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1.
Revista Digital de Postgrado ; 13(3): e405, dic.2024.
Article in Spanish | LILACS, LIVECS | ID: biblio-1584756

ABSTRACT

El interés científico que existe sobre los mecanismos involucrados en el proceso que da origen a la aterosclerosis es considerablemente notable e importante. El gran volumen de artículos y conocimiento sobre este tema cada vez es mayor, permitiendo profundizar constantemente en los mecanismos fisiopatológicos que comprende la aterosclerosis, los factores de riesgo que predisponen a la misma, y las posibles consecuencias a esperar una vez que se desencadena la patología. Ahora se sabe que el carácter multifactorial de esta situación anormal de las arterias es lo que ha llevado a la alta morbimortalidad que representan las enfermedades cardiovasculares actualmente. Objetivo: Investigar los mecanismos de la aterosclerosis: Profundizar en los procesos fisiopatológicos que conducen al desarrollo de esta enfermedad. Comprender cómo diferentes elementos, incluyendo la inmunidad, genética y microbiota, contribuyen al desarrollo de la aterosclerosis. Métodos: Se realizó una revisión de la literatura científica existente sobre el tema. Análisis de estudios que relacionan factores de riesgo (hormonales, ambientales y genéticos) con el desarrollo de la enfermedad. La investigación sobre el papel del sistema inmunológico y la microbiota en la fisiopatología de la aterosclerosis. Se ha logrado dilucidar las diferentes causas, encontrando una fuerte relación entre el desarrollo de aterosclerosis y diversos factores, para tratar de explicar el sustrato fisiopatológico al cual nos enfrentamos en la búsqueda del tratamiento más eficaz para esta condición anormal del organismo.


The scientific interest that exists in the mechanisms involved in the process that gives rise to atherosclerosis is considerably notable and important. The large volume of articles and knowledge on this topic is increasing, allowing us to constantly delve deeper into the pathophysiological mechanisms that comprise atherosclerosis, the risk factors that predispose to it, and the possible consequences to be expected once the pathology is triggered. It is now known that the multifactorial nature of this abnormal situation of the arteries is what has led to the high morbidity and mortality that cardiovascular diseases currently represent. Objective: To investigate the mechanisms of atherosclerosis: To delve deeper into the pathophysiological processes that lead to the development of this disease. To understand how different elements, including immunity, genetics and microbiota, contribute to the development of atherosclerosis. Methods: A review of the existing scientificliterature on the subject was carried out. Analysis of studies that relate risk factors (hormonal, environmental and genetic) with the development of the disease. Research on the role of the immune system and microbiota in the pathophysiology of atherosclerosis. It has been possible to elucidate the different causes, finding a strong relationship between the development of atherosclerosis and various factors, in order to try to explain the pathophysiological substrate that we face in the search for the most effective treatment for this abnormal condition of the organism.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Atherosclerosis , Atherosclerosis/complications , Atherosclerosis/diagnosis , Cardiovascular Diseases , Indicators of Morbidity and Mortality , Risk Factors , Morbidity , Disease Progression , Knowledge , Immune System
2.
J Biosci ; 2024 Sept; 49: 1-10
Article | IMSEAR | ID: sea-237879

ABSTRACT

Atherosclerosis is a common cardiovascular disease in which the arteries are thickened due to buildup of plaque. This study aims to identify programmed cell death (PCD)-related biomarkers and explore the crucial regulatory mechanisms of atherosclerosis. Gene expression profiles of atherosclerosis and control groups from GSE20129 and GSE23746 were obtained. Necroptosis was elevated in atherosclerosis. Weighted gene coexpression network analysis (WGCNA) was conducted in GSE23746 and GSE56045 to identify PCD-related modules and to perform enrichment analysis. Two necroptosis-related genes (IRF9 and STAT1) were identified and considered as biomarkers. Enrichment analysis showed that these gene modules were mainly related to immune response regulation. In addition, single-cell RNA sequencing data from GSE159677 were obtained and the characteristic cell types of atherosclerosis were identified. A total of 11 immune cell types were identified through UMAP dimension reduction. Most immune cells were mainly enriched in plaque samples, and STAT1 and IRF9 were primarily expressed in T-cells and macrophages. Moreover, the roles of IRF9 and STAT1 were assessed and found to be significantly upregulated in atherosclerosis, which was associated with increased risk of atherosclerosis. This study provides a molecular feature of atherosclerosis, offering an important basis for further research on its pathological mechanisms and the search for new therapeutic targets.

3.
Article | IMSEAR | ID: sea-241272

ABSTRACT

Introduction: Cerebrovascular stroke is a public health problem. They are dominated by ischemic origin, of which cardioembolic etiology is a significant cause. The aim of our study is to determine the in-hospital prevalence of cardiovascular disease in patients with cerebrovascular stroke and the diagnostic and therapeutic impact of all the complementary examinations carried out. Materials and Methods: This is a retrospective descriptive and analytical study carried out over a 7-year period (July 2017-June 2024) compiling cases of ischemic stroke admitted to the cardiology and neurology departments of the Mohamed VI University Hospital in Marrakech. Routine examinations included ECG, transthoracic cardiac echocardiography and echocardiography-doppler of the neck vessels, while transesophageal echocardiography (TEE) and Holter ECG were performed only in a select cases. Results: Three hundred cases were collected and evaluated. The mean age of the patients was 68.3 ± 8.9 years (21-90 years), with a clear male predominance (64.3%). Eighty percent had at least one cardiovascular risk factor. A cardiovascular history of hypokinetic cardiomyopathy at the dilated stage was found in 7.6% of cases. The average consultation time was 26 hours. Clinical presentation according to NIHSS score was as follows: a score below 10 in 65% of cases, between 10 and 20 in 21% and above 20 in 14%. ECG was abnormal in 67.6% of cases (203 patients); TTE was abnormal in 63%, with dilatation of the left atrium (LA) the main abnormality. TEE in 8% of cases revealed 3 cases of inter-atrial aneurysm with patent foramen oval, seven cases of left atrial thrombus, one left atrial myxoma, 3 cases of mitral valve wing block and 2 cases of complex aortic atheroma exceeding 4 mm in thickness. Holter ECG revealed 27 cases of transition to atrial fibrillation Conclusion: Ischemic stroke etiologies are largely dominated by lacunar infarction and embolic heart disease, followed by atherosclerosis. This highlights the role of the cardiologist in both etiological management and in guiding the therapeutic approach. Thus, improving prognosis hinges on early diagnosis and a thorough etiological assessment before concluding a cryptogenic stroke.

