Prevalence Of Atherosclerotic Disease Research Articles

Prevalence of Atherosclerosis in Psoriatic Patients Detected with Epiaortic Color Doppler Ultrasound and Computed Tomography Angiography.

IntroductionPsoriasis (PsO), a chronic inflammatory, multisystemic, and multifactorial disease can cause endothelial dysfunction, artery calcification, and atherosclerotic disease. A higher incidence of vascular occlusive events has been observed in psoriatic patients compared to healthy controls, and multiple studies confirm the association between moderate-severe PsO and atherosclerosis, coronary artery calcification, and higher cardiovascular risk.ObjectiveWe sought to analyze atherosclerotic disease prevalence in epiaortic vessels of psoriatic and non-psoriatic patients to understand if PsO could represent an independent risk factor predisposing to atherosclerotic disease.MethodsWe evaluated 47 psoriatic patients without cardiovascular risk factors with color Doppler ultrasound (CDUS). If atheromatous plaques were detected, a computed tomography angiography (CTA) was performed. We evaluated 47 non-psoriatic patients without cardiovascular risk factors with CDUS. Atherosclerosis prevalence in both groups were statistically analyzed. CDUS performance was compared to CTA.ResultsIn the psoriatic group (mean age 50.9 years), 6 had atheromatous plaques and 12 had an intima-media thickness (IMT) > 1 mm (overall prevalence of atherosclerotic disease: 38.2%). All plaques detected with CDUS were confirmed at CTA. In the control group (mean age 51.3 years), CDUS revealed atheromatous plaques in 4 patients and IMT > 1 mm in 4 ones (overall prevalence of 17%). The difference of atherosclerotic disease prevalence between the groups was statistically significant (P < 0.05).ConclusionOur results highlight that PsO could be considered a predisposing factor for atherosclerotic disease development in epiaortic vessels, as it causes an increased IMT, that is also considered an independent cardiovascular risk factor.

Prevalence of atherosclerotic diseases and cardiovascular risk factors in military health care centres

The high burden of atherosclerotic diseases is attributable to preventable cardiovascular (CV) risk factors particularly hypertension (HPT), diabetes mellitus (DM), hyperlipidaemia and smoking.

Abstract P047: US Asian Indians Dying With Atherosclerosis Are More Likely To Have Concurrent Diabetes Mellitus

Background: Asian Indians (AI) in the US are known to have a high prevalence of atherosclerotic diseases and diabetes mellitus (DM). However, it is not known if these two cluster as causes of death in AI compared to the rest of US population. Methods: Using 2017 Multiple Cause-of-Death Data from the National Centre for Health Statistics, we included deaths at age ≥ 45 years among US residents where AI vs not-AI could be ascertained (n = 7940 AI; n = 2.6 million not-AI). DM (ICD-10 range: E10-E14) and any atherosclerosis (either of: ischemic heart disease, ischemic stroke, atherosclerosis; ICD-10 range: I20-I25, I69, I70, respectively) as contributing causes of death were identified in AI and not-AI. We calculated dichotomous tetrachoric correlation (Rho) between DM and atherosclerosis as co-occurring contributing causes. To examine whether this association differed by age decade and sex, we calculated the difference in fraction of deaths with DM in those with atherosclerosis versus those without atherosclerosis as a co-occurring cause of death. Results: There were 114,210 atherosclerosis deaths and 24,331 DM deaths in 2017 in the sample. DM and atherosclerosis as contributing causes correlated more strongly in AI (Rho = 0.36, p &lt; 0.001) as compared to not-AI (Rho = 0.31, p &lt; 0.001; difference between groups, p &lt; 0.001). The excess fraction of deaths due to DM when atherosclerosis also contributed vs when atherosclerosis did not contribute was higher in AI men of all ages and in most ages for AI women, except for a group where AI death numbers were smaller (Figure). Conclusion: Our findings highlight the increased burden of co-occurring DM and atherosclerotic disease together contributing as causes of death in AI compared to not-AI in the US. Public health strategies targeted to AI should focus on prevention and clinical treatment of both conditions jointly, in both men and women, especially during young adulthood and middle age.

