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1.
Effect of folic acid combined with pravastatin on arteriosclerosis in elderly hypertensive patients with lacunar infarction.
Li, C, Bu, X, Liu, Y
Medicine. 2021;(28):e26540
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Abstract
This study aimed to assess the effect of folic acid combined with pravastatin on atherosclerosis-related indexes in elderly patients with hypertension complicated with lacunar cerebral infarction.A total of 134 elderly hypertensive patients with lacunar cerebral infarction were randomly divided into 3 groups using the random number table method. Group A, the folic acid group, had 45 cases and received low-dose folic acid (0.8 mg/d) treatment on the basis of antihypertensive treatment. Group B, the pravastatin group, had 45 cases and received pravastatin (20 mg/d) treatment on the basis of antihypertensive treatment. Group C, the folic acid combined with the pravastatin group, had 44 cases. Members of this group received pravastatin (20 mg/d) and low-dose folic acid (0.8 mg/d) based on antihypertensive treatment. Levels of folic acid, homocysteine (Hcy), tumor necrosis factor alpha (TNF-a), matrix metallopeptidase 9 (MMP-9), cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) were measured by ELISA before treatment in all 3 groups. Carotid intima-media thickness (IMT) was measured using ultrasound, and systolic and diastolic blood pressure were measured with a mercury column. After 8 weeks of treatment, the levels of folic acid, Hcy, TNF-a, MMP-9, TC, LDL-C, and systolic and diastolic blood pressure were compared among the 3 groups. IMT levels were measured at 12 weeks of treatment.After 8 weeks of treatment, compared with group B, patients in groups A and C had folic acid levels significantly higher than baseline levels, with significantly lower Hcy levels (both P < .05). Patients in group C presented significantly decreased TNF-a, MMP-9, TC, and LDL-C levels and systolic and diastolic blood pressure after 8 weeks of treatment, compared with those in groups A and B (both P < .05). These patients also showed significantly decreased IMT levels compared with those in the other groups (P < .05).Low-dose folic acid combined with pravastatin in elderly patients with lacunar cerebral infarction can reduce the level of homocysteine, improve the degree of carotid atherosclerosis, protect vascular endothelium, and reduce blood lipids and blood pressure, presenting better benefits than pravastatin alone.
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Current Data on Dietary Sodium, Arterial Structure and Function in Humans: A Systematic Review.
Tsirimiagkou, C, Basdeki, ED, Argyris, A, Manios, Y, Yannakoulia, M, Protogerou, AD, Karatzi, K
Nutrients. 2019;(1)
Abstract
BACKGROUND Subclinical arterial damage (SAD) (arteriosclerosis, arterial remodeling and atheromatosis) pre-exists decades before cardiovascular disease (CVD) onset. Worldwide, sodium (Na) intake is almost double international recommendations and has been linked with CVD and death, although in a J-shape manner. Studies regarding dietary Na and major types of SAD may provide pathophysiological insight into the association between Na and CVD. OBJECTIVES Systematic review of data derived from observational and interventional studies in humans, investigating the association between dietary Na with (i) atheromatosis (arterial plaques); (ii) arteriosclerosis (various biomarkers of arterial stiffness); (iii) arterial remodeling (intima-media thickening and arterial lumen diameters). DATA SOURCES Applying the PRISMA criteria, the PubMed and Scopus databases were used. RESULTS 36 studies were included: 27 examining arteriosclerosis, four arteriosclerosis and arterial remodeling, three arterial remodeling, and two arterial remodeling and atheromatosis. CONCLUSIONS (i) Although several studies exist, the evidence does not clearly support a clinically meaningful and direct (independent from blood pressure) effect of Na on arterial wall stiffening; (ii) data regarding the association of dietary Na with arterial remodeling are limited, mostly suggesting a positive trend between dietary Na and arterial hypertrophy but still inconclusive; (iii) as regards to atheromatosis, data are scarce and the available studies present high heterogeneity. Further state-of-the-art interventional studies must address the remaining controversies.
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Resveratrol and anti-atherogenic effects.
Riccioni, G, Gammone, MA, Tettamanti, G, Bergante, S, Pluchinotta, FR, D'Orazio, N
International journal of food sciences and nutrition. 2015;(6):603-10
Abstract
The role of inflammation and oxidative stress in atherosclerosis development has been increasingly well recognized over the past decade. Inflammation has a significant role at all stages of atherosclerosis, including initiation, progression and plaque formation. Resveratrol is a naturally occurring polyphenolic compound found in grape products, berry fruits and red wine. Its ability to behave therapeutically as a component of red wine has attracted wide attention. Accumulating evidence suggests that it is a highly pleiotropic molecule that modulates numerous targets and molecular functions. Epidemiological studies indicate that the Mediterranean diet, rich in resveratrol, is associated with a reduced risk of atherosclerosis. Resveratrol is believed to decrease circulating low-density lipoprotein cholesterol levels, reduce cardiovascular disease risk; it reduces lipid peroxidation, platelet aggregation and oxidative stress. Resveratrol is considered a safe compound, since no significant toxic effects have been demonstrated after administration of a broad range of concentrations, and an effective anti-atherogenic agent.
