Platelet activity and cardiovascular risk in apparently healthy individuals: a review of the data

Cardiovascular disease is a major cause of morbidity and mortality. Numerous risk scores exist to identify healthy individuals at increased risk of developing cardiovascular disease. Although platelets are a key mediator in the pathogenesis of cardiovascular disease, the role of platelet activity measurements and the incidence of cardiovascular disease are uncertain. Platelet aggregometry—the most well studied method of platelet function testing—is associated with risk factors for cardiovascular disease. However, data supporting platelet aggregation and incident cardiovascular disease is conflicting. Plasma markers of platelet activation are promising candidates. Soluble CD40L and P-selectin are easily measured with a standardized ELISA, and there is some data to suggest an association with cardiovascular disease, but further studies are required. While mean platelet volume is a promising candidate, platelet count and bleeding time are not specific for platelet activity nor are they associated with cardiovascular disease in a healthy population. For this field to progress, we recommend large-scale, prospective studies that measure a battery of these platelet function tests in individuals without cardiovascular disease to better understand the associations, if any, between platelet activity and cardiovascular disease.     

Do clinical factors help to predict disease course in inflammatory bowel disease?

While therapeutic strategies able to change the natural history of the disease are developing,it is of major importance to have available predictive factors for aggressive disease to try and target these therapeutic strategies.Clinical predictors have probably been the most broadly studied.In both Crohn's disease(CD) and ulcerative colitis(UC),age at diagnosis,disease location and smoking habit are currently the strongest predictors of disease course.A younger age at onset is associated with more aggressive...     

Chronic kidney disease: effects on the cardiovascular system

Accelerated cardiovascular disease is a frequent complication of renal disease. Chronic kidney disease promotes hypertension and dyslipidemia, which in turn can contribute to the progression of renal failure. Furthermore, diabetic nephropathy is the leading cause of renal failure in developed countries. Together, hypertension, dyslipidemia, and diabetes are major risk factors for the development of endothelial dysfunction and progression of atherosclerosis. Inflammatory mediators are often elevated and the renin-angiotensin system is frequently activated in chronic kidney disease, which likely contributes through enhanced production of reactive oxygen species to the accelerated atherosclerosis observed in chronic kidney disease. Promoters of calcification are increased and inhibitors of calcification are reduced, which favors metastatic vascular calcification, an important participant in vascular injury associated with end-stage renal disease. Accelerated atherosclerosis will then lead to increased prevalence of coronary artery disease, heart failure, stroke, and peripheral arterial disease. Consequently, subjects with chronic renal failure are exposed to increased morbidity and mortality as a result of cardiovascular events. Prevention and treatment of cardiovascular disease are major considerations in the management of individuals with chronic kidney disease.     

Cardiovascular manifestations in patients with COPD

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is characterized mainly by airway obstruction due to chronic bronchitis and/or emphysema. In addition, COPD is frequently associated with other health problems with serious systemic manifestations. In particular, COPD patients are at increased risk of cardiovascular disease. BACKGROUND: Current knowledge about cardiovascular disease in patients with COPD mainly concerns the high prevalence of cardiac arrhythmias in this population. Systemic hypertension, cardiovascular disease, heart failure and cerebro-vascular disease are also frequently encountered. This review discusses the cardiovascular manifestations associated with COPD, excluding right heart failure due to pulmonary hypertension. VIEWPOINTS AND CONCLUSION: Non pulmonary health problems in patients with COPD, such as cardiovascular disease, are arousing increasing interest in the medical community. More studies are needed to increase our knowledge of cardiovascular disease in COPD and allow better medical management of patients.     

Narrative review: hepatobiliary disease in type 2 diabetes mellitus

Diabetes mellitus is the fifth leading cause of death in the United States; 17 million people are affected. Liver disease is one of the leading causes of death in persons with type 2 diabetes. The standardized mortality rate for death from liver disease is greater than that for cardiovascular disease. The spectrum of liver disease in type 2 diabetes ranges from nonalcoholic fatty liver disease to cirrhosis and hepatocellular carcinoma. The incidence of hepatitis C and acute liver failure is also increased. Nonalcoholic fatty liver disease is now considered part of the metabolic syndrome, and, with alcohol and hepatitis C, is the most common cause of chronic liver disease in the United States. Weight reduction and exercise are the mainstays of treatment for nonalcoholic fatty liver disease, but there are promising results with the new thiazolidinediones (pioglitazone and rosiglitazone) as well as metformin and 3-hydroxy-3-methylglutaryl coenzyme A inhibitors.     

