The Use of Gamma Linolenic Acid in the Prevention and Treatment of Diabetic Neuropathy

A substantial disturbance of the metabolism of the n-6 essential fatty acids (EFAs) exists in both human and experimental diabetes mellitus. The process of conversion of dietary linoleic acid to gammalinolenic, dihomogammalinolenic and arachidonic acids, and other polyunsaturates is inadequate in diabetic patients. Disturbances of these EFAs and the 1– and 2–series prostaglandins derived from them cause a variety of microvascular, haemorheological, and other abnormalities leading to reduced blood flow and neural hypoxia. This will in turn produce an escalating cycle of further hypoxia through the generation of oxygen-free radicals and aggravation of neural capillary endothelial damage. Endoneurial hypoxia impairs axonal transport, produces demyelination, and reduces neural ATP-ase activity. Furthermore, depletion of polyunsaturated fatty acids derived from n-6 pathway may lead to abnormalities of myelin turnover, membrane-bound proteins (such as enzymes and receptors) and other axonal structural abnormalities. The disorders postulated here may synergistically interact with the metabolic changes described in both the glycosylation and the myoinositol hypotheses and may have important implications in the approach to treat diabetic neuropathy.     

The Prevention of Cardiovascular Disease in Older Adults

Cardiovascular disease (CVD) is common in older adults. CVD is a significant cause of both death and disability in old age. Though the prevention and treatment of CVD have been extensively studied, historically older adults and especially those older than 75 years have been underrepresented in clinical investigations designed to determine the best way to prevent or treat CVD. As a result, geriatrics clinicians frequently need to decide which interventions to recommend for their patients by extrapolation from existing data, which may or may not be applicable to the patients they are caring for. This narrative review summarizes existing data regarding the prevention of three common CVDs in older adults: stroke, coronary artery disease, and peripheral artery disease. Special emphasis is given to the prevention of CVD in those aged 75 years or older. J Am Geriatr Soc 68:1098–1106, 2020     

Statin Use for Primary Cardiovascular Disease Prevention Is Low in Inflammatory Arthritis

BackgroundPatients with inflammatory arthritis (IA) are at high risk for atherosclerotic cardiovascular disease (ASCVD), yet management of dyslipidemia is infrequently prioritized. We applied Canadian dyslipidemia guidelines to determine how many patients with IA would be eligible for primary prevention with statins.MethodsWe conducted a cross-sectional study of patients with IA in a cardio-rheumatology clinic, with no known CVD and without statin therapy at cohort entry. We stratified patients by Framingham Risk Score (FRS) and summarized the proportion meeting guideline statin-indicated criteria. Multivariable logistic regression analyses determined the association of variables with statin indication after adjustment for age, sex, traditional ASCVD risk factors, and arthritis characteristics.ResultsAmong 302 patients, most had rheumatoid arthritis (59%). Mean age was 58 years, and 71% were female. Overall, 50% of the cohort was eligible for statin therapy. The majority was low FRS risk category (68%), and the most frequent qualifier for statins was elevated apolipoprotein B (ApoB) levels or low-density lipoprotein cholesterol (LDL-c) levels. In the intermediate FRS group, 91% met criteria for statin therapy based on the presence of a coronary artery calcification (CAC) score > 0 or an elevated high-sensitivity C-reactive protein. Male sex, hypertension, elevated ApoB, and a CAC score > 0 were the factors most strongly associated with indication for statin therapy.ConclusionsStatin therapy is suboptimal in IA despite a significant number of patients meeting indication based on lipoprotein thresholds or CAC scores. Understanding the barriers and potential facilitators of implementing and interpreting these CVD screening tools in IA is needed.     

Expediency of the Use of Fibrates for Primary and Secondary Prevention of Cardiovascular Complications

Fibrates primarily cause lowering of triglycerides and elevation of high density cholesterol levels. In WHO, HHS and VA-HIT trials fibrates were shown to decrease development of complications of cardiovascular diseases. Efficacy of fenofibrate in subjects with moderate risk and type 2 diabetes combined with mild dyslipidemia was studied in the placebo controlled FIELD study. Administration of fenofibrate was associated with insignificant 11% decrease of cardiovascular events (19% decrease after adjustment for statin use) and significant 24% decrease of nonfatal myocardial infarctions. Among effects on secondary end points were significant decreases of coronary revascularizations (-21%), strokes (-11%) and requrements in laser therapy for diabetic retinopathy (-30%). Fenofibrate also caused significant slowing of progression of albuminuria and nephropathy. Fenofibrate can be used in subjects with high coronary risk and metabolic syndrome combined with atherogenic dyslipidemia (total cholesterol/high density lipoprotein cholesterol >4 mmol/l), as well as in patients with moderate and pronounced hypertriglyceridemia or normal or elevated high density lipoprotein cholesterol. One of important indications for administration of fenofibrate is type 2 diabetes without ischemic heart disease but with microvascular complications. Fenofibrate can be also used in combination with other lipid lowering drugs (e.g. statins) in primary and secondary prevention for facilitation of achievement of target lipid levels.     