Relation of Maximum Lifetime Body Mass Index with Age at Hemodialysis Initiation and Vascular Complications in Japan

Objective: The aim of this study was to investigate the association of the maximum lifetime body mass index (max BMI) with hemodialysis initiation and comorbidities in Japanese hemodialysis patients. Methods: In a retrospective cross-sectional study on 724 hemodialysis patients, max BMI, age at hemodialysis initiation, and comorbidities including sleep apnea syndrome, cerebro-cardiovascular diseases, and proliferative diabetic retinopathy (PDR) were analyzed. Early hemodialysis initiation was defined as age <50 years. Result: Diabetes patients showed a higher max BMI and prevalence of atherosclerotic diseases than nondiabetes patients, despite almost the same age at hemodialysis initiation. Patients with early hemodialysis initiation showed higher male ratio, prevalence of PDR, and max BMI than those with later initiation, despite almost equal prevalence of diabetes. Receiver-operating characteristic curve analysis determined a max BMI of 28.4 kg/m² as a reliable cutoff value for predicting early hemodialysis initiation, and this parameter was identified as an independent predictor of early hemodialysis initiation using bivariate logistic regression analysis. Vitrectomy for PDR also tended to contribute independently to early hemodialysis initiation. Conclusion: A high max BMI contributed to early hemodialysis initiation independent of diabetes. Furthermore, PDR was associated with a high max BMI and early hemodialysis initiation. These results suggest that weight reduction in young chronic kidney disease patients with obesity may prevent hemodialysis and blindness.

Higher Cholesterol Level Predicts Cardiovascular Event and Inversely Associates With Mortality in Hemodialysis Patients: 10‐Year Outcomes of the Q‐Cohort Study

The prevalence of atherosclerotic diseases is higher in hemodialysis patients. The aim of the current study was to investigate associations between cholesterol level and the incidences of cardiovascular disease (CVD) and mortality in hemodialysis patients. A total of 3517 participants undergoing maintenance hemodialysis were followed up for 10 years. Total cholesterol (TC) level was divided into quartile in baseline data. The multivariate analyses were calculated by a Cox proportional hazards model. The incidences of ischemic heart disease (IHD), peripheral artery disease (PAD), and CVD were significantly positively associated with higher cholesterol levels after adjustment for confounding factors (P < 0.01, P = 0.04, and P < 0.01, respectively). Furthermore, the incidences of cancer-associated mortality and all-cause mortality were significantly positively associated with lower cholesterol levels after adjustment for confounding factors (both P < 0.01). The lowest TC level at all-cause mortality risk was 179 mg/dL. From these results, higher TC predicts IHD, PAD, and CVD events, and lower TC predicts cancer-associated mortality and all-cause mortality in patients undergoing maintenance hemodialysis.

Review of Stroke: The 2nd International and the 8th National Iranian Stroke Congress : Shiraz, Iran

Dear reader,Stroke is a major health problem in Iran as other developing countries. Meanwhile, epidemiological characteristics of stroke in Iranian population are different with other countries. Both population-based and hospital-based studies showed that incidence and mortality of stroke in Iran is higher than most western countries [1,2]. Higher rates of patients with young-adult stroke in Iranian population are a prominent feature too [3]. In the same time, prevalence of cerebral venous sinus thrombosis is higher than western populations [4] but the frequency of the intracranial stenosis is more or less same as Europeans [5]. The high prevalence of atherosclerotic disease in Iran can be attributed to social and economic factors, including increased life span, changes in dietary habits and an increasingly sedentary lifestyle [6]. In the light of these changes, Iranian health policymakers should consider concerted primary and secondary preventive measures to reduce the impact of this increasingly problematic public health issue.Iranians who have had a stroke consider their social, financial and rehabilitative support to be inadequate. Moreover, awareness of the manifestations of stroke is poor in the Iranian general population [7]. Consequently, the clinical status of stroke patients by the time they are transferred to the referral center may be worse than it could have been. There is an urgent need for Iranian hospitals to develop better measures to manage acute stroke patients.The second international Iranian stroke congress was held from 23-25 September 2015 in Shiraz, Iran. This Conference was a joint effort of the Clinical Neurology Research Center of Shiraz University of Medical Sciences and Iranian Stroke Association.Here we presented some selected reviews from outstanding platforms of this congress. Ghandehari presented the epidemiology of stroke in Iran [8]. Safari et al presented a comprehensive review about immunology of stroke [9]. Abolhasani-Foroughi and Nazeri summarized the role of Computed topography scan for diagnosis and treatment planning of stroke patients [10].Lotfi discussed about pearls and pitfalls of color doppler sonography of cervical arteries [11]. We also have three reviews about clinical and radiologic aspects of cerebral venous sinus thrombosis [12-14]. Two reviews focused on importance of rehabilitation in new stroke era [15,16].