4.
Article | IMSEAR | ID: sea-240353

ABSTRACT

Background: One of the most common reasons for preventable mortality is the smoking habit. Cigarette smoke promotes the process of atherogenesis by producing oxygen-derived free radicals which cause damage to the lipids. Cigarette smoking is associated with impaired endothelium-dependent vasodilatation and cardiovascular disease (CVD). Aims and Objectives: The objectives of the study were the following: (i) to compare the levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very LDL (VLDL) in asymptomatic male smokers and non-smokers of the age group 25–50 years; (ii) to determine and compare the levels of high sensitivity C-reactive protein (hs-CRP) in the above two groups, and (iii) to study and compare the levels of malondialdehyde (MDA) in the above groups. Materials and Methods: The study was conducted on 60 males in which 30 smokers and 30 non-smokers of the age group 25–50 years were incorporated. It was a cross-sectional comparative study, which included the participants who met all the inclusion and exclusion criteria. Before the conduct of the study, informed consent was obtained from all the participants. Moreover, the selection of participants was done in a consecutive manner until the sample size was achieved. TC and TGs were estimated by the enzymatic colorimetric method, HDL cholesterol by the phosphotungstic acid method, and LDL and VLDL by Friedwald’s formula. MDA was determined by spectrophotometry and hs-CRP by the immunoturbidometric method. The data acquired were analyzed by utilizing the Statistical Package for the Social Sciences version 18. Results: Dyslipidemia was seen in smokers as evidenced by significantly elevated levels of TC, TG, LDL, and VLDL; and significantly reduced levels of HDL. The mean values of hs-CRP were significantly elevated in smokers when compared to that of non-smokers. Oxidative stress was increased in subjects who were smokers. The mean values of MDA were significantly elevated in the smokers. Conclusion: The smoking habit is associated with dyslipidemia, oxidative stress, and inflammation which predisposes to the development of endothelial dysfunction and atherosclerosis. The significance of early screening measures to be undertaken in asymptomatic smokers for dyslipidemia, oxidative stress, and hs-CRP is unveiled by the present study. Therefore, early screening can be used to advise smokers to refrain from smoking to avoid complications of CVDs, so that they can upgrade the quality of their life.

5.
Rev. Finlay ; 14(2)jun. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1565171

ABSTRACT

Fundamento: la aterosclerosis es una enfermedad de origen multifactorial que se agrava a consecuencia de un medio ambiente adverso y de estilos de vida no saludables. Las evidencias confirman su inicio desde las etapas más tempranas de la vida. Objetivo: describir la presencia de lesiones ateroscleróticas tempranas en las aortas de fetos y neonatos fallecidos hijos de madres hipertensas. Método: se realizó un estudio descriptivo de tipo transversal que incluyó a los fetos mayores de 22 semanas y neonatos fallecidos hijos de madres hipertensas, a quienes se les realizó autopsia en el departamento de anatomía patológica, del Hospital Universitario Ginecobstétrico Eusebio Hernández Pérez, en el período comprendido entre enero del 2021 hasta diciembre 2022, con un total de 18. Se recogieron los siguientes datos en las historias clínicas: sexo del fallecido, edad gestacional en el momento del parto, peso postparto, edad materna y antecedentes de hipertensión arterial (crónica o gestacional). Se analizaron las 18 aortas (torácicas y abdominales) de los fallecidos seleccionados. Resultados: del total de fallecidos estudiados el 70,6 % presentó lesiones ateroscleróticas tempranas, caracterizadas por engrosamiento de la íntima a modo de cojinete, presencia de linfocitos en la íntima o en la pared arterial cercana a ella y/o macrófagos. En algunos casos se observó una de estas variantes histológicas y en otros la combinación de dos o tres. Conclusiones: las lesiones ateroscleróticas tempranas están presentes en las aortas de la mayoría de los fetos y neonatos estudiados, con predominio en las que presentaban hipertensión gestacional.


Foundation: atherosclerosis is a disease of multifactorial origin that is aggravated as a result of an adverse environment and unhealthy lifestyles. Evidence confirms its onset from the earliest stages of life. Objective: to describe the presence of early atherosclerotic lesions in the aortas of deceased fetuses and neonates born to hypertensive mothers. Method: a descriptive cross-sectional study was carried out that included fetuses older than 22 weeks and deceased neonates born to hypertensive mothers, who underwent autopsy in the pathological anatomy department of the Eusebio Hernández Pérez Gynecobstetric University Hospital, in the period between January 2021 and December 2022, with a total of 18. The following data were collected in the medical records: sex of the deceased, gestational age at the time of delivery, postpartum weight, maternal age, and history of arterial hypertension (chronic or gestational). The 18 aortas (thoracic and abdominal) of the selected deceased were analyzed. Results: of the total number of deceased studied, 70.6 % presented early atherosclerotic lesions, characterized by thickening of the intima as a cushion, presence of lymphocytes in the intima or in the arterial wall close to it and/or macrophages. In some cases, one of these histological variants was observed and in others a combination of two or three. Conclusions: early atherosclerotic lesions are present in the aortas of the majority of the fetuses and neonates studied, with a predominance in those with gestational hypertension.

