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Castellano JM, Fuster V. Scientific development of the CNIC cardiovascular polypill: from conceptualization to clinical efficacy. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:1055-1060. [PMID: 37866619 DOI: 10.1016/j.rec.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 10/24/2023]
Affiliation(s)
- José M Castellano
- Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario HM Montepríncipe, Grupo HM Hospitales, Madrid, Spain; Facultad HM Hospitales de Ciencias de la Salud de la Universidad Camilo José Cela, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Instituto de Salud Carlos III, Madrid, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Instituto de Salud Carlos III, Madrid, Spain; Mount Sinai Heart, The Mount Sinai Hospital, Nueva York, United States.
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Echocardiographic parameters of left ventricular structure and diastolic function and their relation to coronary artery calcification. Int J Cardiovasc Imaging 2021; 37:2861-2869. [PMID: 33945053 DOI: 10.1007/s10554-021-02256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Alteration in left ventricular (LV) structure and diastolic function is associated with poor cardiovascular (CV) prognosis. Coronary artery calcium score (CACS) is a reliable marker for coronary artery calcification, predicting adverse CV events. However, evidence is still insufficient to establish the association between alteration in LV structure and diastolic function and CACS. 9053 Korean adults (male: 84.2%, mean age: 42.5 years) were grouped by quartile levels of echocardiographic parameters for LV structure and diastolic function. CACS was detected by multidirectional computed tomography and categorized into CACS > 0 or CACS = 0. Multivariate regression analysis was used to calculate adjusted odd ratios (OR) and 95% confidence interval (CI) for CACS > 0 (adjusted OR [95% CI]) in each quartile group of echocardiographic parameters (reference: quartile 1 group). CACS > 0 was significantly associated with structural parameters above third quartile in LVMI (1.19 [1.00-1.41]), RWT (1.23 [1.03-1.46]) and IVST (1.42 [1.20-1.70]) and fourth quartile in PWT (1.36 [1.14-1.63]). In parameters of diastolic function, septal e' velocity ≥ 10.7 cm/s (fourth quartile) was less associated with CACS > 0 than septal e' velocity ≤ 7.7 cm/s (first quartile). Additionally, the fourth quartile of E/e' was more significantly associated with CACS > 0 than that of first quartile. Echocardiographic parameters close to LV hypertrophy and LV diastolic dysfunction are associated with CACS > 0.
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Xu W, Huang J, Yu Q, Yu H, Pu Y, Shi Q. A systematic review of the status and methodological considerations for estimating risk of first ever stroke in the general population. Neurol Sci 2021; 42:2235-2247. [PMID: 33783660 DOI: 10.1007/s10072-021-05219-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/23/2021] [Indexed: 01/01/2023]
Abstract
AIMS The methodological quality of development, validation, and modification of those models have not been evaluated via a thoroughly literature review. This study aims to describe the overall status and evaluate the methodological quality of risk prediction models for stroke incidence in the general population. METHODS We searched the database of EMBASE and MEDLINE by the combination of subject words and key words to collect the research on stroke risk prediction model in the general population. The retrieval time was from the establishment of the database to September 2019. It should be mentioned that risk of bias for each model was assessed, and data on population characteristics and model performance was also extracted. RESULTS The search screened 11,386 peer-reviewed publications and 57 citation searching, of which 48 were included in the review, describing the development of 51 prediction models, 47 external validation models, and 12 modification models. Among 51 development models, the predicted outcome concentrated on fatal or non-fatal stroke (n = 37, 73%). Thirty-nine development models (76%) were without internal validation. C-statistic or AUC was adopted for discrimination in 80% models, and Hosmer-Lemeshow test (n = 25, 49%) was also performed for calibration. Twenty-six development models (53%) were externally validated, among which only 2 (8%) were validated by independent researchers. Risk prediction performance was improved when models were modified by adding novel risk factors, such as the internal carotid artery plaque and intima-media thickness. CONCLUSION Models for predicting stroke occurrence need further external validation, recalibration, or modification in different populations, to help interpret those models in the practice of stroke prevention.
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Affiliation(s)
- Wei Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China
| | - Jiuyi Huang
- Community Prevention Research Unit, Shanghai Institute of Cerebrovascular Disease Prevention, Shanghai, 201203, China
| | - Qingsong Yu
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China
| | - Hongfan Yu
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China
| | - Yang Pu
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China
| | - Qiuling Shi
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China.
