Cardiovascular Risk Profile In Patients Research Articles

The Effect of Supervised Exercise Therapy on Cardiovascular Risk Profile of Patients with Intermittent Claudication? A Systematic Review and Meta-analysis

Introduction - Patients with intermittent claudication (IC) are at increased risk for cardiovascular morbidity and mortality. Therefore, in patients with IC, the primary goal is to reduce risk factors for cardiovascular disease. Next to optimal medical treatment and life-style advice, supervised exercise training (SET) is nowadays a class IA recommendation in the treatment of patients with IC. Whereas bountiful evidence supports the beneficial effects of SET on walking capacity, we know little about the effect of SET on the cardiovascular risk profile of patients with IC. Therefore, the objective of this study was to evaluate the effects of SET on cardiovascular risk factors in patients with IC by using meta-analytic techniques. Methods - A systematic review of the electronic databases Pubmed, EMBASE, Cinahl and Central was conducted. Randomized and non-randomized controlled trials lasting ≥ 4 weeks and investigating the effects of SET on traditional cardiovascular risk factors in patients with IC were included. Traditional cardiovascular risk factors were studied as primary outcomes, pain-free (PFWD) and maximal walking distances (MWD) were included as secondary outcomes. All meta-analyses were performed using random-effects models with summary data reported as weighted means, Hedges’ g and 95% confidence interval (CIs). Results - We included 14 trials, involving 17 study groups (9 walking, 3 resistance, 3 combined and 2 aerobic training groups), totaling 828 patients (mean age: 66.4 yrs, mean ABI: 0.65). Overall, exercise training induced a significant reduction in systolic blood pressure [-4.4 mmHg (CIs -8.1;-0.65, p=0.02)] and fasting triglycerides [-0.22 mmol/l (CIs -0.42;-0.01, p=0.04)]. All other cardiovascular variables including body weight, body mass index, diastolic blood pressure, total cholesterol, low and high density cholesterol remained statistically unaltered. Exercise training also significantly improved PFWD [+117 m (CIs +51;+183, p=0.001)] and MWD [+161 m (CIs +78;+245, p<0.001). Conclusion - This meta-analysis supports the beneficial effects of SET on walking capacity. In addition, we found some evidence for SET to ameliorate the cardiovascular risk profile in patients with IC. However, the small number of studies warrants the need for more RCTs evaluating the effect of exercise therapy on cardiovascular risk factors as primary outcomes in patients with IC.

CARDIOVASCULAR RISK PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION WHO FIRST SEEK MEDICAL ATTENTION

Objective: Objective assessment of cardiovascular risk (CVR) in patients with arterial hypertension (AH), who first contacted with primary care setting. Design and method: 300 patients (age 40–65 years) with sustained increase in arterial pressure and first seek medical attention were included in the study. All patients underwent medical examination, history taking to identify risk factors, blood pressure measurement and anthropometric research, biochemical blood assay to estimate levels of total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, glucose. Based on the specified parameters, the risk was determined by SCORE (Systematic Coronary Risk Evaluation). After the risk assessment, all patients underwent an echo-cardiography, duplex ultrasonography screening of the brachiocephalic arteries and determination of microalbuminuria to detect target organ damage. According to results of a complex survey, the risk was reclassified based on the presence of target organ damage. Results: The study showed that patients with sustained AH who first seek medical attention have a large number of risk factors and their combinations, among which the most common are dyslipidemia (89,3%), smoking (37,7%) and obesity (28,3%). Patients with AH who first seek medical attention without clinical signs of atherosclerosis often have various disorders of target organs, such as left ventricular hypertrophy — 67,3%, thickening of carotid intima-media complex — 46,3%, atherosclerotic plaques in carotid arteries — 34,7%, microalbuminuria — 25,3%, as well as different combinations thereof. After a complex examination, the CVR profile of patients changes increases. According to SCORE 60% of patients with low and mean risk is reclassified to high risk. Conclusions: The results show the importance of examination of AH patients aimed at revealing of target organ damage for reclassification of CV risk and adequate strategy of treatment.