6.
Arq. bras. cardiol ; Arq. bras. cardiol;121(7): e20230705, jun.2024. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1568793

ABSTRACT

Resumo Fundamento Alcançar as metas nutricionais estabelecidas pelas sociedades científicas é um desafio constante e nem sempre alcançado. Objetivo Investigar a adequação alimentar de indivíduos com doença cardiovascular (DCV), participantes do Programa Alimentar Brasileiro Cardioprotetor residentes da região Nordeste do Brasil, segundo as recomendações da Sociedade Brasileira de Cardiologia (SBC). Métodos Análise transversal com dados do estudo de implementação da Dieta Cardioprotetora Brasileira (DICA BR) que avaliou indivíduos com DCV, atendidos em centros especializados em saúde cardiovascular em oito estados do Nordeste. O consumo alimentar foi obtido por recordatório alimentar de 24 horas e a adequação da dieta seguiu as recomendações da SBC. Foram considerados significantes valores de p < 0,05. Resultados Foram estudados 647 pacientes, com média (desvio padrão) de idade de 63,1 (9,4) anos, sendo 50,2% do sexo feminino. Na avaliação da ingestão alimentar, observou-se baixa adequação de carboidratos (52,3%), proteínas (70,9%), lipídios (38,8%) e fibras (22,4%). Observou-se que a maioria das mulheres consumia dieta hipoproteica (59,2%) e idosos tinham maior inadequação no consumo de carboidratos (52,6%). Em relação a ingestão de sódio, os homens apresentaram maior ingestão (72,9%), enquanto os idosos apresentaram redução de 13%. Além disso, foi demonstrado que os homens ingeriam mais fibras (28,1%) e indivíduos com maior escolaridade tinham um consumo elevado de ácidos graxos saturados (70,5%). Conclusões A maioria dos indivíduos não alcançou as metas dietoterápicas preconizadas para prevenção cardiovascular secundária. Os achados do presente estudo reforçam a necessidade de implementação de estratégias estruturadas, a fim de estimular hábitos alimentares saudáveis nesses indivíduos.


Abstract Background Achieving nutritional goals established by scientific societies is a constant challenge and not always achieved. Objective To investigate the dietary adequacy of individuals with cardiovascular disease (CVD), participants in the Cardioprotective Brazilian Food Program residing in the Northeast region of Brazil, according to the recommendations of the Brazilian Society of Cardiology (SBC). Methods Cross-sectional analysis with data from the study implementing the Brazilian Cardioprotective Diet (DICA BR), which evaluated individuals with CVD treated in specialized cardiovascular health centers in eight states in the Northeast region. Food consumption was obtained by 24-hour dietary records and dietary adequacy followed SBC recommendations. Values of p < 0.05 were considered significant. Results 647 patients were studied, with a mean (standard deviation) age of 63.1 (9.4) years, 50.2% of whom were female. When evaluating food intake, a low adequacy of carbohydrates (52.3%), proteins (70.9%), lipids (38.8%), and fiber (22.4%) was observed. It was observed that the majority of women consumed a low-protein diet (59.2%) and the elderly had a greater inadequacy in carbohydrate consumption (52.6%). Regarding sodium intake, men had a higher intake (72.9%), while the elderly showed a 13% reduction. Furthermore, it was shown that men ate more fiber (28.1%) and individuals with higher education had a high consumption of saturated fatty acids (70.5%). Conclusions Most individuals did not achieve the recommended dietary therapy goals for secondary cardiovascular prevention. The findings of the present study reinforce the need to implement structured strategies to encourage healthy eating habits in these individuals.

7.
Rev. cuba. med. mil ; 53(2)jun. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1583722

ABSTRACT

Introducción: Se realizó una revisión narrativa de los estudios publicados desde 2016 hasta 2021 sobre los aspectos clínicos, etiológicos, imagenológicos y terapéuticos de las diferentes formas clínica de la enfermedad cerebral vascular en los ancianos. Se consultaron las bases de datos de Medline (PubMed), SciELO, Cochrane y Google Académico. Se tuvieron en cuenta los artículos originales, publicados en revistas con revisión por pares, que incluyeran pacientes mayores de 65 años, con diagnóstico de enfermedad vascular cerebral. Objetivo: Actualizar sobre las particularidades de la enfermedad vascular cerebral en el adulto mayor. Desarrollo: En la enfermedad cerebrovascular del adulto mayor se observan condiciones particulares: biológicas, psicológicas y sociales, que son menos frecuente o incluso pueden estar ausentes, en los grupos etarios más jóvenes. La arterioesclerosis de grandes vasos, el cardioembolismo, la enfermedad de pequeños vasos y la angiopatía cerebral amiloidea constituyen las etiologías predominantes, aunque pueden existir otras causas. El deterioro cognitivo vascular representa la segunda causa de demencia y es una forma clínica de presentación de la enfermedad vascular cerebral en este grupo etario. Conclusiones: La enfermedad cerebrovascular en el adulto mayor, presenta características particulares que se resumen en: mayor comorbilidad y riqueza de factores de riesgo, que obligan a un enfoque diagnóstico sistémico, dialécticamente interrelacionado y personalizado, en el cual las neuroimágenes ocupan un lugar de singular importancia; que, en interacción con la clínica, permitirán un diagnóstico y seguimiento evolutivo más integral de estos pacientes.