Maladie de Fabry : quand y penser ?

Fabry disease is the second most frequent lysosomal storage disorder. It is a X-linked genetic disease secondary to alpha-galactosidase A enzyme deficiency. This is a progressive and systemic disease that affects both males and females. Classical symptoms and organ involvements are acral pain crisis, cornea verticillata, hypertrophic cardiomyopathy, stroke and chronic kidney disease with proteinuria. Nevertheless, organ damages can be missing or pauci-symptomatic and other common symptoms are poorly recognised, such as gastrointestinal or ear involvement. In classical Fabry disease, symptoms first appear during childhood or teenage in males, but later in females. Patients may have non-classical or late-onset Fabry disease with delayed manifestations or with single-organ involvement. Recognition of Fabry disease is important because treatments are available, but it may be challenging. Diagnosis is easy in males, with dosage of alpha-galactosidase A enzyme activity into leukocytes, but more difficult in females who can express normal residual activity. Other plasmatic biomarkers, such as lyso-globotriaosylceramide (lyso-Gb3), are interesting in females, but need to be associated with GLA gene analysis. In this review, we aimed at summarize the main clinical manifestations of Fabry disease and propose a practical algorithm to know how to diagnose this complex disease.     

Cardiovascular involvement in rheumatoid arthritis

Cardiovascular (CV) disease morbidity and mortality are increased in patients with rheumatoid arthritis (RA) and much of the excess CV disease morbidity appears to be due to atherosclerosis. The pathogenesis of atherosclerosis (ATS) in RA is complex and there is increasing evidence that many factors including novel and traditional cardiovascular risk factors, RA treatments and the RA inflammatory disease process are involved in the development of CV disease in these patients. Of particular interest are the effects of chronic inflammation and immune dysregulation associated with RA. These have been shown to be associated with endothelial dysfunction, which is an early, potentially reversible, functional abnormality of the arterial wall. However, as several CV disease risk factors and drug prescribing are also influenced by RA disease severity it is very difficult to separate out the effects of the inflammatory disease burden on the cardiovascular system in RA.     

Long-term Disease Course of Crohn’s Disease: Changes in Disease Location,Phenotype, Activities,and Predictive Factors

Crohn’s disease (CD) is a chronic destructive inflammatory bowel disease that affects young people and is associated with significant morbidity. The clinical spectrum and disease course of CD are heterogeneous and often difficult to predict based on the initial presentation. In this article, changes in the disease location, behavior, clinical course during long-term follow-up, and predictive factors are reviewed. Generally, four different patterns of clinical course are discussed: remission, stable disease, chronic relapsing disease, and chronic refractory disease. Understanding the long-term disease course of CD is mandatory to reveal the underlying pathophysiology of the disease and to move toward a more optimistic disease course, such as remission or stability, and less adverse outcomes or devastating sequelae.     

Increased mortality in chronic kidney disease: a call to action

The mortality rate among patients with chronic kidney disease is much higher than among those without. As glomerular filtration rate declines and patients approach end-stage renal disease, the mortality rate increases and patients at this stage are more likely to die than receive renal replacement therapy. The higher mortality and its underlying causes among chronic kidney disease patients is a serious issue. Lack of physician awareness of chronic kidney disease and its association with excess mortality remains a problem. In this review of current literature, we aim to increase this awareness among health care professionals and the general public and to call for action to improve survival in chronic kidney disease patients. The data strongly suggest that advancing kidney dysfunction leads to increased mortality risk. Contributing to the mortality associated with chronic kidney disease are the comorbidities that accompany this disease state. For instance, patients with chronic kidney disease and comorbidities are at 1.3 to 3.6 times more risk than patients without chronic kidney disease. Further, cardiovascular disease is the leading cause of death among chronic kidney disease patients. It appears that both traditional (such as diabetes mellitus, hypertension, and smoking) and nontraditional risk factors (C-reactive protein and interleukin-6 levels) present in the chronic kidney disease population promote the frequent development of cardiovascular disease. Therefore, therapies targeting both progression of chronic kidney disease and comorbidities such as cardiovascular disease are required to reduce mortality among these patients.     