From the Editor’s desk…: April 2019

From the Editor’s desk…: April 2019

Rosuvastatin improves the FGF19 analogue NGM282-associated lipid changes in patients with non-alcoholic steatohepatitis

NGM282, an engineered analogue of the gut hormone FGF19, improves hepatic steatosis and fibrosis biomarkers in patients with non-alcoholic steatohepatitis (NASH). However, NGM282 increases serum cholesterol levels by inhibiting CYP7A1, which encodes the rate-limiting enzyme in the conversion of cholesterol to bile acids. Herein, we investigate whether administration of a statin can manage the cholesterol increase seen in patients with NASH receiving treatment with NGM282. In this phase II, open-label, multicenter study, patients with biopsy-confirmed NASH were treated with subcutaneous NGM282 once daily for 12 weeks. After 2 weeks, rosuvastatin was added in stepwise, biweekly incremental doses to a maximum of 40 mg daily. Both drugs were continued until the end of treatment at week 12. We evaluated plasma lipids, lipoprotein particles and liver fat content. In 66 patients who received NGM282 0.3 mg (n = 23), NGM282 1 mg (n = 21), or NGM282 3 mg (n = 22), circulating cholesterol increased from baseline at week 2. Initiation of rosuvastatin resulted in rapid decline in plasma levels of total cholesterol and low-density lipoprotein cholesterol. At week 12, reductions from baseline in total cholesterol levels of up to 18% (p <0.001), low-density lipoprotein cholesterol of up to 28% (p <0.001), triglycerides of up to 34% (p <0.001) and an increase in high-density lipoprotein cholesterol of up to 16% (p <0.001), with similar changes in lipoprotein particles, were observed in these patients. Robust decreases from baseline in 7alpha-hydroxy-4-cholesten-3-one (p <0.001) and liver fat content (p <0.001) were also observed. Rosuvastatin was safe and well-tolerated when co-administered with NGM282 in patients with NASH. In this multicenter study, NGM282-associated elevation of cholesterol was effectively managed with rosuvastatin. Co-administration of rosuvastatin with NGM282 may be a reasonable strategy to optimize the cardiovascular risk profile in patients with NASH. Non-alcoholic steatohepatitis (NASH) represents a large and growing public health concern with no approved therapy. NGM282, an engineered analogue of the gut hormone FGF19, reduces liver fat, liver injury and inflammation in patients with NASH. However, NGM282 increases cholesterol levels. Here we show that co-administration of a statin can manage the cholesterol increase seen in patients with NASH receiving treatment with NGM282, producing a favorable overall lipid profile.

Cardiovascular risk profile in patients with arterial hypertension who first seek medical attention

Aim.Objective assessment of cardiovascular risk (CVR) in patients with arterial hypertension (AH), who first contact with primary care setting.Material and methods. 300 patients (age 40-65 years) with sustained increase in arterial pressure and first seek medical attention were included in the study. All patients underwent medical examination, history taking to identify risk factors, blood pressure measurement and anthropometric research, biochemical blood assay to estimate levels of total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, glucose. Based on the specified parameters, the risk was determined by SCORE (Systematic Coronary Risk Evaluation). After the risk assessment, all patients underwent an echo-cardiography, duplex ultrasonography screening of the brachiocephalic arteries and determination of microalbuminuria to detect target organ damage. According to results of a complex survey, the risk was reclassified based on the presence of target organ damage.Results.The study showed that patients with sustained AH who first seek medical attention have a large number of risk factors and their combinations, among which the most common are dyslipidemia (89,3%), smoking (37,7%) and obesity (28,3%). Patients with AH who first seek medical attention without clinical signs of atherosclerosis often have various disorders of target organs, such as left ventricular hypertrophy — 67,3%, thickening of carotid intima-media complex — 46,3%, atherosclerotic plaques in carotid arteries — 34,7%, microalbuminuria — 25,3%, as well as different combinations thereof. After a complex examination, the CVR profile of patients changes increases. According to SCORE 60% of patients with low and mean risk is reclassified to high risk.Conclusion.One of the most important tasks of health care system in Russia is to increase the efficiency of the CVR stratification systems, as well as to develop a new standards of examination of patients with AH on an outpatient stage, in order to reduce cardiovascular morbidity and mortality.