Introduction: A narrative review was carried out of the studies published from 2016 to 2021 on the clinical, etiological, imaging and therapeutic aspects of the different clinical forms of vascular cerebral disease in the elderly. The databases of Medline (PubMed), SciELO, Cochrane and Google Scholar were consulted. Original articles, published in peer-reviewed journals, that included patients over 65 years of age, with a diagnosis of cerebral vascular disease, were taken into account. Objective: Update on the particularities of cerebral vascular disease in older adults. Development: In cerebrovascular disease of the elderly, particular conditions are observed: biological, psychological and social, which are less frequent or may even be absent in younger age groups. Large vessel atherosclerosis, cardioembolism, small vessel disease, and cerebral amyloid angiopathy are the predominant etiologies, although other causes may exist. Vascular cognitive impairment represents the second cause of dementia and is a clinical form of presentation of cerebral vascular disease in this age group. Conclusions: Cerebrovascular disease in the elderly presents particular characteristics that are summarized in: greater comorbidity and richness of risk factors, which require a systemic, dialectically interrelated and personalized diagnostic approach, in which neuroimaging occupies a unique place. importance; which, in interaction with the clinic, will allow a more comprehensive diagnosis and evolutionary follow-up of these patients.

8.
Article | IMSEAR | ID: sea-236177

ABSTRACT

In most institutions, patients with erectile dysfunction due to penile arterial insufficiency are offered palliative treatments like vacuum constrictor devices, intraurethral alprostadil, intracavernosal injection of prostaglandins, and/or implantation of penile prosthesis when these patients can be treated by endovascular penile revascularization. 50% of patients with erectile dysfunction are non-responders to phosphodiesterase-5 inhibitors. 70% of non-responders to phosphodiesterase-5 inhibitors have penile arterial insufficiency that can be treated with endovascular penile revascularization. Patients who are non-responders to phosphodiesterase-5 inhibitors should be screened for penile arterial insufficiency using penile duplex scan. If penile artery peak systolic velocity is <35 cm/s, then arterial insufficiency is suspected, and computed tomography (CT) angiogram is obtained to confirm presence of significant stenosis in iliac-pedundle-penile arterial system. Patients with penile arterial insufficiency should be offered endovascular penile revascularization. This minimally invasive procedure has minimal perioperative complications (<1%) and has significant clinical improvement in erectile function in >60% of patients at 12 months. Endovascular penile revascularization is safe and has long term clinical improvement in erectile function. This minimally invasive procedure can result in improved erectile function and preserves penile size and shape in most non-responders to phosphodiesterase-5 inhibitors.

9.
Article | IMSEAR | ID: sea-234077

ABSTRACT

Background: Carotid intima-media thickness (CIMT) is a reliable marker of atherosclerosis and cardiovascular events. Association between CIMT with non-alcoholic fatty liver disease (NAFLD) is well known; however, such data are limited from India. This study aimed to assess CIMT in NAFLD patients compared to the healthy control, its relationship with other metabolic covariates, and predators of increased CIMT. Methods: In an observational study, involving 150 subjects (84 NAFLD and 66 healthy controls), B-mode ultrasound was used for the evaluation of CIMT. Results: The mean CIMT was significantly higher in NAFLD patients compared to the control group: 0.77±0.27 versus 0.57±0.11 mm on left side, p<0.001 and 0.79±0.22 versus 0.54±0.12 mm on right side, p<0.001. The difference was significant even after adjustment of metabolic confounders. Eight NAFLD patients had carotid plaques compared to none in the controls. The mean CIMT did not differ significantly between lean, overweight and obese subjects. A progressive increase in mean CIMT was noted with increasing grades of hepatic steatosis. High CIMT values (>95th percentile value in controls, 0.79 mm) were found in 52.3% of NAFLD. On multivariate regression analysis, age [odds ratio (OR) 1.42, p<0.001], serum HDL cholesterol [OR 0.92), p=0.02] and NAFLD [OR: 3.5, p<0.001] were found to be independently associated with high CIMT. Conclusions: NAFLD was significantly associated with CIMT which increased progressively with increasing grades of hepatic steatosis. Over half of NAFLD had increased CIMT, and NAFLD along with higher age and lower HDL- cholesterol independently predicted high CIMT values.

10.
Article | IMSEAR | ID: sea-239045

ABSTRACT

Background: It is estimated that around 17.9 million people die each year of cardiovascular disease. High LDL is an important risk factor for coronary artery disease. Apolipoprotein B (ApoB) is the primary apolipoprotein of chylomicrons, VLDL, IDL, and LDL. Increased Apo B levels and LDL levels are known to cause atherosclerotic coronary artery disease. Aim and Objectives: To measure LDL and Apo B levels of adult people and to calculate the prevalence of high ApoB and LDL in Coimbatore region. Material and Methods: This was a study done for a period of 3 months in 500 people attending a tertiary hospital in Coimbatore, Tamilnadu. Patients on statins, critically ill patients, pregnant women, and lactating women were excluded. ApoB and LDL levels were measured and the percentage of increased levels of the same was calculated. Results: Out of 500 people studied, 52.87% of the population had high LDL. About 45.76% of the males and 56.49% of the women had high LDL. Out of the study subjects, 4.33% of the people had high ApoB level. Pearson's correlation revealed 'r' value as 1, thereby indicating a positive correlation between ApoB and LDL. Conclusion: This study showed that around 50% of study subjects had high LDL levels and 4% had high ApoB levels, and there was a positive correlation between the two.