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Zhao D, Gao F, Zhu H, Qian Z, Mao W, Yin Y, Chen D. Selenium-enriched Bifidobacterium longum DD98 relieves metabolic alterations and liver injuries associated with obesity in high-fat diet-fed mice. J Funct Foods 2020. [DOI: 10.1016/j.jff.2020.104051] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Cao C, Wu R, Zhu X, Li Y, Li M, An F, Wu J. Ameliorative effect of Lactobacillus plantarum WW-fermented soy extract on rat fatty liver via the PPAR signaling pathway. J Funct Foods 2019. [DOI: 10.1016/j.jff.2019.103439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Ali MT, Al Suwaidi J. Racial and ethnic differences in cardiovascular disease and outcome in type 1 diabetes patients. Expert Rev Endocrinol Metab 2019; 14:225-231. [PMID: 31081398 DOI: 10.1080/17446651.2019.1613887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) has increased dramatically over the last two decades with global variation greater than 350-fold difference reflecting the ethnic, racial, and geographical variation. Diabetic patients remain at a higher risk of cardiovascular mortality than those without diabetes. Therefore, it is vital for clinicians to have in-depth knowledge of T1DM statistics and their impact on people health and health resources. AREAS COVERED This review will cover the epidemiologic characteristics of T1DM and the influence of race, ethnicity, and geographical variation on the incidence and the outcome. The minority populations health disparities in the clinical presentation and outcomes among youth with T1DM, the long-term glycemic control patterns in racially and ethnically diverse youth, and the long-term influence of these factors on cardiovascular outcomes will be elucidated. The PubMed database was searched using the terms: T1DM ± incidence, Race, ethnicity, and Genetic. EXPERT OPINION Understanding the epidemiological characteristics of T1DM including race, ethnicity and the genetic predisposition will help to develop guidelines target these higher risk patients of an unfavorable outcome. Further research and interventional strategies to identify infants at genetic risk of T1DM may help to prevent, stop or retard the destructive autoimmune process leading to T1DM.
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Affiliation(s)
- Mohammed T Ali
- a Heart Hospital , Hamad Medical Corporation , Doha , Qatar
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7
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La Cerra C, Dante A, Caponnetto V, Franconi I, Gaxhja E, Petrucci C, Alfes CM, Lancia L. Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis. BMJ Open 2019; 9:e025306. [PMID: 30798316 PMCID: PMC6398734 DOI: 10.1136/bmjopen-2018-025306] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/13/2018] [Accepted: 01/08/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The purpose was to analyse the effectiveness of high-fidelity patient simulation (HFPS) based on life-threatening clinical condition scenarios on undergraduate and postgraduate nursing students' learning outcomes. DESIGN A systematic review and meta-analysis were conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and its reporting was checked against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. DATA SOURCES PubMed, Scopus, CINAHL with Full Text, Wiley Online Library and Web of Science were searched until July 2017. Author contact, reference and citation lists were checked to obtain additional references. STUDY SELECTION To be included, available full-texts had to be published in English, French, Spanish or Italian and (a) involved undergraduate or postgraduate nursing students performing HFPS based on life-threatening clinical condition scenarios, (b) contained control groups not tested on the HFPS before the intervention, (c) contained data measuring learning outcomes such as performance, knowledge, self-confidence, self-efficacy or satisfaction measured just after the simulation session and (d) reported data for meta-analytic synthesis. REVIEW METHOD Three independent raters screened the retrieved studies using a coding protocol to extract data in accordance with inclusion criteria. SYNTHESIS METHOD For each study, outcome data were synthesised using meta-analytic procedures based on random-effect model and computing effect sizes by Cohen's d with a 95% CI. RESULTS Thirty-three studies were included. HFPS sessions showed significantly larger effects sizes for knowledge (d=0.49, 95% CI [0.17 to 0.81]) and performance (d=0.50, 95% CI [0.19 to 0.81]) when compared with any other teaching method. Significant heterogeneity among studies was detected. CONCLUSIONS Compared with other teaching methods, HFPS revealed higher effects sizes on nursing students' knowledge and performance. Further studies are required to explore its effectiveness in improving nursing students' competence and patient outcomes.