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Modern medical treatment with or without carotid endarterectomy for severe asymptomatic carotid atherosclerosis.
Kolos, I, Troitskiy, A, Balakhonova, T, Shariya, M, Skrypnik, D, Tvorogova, T, Deev, A, Boytsov, S, ,
Journal of vascular surgery. 2015;(4):914-22
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Abstract
OBJECTIVE This study assessed the value of modern medical treatment (MMT) with and without carotid endarterectomy (CEA) in patients with asymptomatic severe carotid artery stenosis. METHODS We conducted a randomized trial involving 55 patients with 70% to 79% carotid stenosis at three Russian centers. Between 2009 and 2013, 31 patients were randomized to undergo CEA with MMT (CEA group) and 24 to receive MMT alone. The primary end point was nonfatal ipsilateral stroke or death from any cause during a follow-up period of 5.0 years. The secondary end point was any nonfatal stroke, carotid revascularization, or death from any cause during follow-up. RESULTS The trial was stopped after a median follow-up of 3.3 years (maximum, 5.0 years). There were two primary events in the CEA group and nine events in the MMT group. The 3.3-year cumulative primary event rates were 6.5% in the CEA group and 37.5% in the MMT group (hazard ratio for the MMT group, 5.06; 95% confidence interval, 1.53-16.79; P = .008). The 3.3-year cumulative secondary end point was 12.9% in the CEA group and 50.0% in the MMT group (hazard ratio for the MMT group, 4.23; 95% confidence interval, 1.55-11.53; P = .0048). CONCLUSIONS CEA as an initial management strategy could reduce the risk of death and major cerebrovascular events when added to MMT.
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[From the Point of View of Health Evaluation and Promotion (Ningen Dock) Facilities].
Yamashita, T, Funatsu, K, Kondo, S, Yokoyama, M, Mizuno, K, Nakamura, H
Rinsho byori. The Japanese journal of clinical pathology. 2014;(9):892-4
Abstract
Since the direct method of LDL measurement is easy and convenient, many health evaluation and promotion facilities adopted it without sufficient discussion after specific health checkups started in Japan. For the purpose of reliable, specific health checkup data, we must review the methods and standardization of LDL measurement. I hope that medical societies, the Ministry of Health, Labour and Welfare, and reagent manufacturers will collaborate.
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Thalassemia intermedia is associated with a proatherogenic biochemical phenotype.
Lai, ME, Vacquer, S, Carta, MP, Spiga, A, Cocco, P, Angius, F, Mandas, A, Dessì, S
Blood cells, molecules & diseases. 2011;(4):294-9
Abstract
OBJECTIVE Unlike beta thalassemia major (β-TM) in which cardiac siderosis represents the leading cause of mortality and morbidity, in beta thalassemia intermedia (β-TI), pulmonary hypertension (PHT) and thrombosis seems to be the major cardiovascular complications. However, the mechanism underlying these complications in β-TI is still unclear. Endothelial dysfunction, the key early event in atherogenesis, is now emerging as an important cardiovascular risk determiner in β-TI patients. Among the factors known to affect endothelial function, iron and cholesterol merit particular consideration in β-TI patients. Therefore, with the aim to extend our knowledge on the mechanisms connecting atherosclerosis to β-TI, in this study, we compared lipid and iron metabolism in serum and in peripheral blood mononuclear cells (PBMCs) from β-TI and β-TM patients and controls. METHODS AND RESULTS In this study the iron status and the lipid profile in serum and in peripheral blood mononuclear cells (PBMCs) of 22 adult β-TI patients were examined, and compared with 70 adult β-TM, and 50 age-matched controls. Despite the great variability, levels of serum iron and transferrin saturation were significantly higher in β-TI compared to both controls and β-TM. By contrast, transferrin and hepcidin levels were lower in β-TI patients. Changes in serum indicators in β-TI patients were associated with altered expressions in PBMCs of hepcidin and IL-1α, involved in some way in the regulation of iron homeostasis. In addition β-TI exhibited a reduction of total and high density lipoprotein cholesterol in serum and of neutral cholesterol ester hydrolase in PBMCs, and an increase of cytoplasmic neutral lipids and mRNA levels of acetyl-coenzymeA:cholesterol acyltransferase. CONCLUSIONS Taken together, these findings provide experimental support for the idea that β-TI patients exhibit a proatherogenic biochemical phenotype which may contribute to enhance cardiovascular risk in these subjects.
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[Chronic liver disease and arteriosclerosis].