11.
Article | IMSEAR | ID: sea-231613

ABSTRACT

This study aimed to create, develop, and optimize a biodegradable stent made of poly lactic co glycolic acid (PLGA) that contained clopidogrel and atorvastatin for the management of asthma. Solvent casting was used to create biodegradable stents. In particular, PLGA 75:25 polymer films were used to create stents using the solution-casting method. The base material was created by dissolving the polymer in isopropyl alcohol and adding PEG 400 as a plasticizer. As the active pharmaceutical ingredients in the stents, clopidogrel and atorvastatin were used. To avoid air bubbles, the resulting mixture was homogenized before being poured onto metal pans and allowed to gently evaporate in a refrigerator. The polymer films were then cut into strips, wound around cylindrical rods to form helical stents, and baked in an oven to guarantee that all of the isopropyl alcohol had evaporated. The biodegradable polylactic acid stents that included clopidogrel and atorvastatin demonstrated an impressive 99.34±0.44% encapsulation efficiency. Differential scanning calorimetry (DSC) analysis revealed that there were no chemical interactions between the stent's component parts. Significant water absorption over 80% was seen over a period of 8 days, which is remarkable. A thorough effect on disrupting plaque was seen at day 21, and on day 22, the stent began to biodegrade. Over the course of 20 days, the cumulative medication release percentage rose to 99.92%. According to the study's findings, treating atherosclerosis with an optimized biodegradable polymeric stent made of PLGA and combining atorvastatin and clopidogrel is a novel and promising treatment option.

12.
Article | IMSEAR | ID: sea-239500

ABSTRACT

Rosacea is a chronic inflammatory dermatological condition with different clinical phenotypes, usually diagnosed clinically and treated with systemic and topical medications. Rosacea is one of the skin conditions that is often believed to just have cutaneous manifestation, but it is actually a systemic condition that affects many different systems. The correlation between rosacea and a variety of comorbidities, including depression, gastrointestinal disorders, migraines, autoimmune conditions, and cardiovascular diseases (CVD) are noted in many different studies. There are numerous risk factors for CVD, including hypertension (HTN), diabetes mellitus (DM), metabolic syndrome (MS), and dyslipidemia. CVD has a high mortality rate and should not be overlooked. Rosacea patients must receive the appropriate education regarding the management of CVD risk factors in addition to rosacea. We thought it was important to conduct a literature review to investigate the association between rosacea and the risk factors associated with CVDs, since both conditions are chronic and involve the interaction of genetic and inflammatory factors. The purpose of this narrative review is to overview rosacea, draw attention to the cardiovascular risk that rosacea patients face, and alert dermatologists, cardiologists, and primary care physicians to the need for immediate risk factor treatment.

13.
Rev. cuba. med. mil ; 53(1)mar. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1569869

ABSTRACT

Introducción: Se reconoce la asociación entre los factores de riesgo aterogénico y las alteraciones microvasculares de la retina, pero no hay consenso sobre si estas afectaciones en la retina preceden o son una respuesta fisiopatológica a dichos factores. Objetivo: Determinar si la presencia de los factores de riesgo aterogénico predice las alteraciones vasculares retinianas, a través del fondo de ojo y la retinografía. Métodos: Estudio trasversal en 55 sujetos mayores de 19 años de edad, de cualquier sexo, sin opacidades en los medios transparentes del ojo. Se estudiaron las variables edad, sexo, dislipidemia, hábito de fumar, consumo de alcohol, hipertensión arterial, diabetes mellitus tipo 2, presión arterial sistólica y diastólica, índice de masa corporal, colesterol, glicemia, triglicéridos, creatinina, lipoproteínas de alta densidad, urea, eritrosedimentación y conteo leucocitario. Resultados: El 65,45 % presentó alteraciones en el fondo de ojo: aumento del brillo arteriolar (53,03 %) y disminución del calibre arteriolar generalizado (52,24 %). La retinografía mostró daño en el 58,18 %: rectificación de los cruces arteriovenosos (65,71 %), tortuosidad venosa (28,21 %) y cruces arteriovenosos con aplastamiento (85,71 %). El aumento del colesterol sérico (p= 0,003) se asoció con la presión arterial sistólica (p= 0,037) en el fondo de ojo, y con el antecedente de hipertensión arterial (p= 0,023) en la retinografía. Conclusiones: El colesterol sérico, las cifras elevadas de tensión arterial sistólica y antecedentes de hipertensión arterial son los factores de riesgo que mejor predicen el daño vascular retinal.


Introduction: The association between atherogenic risk factors and retinal microvascular alterations is recognized, but there is no consensus on whether these retinal disorders precede or are a pathophysiological response to these factors. Objective: To determine if the presence of atherogenic risk factors predicts retinal vascular alterations, through fundus examination and retinography. Methods: Cross-sectional study in 55 subjects over 19 years of age, of either sex, without opacities in the transparent media of the eye. The variables studied were age, sex, dyslipidemia, smoking habit, alcohol consumption, arterial hypertension, type 2 diabetes mellitus, systolic and diastolic blood pressure, body mass index, cholesterol, glycemia, triglycerides, creatinine, high-density lipoproteins, urea, erythrocyte sedimentation rate and leukocyte count. Results: 65.45% presented alterations in the fundus of the eye: increased arteriolar brightness (53.03%) and decreased generalized arteriolar caliber (52.24%). Retinography showed damage in 58.18%: rectification of arteriovenous crossings (65.71%), venous tortuosity (28.21%), and arteriovenous crossings with crushing (85.71%). The increase in serum cholesterol (p= 0.003) was associated with systolic blood pressure (p= 0.037) in the fundus, and with a history of arterial hypertension (p= 0.023) in retinography. Conclusions: Serum cholesterol, high systolic blood pressure and a history of hypertension are the risk factors that best predict retinal vascular damage.