Changing lesion demographics of the adult with congenital heart disease: an emerging population with complex needs

The demography of congenital heart disease is changing. Largely as a consequence of successful cardiac surgery in childhood, there are an increasing number of adults with congenital heart disease with a prevalence of more than four per 100 adults. The type of disease in adults is also changing with an increasing number of survivors with complex disease. These patients have a significantly increased healthcare requirement in comparison to healthy adults and this includes noncardiac, multisystem morbidity. The adult congenital heart disease population are now developing problems associated with aging and there is a new population of geriatrics with congenital heart disease. As survival continues to improve, increased healthcare resources need to be directed towards the management of the adult with congenital heart disease.     

Radiation Therapy and Cardiovascular Disease Risk in Breast Cancer

The cardiovascular disease risk among the breast cancer population is becoming increasingly important as the population of long-term survivors continues to rise. Radiation therapy decreases local reoccurrence and improves overall survival. These benefits however are not met without challenges including the potential for an increased risk of developing cardiovascular disease. Early clinical trials demonstrate that cardiovascular mortality is increased following radiation therapy compared to those treated without radiation therapy. Cardiovascular disease morbidity is also associated with radiation therapy for women with breast cancer. Among those who are irradiated, potential risk factors including age, surgery type, left-sided disease, dose, and previous cardiovascular disease may increase the risk of developing fatal cardiovascular disease. Newer clinical trials are showing promising results, with a decline in cardiovascular disease risk among those treated with radiation therapy; however, longer-term follow up is needed to confirm these findings.     

Multi-Bed Vascular Disease and Atherothrombosis: Scope of the Problem

While atherosclerosis has traditionally been divided into three types of disease, coronary artery or coronary heart disease (CHD), cerebrovascular disease, and peripheral vascular or peripheral arterial disease (PAD), it is now clear that atherosclerosis is a systemic disease caused by the same pathologic processes regardless of the vascular bed involved. The burden of disease is enormous both in the US and around the world with 61,800,000 Americans affected with one or more types of CVD, responsible for 958,775 deaths annually at a cost of approximately US 329.2 billion dollars annually. Despite trends of decreasing cardiovascular mortality, the global burden of cardiovascular disease is expected to rise, with CHD and stroke becoming the first and fourth most common causes of mortality and morbidity globally. Atherosclerosis is a multibed process with a substantial portion of patients afflicted with disease in more than one bed, although often assymptomatic. Now that there are multiple therapies available to modify and treat atherosclerosis and atherosclerotic risk factors, identification and treatment of these patients are important since their leading cause of death is from co-existing cardiovascular disease.     

Atrial fibrillation in chronic non-cardiac disease: where do we stand?

Atrial fibrillation is the most common arrhythmia, and is associated with increased risk of stroke and death. Most of present knowledge is derived from studies in patients with cardiac disease whilst limited information is available for patients with several chronic non-cardiac conditions like cancer, chronic obstructive pulmonary disease and chronic kidney disease. Although millions of patients are affected and are at risk of adverse prognosis due to co-existent atrial fibrillation, we are left with very limited guidance for management of atrial fibrillation itself and prevention of complications in those patients. In this paper, we review data on incidence, prognostic importance and treatment modalities of atrial fibrillation in patients with cancer, chronic obstructive pulmonary disease, and chronic kidney disease.     

Lyme disease

Lyme disease is a recently described disease of unknown cause that may involve the skin, joints, heart, or nervous system with characteristic symptoms. The disease follows a bite from an Ixodes tick. Symptoms are generally self-limited and despite the varied and sometimes protracted manifestations, the outcome of the disease is favorable. The epidemiologic, clinical, and laboratory features and treatment of Lyme disease are reviewed.     

Buerger's disease with intestinal ischemic involvement

Buerger's disease is uncommon arterial disease that affects mainly young people with heavy smoking history. Ischemic symptoms of upper and lower extremities are clearly defined as the most common kind of presentation. Visceral arteries are rarely affected. We report a case of a 44 year old young female with Buerger's disease and mesenteric ischemic involvement, and a revision of the literature about Buerger's disease with visceral affection. Due to the extreme rarity of the intestinal involvement of Buerger's disease, the early diagnosis is difficult, for this reason all patients affected by Buerger's disease who present intestinal symptoms should be carefully evaluated. Aortography and early laparoscopic revision are very important to limit ischemic intestinal injury and later complications. If hemodynamic instability is present emergency laparotomy at the operating theatre is recommended.     