Cardiovascular risk profile of patients with atherogenic dyslipidemia in middle age Lithuanian population

BackgroundAtherogenic dyslipidemia (AD) is a blood serum lipid profile abnormality characterized by elevation of triglycerides and reduced levels of high density lipoprotein cholesterol (HDL-C). It is associated with residual cardiovascular risk. This study evaluated and compared the risk profiles of patients with hypertriglyceridemia, low-HDL-C levels or AD, in order to understand, which lipid profile is associated with greater risk.MethodsDuring the period of 2009–2016 a population of 92,373 Lithuanian adults (men 40–54 years old and women 50–64 years old) without overt cardiovascular disease were analyzed. Data of 25,746 patients (68.6% women and 31.4% men) with hypertriglyceridemia and/or low HDL-C low levels were collected and used for further statistical analysis.ResultsParticipants with AD tend to have more unfavorable risk profile than participants with hypertriglyceridemia or low-HDL-C. AD tends to cluster with other atherogenic risk factors, such as arterial hypertension [odds ratio (OR) 1.96, 95% confidence intervals (CI) 1.87–2.01], smoking [OR 1.20, 95% CI 1.14–1.27], diabetes mellitus [OR 2.74, 95% CI 2.58–2.90], obesity [OR 2.92, 95% CI 2.78–3.10], metabolic syndrome [OR 22.27, 95% CI 20.69–23.97], unbalanced diet [OR 1,59, 95% CI 1.51–1.68], low physical activity [OR 1.80, 95% CI 1.71–1,89], CHD history in first degree relatives [OR 1.18, 95% CI 1.12–1.25] and total number of risk factors [OR 1.47, 95% CI 1.38–1.57].ConclusionAD is associated with more unfavorable cardiovascular risk profile than hypertriglyceridemia or low-HDL cholesterol levels. Once identified AD should require additional medical attention since it is an important factor of residual cardiovascular risk.

Sex Differences in Perceived Health and Cardiovascular Risk Profiles in Patients Enrolled in Cardiac Rehabilitation

Sex Differences in Perceived Health and Cardiovascular Risk Profiles in Patients Enrolled in Cardiac Rehabilitation

Cardiac function in paediatric patients with congenital adrenal hyperplasia due to 21 hydroxylase deficiency.

Hyperandrogenism and exogenous glucocorticoid excess may cause unfavourable changes in the cardiovascular risk profile of patients with congenital adrenal hyperplasia (CAH). To evaluate the cardiac function in paediatric patients with CAH. Twenty-seven paediatric patients with CAH, aged 8-16years, were evaluated by physical examination, electrocardiogram (ECG), conventional echocardiography, tissue Doppler imaging and two-dimensional (2D) myocardial strain (rate) imaging. Results were compared to 27 age- and gender- matched healthy controls. No signs of left ventricular hypertrophy or dilatation were detected on echocardiography. ECG revealed a high prevalence (25.9%) of incomplete right bundle branch block. Left ventricular posterior wall thickness in diastole (LVPWd) was significantly lower in patients with CAH compared to controls (5.55 vs 6.53mm; P=.009). The LVPWd Z-score was significantly lower in patients with CAH yet within the normal range (-1.12 vs -0.35; P=.002). Isovolumetric relaxation time was significantly lower in patients with CAH (49 vs 62ms; P=.003). Global longitudinal, radial and circumferential strain was not significantly different compared to controls. Global radial strain rate was significantly higher compared to healthy controls (2.58 vs 2.06 1/s; P=.046). Global longitudinal strain was negatively correlated with 24-hour blood pressure parameters. Cardiac evaluation of paediatric patients with CAH showed no signs of left ventricular hypertrophy or ventricular dilatation. LVPWd was lower in patients with CAH than in controls but within the normal range. A shorter isovolumetric relaxation time in patients with CAH may be a sign of mild left ventricular diastolic dysfunction.