14.
Article | IMSEAR | ID: sea-241306

ABSTRACT

Familial Hypercholesterolemia (FH) is among the most common genetic disorders, present from birth. The transmission is mainly autosomal dominant. It is characterized by a exclusive increase in low-density lipoproteins (LDL). It is associated with a high risk of premature cardiovascular complications. The diagnosis of FH is generally based on the clinical presentation or genetic tests. The commonly used criteria are those of the Dutch Lipid Clinic Network. FH is a hereditary condition still largely underdiagnosed and undertreated. The prognosis of the disease is related to atheromatous cardiovascular complications, which, in the absence of treatment, lead to the patient's death in the first three decades, often due to myocardial infarction or sudden death. The management of familial hypercholesterolemia systematically involves two categories of measures: so-called hygienic-dietary measures associated with the treatment of other risk factors when they exist, and drug treatments. Familial hypercholesterolemia is still poorly detected. It is necessary to develop systematic approaches to identify patients with FH, conduct cascade screening of their relatives, and increase awareness and control of FH.

15.
Article | IMSEAR | ID: sea-240140

ABSTRACT

Background: Development of high sensitivity CRP (Hs-CRP) assays has improved the role of this acute phase reactant in predicting the first cardiovascular events. Hs-CRP levels partially reflect the extent of myocardial necrosis and can be used to predict inhospital and long-term outcome in patients with acute myocardial infarction. Aims and Objectives: The objectives of the study are to study and correlate increased level of Hs-CRP with various traditional risk factors such as age, sex, lifestyle, and comorbidities and to establish increased level of Hs-CRP as an independent marker for cardiovascular events. Materials and Methods: A 100 patients’ prospective cross-sectional study was conducted at tertiary care center with traditional risk factors and existing cardiovascular diseases. Measurements of Hs-CRP levels were done with immunoturbidimetric methods with statistical correlation. The statistical analysis was done using IBM SPSS version 26 software. Results: In total 100 patients, 67 patients had Hs-CRP value more than 3 mg/L where-as 33 patients had Hs-CRP value <3 mg/L, 32% of patients belonged to age group 51–60 years and majority 78% were male. Among all the individual life style parameters and traditional risk factor which were considered, five parameters, namely, sedentary life style, smoking, pre-existing hypertension, diabetes mellitus, and electrocardiogram changes were proved statistically significant and correlation between elevated high sensitivity C reactive protein and cardiovascular disease was proved statistically significant. Conclusion: Hs-CRP is independent biomarker for cardiovascular disease and positive correlation was established between elevated level of Hs-CRP and major traditional risk factors such as sedentary life style, smoking, hypertension, and diabetes mellitus.

16.
Article | IMSEAR | ID: sea-233847

ABSTRACT

Background: Indians are known to have the highest coronary artery disease (CAD) rates, and the conventional risk factors fail to explain this increased risk. At present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). Methods: An autopsy study of 6 years: January 2015 to December 2020 which included heart specimens affected by MI from medicolegal autopsies received in histopathology section. The received heart specimens were fixed in 10% formalin and processed as per routine histotechniques with H&E stain and slides prepared were studied under light microscopy. Results: Maximum number of myocardial infarction cases 21 (23.5%) were seen in the age group of 41-50. Commonest histopathological pattern noted was Healed myocardial infarction 38 (42.6%), followed by acute myocardial infarction (AMI) 29 (32.5%) then acute with healed myocardial infarction (AHMI) 22 (24.7%). Conclusions: Atherosclerosis being the most common cause of MI but frequency of non-atherosclerotic myocardial infarction is rising in 4th decade which is a matter of concern. The study of human atherosclerotic lesion is an extremely difficult task in a living subject and an autopsy study is the best possible way to work on it.

17.
Gac. méd. Méx ; Gac. méd. Méx;160(1): 26-35, ene.-feb. 2024. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1557800

ABSTRACT

Resumen Antecedentes: La sospecha de disfunción endotelial (DE) permitirá prevenir la aterosclerosis acelerada y la muerte prematura. Objetivo: Establecer la utilidad de la termografía en el cribado de la función endotelial en adultos con factores de riesgo cardiovascular. Material y métodos: Estudio transversal analítico de prueba diagnóstica. El incremento del diámetro de la arteria braquial < 11 % a un minuto posisquemia significó probable DE, confirmada si el diámetro fue ≥ 11 % posnitroglicerina sublingual. Se obtuvieron fotografías termográficas al minuto de la región palmar. Se aplicó estadística descriptiva, curva ROC, pruebas U de Mann-Whitney, chi cuadrada o exacta de Fisher. Resultados: Se incluyeron 38 sujetos, mediana de edad de 50 años, con 624 mediciones termográficas; nueve presentaron DE (vasodilatación mediada por flujo de 2.5 %). El mejor punto de corte para la función endotelial normal en sujetos con factores de riesgo cardiovascular fue ≥ 36 °C al minuto de isquemia, con sensibilidad de 85%, especificidad de 70%, valores predictivos positivo y negativo de 78 y 77%, área bajo la curva de 0.796, razón de verisimilitud positiva de 2.82 y razón de verisimilitud negativa de 0.22. Conclusión: La medición de la temperatura en la región palmar mediante termografía infrarroja ≥ 36 °C tras un minuto de isquemia es práctica, no invasiva y económica para el cribado de la función endotelial normal en adultos con factores de riesgo cardiovascular.