Genetic basis for congenital heart defects: current knowledge: a scientific statement from the American Heart Association Congenital Cardiac Defects Committee, Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics

The intent of this review is to provide the clinician with a summary of what is currently known about the contribution of genetics to the origin of congenital heart disease. Techniques are discussed to evaluate children with heart disease for genetic alterations. Many of these techniques are now available on a clinical basis. Information on the genetic and clinical evaluation of children with cardiac disease is presented, and several tables have been constructed to aid the clinician in the assessment of children with different types of heart disease. Genetic algorithms for cardiac defects have been constructed and are available in an appendix. It is anticipated that this summary will update a wide range of medical personnel, including pediatric cardiologists and pediatricians, adult cardiologists, internists, obstetricians, nurses, and thoracic surgeons, about the genetic aspects of congenital heart disease and will encourage an interdisciplinary approach to the child and adult with congenital heart disease.     

Cost-effective management of chronic stable angina

In certain patients with stable angina who are at moderate to high risk, coronary bypass surgery or coronary angioplasty are the therapeutic options of choice. However, in selected other patients the use of anti-ischemic drug therapy and secondary prevention reduce episodes of myocardial ischemia and result in a good long-term prognosis. Factors affecting management include the extent of coronary disease, the magnitude of cardiac symptoms, the severity of myocardial ischemia and of left ventricular function. Based upon these and other clinical characteristics, patients can be divided into low-, moderate-, or high-risk categories for morbidity and mortality. Patients at high risk are more likely to be selected for myocardial revascularization and patients at low risk are often treated with medical therapy, at least initially. Based on the available cost-effectiveness data, medical therapy or coronary angioplasty are the preferred initial strategies for low-risk coronary disease, whereas coronary bypass surgery (CABG) is recommended for many high-risk patients, particularly for those with triple-vessel disease and impaired left ventricular function or ischemia at a low workload. CABG is cost-effective for patients with severe angina and left main coronary artery disease and also for patients with mild angina and triple-vessel disease. Coronary angioplasty is cost-effective for patients with severe angina, and single- or multivessel disease. In patients with lesser symptoms and mild coronary disease, the cost effectiveness of myocardial revascularization therapy is less likely to be as good as it is in patients with more extensive disease and severe symptoms.     

Foot problems in patients with diabetes and chronic kidney disease

There is a much higher incidence of diabetic foot disease in those with concurrent renal disease and outcomes, including amputation and mortality, are generally poorer. The risk factors contributing to the higher incidence of foot disease in those with both diabetes and renal disease are outlined, and the evidence explored demonstrating higher incidence of foot disease across categories of renal disease, including impaired renal function (chronic kidney disease stages 3 and 4), haemodialysis, continuous ambulatory peritoneal dialysis, renal transplantation and simultaneous pancreas and kidney transplantation. Three major pathological aspects of diabetic foot disease in which concurrent renal disease either contributes to a higher incidence, or modifies the clinical manifestations and outcomes, are described: ulceration; Charcot neuroarthropathy and necrotic toes. Pathophysiology, clinical features and management strategies for these three conditions are described. Finally, the evidence for preventative strategies for foot disease is explored, and the important role of speed of access to specialist multi-disciplinary diabetic foot services discussed.     

Diagnosing nontuberculous mycobacterial lung disease. A process in evolution

Assessing the impact of the diagnosis if NTM lung disease on the patient and choosing appropriate therapy are separate considerations. Health care professionals have progressed from an era when patients had unrecognized, progressive, and untreated NTM disease to an era when NTM disease is diagnosed frequently but therapy is either unnecessary or possibly worse than the disease. Perhaps the 1990 ATS statement was correct. The problem is not diagnosing patients with NTM lung disease, the problem is deciding what to do with them after they are diagnosed.     

低氧环境下帕金森病与骨质疏松的相关性研究进展

帕金森病是多见于老年人的神经退行性疾病,严重影响患者的生活质量。骨质疏松亦是老年人的一种常见疾病,以易发生骨折为特征的一种全身代谢性骨骼疾病。有研究证明,帕金森病患者更易患骨质疏松,两者具有高度相关性。而低氧环境可能加重帕金森病患者的病情及并发症,其可能机制为缺氧阻断成骨细胞的生长与分化、促进破骨细胞的形成,增加骨质疏...