Abstract 100: Extracranial Vertebral Artery Atherosclerotic Disease in Patients With Symptomatic Stenosis of the Internal Carotid Artery. The North American Symptomatic Carotid Endarterectomy Trial

Background and Purpose: The prevalence of atherosclerotic disease of extracranial vertebral artery and associated long-term outcomes in patients with stenosis of the internal carotid artery (ICA) are not well defined. Methods: We ascertained the rates of any stroke, vertebrobasilar stroke, and all-cause mortality over 5 years associated with various categories of extracranial vertebral artery disease based on angiographic severity (&lt;30%, 30-69%, 70-99%, and occlusion) in patients with symptomatic ICA stenosis who participated in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). We also studied the relative benefit of carotid endarterectomy in reduction of ipsilateral stroke in patients with various categories of extracranial vertebral artery disease after adjusting for age, gender, and severity of ICA stenosis. Results: Among the 798 patients who underwent angiographic catheterization of extracranial vertebral artery, the severity of stenosis was categorized as &lt;30% (n=342), 30-69% (n=164), 70-99% (n=70), and occlusion (n=30). Compared with those with stenosis &lt;30%, the relative risk of any stroke was similar between those with 30-69% (relative risk (RR) 1.1, 95% confidence interval [CI] 0.9-1.3 ), 70-99% (RR 0.9, 95% CI 0.7-1.3), and occlusion (RR 1.2, 95% CI 0.8-1.9) after adjustment for age, gender, severity of ICA stenosis, and allocated treatment (endarterectomy versus medical treatment). The relative risk of vertebrobasilar stroke was two folds higher in patients with extracranial vertebral artery stenosis 70-99% compared with those with &lt;30% stenosis (RR 2.1, 95% CI 0.8-5.2) after adjusting for potential confounders. The relative benefit of carotid endarterectomy over medical treatment was similar according to categories of extracranial vertebral artery disease: &lt;30% (RR 0.6, 95% CI 0.3-0.9), 30-69% (RR 0.3, 95% CI 0.2-0.9), 70-99% (RR 0.6, 95% CI 0.2-2.4), and occlusion (RR 0.4, 95% CI 0.07-2.9) Conclusions: The increased risk of vertebrobasilar stroke in patients with symptomatic ICA stenosis who have concurrent extracranial vertebral artery disease supports critical evaluation of additional endovascular treatment options in such patients.

Abstract 15920: The Prevalence of Atherosclerotic Disease in Those With Connective Tissue Disease as a Function of Age, Race, and Traditional Risk Factors

Background: Atherosclerosis is a multifactorial disease with an intrinsic inflammatory component, but it may also be influenced by systemic inflammation. There is cardiovascular risk associated with rheumatoid arthritis (RA), but there is still a need to clarify the contributions of traditional risk factors in those with inflammatory connective tissue diseases (CTD, which includes RA) in the development of atherosclerotic cardiovascular disease (ASCVD). It would also be useful to identify particular groups of patients that are at disproportionately greater conferred risk for ASCVD owing to their CTD. For these reasons, a cross-sectional analysis of a diverse patient population could help develop finer ASCVD risk estimations in those with and without CTD. Results: A systematically queried warehouse of de-identified data from over a quarter-million adult patients at our urban medical center over the past six years showed that prevalence of ASCVD steadily increases with age, consistent with rates found in other large cohorts, in both white and African-American patients. Amongst the ~9,000 patients with CTD (RA, other inflammatory polyarthropathy, lupus, Sjögren’s syndrome, systemic sclerosis, dermatomyositis, polymyositis), the overall prevalence of ASCVD was higher than amongst those without CTD with a rate ratio of 1.9 [95% CI 1.8-2.1] for white patients and 3.3 [95% CI 3.1-3.5] for African-American patients. Subgroup analysis revealed that the rate ratio was particularly high for young adults, and especially young African-American patients (ages 18-44; rate ratio for women: 10.7 [95% CI 8.5-13.5], for men: 9.9 [95% CI 6.8-14.5]). Rate ratios of ASCVD in those with vs. without CTD declined with age as traditional risk factors became more prevalent. Importantly, in those without any documented traditional risk factors (smoking, hypertension, diabetes, dyslipidemia), a diagnosis of ASCVD was found nearly three times more frequently in those with CTD than without [rate ratio 2.9, 95% CI 2.4-3.5]. Conclusions: CTD is associated with increased ASCVD rates, and major traditional risk factors do not fully account for these increased rates. African-Americans and young adults have a disproportionately strengthened association between CTD and ASCVD.