The impact of periodontal treatment on inflammatory markers and cellular parameters associated with atherosclerosis in patients after myocardial infarction

IntroductionThe aim of this study was to analyze whether periodontal treatment affects the cardiovascular risk profile of patients after myocardial infarction (MI).Material and methodsThe study included 30 patients with chronic periodontitis (ChP). Sociodemographic and medical variables were collected. Patients were provided with scaling and root planing (SRP) 3 months after MI (1st visit). Periodontal examination and blood tests were performed immediately before SRP, then 1 month and 6 months after treatment (2nd and 3rd visit, respectively).ResultsA statistically significant decrease in blood hsCRP concentration and a decrease in the number of white blood cells (WBC) and neutrophils between the first and the second visit were observed. At 6 months after SRP, the mean platelet volume (MPV) had increased with respect to the value at 1 month after treatment. Multivariate analysis showed that the associations between: 1) change in LDL-C concentration and change in approximal plaque index value (b = –0.546, p = 0.005); 2) change in the number of monocytes and change in the plaque index value (b = 0.616, p = 0.01); 3) change in MPV and change in probing pocket depth (b = 0.567, p = 0.018) are all independent of the classic cardiovascular risk factors.ConclusionsThe obtained results indicate the existence of a relationship between the state of periodontal tissues on one hand and mediators of atherosclerosis and the number of immunologically competent cells on the other hand.

Paramètres hémodynamiques artériels et risque cardiovasculaire chez les patients vivant avec le VIH et en succès immuno-virologique

Although viral replication is apparently controlled with highly active antiretroviral therapy, cardiovascular risk of patients living with HIV remains a concern in clinical practice with population ageing. Cardiovascular risk profile in patients living with HIV is changing with the emergence of new parameters related to the persistence of residual viral replication, the antecedent and severity of immunodepression, the resulting chronic inflammation, as well as prolonged exposure to antiretroviral drugs and "classical" cardiovascular risk factors. Estimating risk models in patients living with HIV are not sufficient to integrate duration of exposure and control quality of all cardiovascular risk factors at the individual level. Aortic stiffness is a marker of the alteration of structural and functional properties of the wall of the large arterial trunks. This marker has an independent predictive value for total and cardiovascular mortality in the general population but also in the presence of risk factors and may offer clinical information about accelerated vascular ageing in people living with HIV. Aortic stiffness can be estimated non-invasively by applanation tonometry with carotid-femoral pulse wave velocity. This measure may be useful in clinical practice for early identification of at risk patients. Study of the determinants of aortic stiffening process in this population may optimize cardiovascular prevention.

OP.3C.01] COMPARISON BETWEEN EUROPEAN SYSTEMATIC CORONARY RISK EVALUATION AND ITALIAN CUORE ALGORITHMS IN ADULT OUTPATIENTS FOLLOWED BY GENERAL PRACTITIONERS AND SPECIALISED CENTRES

Objective: Global cardiovascular (CV) risk stratification based on either European Systematic Coronary Risk Evaluation (SCORE) or Italian CUORE algorithms should be performed in all adult outpatients by both general practitioners (GPs) and specialised physicians (SPs). Design and method: To compare individual CV risk profile by using either European SCORE and Italian CUORE algorithms in adult outpatients followed by GPs and SPs in Italy. All available data were centrally analysed for global CV risk assessment and rates of control of major CV risk factors, including blood pressure (BP), serum cholesterol, triglycerides and glucose levels. CV risk profile characterization was based on both SCORE and CUORE algorithms. Study population was stratified according to referring physicians (GPs, cardiologists, diabetologists, other SPs). Results: We analysed data from an overall population sample of 10,404 adult outpatients (age 60.76.5 years, BMI 28.34.9 kg/m2, BP 136.714.4/82.18.2 mmHg, total cholesterol 212.240.7 mg/dl, HDL cholesterol 50.812.3 mg/dl), among whom 7,767 (74.7%) were followed by GPs, 1,239 (11.9%) by cardiologists, 1,006 (9.7%) by diabetologists and 392 (3.8%) by other SPs. Systolic/diastolic BP, total/LDL cholesterol and triglycerides levels were higher and HDL cholesterol was lower in patients followed by GPs and cardiologists compared to other groups. Conversely, BMI and fasting glucose levels were higher in patients followed by diabetologists than in other groups. All major CV risk factors and comorbidities were more frequently reported and controlled in patients followed by cardiologists than in the other groups, with the only exception of diabetes. Both European SCORE (4.74.5) and Italian CUORE (13.711.5) were significantly higher in outpatients followed by cardiologists than in those followed by GPs (4.03.6 and 11.59.7) and diabetologists (3.73.5 and 10.39.2) or other SPs (3.32.8 and 9.47.4; P < 0.001 for all comparisons). Conclusions: Despite proper use of drugs and better pharmacological control of major risk factors, both European SCORE and Italian CUORE algorithms reported higher CV risk profile in patients followed by cardiologists than in patients followed by diabetologists, GPs, and other SPs.

