Progression Of Cardiovascular Disease In Patients Research Articles

Lipoproteins and fatty acids in chronic kidney disease: molecular and metabolic alterations.

Chronic kidney disease (CKD) induces modifications in lipid and lipoprotein metabolism and homeostasis. These modifications can promote, modulate and/or accelerate CKD and secondary cardiovascular disease (CVD). Lipid and lipoprotein abnormalities - involving triglyceride-rich lipoproteins, LDL and/or HDL - not only involve changes in concentration but also changes in molecular structure, including protein composition, incorporation of small molecules and post-translational modifications. These alterations modify the function of lipoproteins and can trigger pro-inflammatory and pro-atherogenic processes, as well as oxidative stress. Serum fatty acid levels are also often altered in patients with CKD and lead to changes in fatty acid metabolism - a key process in intracellular energy production - that induce mitochondrial dysfunction and cellular damage. These fatty acid changes might not only have a negative impact on the heart, but also contribute to the progression of kidney damage. The presence of these lipoprotein alterations within a biological environment characterized by increased inflammation and oxidative stress, as well as the competing risk of non-atherosclerotic cardiovascular death as kidney function declines, has important therapeutic implications. Additional research is needed to clarify the pathophysiological link between lipid and lipoprotein modifications, and kidney dysfunction, as well as the genesis and/or progression of CVD in patients with kidney disease.

Majmaah Bölgesi'nde (Suudi Arabistan Krallığı) Kardiyovasküler Hastalığı Olan Hastalarda Kardiyak Otonom Fonksiyon ile Metabolik Sendrom Arasındaki İlişki: Vaka Kontrol Gözlem Çalışması

Objective: Lacunae in literature persist regarding the mechanisms connected with the progression from metabolic syndrome (MetS) to Type 2 diabetes and cardiovascular disease (CVD). To validate heart rate variability (HRV), as a tool for progression of CVD in patients visiting cardiovascular outpatient clinic. Material and Methods: This crosssectional study involved screening of 126 patients for the presence of one or more cardiometabolic risk factors and followed with HRV measurement after categorizing them as MetS+ or control MetS-. Results: Time domain analysis showed a significant reduction between male and female of MetS- and MetS+ While frequency domain analysis in MetS+ male showed no difference, MetS+ female showed significant difference in TP and HF indices. With increasing number of metabolic components, the MetS+ males exhibited significant decrease in the time domain and increase in frequency domain indices of HRV. Body mass index (BMI), waist circumference (WC), high-density lipoprotein (HDL), and triglyceride (TG) were associated with time and frequency domain of HRV among MetS+ and MetS- males and females. Low density lipoprotein (LDL) was a significant predictor of SDNN, RRSSD, and NN50 in patients with MetS+ while HDL was a significant predictor of Standard deviation of normal-to-normal intervals (SDNN) and pNN50. BMI was significant predictor of SDNN and pNN50 in MetS- patients and NN50 in MetS+ patients. In MetS+, the significant predictor of HF was WC, TG, HDL and LDL and that of LF were TG and LDL while in MetS-, WC was significant predictor of LF and HDL of LF/HF. Conclusion: MetS+ females showed lower vagal activity and decreased sympathetic predominance as compared to MetS males suggesting greater cardiovascular risk.

A Framework to Understand the Progression of Cardiovascular Disease for Type 2 Diabetes Mellitus Patients Using a Network Approach.

The prevalence of chronic disease comorbidity has increased worldwide. Comorbidity—i.e., the presence of multiple chronic diseases—is associated with adverse health outcomes in terms of mobility and quality of life as well as financial burden. Understanding the progression of comorbidities can provide valuable insights towards the prevention and better management of chronic diseases. Administrative data can be used in this regard as they contain semantic information on patients’ health conditions. Most studies in this field are focused on understanding the progression of one chronic disease rather than multiple diseases. This study aims to understand the progression of two chronic diseases in the Australian health context. It specifically focuses on the comorbidity progression of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM), as the prevalence of these chronic diseases in Australians is high. A research framework is proposed to understand and represent the progression of CVD in patients with T2DM using graph theory and social network analysis techniques. Two study cohorts (i.e., patients with both T2DM and CVD and patients with only T2DM) were selected from an administrative dataset obtained from an Australian health insurance company. Two baseline disease networks were constructed from these two selected cohorts. A final disease network from two baseline disease networks was then generated by weight adjustments in a normalized way. The prevalence of renal failure, fluid and electrolyte disorders, hypertension and obesity was significantly higher in patients with both CVD and T2DM than patients with only T2DM. This showed that these chronic diseases occurred frequently during the progression of CVD in patients with T2DM. The proposed network-based model may potentially help the healthcare provider to understand high-risk diseases and the progression patterns between the recurrence of T2DM and CVD. Also, the framework could be useful for stakeholders including governments and private health insurers to adopt appropriate preventive health management programs for patients at a high risk of developing multiple chronic diseases.

