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Increased Cardiovascular Risk (increased + cardiovascular_risk)

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Medical Sciences100%

Selected Abstracts

Reverse cholesterol transport in type 2 diabetes mellitus

DIABETES OBESITY & METABOLISM, Issue 6 2009
K. C. B. Tan
High-density lipoprotein (HDL) plays an important protective role against atherosclerosis, and the anti-atherogenic properties of HDL include the promotion of cellular cholesterol efflux and reverse cholesterol transport (RCT), as well as antioxidant, anti-inflammatory and anticoagulant effects. RCT is a complex pathway, which transports cholesterol from peripheral cells and tissues to the liver for its metabolism and biliary excretion. The major steps in the RCT pathway include the efflux of free cholesterol mediated by cholesterol transporters from cells to the main extracellular acceptor HDL, the conversion of free cholesterol to cholesteryl esters and the subsequent removal of cholesteryl ester in HDL by the liver. The efficiency of RCT is influenced by the mobilization of cellular lipids for efflux and the intravascular remodelling and kinetics of HDL metabolism. Despite the increased cardiovascular risk in people with type 2 diabetes, current knowledge on RCT in diabetes is limited. In this article, abnormalities in RCT in type 2 diabetes mellitus and therapeutic strategies targeting HDL and RCT will be reviewed. [source]

The Impact of the Components of Metabolic Syndrome on Heart Rate Variability: Using the NCEP-ATP III and IDF Definitions

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2008
KYOUNG-BOK MIN M.D., Ph.D.
Background: This study examined the relationship between metabolic syndrome (MetS) and heart rate variability (HRV) in Korean adults. Methods: Data were collected from family health examinations performed from December 2003 through January 2004, and 1,041 subjects consisting of males and females aged 20,87 years were included in this study. Measurement of the 5-minute HRV and several examinations for MetS were completed. The HRV was analyzed in both the time domain with the standard deviation of NN (SDNN) intervals and the frequency domain with the low frequency (LF) and high frequency (HF) components. MetS was defined by the criteria of the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation (IDF). Results: There were significant differences in the MetS components and HRV indices between the two groups (with vs without MetS). The adjusted means of the HRV indices in the group with MetS were significantly lower than those in the group without MetS (P < 0.05). Furthermore, a significant negative correlation was found between all components of MetS and the HRV indices; additionally, as the number of MetS components increased, the HRV indices gradually decreased. Conclusions: Decreased cardiac autonomic tone was strongly associated with an increased cardiovascular risk, and HRV measurement could become an indispensable part of evaluating one's risk of cardiovascular disease, though we currently do not have sufficient information to identify the cutoff values for the HRV indices. [source]

Lipid treatment strategies for metabolic syndrome in established cardiovascular disease: a consensus guideline

PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 2 2006
M Davis MB BS General Practitioner
Abstract In this paper we present an evidence-based guideline for the management of metabolic syndrome in patients with established cardiovascular disease. We initially discuss the relationship between the various components of metabolic syndrome and dyslipidaemia, the evidence base for treatment of both LDL and HDL cholesterol and the specific issue of extremely high rates of cardiovascular disease in the Indo-Asian community in the UK. Although several national and international guidelines provide treatment strategies for prevention of cardiovascular disease, none provide separate guidance on the prevention and management of coronary heart disease in the context of metabolic syndrome. In this document we emphasise that although statins will remain the mainstay of therapy, there remain a range of additional treatment options to further improve the lipid profile. These include the cholesterol absorption inhibitor, ezetimibe, fibrates and nicotinic acid derivatives. We present an algorithm to guide health professionals treating patients with cardiovascular disease and metabolic syndrome from lifestyle modification through to pharmacotherapy. We hope this will provide a practical, accessible tool for managing the increased cardiovascular risk in patients with metabolic syndrome and established cardiovascular disease. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Hormone replacement therapy and cardiovascular disease: increased risks of venous thromboembolism and stroke, and no protection from coronary heart disease

JOURNAL OF INTERNAL MEDICINE, Issue 5 2004
G. D. O. Lowe
Abstract. Hormone replacement therapy (HRT) was increasingly promoted over the last 40 years to improve quality of life, and to reduce the risks of osteoporotic fractures and coronary heart disease (CHD). In recent years, observational studies, randomized trials and systematic reviews of such trials have shown that HRT does not reduce, but actually increases cardiovascular risk. HRT increases the relative risks of venous thromboembolism (twofold), and of fatal or disabling stroke (by 50%); whilst increasing the early risk of myocardial infarction and having no protective effect against CHD on longer term use. Possible mechanisms for these increased cardiovascular risks include down-regulation of several inhibitory pathways of blood coagulation, resulting in increased coagulation activation, which promotes venous and arterial thrombosis. The implications for prescription are discussed, as are lessons for future evaluation of health care interventions. [source]