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Resumen En esta revisión de la literatura presentamos diversos mecanismos terapéuticos para tratar la rigidez vascular en pacientes con enfermedad renal crónica. En el ámbito de la terapéutica no farmacológica la restricción de sodio y la indicación de dieta mediterránea han demostrado efectos benéficos, mientras que acerca de la indicación de actividad física aún no hay evidencia clara sobre su utilidad para disminuir la rigidez vascular en este grupo específico de pacientes. Es con el tratamiento farmacológico donde se evidencian los mayores beneficios, tanto en la rigidez vascular como en los eventos cardiovasculares asociados. Está ampliamente demostrada la efectividad de los inhibidores del sistema renina-angiotensina-aldosterona y de los fármacos antialdosterónicos para disminuir la presión y la rigidez arterial. Otras drogas, como los bloqueadores del receptor de endotelina, han demostrado sus efectos protectores sobre la pared arterial, aunque no están carentes de potenciales efectos adversos. También repasamos los resultados obtenidos con el uso de las nuevas drogas antidiabéticas, en particular los iSLGT2 y los aGLP-1, y su efecto sobre la presión arterial y la rigidez vascular, en particular en pacientes con enfermedad renal crónica. Se revisan además la utilidad de aquellas drogas con efecto sobre la cascada inflamatoria y sobre las calcificaciones vasculares, muy propensas durante los tratamientos sustitutivos de la función renal. Este trabajo se enfoca, en síntesis, en las diversas intervenciones terapéuticas sobre la rigidez arterial, con énfasis en la disminución de eventos cardiovasculares y de la mortalidad en pacientes con enfermedad renal crónica.
Abstract In this literature review we present various therapeutic alternatives for vascular stiffness in patients with chronic kidney disease. Here we discussed the role of non-pharmacological treatments with evidence of the benefit of sodium restriction on vascular stiffness, the positive effects in that sense shown by the Mediterranean diet, and the small benefits of physical activity on vascular stiffness in this group of patients. Is in the pharmacological treatment where the best benefits are evidenced; both, on vascular stiffness and on the associated cardiovascular events. The effectiveness of renin-angiotensin-aldosterone system inhibitors and antialdosteronic drugs to decrease blood pressure and stiffness has been widely demonstrated. Other drugs, such as endothelin receptor blockers, showed their protective effects on the arterial wall, but with potential adverse effects. This article also reviews the effects of new anti-diabetic drugs, iSLGT2 and aGLP-1 in particular, and their effect on blood pressure and vascular stiffness, particularly in patients with chronic kidney disease. The utility of drugs with effects on the inflammatory cascade and drugs with a potential effect on vascular calcification, complication occurring frequently during renal function replacement treatment, are also reviewed. In short, this work focuses in the therapeutic interventions on arterial stiffness, with emphasis on the reduction of cardiovascular events and mortality in patients with chronic kidney disease.
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Objective:To observe the efficacy of modified Yuquanwan combined with Taohong Siwutang on major cardiovascular risk factors of type 2 diabetes and its effect on inflammatory factors and endothelial function. Method:One hundred and sixty patients were randomly divided into control group (80 cases) and observation group (80 cases) by random number table. The control group was given Tianqi Jiangtang capsule 5 tablets/time,3 times/day. Bothgroups were taken orally. aspirin enteric-coated tablets, 0.1 g/time,1 time/day, insulin for injection or oral antidiabetic, simvastatin tablets, 20 mg/time, 1 time/day, and irbesartan tablets, 150 mg/time, 1 time/day.patients in observation group were added with modified Yuquanwan combined with Taohong Siwutang for 24 weeks, 1 dose/day, and a 48-week follow-up visit were paid. Blood glucose, lipid, blood pressure, fasting plasma glucose (FPG), blood sugar 2 h after meal (2 h PG), glycosylated hemoglobin (HbA1c), systolic (SBP) and diastolic pressure (DBP) were detected for every 8 weeks, and at the 8th, 16th, and 24th week after treatment, up-to-standard HbA1c, LDL-C, SBP, DBP and all of those indexes were recorded, and