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Affiliation(s)
- Carmen La Cerra
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Angelo Dante
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Valeria Caponnetto
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Ilaria Franconi
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Elona Gaxhja
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Cristina Petrucci
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Celeste M Alfes
- Center for Nursing Education, Simulation, and Innovation, France Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Loreto Lancia
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
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Ralston J, Reddy KS, Fuster V, Narula J. Cardiovascular Diseases on the Global Agenda: The United Nations High Level Meeting, Sustainable Development Goals, and the Way Forward. Glob Heart 2018; 11:375-379. [PMID: 27938821 DOI: 10.1016/j.gheart.2016.10.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In 2011, the United Nations (UN) organized the first ever meeting for heads of state to discuss the problem of noncommunicable diseases (NCD), including cardiovascular disease (CVD), cancer, chronic respiratory disease, and diabetes mellitus. Recognizing that these had emerged as leading causes of morbidity and mortality in the world, including in many low- and middle-income countries, advocates from government and civil society had called for increased attention and a UN response. Earlier, NCD including CVD were absent from the global health agenda in part because of their omission from the Millennium Development Goals. The UN meeting and the global advocacy response offered a game-changing opportunity to redress this omission. The World Heart Federation (WHF) played an instrumental role in the UN meeting and follow up, including inclusion of CVD in the Sustainable Development Goals. The next phase of the global CVD movement is expected through national action, including CVD roadmaps and partnering with the World Health Organization. The WHF is heavily committed to these goals and the other nongovernmental organizations invested in the mission must help take this historical mandate forward. Instrumental to this will be the engagement of people affected by or at risk of developing CVD, to draw more attention and resources to NCD and to ensure that successes to date in global policy translate into action at the national level.
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Affiliation(s)
| | | | | | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Baatiema L, de-Graft Aikins A, Sav A, Mnatzaganian G, Chan CKY, Somerset S. Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals. BMJ Open 2017; 7:e015385. [PMID: 28450468 PMCID: PMC5719663 DOI: 10.1136/bmjopen-2016-015385] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals' views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings. DESIGN A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes. SETTING A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana. PARTICIPANTS A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian. RESULTS Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals. CONCLUSION Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes.
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Affiliation(s)
- Leonard Baatiema
- Regional Institute for Population Studies, University of Ghana, Accra, Legon, Ghana
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Legon, Ghana
| | - Adem Sav
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - George Mnatzaganian
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Melbourne, Australia
| | - Carina K Y Chan
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Shawn Somerset
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
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Morales Salinas A, Baranchuk A, Bayés de Luna A. Colaboración íbero-americana en Medwave a propósito del Día Mundial del Corazón. Medwave 2017; 17:e6883. [DOI: 10.5867/medwave.2017.02.6883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/23/2017] [Indexed: 11/27/2022] Open
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11
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Baatiema L, Otim M, Mnatzaganian G, Aikins ADG, Coombes J, Somerset S. Towards best practice in acute stroke care in Ghana: a survey of hospital services. BMC Health Serv Res 2017; 17:108. [PMID: 28153014 PMCID: PMC5290633 DOI: 10.1186/s12913-017-2061-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/27/2017] [Indexed: 12/25/2022] Open
Abstract
Background Stroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice. Methods A multi-site, hospital-based survey was conducted in 11 major referral hospitals (regional and tertiary - teaching hospitals) in Ghana from November 2015 to April 2016. Respondents included neurologists, physician specialists and medical officers (general physicians). A pre-tested, structured questionnaire was used to gather data on available hospital-based acute stroke services in the study sites, using The World Stroke Organisation Global Stroke Services Guideline as a reference for global standards. Results Availability of evidence-based services for acute stroke care in the study hospitals were varied and limited. The results showed one tertiary-teaching hospital had a stroke unit. However, thrombolytic therapy (thrombolysis) using recombinant tissue plasminogen activator for acute ischemic stroke care was not available in any of the study hospitals. Aspirin therapy was administered in all the 11 study hospitals. Although eight study sites reported having a brain computed tomographic (CT) scan, only 7 (63.6%) were functional at the time of the study. Magnetic resonance imaging (MRI scan) services were also limited to only 4 (36.4%) hospitals (only functional in three). Acute stroke care by specialists, especially neurologists, was found in 36.4% (4) of the study hospitals whilst none of the study hospitals had an occupational or a speech pathologist to support in the provision of acute stroke care. Conclusion This study confirms previous reports of limited and variable provision of evidence based stroke services and the low priority for stroke care in resource poor settings. Health policy initiatives to enhance uptake of evidence-based acute stroke services is required to reduce stroke-related mortality and morbidity in countries such as Ghana. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2061-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leonard Baatiema
- Regional Institute for Population Studies, University of Ghana, P.O Box LG96, Legon, Accra, Ghana. .,School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia.