Cardiovascular risk profile in patients with myelopathy associated with HTLV-1

HAM/TSP (HTLV-1-associated myelopathy/tropical spastic paraparesis) is a slowly progressive disease, characterized by a chronic spastic paraparesis. It is not known if the disease carries an independent risk for cardiovascular disease. The objective of this study was to evaluate the cardiovascular risk profile related to HAM/TSP and compare it with the general population. MethodsThis was a cross-sectional study, with a control group. HAM/TSP patients were evaluated using cardiovascular risk scores (ASCVD RISK, SCORE and Framingham) and inflammatory markers (ultrasensitive CRP and IL-6), and compared with a control group of healthy individuals. We also evaluated the correlation between cardiovascular risk and the functional status of patients with HAM/TSP evaluated by the FIM scale. ResultsEighty percent of patients in this study were females, mean age of 51 years (11.3). The control group showed an increased cardiovascular event risk in 10 years when ASCVD was analyzed (cardiovascular risk ≥7.5% in 10 years seen in 43% of patients in the control group vs. 23% of patients with HAM/TSP; p=0.037). There was no difference in ultrasensitive CRP or IL-6 values between the groups, even when groups were stratified into low and high risk. There was no correlation between the functional status of HAM/TSP patients and the cardiovascular risk. ConclusionsIn this study, the cardiovascular risk profile of patients with HAM/TSP was better than the risk of the control group.

Effect of Aspalathus Linearis (Rooibos) Supplementation on the Heart and Aortas of Male Wistar Rats Exposed to Antiretroviral Therapy (ART) and the Effects of Rooibos Tea Consumption on the Cardiovascular Risk Profile of Patients on ART

Effect of Aspalathus Linearis (Rooibos) Supplementation on the Heart and Aortas of Male Wistar Rats Exposed to Antiretroviral Therapy (ART) and the Effects of Rooibos Tea Consumption on the Cardiovascular Risk Profile of Patients on ART

Cardiovascular Risk in the Different Phenotypes of Polycystic Ovary Syndrome.

The polycystic ovary syndrome (PCOS) is the commonest endocrine disorder in women of reproductive age and shows substantial phenotypic variability. According to the presence of the three diagnostic criteria of PCOS, i.e. oligo- and/or anovulation, hyperandrogenemia and/or clinical signs of high androgen levels, and polycystic ovaries, four different phenotypes of PCOS are identified. It appears that these phenotypes differ in the prevalence of several established and emerging cardiovascular risk factors. We searched the literature for studies that compared the cardiovascular risk profile of patients with the different phenotypes of PCOS. Patients with both anovulation and hyperandrogenemia have more pronounced insulin resistance and higher levels of proinflammatory and prothrombotic mediators than patients with polycystic ovaries and either anovulation or hyperandrogenemia. Given that these differences appear to be mainly driven by the more pronounced obesity of the former patients, diet and exercise aiming at weight loss should constitute the cornerstone of management of PCOS and should be particularly emphasized in patients with the higher risk phenotypes of the syndrome.

Impact of Chronic Kidney Disease on Risk for Vascular Events.