FEATURES OF CYTOKINE PRODUCTION IN PATIENTS WITH UNSTABLE ANGINA: DEPENDENCE ON ETHNICITY IN THE REPUBLIC OF SAKHA (YAKUTIA)

Abstract. We investigated levels of spontaneous and mitogen-induced cytokine production (IL-1β, IL-4, IL-6, IL-10 and IFNγ) by peripheral blood cells of 24 men with unstable angina (UA), including indigenous population (n = 12, Yakuts), and a group of Russian migrants to the Republic of Sakha (n = 12). Activation of inflammatory response was revealed in the total group of patients with UA, manifesting by increase of spontaneous and induced production of the pro-inflammatory IL-1β, IL-6 cytokines, and mitogen-induced production of IFNγ. As compared with healthy individuals, spontaneous and induced production of anti-inflammatory IL-4 was decreased in UA patients, whereas the mitogen-induced production of IL-10 proved to be enhanced. Therefore, it is highly possible that a pro-atherogenic Th1-immune response is developing during UA, along with suppression of Th2-driving response. The differences revealed for different ethnic groups suggest that severity and prevalence of atherosclerotic disease, which is more common in the non-native patients, is associated with increased production of pro-inflammatory IL-1β and IL-6 cytokines.

Peripheral arterial disease in the Middle East: Underestimated predictor of worse outcome

Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis and is associated with significant morbidity and mortality. The prevalence of PAD in the developed world is approximately 12% among adult population, which is age-dependent and with men being affected slightly more than women. Despite the strikingly high prevalence of PAD, the disease is underdiagnosed. Surprisingly, more than 70% of primary health care providers in the US were unaware of the presence of PAD in their patients. The clinical presentation of PAD may vary from asymptomatic to intermittent claudication, atypical leg pain, rest pain, ischemic ulcers, or gangrene. Claudication is the typical symptomatic expression of PAD. However, the disease may remains asymptomatic in up to 50% of all PAD patients. PAD has also been reported as a marker of poor outcome among patients with coronary artery disease. Despite the fact that the prevalence of atherosclerotic disease is increasing in the Middle East with increasing cardiovascular risk factors (tobacco use, diabetes mellitus and the metabolic syndrome), data regarding PAD incidence in the Middle East are scarce.

Circulating pro-inflammatory CD4posCD28null T cells are independently associated with cardiovascular disease in ESRD patients

Cytomegalovirus seropositivity is associated with an increased risk for cardiovascular disease in end-stage renal disease (ESRD) patients. Circulating pro-inflammatory CD4posCD28null T cells are expanded in cytomegalovirus-seropositive ESRD patients and potentially could mediate atherosclerotic plaque instability and rupture. In this study, we tested the hypothesis that increased numbers of circulating CD4posCD28null T cells may represent a risk factor for cardiovascular disease in ESRD patients. Prospectively collected data from 240 cytomegalovirus-seropositive stable ESRD patients were analysed. Traditional cardiovascular risk factors (age, smoking, hypercholesterolaemia and diabetes mellitus) and the percentage and absolute number of CD4posCD28null T cells were significantly associated with the presence of atherosclerotic disease, after univariate and multivariate statistical analysis. An ~2-3-fold increase in the prevalence of atherosclerotic disease was noted between patients with the highest and lowest number of CD4posCD28null cells. CD8posCD28null T-cell populations were also significantly expanded in cytomegalovirus-seropositive ESRD patients and closely correlated with the number of CD4posCD28null T cells. However, this cell population was not related to an increased prevalence of cardiovascular disease. Cytomegalovirus-seropositive ESRD patients may have substantially increased numbers of circulating pro-inflammatory CD4posCD28null T cells that are independently associated with the presence of atherosclerotic disease. The expansion of these cells may therefore represent a novel non-traditional cardiovascular risk factor for ESRD patients.