他汀类药物预防心血管病事件的非调脂机制

他汀类药物可以竞争性地抑制胆固醇生物合成初期阶段的限速酶 ,从而减少胆固醇的生物合成 ,加强血液中低密度脂蛋白 (ＬＤＬ)及ＬＤＬ前体的清除[1] 。有关于他汀类药物的临床试验[2 ,3 ] 都证实他汀类药物不仅可调整血脂水平 ,而且可减少致死性和非致死性心血管病事件[4 ,5] 。同时发现他汀类药物治疗带来的临床益处远超出其调脂作用所产生的。这就使人们思考是否存在着其它非调脂机制[6 ] ,对心血管病的发生、发展起到抑制作用。本文就此综述如下。1　改善内皮功能研究发现许多急性心肌梗死患者其冠脉血管造影仅有轻中度病变 ,远不足以导…     

Current Use of Statins for Primary Prevention of Cardiovascular Disease: Patient-Reported Outcomes and Adherence

Recent updates in atherosclerotic cardiovascular disease (ASCVD) risk assessment and management guidelines have expanded the global number of statin-indicated persons, prompting clinicians to rethink conversations about initiating new statin therapy. The benefits of statins in primary prevention of ASCVD are less convincing than in secondary prevention, although higher ASCVD risk is associated with greater statin benefit. Therefore, clinicians must engage patients in a shared decision about starting new statin therapy, which should involve discussion about the risks and benefits of therapy, patient perceptions, and health status. Research has identified nonadherence to statin therapy as a factor associated with reduced clinical benefits of statin therapy. Clinicians should be aware of patient-specific factors associated with nonadherence and implement strategies to improve adherence as indicated. Data on the impact of adherence improvement strategies and the accuracy of how we currently measure adherence are lacking. Additionally, research focusing on patient preferences and reported outcomes would greatly inform practice and improve clinician–patient relationships.     

The Use of Cardiovascular Magnetic Resonance in Acute Myocardial Infarction

Acute myocardial infarction (MI) results in reversible and irreversible injury to the myocardium, including stunning, edema, myocyte necrosis, and microvascular obstruction. Because of its unique tissue characterization capabilities, cardiovascular magnetic resonance provides a reliable means of visualizing and quantifying the extent of these injuries. Such characterization is readily achieved through a comprehensive examination including function, first-pass perfusion, T2 (edema), and late enhancement imaging sequences. This helps to predict the prognosis, assess the success of reperfusion, detect acute phase complications, localize the area of the acute event, and confirm the diagnosis in clinical scenarios with clinical presentations similar to that of acute MI. Finally, one emerging application is the role cardiovascular magnetic resonance (CMR) may play in detecting some infarcts very early on in their evolution. This article covers the established and emerging clinical applications of CMR in the settings of reperfused and nonreperfused infarcts and in acute myocardial ischemia, the step immediately preceding actual irreversible injury.     

The Use of Magnetic Resonance Methods in Translational Cardiovascular Research

Magnetic resonance methods are widely applicable to research questions posed in translational cardiovascular studies. The main intent of this review was to offer the cardiovascular translational research scientist a “menu” of magnetic resonance (MR) approaches that can be applied to answering research questions posed in a variety of experimental situations including those involving the use of human subjects. Obviously, this menu is not comprehensive and many other topics could have been selected for emphasis. However, we hope that the material presented encompasses a broad enough slice of the field to stimulate thinking about the possible applications of MR methods to specific research questions.     

Nuts and Cardiovascular Disease Prevention

Purpose of Review

We review recent epidemiological and clinical studies investigating the consumption of tree nuts and peanuts and cardiovascular disease (CVD) mortality as well as CVD risk factors.

Recent Findings

A greater consumption of tree nuts and peanuts is associated with a reduced risk of CVD mortality, as well as lower CVD events. Furthermore, risk factors associated with the development of CVD such as dyslipidemia, impaired vascular function, and hypertension are improved with regular tree nut and peanut consumption through a range of mechanism associated with their nutrient-rich profiles. There is weak inconsistent evidence for an effect of nut consumption on inflammation. There is emerging evidence that consuming tree nuts reduces the incidence of non-alcoholic fatty liver disease (NAFLD) and promotes diversity of gut microbiota, which in turn may improve CVD outcomes.

Summary

Evidence for CVD prevention is strong for some varieties of tree nuts, particularly walnuts, and length of supplementation and dose are important factors for consideration with recommendations.

     

心脏介入治疗拔鞘管后心血管迷走反射的预防

探讨心脏介入治疗拔除鞘管后“拔管反应”的预防与处理 ,选择 1310例患者 ,其中经动脉逆行射频消融 810例、冠状动脉 (简称冠脉 )介入治疗 5 0 0例 ,随机分为预防组 (80 0例 )和对照组 (5 10例 )。预防组拔管前给予生理盐水 10 0～ 2 0 0ml/h ,应用 3～ 4h ,拔管时局部应用 1%利多卡因于鞘管旁浸润麻醉 ;对照组未经上述处理直接拔管。结果 :预防组心血管迷走反射发生 10例 (1.2 5 % ) ;对照组发生 33例 (6 .4 7% ) ,两组比较 ,差异有显著性 ,P <0 .0 0 1。结论 :心血管介入治疗后 ,拔鞘管时应用利多卡因穿刺点局部浸润麻醉 ,拔管前输注生理盐水可以预防心血管迷走反射发生     

Vitamin D and Cardiovascular Prevention

Vitamin D has been known to medical science for almost a century. Yet, it is only in the last 15 years that we have realized that the biological effects of vitamin D extend far beyond the control of calcium metabolism. Recent observational evidence suggests strong links between low vitamin D levels and a range of cardiovascular conditions, including stroke, myocardial infarction, hypertension, and diabetes. Interventional studies are beginning to explore whether vitamin D supplementation can modify vascular health and prevent cardiovascular disease. This article reviews the physiology and function of vitamin D, examines the current observational and intervention data in cardiovascular disease, and discusses future research and current practice recommendations.