| | - Michael Otim
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - George Mnatzaganian
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia
| | - Ama De-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, P.O Box LG96, Legon, Accra, Ghana
| | - Judith Coombes
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Shawn Somerset
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
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Zhang L, Chen Y, Yang X, Yang J, Cao X, Li X, Li L, Miao QR, Hajjar DP, Duan Y, Han J. MEK1/2 inhibitors activate macrophage ABCG1 expression and reverse cholesterol transport-An anti-atherogenic function of ERK1/2 inhibition. Biochim Biophys Acta Mol Cell Biol Lipids 2016; 1861:1180-1191. [PMID: 27365310 DOI: 10.1016/j.bbalip.2016.06.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/03/2016] [Accepted: 06/24/2016] [Indexed: 02/07/2023]
Abstract
Expression of ATP-binding cassette transporter G1 (ABCG1), a molecule facilitating cholesterol efflux to HDL, is activated by liver X receptor (LXR). In this study, we investigated if inhibition of ERK1/2 can activate macrophage ABCG1 expression and functions. MEK1/2 inhibitors, PD98059 and U0126, increased ABCG1 mRNA and protein expression, and activated the natural ABCG1 promoter but not the promoter with the LXR responsive element (LXRE) deletion. Inhibition of ABCG1 expression by ABCG1 siRNA did enhance the formation of macrophage/foam cells and it attenuated the inhibitory effect of MEK1/2 inhibitors on foam cell formation. MEK1/2 inhibitors activated macrophage cholesterol efflux to HDL in vitro, and they enhanced reverse cholesterol transport (RCT) in vivo. ApoE deficient (apoE(-/-)) mice receiving U0126 treatment had reduced sinus lesions in the aortic root which was associated with activated macrophage ABCG1 expression in the lesion areas. MEK1/2 inhibitors coordinated the RXR agonist, but not the LXR agonist, to induce ABCG1 expression. Furthermore, induction of ABCG1 expression by MEK1/2 inhibitors was associated with activation of SIRT1, a positive regulator of LXR activity, and inactivation of SULT2B1 and RIP140, two negative regulators of LXR activity. Taken together, our study suggests that MEK1/2 inhibitors activate macrophage ABCG1 expression/RCT, and inhibit foam cell formation and lesion development by multiple mechanisms, supporting the concept that ERK1/2 inhibition is anti-atherogenic.
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Affiliation(s)
- Ling Zhang
- Department of Cardiology, Xijing Hospital, the 4th Military Medical University, Xi'an, China
| | - Yuanli Chen
- College of Biomedical Engineering, Hefei University of Technology, Hefei, China; School of Medicine, Nankai University, Tianjin, China
| | - Xiaoxiao Yang
- College of Life Sciences, Nankai University, Tianjin, China
| | - Jie Yang
- College of Life Sciences, Nankai University, Tianjin, China
| | - Xingyue Cao
- College of Life Sciences, Nankai University, Tianjin, China
| | - Xiaoju Li
- College of Life Sciences, Nankai University, Tianjin, China
| | - Luyuan Li
- College of Pharmacy, Nankai University, Tianjin, China
| | | | | | - Yajun Duan
- College of Biomedical Engineering, Hefei University of Technology, Hefei, China; College of Life Sciences, Nankai University, Tianjin, China; State Key Laboratory of Medicinal Chemical Biology, Collaborative Innovation Center of Biotherapy, Nankai University, Tianjin, China.
| | - Jihong Han
- College of Biomedical Engineering, Hefei University of Technology, Hefei, China; College of Life Sciences, Nankai University, Tianjin, China; State Key Laboratory of Medicinal Chemical Biology, Collaborative Innovation Center of Biotherapy, Nankai University, Tianjin, China.
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Abdalla M, Kovach N, Liu C, Damp JB, Jahangir E, Hilliard A, Gopinathannair R, Abu-Fadel MS, El Chami MF, Gafoor S, Vedanthan R, Sanchez-Shields M, George JC, Priester T, Alasnag M, Barker C, Freeman AM. The Importance of Global Health Experiences in the Development of New Cardiologists. J Am Coll Cardiol 2016; 67:2789-2797. [PMID: 26763797 DOI: 10.1016/j.jacc.2015.10.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/21/2015] [Indexed: 11/28/2022]
Abstract
As the global burden of cardiovascular disease continues to increase worldwide, nurturing the development of early-career cardiologists interested in global health is essential to create a cadre of providers with the skill set to prevent and treat cardiovascular diseases in international settings. As such, interest in global health has increased among cardiology trainees and early-career cardiologists over the past decade. International clinical and research experiences abroad present an additional opportunity for growth and development beyond traditional cardiovascular training. We describe the American College of Cardiology International Cardiovascular Exchange Database, a new resource for cardiologists interested in pursuing short-term clinical exchange opportunities abroad, and report some of the benefits and challenges of global health cardiovascular training in both resource-limited and resource-abundant settings.