Psoriasis: Can statins play a dual role?

Recently, a strong association between "psoriasis" and "atherosclerosis" has emerged. Psoriasis patients have an increased prevalence of atherosclerotic disease including coronary artery, cerebrovascular, and peripheral vascular diseases. The exact connection between psoriasis and atherosclerosis remains unclear, but it is thought that inflammation, which plays an important role in both diseases, may be the causative link. Nevertheless, psoriasis patients suffer from an increased burden of atherosclerotic disease and most commonly die from "coronary artery disease" (CAD). Psoriatic patients have an increased prevalence of CAD risk factors and an increased risk of myocardial infarction (MI). One CAD risk factor in psoriasis patients that can easily be managed is "hyperlipidemia." "Statins" are safe, cost-effective, and have been proven to be highly effective in preventing CAD, including MI, in patients with hyperlipidemia. Furthermore, in addition to their lipid lowering properties, statins have anti-inflammatory immunomodulator activities that may be beneficial in several autoimmune diseases including psoriasis. Considering the safety and cost-effectiveness of statins, we feel that it is worth investigating if statins can play a dual role in psoriasis by treating the increased atherosclerotic disease burden in these patients through their lipid lowering effects and by decreasing psoriatic disease activity through their anti-inflammatory immunomodulatory properties.

Prävention der koronaren Herzerkrankung

Coronary artery disease is still the leading cause of premature death, reduction in physical work capacity and diminished quality of life in western civilizations. Given the fact that coronary artery disease is a preventable disease in most of the cases, its prevalence remains unacceptably high. Consequent application of preventive recommendations with regards to life-style aspects like tobacco use, nutrition, overweight and physical activity could help to reduce the prevalence of atherosclerotic diseases by half. Aim of this review is to focus the reader's attention to the most important risk factors, their influence on progression of atherosclerotic lesions and ways to reduce risk factor burden.

Carotid intima‐media thickness and markers of inflammation, endothelial damage and hemostasis

Background. Different soluble molecules involved in inflammation, endothelial damage, or hemostasis are recognized as potential cardiovascular risk markers. Studies to assess the role of these markers in the atherosclerotic process by evaluating their relationship to carotid intima‐media thickness (C‐IMT) tend to provide contrasting results.Purpose. To perform a review of studies addressing the association between C‐IMT and soluble markers and to investigate whether the observed inconsistencies could be explained by the characteristics of the patients included in different studies, for example prevalence of atherosclerotic disease (atherosclerotic burden), gender, age, or occurrence of specific vascular risk factors (VRFs).Data sources. PubMed and Embase (January 1990 to March 2006).Study selection. Articles in English reporting original cross‐sectional studies.Data extraction. Two authors independently extracted data on study design, population, sample size, ultrasonic methodology, and statistical approach.Data synthesis. Despite the marked heterogeneity of results presented in the literature, meta‐analysis established that studies showing positive associations between C‐IMT and plasma levels of C‐reactive protein (CRP) or fibrinogen are in the majority. Funnel plot analyses suggested the absence of an important publication bias. Data on the relationships between C‐IMT and other soluble markers are by contrast scanty, contradictory, or unconfirmed by multivariate (as opposed to univariate) analyses, and the freedom from publication bias here cannot be vouched for. The degree of atherosclerotic burden in the population studied does not account for the heterogeneity of findings reported. Gender, noninsulin‐dependent diabetes mellitus (NIDDM) and hypercholesterolemia influence the association between C‐IMT and CRP. Blood pressure and hypercholesterolemia influence the association between C‐IMT and fibrinogen. For all the other soluble markers considered, the number of groups was too small for this kind of statistical considerations.Limitations. Heterogeneity in ultrasound methodologies and in statistical approach limited comparability between studies. For most soluble markers, publication bias of positive results cannot be excluded.Conclusions. Only CRP and fibrinogen seem to be unequivocally related to C‐IMT. For all the other soluble markers considered, no clear‐cut conclusions can be drawn.