levels of blood glucose, lipids and blood pressure were compared at different time points. During the treatment and within the 72-week follow-up, cardiovascular events, stroke events, peripheral vascular events and microvascular complications were recorded. And levels of tumor necrosis factor-α (TNF-α), homocysteine (Hcy), interleukin-6 (IL-6), hypersensitive C-reactive protein (hs-CRP), endothelin (ET-1) and nitric oxide (NO) were detected, and at the 8th, 16th and 24th week after treatment, body mass index (BMI) was recorded. Result:At the 24th week after treatment, the compliance rate of HbA1c in observation group was 81.16%（56/69）, which was higher than 64.71%（44/68） in control group (χ2=4.701, P<0.05), and the compliance rate of SBP was 94.2%（65/69）, which was higher than 82.36%（56/68） in control group (χ2=4.662, P<0.05). At the 16th week and 24th week after treatment, the compliance rate of LDL-C were 79.71%（55/69） and 88.41%（61/69）, which were higher than 63.24%（43/68） and 70.59%（48/68） in control group (χ2=4.5642, χ2=5.108, P<0.05). At the 16th week, the comprehensive compliance rate (blood glucose, blood pressure, blood lipid) in observation group was 59.42%（41/49）, which was higher than 41.18% （28/68） in control group (χ2=4.559, P<0.05). At the 24th week, the comprehensive compliance rate in observation group was 69.57% （48/69）, which was higher than 51.47% （36/68） in control group (χ2=4.695, P<0.05). At the 16th week, the compliance rate of BMI was 60.87% （42/69）, which was higher than 39.71% （27/68）in control group (χ2=6.136, P<0.05). At the 24th week, the compliance rate of BMI was 72.46% （50/69）, which was higher than 52.94% （36/68） in control group (χ2=5.585, P<0.05). At the 16th week after treatment, levels of 2 h PG and HbA1cin observation group were lower than those in control group (P<0.05). At the 24th week after treatment, levels of FPG, 2 hPG, HbA1c, SBP and DBP were lower than those in control group (P<0.05). Levels of TNF-α, Hcy, IL-6, hs-CRP and ET-1 were lower than those in control group (P<0.01), while level of NO was higher than that in control group (P<0.01). During 72 weeks of observation period, the rate of adverse vascular events in observation group was 13.04%(9/69), which was lower than 30.88%(21/68) in control group (χ2=5.957, P<0.05). Conclusion:In addition to the conventional western medicine therapy, modified Yuquanwan combined with Taohong Siwutang can further control the main cardiovascular risk factors of patients with T2DM, improve the endothelial function of T2DM patients, inhibit the expression of pro-inflammatory factors, and reduce the incidence of adverse vascular events.
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Background:@#High on-treatment platelet reactivity (HTPR) has been suggested as a risk factor for patients with ischemic vascular disease. We explored a predictive model of platelet reactivity to clopidogrel and the relationship with clinical outcomes.@*Methods:@#A total of 441 patients were included. Platelet reactivity was measured by light transmittance aggregometry after receiving dual antiplatelet therapy. HTPR was defined by the consensus cutoff of maximal platelet aggregation >46% by light transmittance aggregometry. CYP2C19 loss-of-function polymorphisms were identified by DNA microarray analysis. The data were compared by binary logistic regression to find the risk factors. The primary endpoint was major adverse clinical events (MACEs), and patients were followed for a median time of 29 months. Survival curves were constructed with Kaplan-Meier estimates and compared by logrank tests between the patients with HTPR and non-HTPR.@*Results:@#The rate of HTPR was 17.2%. Logistic regression identified the following predictors of HTPR: age, therapy regimen, body mass index, diabetes history, CYP2C19*2, or CYP2C19*3 variant. The area under the curve of receiver operating characteristic for the HTPR predictive model was 0.793 (95% confidence interval: 0.738–0.848). Kaplan-Meier analysis showed that patients with HTPR had a higher incidence of MACE than those with non-HTPR (21.1% vs. 9.9%; χ2 = 7.572, P = 0.010).@*Conclusions:@#Our results suggest that advanced age, higher body mass index, treatment with regular dual antiplatelet therapy, diabetes, and CYP2C19*2 or CYP2C19*3 carriers are significantly associated with HTPR to clopidogrel. The predictive model of HTPR has useful discrimination and good calibration and may predict long-term MACE.