Select Articles Published on the Topic of Coronary Heart Disease in 2013

Select Articles Published on the Topic of Coronary Heart Disease in 2013

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Role of Dyslipidemia in Patients With Chronic Kidney Disease

The presence of dyslipidemia is associated with chronic kidney disease (CKD) in patients and likely contributes to the development of both renal disease and cardiovascular disease (CVD). In vitro and animal studies have demonstrated that renal lipid accumulation is nephrotoxic and can play a role in the initiation and/or progression of renal disease. Data from clinical studies have suggested that dyslipidemia is not causative of renal disease but likely contributes to the progression and severity of renal injury in patients. Cardiovascular disease is the leading cause of morbidity and mortality in patients with CKD, and there is extensive literature that supports the use of lipid-lowering agents to inhibit progression of CVD in patients with CKD. Thus, there is great potential for use of lipid-lowering agents to prevent or inhibit progression of CVD in patients with CKD, and, possibly, to limit progression of CKD for these patients as well. Our article reviews the literature identifying the role of dyslipidemia in the development and progression of renal disease in patients, and the effects of lipid-lowering therapy on the progression of renal disease and development and progression of CVD in patients with CKD.

Cardiovascular disease in recent onset diabetes mellitus

Diabetes is associated with a marked increased risk of atherosclerotic vascular disorders, including coronary, cerebrovascular, and peripheral artery disease. Cardiovascular disease (CVD) could account for disabilities and high mortality rates in patients with diabetes. Conventional risk factors, including hyperlipidemia, hypertension, smoking, obesity, lack of exercise, and a positive family history, contribute similarly to macrovascular complications in type 2 diabetic patients and non-diabetic subjects. The levels of these factors in diabetic patients are certainly increased, but not enough to explain the exaggerated risk for macrovascular complications in the diabetic population. Furthermore, recently, macrovascular complications of diabetes have been shown to start before the onset of diabetes. Indeed, several clinical studies have confirmed the increased risk of CVD in patients with impaired glucose tolerance (IGT). Since insulin resistance-related postprandial metabolic derangements are thought to play a central role in the development and progression of CVD in patients with IGT, amelioration of postprandial metabolic disturbance is a therapeutic target for the prevention of CVD in these high-risk patients. Therefore, in this paper, we review the molecular mechanisms for the increased risk of CVD in recent onset diabetes mellitus, especially focusing on postprandial dysmetabolism. We also discuss here the potential therapeutic strategies that specially target the mechanisms responsible for vascular alterations in diabetes.

Clinical Utility of Acarbose, an &amp;#945;-Glucosidase Inhibitor in Cardiometabolic Disorders

Diabetes is associated with an increase risk for cardiovascular disease (CVD). Recently, macrovascular complications of diabetes have been shown to start before the development of diabetes. Indeed, several clinical studies have confirmed the increased risk of CVD in patients with impaired glucose tolerance (IGT). Since postprandial hyperglycemia and insulin resistance are thought to play a central role in the development and progression of CVD in patients with IGT, amelioration of postprandial hyperglycemia as well as insulin resistance is a therapeutic target for the prevention of CVD in these high-risk patients. Acarbose, an alpha-glucosidase inhibitor, delays the absorption of carbohydrate from the small intestine, thereby reducing postprandial hyperglycemia. Further, recently, acarbose has been shown to improve insulin resistance in vivo. These findings suggest that acarbose is a promising metabolic modifier that could reduce the risk of CVD in patients with the metabolic syndrome. In this paper, we review the clinical utility of acarbose in various cardiometabolic disorders.