Controlled release systems of angiogenic growth factors for cardiovascular diseases

Worldwide, there is a growing number of patients with myocardial ischemia and limb ischemia associated with the aging population and an increased prevalence of atherosclerotic diseases. Medical therapy, percutaneous angioplasty and surgical revascularization are the present treatments of choice, but such treatments are not feasible for some patients with severe atherosclerosis. Therapeutic angiogenesis using growth factors or progenitor cells has drawn great attention as a favorable alternative treatment for such patients. This review discusses clinical trials using angiogenic growth factors for myocardial ischemia and limb ischemia, and also introduces a novel controlled release system for growth factors using a gelatin hydrogel.

The methylguanidine-to-creatinine ratio, serum NOx concentrations, and vascular disease in nondiabetic hemodialysis patients

Background. Hemodialysis (HD) patients are in a highly oxidative state, which may contribute to accelerated atherosclerosis. Methylguanidine (MG) and lipid peroxides may be used as markers of the oxidative status in HD patients. A recent study demonstrated the non-enzymatic generation of nitric oxide (NO) via a reaction between hydrogen peroxide and arginine. We determined the relationships between serum concentrations of the oxidation products of NO (NOx) and oxidative status markers, and the relationships between these markers and the prevalence of atherosclerotic disease in HD patients. Methods. We measured serum concentrations of MG, creatinine (Cr), NOx, and thiobarbituric acid reactive substances (TBARS), and determined the presence of apparent vascular disease in 324 nondiabetic HD patients. Results. The MG concentration, but not the NOx concentration, was correlated with the Cr concentration (r = 0.64; P < 0.001). Based on simple linear regression analysis, the NOx concentration (r = 0.13; P < 0.05) correlated with the MG/Cr ratio, but did not correlate with the TBARS concentration. Multiple linear regression analysis revealed that the serum NOx concentration (r = 0.13; P < 0.01) and the duration of dialysis (r = 0.13; P = 0.05) correlated with the MG/Cr ratio. There were no significant differences in the concentrations of NOx, TBARS, or the MG/Cr ratio between HD patients with and without vascular disease. Multivariate logistic regression analysis showed that only age and hypertension were independent risk factors for prevalent vascular disease. Conclusions. These results suggest that non-enzymatic synthesis of NO via oxidative stress may occur in HD patients. However, the serum markers of oxidation status at any one single moment may not correlate with the prevalence of apparent vascular disease in HD patients.

Heart and carotid artery disease in stroke patients with intermittent claudication.

Much has been published on the natural history of intermittent claudication (IC), but little is known about the clinical features of stroke patients with IC. The purpose of this study was to examine clinical features and risk factors in stroke patients with or without IC, including heart disease and carotid artery disease. A hospital-based study was conducted of 3901 stroke patients, who were prospectively coded and entered into a computerized databank. Of these patients, 219 had symptoms of IC. Patients were subdivided by age into 10-year categories. There were at least 12 times more non-IC than IC patients in each category. An age-matched random sample was obtained containing 12 non-IC cases for each IC case, resulting in 219 cases of IC and 2628 non-IC cases. The prevalence of IC in the total stroke population was 5.6%. IC prevalence increased sharply with age until about 70 years. Cardiac ischaemia and internal carotid artery (ICA) disease were significantly more frequent in stroke with IC than without IC. IC patients also exhibited a higher prevalence of atherosclerotic disease as well as other risk factors such as smoking, hypercholesterolaemia, elevated haematocrit, and family history of stroke. Ischaemic heart disease and ICA disease are especially common in stroke with IC. IC, large artery disease and stroke share similar risk factors. IC symptoms in stroke patients may indicate extensive generalized atherosclerosis.