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Objective To investigate the predictive value of peripheral blood neutrophil to lymphocyte ratio(N/L ratio) in patients with hypertension.Methods A total of 660 cases hypertension patients were enrolled from May 2013 to May2014.Peripheral blood N/L ratio was recorded.All patients were followed up to May 31,2016.According to the incidence of cardiovascular and cerebrovascular events,all patients divided into observation group(with cardiovascular and cerebrovascular events) and control group(without cardiovascular and cerebrovascular events),and white blood cell classification was compared.Logistic regression model was used to evaluate the value of N/L to predict cardiovascular events.Results The incidence rates of smoking,diabetes and hyperlipidemia in patients of the observation group were 87.5%,72.5% and 77.5%,higher than those of the control group(P<0.05),and the level of mean arterial pressure(MAP) was(95±12) mmHg,significantly higher than the control group(P<0.05).White blood cell count,percentage of neutrophils,mononuclear cell count,N/L of observation group were(11.6±2.5)×109/L,(70.8±5.9)%,(8.3±5.5)% and 3.7±1.5 were higher than control group(P<0.05).N/L increased by 10%(P=0.04),MAP increased by 10 mmHg(P=0.02) and the proportion of neutrophils(N%) increased by 15%(P=0.03) were independent risk factors for death in patients.Conclusion Neutrophil/lymphocyte ratio and mean arterial blood pressure were independent risk factors for hypertension patients with West-to-cerebral vascular events.
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BACKGROUND AND PURPOSE: One explanation for the ‘obesity paradox’, where obese patients seem to have better cardiovascular outcomes than lean patients, is that obese patients display an identifiable high cardiovascular risk phenotype that may lead to receiving or seeking earlier/more aggressive treatment. METHODS: We analyzed a clinical trial dataset comprising 3643 recent (<120 days) ischemic stroke patients followed up for 2 years. Subjects were categorized as lean (body mass index [BMI], <25 kg/m², n=1,006), overweight (25-29.9 kg/m², n=1,493), or obese (≥30 kg/m², n=1,144). Subjects were classified as level 0 to III depending on the number of secondary prevention prescriptions divided by the number of potentially indicated drugs (0=none of the indicated medications and III=all indicated medications as optimal combination drug treatment [OCT]). Independent associations between each BMI category and stroke/myocardial infarction/vascular death (major vascular events [MVEs]) and all-cause death were assessed. RESULTS: MVEs occurred in 17.4% of lean, 16.1% of overweight, and 17.1% of obese patients; death occurred in 7.3%, 5.5%, and 5.1%, respectively. Individuals with a higher BMI status received more OCT (45.8%, 51.7%, and 55.3%, respectively; P<0.001). In the lean patient group, multivariable adjusted Cox analyses, showed that compared with levels 0-I, level II and level III were linked to lower risk of MVEs (hazard ratio [HR] 0.55; 95% confidence interval [CI]: 0.32–0.95 and HR 0.48; 95% CI: 0.28−0.83, respectively) and death (0.44; 0.21–0.96 and 0.23; 0.10−0.54, respectively). CONCLUSIONS: OCT for secondary prevention after an ischemic stroke is less frequent in lean (vs. obese) subjects, but when implemented is related to significantly better clinical outcomes.
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Humans , Body Mass Index , Dataset , Obesity , Overweight , Phenotype , Prescriptions , Secondary Prevention , Stroke , VitaminsABSTRACT
Objective To investigate effect of combination of rosuvastatin and dual antiplatelet therapy on the serum CRP, cerebral vascular event recurrence rate and carotid artery plaque in cerebral infarction patients.Method 60 cerebral infarction patients were seleted and divided into the control group and the experiment group by different treatment(n=30).Two groups were treated by corresponding drugs.The serum levels of IMT, CRP, plaque area, plaque number and the cases of recurrent cerebral vascular events after 6 month were compared after treatment a month.Results Compared with the control group after treatment,the serum CRP were lower(P<0.05),the recurrence rate of cerebral vascular events were lower(P<0.05),the IMT value, patch area and the number of carotid plaques were lower(P<0.05).Conclusion Rosuvastatin and dual antiplatelet combination therapy has good clinical effect for cerebral infarction patients,and have the clinical guiding significance.
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Homocystinuria is an autosomal recessive inherited disorder of methionine metabolism. The most common cause of homocystinuria is cystathione-beta-synthase deficiency, which has the characteristic clinical features such as ectopia lentis, Marfanoid skeletal changes, mental retardation, and vascular thromboembolic events such as deep vein thrombosis, cerebral infarction, pulmonary embolism, and myocardial infarction. The thromboembolic vascular events occur in 20-50% of untreated patients with homocystinuria at the age of 15, and could be associated with vasculopathy related mortality in 20% of untreated patients before the age of 30. Therefore, homocystinuria is one of the important cause of stroke in children and young adults. Only 2 cases of homocystinuria were reported in Korea; one without vasculopathy and the other with cerebral infarction. Homocystinuria complicated with systemic deep vein thrombosis is first reported in Korea. We report a 13 year old female with homocystinuria complicated with severe systemic deep vein thrombosis and venous infarction of both thalami due to thrombosis of vein of Galen and internal cerebral vein.