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Affiliation(s)
- Marwah Abdalla
- Department of Medicine/Division of Cardiology, Columbia University Medical Center, New York, New York.
| | - Neal Kovach
- International Affairs, American College of Cardiology, Washington, DC
| | - Connie Liu
- International Affairs, American College of Cardiology, Washington, DC
| | - Julie B Damp
- Department of Medicine/Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eiman Jahangir
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, Louisiana
| | - Anthony Hilliard
- Division of Cardiology, Loma Linda University, Loma Linda, California
| | | | - Mazen S Abu-Fadel
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mikhael F El Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Sameer Gafoor
- Cardiovascular Center Frankfurt, Frankfurt, Germany, and the Swedish Heart and Vascular Institute, Seattle, Washington
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Monica Sanchez-Shields
- Department of Medicine/Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jon C George
- Deborah Heart and Lung Center, Browns Mills, New Jersey
| | - Tiffany Priester
- Division of Cardiology, Loma Linda University, Loma Linda, California; School of Medicine, Loma Linda University, Loma Linda, California, and Department of Cardiology, Blantyre Adventist Hospital, Blantyre, Malawi
| | - Mirvat Alasnag
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Andrew M Freeman
- Department of Medicine/Division of Cardiology, National Jewish Health, Denver, Colorado
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14
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Innovación en la prevención cardiovascular: la polipíldora. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2014.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Engels MC, Rajarajan K, Feistritzer R, Sharma A, Nielsen UB, Schalij MJ, de Vries AAF, Pijnappels DA, Wu SM. Insulin-like growth factor promotes cardiac lineage induction in vitro by selective expansion of early mesoderm. Stem Cells 2015; 32:1493-502. [PMID: 24496962 DOI: 10.1002/stem.1660] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 12/21/2013] [Indexed: 12/12/2022]
Abstract
A thorough understanding of the developmental signals that direct pluripotent stem cells (PSCs) toward a cardiac fate is essential for translational applications in disease modeling and therapy. We screened a panel of 44 cytokines/signaling molecules for their ability to enhance Nkx2.5(+) cardiac progenitor cell (CPC) formation during in vitro embryonic stem cell (ESC) differentiation. Treatment of murine ESCs with insulin or insulin-like growth factors (IGF1/2) during early differentiation increased mesodermal cell proliferation and, consequently, CPC formation. Furthermore, we show that downstream mediators of IGF signaling (e.g., phospho-Akt and mTOR) are required for this effect. These data support a novel role for IGF family ligands to expand the developing mesoderm and promote cardiac differentiation. Insulin or IGF treatment could provide an effective strategy to increase the PSC-based generation of CPCs and cardiomyocytes for applications in regenerative medicine.
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Affiliation(s)
- Marc C Engels
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Laboratory of Experimental Cardiology, Department of Cardiology, Heart Center Leiden, Leiden University Medical Center, Leiden, The Netherlands
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Heras M, Bayes-Genis A, Pérez de Isla L, Sanchis J, Avanzas P. Continuing medical education: a priority in Revista Española de Cardiología. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 67:1068-1073. [PMID: 25455757 DOI: 10.1016/j.rec.2014.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/18/2014] [Indexed: 06/04/2023]
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17
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Heras M, Bayes-Genis A, Pérez de Isla L, Sanchis J, Avanzas P. Formación médica continuada: un objetivo prioritario en Revista Española de Cardiología. Rev Esp Cardiol (Engl Ed) 2014. [DOI: 10.1016/j.recesp.2014.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Gidwani S, Nair A. The burden of pulmonary hypertension in resource-limited settings. Glob Heart 2014; 9:297-310. [PMID: 25667181 DOI: 10.1016/j.gheart.2014.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 12/11/2022] Open
Abstract
Pulmonary vascular disease (PVD) is a significant global health problem and accounts for a substantial portion of cardiovascular disease in the developing world. Although there have been considerable advances in therapeutics for pulmonary arterial hypertension, over 97% of the disease burden lies within the developing world where there is limited access to health care and pharmaceuticals. The causes of pulmonary arterial hypertension differ between industrialized and developing nations. Infectious diseases-including schistosomiasis human immunodeficiency virus, and rheumatic fever-are common causes of PVD, as are hemoglobinopathies, and untreated congenital heart disease. High altitude and exposure to household air pollutants also contribute to a significant portion of PVD cases. Although diagnosis of pulmonary arterial hypertension requires the use of imaging and invasive hemodynamics, access to equipment may be limited. PVD therapies may be prohibitively expensive and limited to a select few. Prevention is therefore important in limiting the global PVD burden.