Increased thrombus formation relates to ambient blood glucose and leukocyte count in diabetes mellitus type 2

The prevalence of atherosclerotic disease is increased in type 2 diabetes mellitus, and its thrombotic complications cause the high morbidity and mortality from coronary heart disease, cerebrovascular disease, and peripheral vascular disease. 1 Kannel W.B. D’Agostino R.B. Wilson P.W. Belanger A.J. Gagnon D.R. Diabetes, fibrinogen, and risk of cardiovascular disease the Framingham experience. Am Heart J. 1990; 120: 672-676 Abstract Full Text PDF PubMed Scopus (314) Google Scholar , 2 Grundy S.M. Benjamin I.J. Burke G.L. Chait A. Eckel R.H. Howard B.V. Mitch W. Smith S.C. Sowers J.R. Diabetes, and cardiovascular disease. A statement for healthcare professionals from the American Heart Association. Circulation. 1999; 100: 1134-1136 Crossref PubMed Scopus (1636) Google Scholar , 3 Aronson D. Rayfield E.J. Chesebro J.H. Mechanism determining course and out come of diabetic patients who have had acute myocardial infarction. Ann Intern Med. 1997; 126: 296-306 Crossref PubMed Scopus (272) Google Scholar , 4 Aronson D. Bloomgarden Z. Rayfield E.J. Potential mechanisms promoting restenosis in diabetic patients. J Am Coll Cardiol. 1996; 27: 528-535 Abstract Full Text PDF PubMed Scopus (308) Google Scholar Diabetes is known to affect the thrombogenicity of the vessel wall and circulating blood. This study aims to examine the blood thrombogenicity in diabetes by controlling the vessel wall-related factors of thrombogenicity. Hyperglycemia seems to influence the thrombogenicity of the circulating blood by the following mechanisms: (1) platelet function and aggregability are altered, 5 Davi G. Averna M. Catalano I. Barbagallo C.M. Giovenco E. Carroccio A. Notarbartolo A. Strano A. Platelet function in patients with type 2 diabetes mellitus the effect of glycaemic control. Diabetes Res. 1989; 10: 7-12 PubMed Google Scholar , 6 Rauch U. Ziegler D. Piolot R. Schwippert B. Benthake H, Schultheiss HP, Tschoepe D. Platelet activation in diabetic cardiovascular autonomic neuropathy. Diabet Med. 1999; 16: 848-852 Crossref PubMed Scopus (34) Google Scholar (2) the balance between blood coagulation and fibrinolysis is affected, 7 Ceriello A. Coagulation activation in diabetes mellitus the role of hyperglycemia and therapeutic prospects. Diabetologia. 1993; 36: 1119-1125 Crossref PubMed Scopus (278) Google Scholar , 8 Hughes A. McVerry B.A. Wilkinson L. Goldstone A.H. Lewis D. Bloom A. Diabetes, a hypercoagulable state? Hemostatic variables in newly diagnosed type 2 diabetic patients. Acta Haematol. 1983; 69: 254-259 Crossref PubMed Scopus (48) Google Scholar , 9 Rao A.K. Chouhan V. Chen X. Sun L. Boden G. Activation of the tissue factor pathway of blood coagulation during prolonged hyperglycemia in young healthy men. Diabetes. 1999; 48: 1156-1161 Crossref PubMed Scopus (99) Google Scholar and (3) leukocyte activation and procoagulant activity is increased in the diabetic state. 10 Tschoepe D. Rauch U. Schwippert B. Platelet-leukocyte cross-talk in diabetes mellitus. Horm Metab Res. 1997; 29: 631-635 Crossref PubMed Scopus (84) Google Scholar , 11 Bazzan M. Gruden G. Stella S. Vaccarino A. Tamponi G. Olivetti C. Giunti S. Cavallo-Perin P. Microalbuminuria in IDDM is associated with increased expression of monocyte procoagulant activity. Diabetologia. 1998; 41: 767-771 Crossref PubMed Scopus (14) Google Scholar Although the effects of diabetes on different platelet and leukocyte functions have already been assessed by several in vitro tests, studies evaluating thrombus formation under defined rheologic conditions that mimic in vivo blood flow in a mildly stenosed coronary artery have not been performed. To assess blood thrombogenicity independent of the effects of diabetes on the vasculature, ex vivo thrombus formation was examined by perfusing nonanticoagulated blood of patients with type 2 diabetes and of controls over a defined thrombogenic substrate. The blood thrombogenicity was correlated with ambient blood glucose level and total leukocyte count.