Abstract Background: Endothelial dysfunction (ED) suspicion will allow to prevent accelerated atherosclerosis and premature death. Objective: To establish the usefulness of thermography for endothelial function screening in adults with cardiovascular risk factors. Material and methods: Cross-sectional, analytical diagnostic test. A brachial arterial diameter (BAD) increase <11 % at one-minute post-ischemia meant probable ED and was confirmed if BAD was ≥ 11 % post-sublingual nitroglycerin. Thermographic photographs of the palmar region were obtained at one minute. Descriptive statistics, ROC curve, Mann-Whitney’s U-test, chi-square test, or Fisher’s exact test were used. Results: Thirty-eight subjects with a median age of 50 years, and with 624 thermographic measurements were included. Nine had ED (flow-mediated vasodilation (FMV): 2.5 %. The best cutoff point for normal endothelial function in subjects with cardiovascular risk factors was ≥ 36 °C at one minute of ischemia, with 85 % sensitivity, 70 % specificity, positive and negative predictive values of 78 and 77 %, area under the curve of 0.796, LR+ 2.82, LR- 0.22. Conclusions: An infrared thermography-measured temperature in the palmar region greater than or equal to 36 °C after one minute of ischemia is practical, non-invasive, and inexpensive for normal endothelial function screening in adults with cardiovascular risk factors.

18.
Article | IMSEAR | ID: sea-240980

ABSTRACT

Introduction: According to the India Report 2020, Kerala had the highest prevalence of atherosclerotic cardiovascular diseases (ASCVDs). Dyslipidemia is a modifiable risk factor that can prevent secondary events. American College of Cardiology/American Heart Association 2018 Guidelines for the management of blood cholesterol for secondary prevention of clinical ASCVD recommend high?intensity statins and moderate?intensity statin combination therapy for achieving target low?density lipoprotein?cholesterol (LDL?C). We conducted a study to evaluate the achievement of therapeutic goals in accordance with the guidelines in a tertiary care hospital in Kerala. Materials and Methods: Three hundred and twenty adult patients prescribed with high?intensity statin monotherapy (atorvastatin 40 mg, rosuvastatin 20 mg, and rosuvastatin 40 mg) or moderate?intensity statin combination therapy (atorvastatin 10 mg and fenofibrate 145 mg) for the secondary prevention of ASCVD event were included. Data were collected from the medical records and patient interviews. Achievement of the therapeutic goal of LDL?C ?70 mg/dL in accordance with guidelines was evaluated and compared; the mean percentage change in LDL?C was at the baseline and after 3 months. Patients were counselled on lifestyle modifications and educated about hypolipidemic agents. Since we are aiming for secondary prevention, the patients were given appropriate counselling concerning their disease and medications they are on. Dietary lifestyle modifications were also taught. Results: One hundred and thirty?eight patients achieved the therapeutic goal, with atorvastatin 40 mg (89.37%) being the most prescribed drug, followed by rosuvastatin 20 mg (5.62%) while rosuvastatin 40 mg had a higher efficacy with mean LDL reduction 65.71 ± 15.93 at 3 months follow?up. Comparing the adherence scores before and after patient counseling, the P value was found to be < 0.001, indicating it is significant. Conclusion: Lifestyle modifications and lipid?lowering therapy are crucial to tackle dyslipidemia. Poor achievement of therapeutic goals implies the need for adopting measures to improve adherence and health?related outcomes for patients with ASCVD.

19.
Arq. bras. cardiol ; Arq. bras. cardiol;121(1): e20230242, jan. 2024. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1533726

ABSTRACT

Resumo Fundamento: As diretrizes da Sociedade Europeia de Cardiologia recomendam um nível de colesterol LDL (LDL-C) < 55 mg/dL para pacientes com doença cardiovascular estabelecida. Embora a fórmula de Friedewald ainda seja amplamente utilizada para estimar o LDL-C, a fórmula mais recente de Martin-Hopkins mostrou maior precisão. Objetivos: Nosso objetivo foi avaliar: A) a proporção de pacientes que atingiram a meta de LDL-C e as terapias utilizadas em um centro terciário; B) o impacto da utilização do método de Martin-Hopkins em vez do método de Friedewald na proporção de pacientes controlados. Métodos: Estudo transversal monocêntrico, incluindo pacientes consecutivos pós-infarto do miocárdio, acompanhados por 20 cardiologistas, em um hospital terciário. Os dados foram coletados retrospectivamente de consultas clínicas realizadas após abril de 2022. Para cada paciente, os níveis de LDL-C e o atingimento das metas foram estimados a partir de um perfil lipídico ambulatorial, utilizando as fórmulas de Friedewald e Martin-Hopkins. Um valor-p bicaudal < 0,05 foi considerado estatisticamente significativo para todos os testes. Resultados: Foram incluídos 400 pacientes (com 67 ± 13 anos, 77% do sexo masculino). Utilizando a fórmula de Friedewald, a mediana de LDL-C sob terapia foi de 64 (50-81) mg/dL, e 31% tinham LDL-C dentro da meta. Estatinas de alta intensidade foram usadas em 64% dos pacientes, 37% estavam em uso de ezetimiba e 0,5% estavam em uso de inibidores de PCSK9. A terapia combinada de estatina de alta intensidade + ezetimiba foi utilizada em 102 pacientes (26%). A aplicação do método de Martin-Hopkins reclassificaria um total de 31 pacientes (7,8%). Entre aqueles considerados controlados pela fórmula de Friedewald, 27 (21,6%) teriam LDL-C estimado por Martin-Hopkins acima da meta. Conclusões: Menos de um terço dos pacientes pós-infarto do miocárdio apresentaram LDL-C dentro da meta. A aplicação da fórmula de Martin-Hopkins reclassificaria um quinto dos pacientes presumivelmente controlados no grupo de pacientes não controlados.