Mawatari, S, Uto, H, Tsubouchi, H
Nihon rinsho. Japanese journal of clinical medicine. 2011;(1):153-7
Abstract
The liver is the main metabolic organ of the body and is strongly associated with lifestyle-related diseases in which abnormal metabolism of glucose and lipid are the main manifestations. Recently, the prevalence of nonalcoholic fatty liver disease(NAFLD), including nonalcoholic steatohepatitis (NASH), has been increasing due to a higher rates of obesity. It has been reported that the presence of NAFLD/NASH and associated liver dysfunction are predictors for cardiovascular disease. In addition, attention has been paid to the link between chronic hepatitis C and lifestyle-related diseases such as obesity and insulin resistance. Atherosclerosis is an important risk factor for cardiovascular disease and is associated with lifestyle-related diseases. Thus, chronic liver disease seems to be strongly associated with atherosclerosis. Cardiovascular disease induced by atherosclerosis should be attended to along with liver cirrhosis and hepatocellular carcinoma, and medications for lifestyle-related diseases are needed in patients with chronic liver disease.
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[Lifestyle-related diseases and H. pylori].
Suzuki, H, Matsuzaki, J, Hibi, T
Nihon rinsho. Japanese journal of clinical medicine. 2009;(12):2366-71
Abstract
H. pylori infection elicits a chronic cellular inflammatory response not only in the gastric mucosa, but also in the extra-digestive organs. Indeed, H. pylori infection has been epidemiologically linked to the extra-digestive conditions and diseases. In this article, we review recent progress in our understanding about the relationship between H. pylori infection and lifestyle-related diseases, such as atherosclerosis, diabetes mellitus, obesity, hyperlipidemia, hypertension, and osteoporosis. Although the relationships between all of these diseases and H. pylori infection are still controversial, H. pylori infection may increase the risk for cardiovascular and cerebrovascular diseases, especially when CagA+ cytotoxic strains of H. pylori are present.
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Atherothrombotic disease and the role of antiplatelet therapy in women.
Grines, C, Cho, L
Journal of women's health (2002). 2008;(1):35-46
Abstract
BACKGROUND Atherothrombosis is associated with significant mortality and morbidity in both men and women. Management of this disease, however, is generally guided by evidence from trials conducted predominantly in men, with few studies focused on women alone. Our objective was to review the characteristics and management of atherothrombotic disease in women, with particular emphasis on the therapeutic role of antiplatelet agents. METHODS Landmark clinical trials and other studies pertaining to atherothrombosis in women (including risk factors, clinical outcomes, and treatment patterns) were obtained through Pubmed and Medline literature research and reviewed. RESULTS Primary prevention studies indicate a clear benefit of antiplatelet therapy in the reduction of cardiovascular events and, in particular, the risk of stroke in women >or=65 years. In men, this benefit is attributable to a reduction in the risk of myocardial infarction (MI). Combination therapies, including aspirin plus dipyridamole or clopidogrel, effectively reduce the risk of recurrent ischemic events in women. However, the effects are not consistent between men and women across studies. Similarly, gender differences exist in the effect of intravenous glycoprotein IIb/IIIa inhibitors plus aspirin on the risk of death or cardiovascular events. CONCLUSIONS The effects of antiplatelet therapy regimens differ between men and women. The mechanisms underlying these differences are still to be elucidated; this report highlights the need for more studies focused on women in order to optimize gender-specific therapy and, therefore, improve clinical outcomes in women with atherothrombosis.
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Use of vascular ultrasound in clinical trials to evaluate new cardiovascular therapies.
Nash, DT
Journal of the National Medical Association. 2008;(2):222-9
Abstract
Though progress has been made in the fight against cardiovascular disease (CVD), the increasing global prevalence of cardiovascular (CV) risk factors ensures that CVD rates remain high. In order to reduce CVD incidence, a huge effort has been made to uncover additional targets for therapy and novel methods of identifying patients at risk. A low level of high-density-lipoprotein (HDL) cholesterol is recognized as an important independent risk factor for occurrence of a CV event, and new therapies capable of producing effective, clinically relevant increases in this key lipoprotein particle are in development. These therapies will most likely be assessed in comparison with proven CV-risk-reducing therapies such as statin treatment, rather than against a placebo comparator. Inevitably, therefore, clinical end-point trials will increase in both complexity and longevity. Potential efficacy data on new therapies may be revealed sooner by trials using surrogate end points, biomarkers of disease progression known to correlate with clinical events. For novel CV therapies, ultrasound-measured changes in atherosclerosis, such as the change in atheroma burden or plaque volume measured by intravascular ultrasound (IVUS), or ultrasound-measured increase in carotid intima-media thickness (CIMT), may represent useful biomarkers. Both IVUS and CIMT are being widely deployed in trials of new and existing CV therapies to assess their impact on slowing the progression of atherosclerosis, and their use in this regard is the subject of this review.