevention has significant impact on the development of heart failure. It is estimated that the risk factors of hypertension, myocardial infarction, and diabetes contribute to 80% of the heart failure diagnosed in the United States [21]. More... 

Broeckel U, Hengstenberg C, Mayer B, et al. A comprehensive linkage analysis for myocardial infarction and its related risk factors. Nat Genet. Feb 2002 30(2) 210-214. 

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