Chronic kidney disease (CKD) accounts for a significant proportion of the morbidity and mortality in the United States. CKD is defined as glomerular filtration rate (GFR) <60ml/min/1.73m2 or clear evidence of renal damage from biopsy. All-cause cardiovascular risk increases with decreasing GFR. Clinically, detection of CKD is through changes in creatinine clearance which estimates GFR, an indicator of kidney function. We reviewed conventional and nonconventional cardiovascular risk factors associated with CKD. Clinically, we reviewed the status of statins as a treatment option for CKD-induced dyslipidemia. CKD has dramatic consequences on cardiovascular risk profile due to a complex pathophysiologic response to declining kidney function. In this review, we explored new, more accurate methods of detecting decreasing kidney function, discerned risk factors for the development of cardiovascular events, and examined the controversial use of statins for renoprotection. Detection of declining renal function by monitoring creatinine has been the clinical gold standard, but it substantially fluctuates with muscle mass, sex, and ethnicity. Newer methods using cystatin C have been at the forefront as the next substance that will be used for detection of CKD. Traditional and non-traditional risk factors contribute to the cardiovascular risk profile of patients with declining renal function. Statins, along with angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB)s, have been used for renoprotection, but evidence shows only modest benefits in non-dialysis patients. Cardio-renal interaction involves multiple risk factors that contribute significantly to the CKD-induced development of accelerated atherosclerosis, an inflammatory state that causes cardiovascular events.

Cardiovascular risk profile of patients with peripheral arterial occlusive disease during nilotinib therapy.

Over the past few years, data have suggested that severe peripheral arterial occlusive disease (PAOD) is associated with nilotinib exposure. However, the characteristics of this adverse drug reaction are poorly described since its frequency is low. As far as we know, no study using a spontaneous adverse drug reactions reporting system was performed to describe the characteristics of cases of PAOD related to nilotinib. We performed a study to describe the cardiovascular risk profile of cases of PAOD in patients treated with nilotinib spontaneously reported to the French Pharmacovigilance Database (FPVD). We selected all cases of "vascular disorders," as the System Organ Class in MedDRA®, in which nilotinib was "suspected" and recorded in the French Pharmacovigilance Database between 2007 and 21 October 2014. We then identified cases of PAOD with a Low Level Term and through a detailed summary of the clinical description. We identified 25 cases of POAD. Most of the patients were older than 60years (84%) or had another cardiovascular risk factor such as hypercholesterolemia, arterial hypertension, overweight/obesity, smoking, or diabetes mellitus (72%). Females (13 cases) and males (12 cases) were equally represented, but the presence of cardiovascular risk factors was more frequent in females than in males. The mean time from initiation of nilotinib to PAOD onset was 24months and was significantly longer in patients aged less than 60years compared with those aged over 60 years (33.8 ± 24.6months vs. 22.6 ± 17.5months, p = 0.002). Pre-existing cardiovascular risk factors, especially diabetes mellitus, also seem to accelerate its occurrence. The FPVD is a useful tool in describing the cardiovascular risk profile of patients with PAOD during nilotinib exposure. Physicians have to be particularly vigilant in patients older than 60years of age; in patients younger than 60years of age, long-term surveillance has to be maintained.

Impact of Chronic Glucocorticoid Treatment on Cardiovascular Risk Profile in Patients with Systemic Lupus Erythematosus

Systemic lupus erythematosus is highly associated with premature atherosclerosis and cardiovascular events. The origin of this subclinical atherosclerosis has been attributed mainly to the inflammatory nature of the disease. To assess the effect of long-term use of glucocorticoids on cardiovascular risk in patients with systemic lupus erythematosus. We conducted a registry-based retrospective cohort study. We determined 2 periods: (1) Time 0, that is, time of diagnosis and (2) time 1, that is, when the study was finalized. At both times, the cardiovascular risk was evaluated using the Framingham scale and their scores were compared. Afterward, the change magnitude between the 2 times was evaluated and associated with the cumulative glucocorticoids dose. One hundred one patients were included. The mean ± SD age was 26.5 ± 5 years. Length of disease evolution was of 7.8 ± 4.9 years. There was an 8-point increase in the Framingham score, from -8.1 ± 4 to 0.8 ± 7; P < 0.0001. The correlation between the magnitude of the increase in Framingham score and their corresponding cumulative dose showed a coefficient of 0.88; P < 0.001. The glucocorticoids are a primary factor that influences cardiovascular risk. There is a directly proportional relationship between the cumulative glucocorticoid dose and the increase in cardiovascular risk.