Increased Fibrinogen Levels and Hemostatic Abnormalities in Patients with Arteriolar Nephrosclerosis: Association with Cardiovascular Events

Increased plasma fibrinogen levels and hemostatic abnormalities suggestive of a prothrombotic state are present in patients with end-stage renal failure and could contribute to increased cardiovascular morbidity in these patients. We investigated the relationship between abnormalities of the hemostatic system and the degree of renal failure and whether these abnormalities are associated with increased prevalence of cardiovascular events in patients with arteriolar nephrosclerosis. In 425 patients recruited at a hypertension clinic we assessed the renal function by creatinine clearance, urinary protein excretion, and microalbuminuria, the prevalence of atherosclerotic disease, and measured prothrombin time, activated partial thromboplastin time. fibrinogen, prothrombin fragment 1+2 (F1+2), D-dimer, and antithrombin. Early impairment of renal function (creatinine clearance, 30 to 89 ml/min per 1.73 m2 of body surface area) caused by arteriolar nephrosclerosis was found in 172 patients. Patients with early renal failure were significantly older and had significantly greater values of blood pressure, plasma fibrinogen, F1+2, and D-dimer than patients with normal renal function. Elevated D-dimer and fibrinogen levels were independently associated with the presence of decreased creatinine clearance. Log fibrinogen, log F1+2, and log D-dimer were inversely correlated with creatinine clearance. The prevalence of coronary artery, cerebrovascular, and peripheral vascular disease was significantly greater in patients with mild renal failure than in those with normal renal function. Elevated levels of fibrinogen and D-dimer were associated with the presence of atherosclerotic disease independent of renal function and other risk factors. In conclusion, changes in hemostatic parameters occur early in the course of renal failure in patients with arteriolar nephrosclerosis, suggesting a prothrombotic state that may contribute to the risk for atherosclerotic disease at all levels of renal function.

Lipoprotein(a) and apolipoprotein(a) isoforms and proteinuria in patients with moderate renal failure

Atherosclerotic diseases are a major cause of death in patients with renal failure. Increased serum concentrations of lipoprotein(a) [Lp(a)] have been established as a genetically controlled risk factor for these diseases and have been demonstrated in patients with moderate renal failure, suggesting that this lipoprotein contributes to the increased cardiovascular risk seen in these patients. Variable alleles at the apolipoprotein(a) [apo(a)] gene locus are the main determinants of the serum Lp(a) level in the general population. The purpose of this study was to investigate apo(a) isoforms in patients with moderate renal failure and mild proteinuria (less than 1.0 g/day). In 250 consecutive subjects recruited at a hypertension clinic, we assessed the renal function by 24-hour creatinine clearance, proteinuria, and microalbuminuria, as well as the prevalence of atherosclerotic disease, and we also measured apo(a) isoforms, serum albumin, and Lp(a) concentrations. Moderate impairment of renal function (creatinine clearance, 30 to 89 ml/min per 1.73 m2 of body surface area) was found in 97 patients. Lp(a) levels were significantly greater in patients with moderate renal failure (21.7+/-23.9 mg/dl) as compared with patients with normal renal function (15.6+/-16.4 mg/dl, P<0.001), and an inverse correlation was observed between log Lp(a) and creatinine clearance (r = -0.181, P <0.01). However, no difference was found in the frequency of low molecular weight apo(a) isoforms between patients with normal (25.5%) and impaired (27.8%) renal function. Only patients with the smallest size apo(a) isoforms exhibited significantly elevated levels of Lp(a), whereas the large-size isoforms had similar concentrations in patients with normal and impaired renal function. No significant relationship was found between serum Lp(a) and proteinuria. Clinical and laboratory evidence of one or more events attributed to atherosclerosis was found in 9.8% of patients with normal renal function and 25.8% of patients with moderate renal failure (P<0.001). These results indicate that renal failure per se or other genes beside the apo(a) gene locus are responsible for the elevation of serum Lp(a) levels in patients with moderate impairment of renal function. The elevation of Lp(a) levels occurs independently of the level of proteinuria and may contribute to the risk for atherosclerotic disease in these patients.