Abstract Background: The European Society of Cardiology guidelines recommend an LDL-cholesterol (LDL-C) < 55 mg/dL for patients with established cardiovascular disease. While the Friedewald equation to estimate LDL-C is still widely used, the newer Martin-Hopkins equation has shown greater accuracy. Objectives: We aimed to assess: A) the proportion of patients reaching LDL-C goal and the therapies used in a tertiary center; B) the impact of using the Martin-Hopkins method instead of Friedewald's on the proportion of controlled patients. Methods: A single-center cross-sectional study including consecutive post-myocardial infarction patients followed by 20 cardiologists in a tertiary hospital. Data was collected retrospectively from clinical appointments that took place after April 2022. For each patient, the LDL-C levels and attainment of goals were estimated from an ambulatory lipid profile using both Friedewald and Martin-Hopkins equations. A two-tailed p-value of < 0.05 was considered statistically significant for all tests. Results: Overall, 400 patients were included (aged 67 ± 13 years, 77% male). Using Friedewald's equation, the median LDL-C under therapy was 64 (50-81) mg/dL, and 31% had LDL-C within goals. High-intensity statins were used in 64% of patients, 37% were on ezetimibe, and 0.5% were under PCSK9 inhibitors. Combination therapy of high-intensity statin + ezetimibe was used in 102 patients (26%). Applying the Martin-Hopkins method would reclassify a total of 31 patients (7.8%). Among those deemed controlled by Friedewald's equation, 27 (21.6%) would have a Martin-Hopkins' LDL-C above goals. Conclusions: Less than one-third of post-myocardial infarction patients had LDL-C within the goal. Applying the Martin-Hopkins equation would reclassify one-fifth of presumably controlled patients into the non-controlled group.

20.
Article in Chinese | WPRIM | ID: wpr-1021833

ABSTRACT

BACKGROUND:The expression efficiency of recombinant adeno-associated virus serotype 9(rAAV9)carrying the macrophage-specific promoter synthetic promoter 146-C1(SP146-C1)and the exogenous gene vascular endothelial growth factor C(VEGFC)in atherosclerosis is uncertain. OBJECTIVE:To investigate the expression efficiency of rAAV9-SP146-C1-VEGFC in atherosclerotic mice and its effect on lymphangiogenesis. METHODS:Thirty ApoE-/-mice were fed high-fat diet for 12 weeks to establish atherosclerosis models and were randomly divided into six groups,five in each group:7-,14-,21-,28-,and 35-day transfection groups and control group.The mice in the transfection groups were transfected with 5.0×1011 vg rAAV9-SP146-C1-VEGFC by caudal vein injection.In the control group,the mice were injected with the same amount of control virus rAAV9-SP146-C1-Scramble.Animals in the first five groups were killed under anesthesia at 7,14,21,28 and 35 days after transfection,respectively,and those in the control group were killed under anesthesia at 7 days.Serum,femur,tibia,heart and aorta tissue samples were collected and retained in each group.The femur and tibia of mice in each group were used to extract bone marrow-derived macrophages.The gene expression of vascular endothelial growth factor C(VEGFC),vascular endothelial growth factor receptor 3(VEGFR3),Podoplanin and lymphatic vessel endothelial hyaluronan receptor-1(LYVE-1)in bone marrow-derived macrophages and the aorta were detected by RT-qPCR.VEGFC protein expression levels in bone marrow-derived macrophages and the aorta were detected by western blot,serum level of VEGFC was detected by ELISA,and VEGFC expression in the aortic sinus and LYVE-1 expression around the aorta and in the myocardium was detected by immunofluorescence. RESULTS AND CONCLUSION:The serum level of VEGFC,the mRNA expression of VEGFC,VEGFR3,Podoplanin,and LYVE-1 in bone marrow-derived macrophages and the aorta,the protein expression of VEGFC in bone marrow-derived macrophages,and the fluorescence intensity of VEGFC in aortic sinus plaques were significantly increased in the 7-day transfection group compared with the control group(P<0.05,P<0.01).Serum VEGFC level of mice transfected with rAAV9-SP146-C1-VEGFC gradually increased with time and began to decrease at 28 days.mRNA levels of VEGFC,VEGFR3,Podoplanin and LYVE-1 in mouse aorta and bone marrow-derived macrophages,VEGFC protein level in bone marrow-derived macrophages,VEGFC fluorescence intensity in aortic sinus plaques,LYVE-1 fluorescence intensity around the aortic sinus and in the myocardium gradually increased with time(P<0.05).In addition,the mRNA level of LYVE-1 in the aorta and the fluorescence intensity of LYVE-1 around the aortic sinus and in the myocardium were the highest at 28 days(P<0.05),and gradually decreased(P<0.05).The expression of the other indicators reached the peak at 21 days.To conclude,rAAV9-SP146-C1-VEGFC could effectively transfect bone marrow-derived macrophages and promote lymphatic hyperplasia in atherosclerotic mice.

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