The effect of metformin on cardiovascular risk profile in patients without diabetes presenting with acute myocardial infarction: data from the Glycometabolic Intervention as adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III) trial

ObjectiveIn patients with diabetes mellitus, metformin treatment is associated with reduced mortality and attenuation of cardiovascular risk. As a subanalysis of the Glycometabolic Intervention as adjunct to Primary Coronary Intervention...

Role of the Renin-Angiotensin-Aldosterone System and Its Pharmacological Inhibitors in Cardiovascular Diseases: Complex and Critical Issues

Hypertension is one of the major risk factor able to promote development and progression of several cardiovascular diseases, including left ventricular hypertrophy and dysfunction, myocardial infarction, stroke, and congestive heart failure. Also, it is one of the major driven of high cardiovascular risk profile in patients with metabolic complications, including obesity, metabolic syndrome and diabetes, as well as in those with renal disease. Thus, effective control of hypertension is a key factor for any preventing strategy aimed at reducing the burden of hypertension-related cardiovascular diseases in the clinical practice. Among various regulatory and contra-regulatory systems involved in the pathogenesis of cardiovascular and renal diseases, renin-angiotensin system (RAS) plays a major role. However, despite the identification of renin and the availability of various assays for measuring its plasma activity, the specific pathophysiological role of RAS has not yet fully characterized. In the last years, however, several notions on the RAS have been improved by the results of large, randomized clinical trials, performed in different clinical settings and in different populations treated with RAS inhibiting drugs, including angiotensin converting enzyme (ACE) inhibitors and antagonists of the AT1 receptor for angiotensin II (ARBs). These findings suggest that the RAS should be considered to have a central role in the pathogenesis of different cardiovascular diseases, for both therapeutic and preventive purposes, without having to measure its level of activation in each patient. The present document will discuss the most critical issues of the pathogenesis of different cardiovascular diseases with a specific focus on RAS blocking agents, including ACE inhibitors and ARBs, in the light of the most recent evidence supporting the use of these drugs in the clinical management of hypertension and hypertension-related cardiovascular diseases.

Correlation between Subclinical Heart Disease and Cardiovascular Risk Profiles in an Urban Emergency Department Population with Elevated Blood Pressures: A Pilot Study

BackgroundUncontrolled hypertension is a primary risk factor for development of cardiovascular complications. ObjectiveDetermine the point prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction in an urban emergency department (ED) population with elevated blood pressures (BP) and examine correlations between subclinical disease and patient cardiovascular risk profiles. MethodsA convenience sample of patients with EBP (>140/90 on two measurements) had limited bedside echocardiograms (LBE). Subclinical hypertensive heart disease was classified as the presence of: LVH, abnormal ejection fraction (EF), or diastolic dysfunction. ResultsThirty-nine patients with EBP were enrolled. The mean age was 46 years (SD = 10.9), 59% were women, 21% were smokers, and 92% had a history of hypertension. The average body mass index was 30.7 (SD = 8.7). Patients were 67% African American, 23% Latino, 5% Caucasian, 3% Asian, and 3% Native American. Subclinical disease was found in 39%: 31% had LVH, 15% had diastolic dysfunction, and 8% had abnormal EF. On bivariate analysis, elevated BP (p = 0.039) and blood urea nitrogen (p = 0.016) were correlated with subclinical heart disease. After adjusting for other covariates, receiving oral/intravenous antihypertensive medications in the ED (p = 0.005) was associated with subclinical heart disease. ConclusionsWe found a point prevalence of subclinical heart disease of 39% in this urban ED population, using LBE. Real-time identification of subclinical heart disease at early stages in the ED in conjunction with abnormal renal function can help emergency physicians identify those patients in need of more aggressive therapy and urgent follow-up.