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Affiliation(s)
| | - Ajith Nair
- Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA.
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Alsheikh-Ali AA, Omar MI, Raal FJ, Rashed W, Hamoui O, Kane A, Alami M, Abreu P, Mashhoud WM. Cardiovascular risk factor burden in Africa and the Middle East: the Africa Middle East Cardiovascular Epidemiological (ACE) study. PLoS One 2014; 9:e102830. [PMID: 25090638 PMCID: PMC4121128 DOI: 10.1371/journal.pone.0102830] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 06/24/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Increased urbanization in the developing world parallels a rising burden of chronic diseases. Developing countries account for ∼ 80% of global cardiovascular (CV) deaths, but contribute a paucity of systematic epidemiological data on CV risk factors. OBJECTIVE To estimate the prevalence of CV risk factors in rural and urban cohorts attending general practice clinics in the Africa and Middle East (AfME) region. METHODS In a cross-sectional epidemiological study, the presence of CV risk factors (hypertension, diabetes mellitus (diabetes), dyslipidemia, obesity, smoking and abdominal obesity) were evaluated in stable adult outpatients attending general practice primary care clinics. A rural population was defined as isolated (>50 km or lack of easy access to commuter transportation) from urban centers. RESULTS 4,378 outpatients were systematically recruited from 94 clinics across 14 AfME countries. Mean age was 46 ± 14 years and 52% of outpatients were female. A high prevalence of dyslipidemia (70%) and abdominal obesity (68%) were observed, followed by hypertension (43%) and diabetes (25%). The vast majority of outpatients (92%) had at least one modifiable CV risk factor, many (74%) had more than one, and half (53%) had 3 or more. These findings were observed in both genders and across urban and rural centers. Among outpatients with pre-existing hypertension or dyslipidemia, many were not at their target blood pressure or LDL-cholesterol goals. CONCLUSION Cardiovascular risk factors are highly prevalent among relatively young, stable outpatients attending general practice clinics across AfME. The findings support opportunistic screening for CV risk factors whenever outpatients visit a general practitioner and provide an opportunity for early identification and management of CV risk factors, including lifestyle interventions.
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Affiliation(s)
- Alawi A. Alsheikh-Ali
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Frederick J. Raal
- Department of Medicine, Faculty of Health Sciences, Johannesburg Hospital, Johannesburg, South Africa
| | - Wafa Rashed
- Mubarak Al Kabeer Hospital, Al Jabriya, Kuwait
| | | | - Abdoul Kane
- L'Hopital General de Grand Yoff, Dakar, Senegal
| | | | - Paula Abreu
- Pfizer Inc., New York, New York, United States of America
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Alencar Filho ACD, Lacerda MVGD, Okoshi K, Okoshi MP. Malaria and vascular endothelium. Arq Bras Cardiol 2014; 103:165-9. [PMID: 25014058 PMCID: PMC4150669 DOI: 10.5935/abc.20140088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 12/18/2013] [Indexed: 02/01/2023] Open
Abstract
Involvement of the cardiovascular system in patients with infectious and
parasitic diseases can result from both intrinsic mechanisms of the disease and
drug intervention. Malaria is an example, considering that the endothelial
injury by Plasmodium-infected erythrocytes can cause
circulatory disorders. This is a literature review aimed at discussing the
relationship between malaria and endothelial impairment, especially its effects
on the cardiovascular system. We discuss the implications of endothelial
aggression and the interdisciplinarity that should guide the malaria patient
care, whose acute infection can contribute to precipitate or aggravate a
preexisting heart disease.
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Affiliation(s)
| | | | - Katashi Okoshi
- Faculdade de Medicina de Botucatu, Unesp, Botucatu, SP, Brazil
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Promoting cardiovascular health worldwide: strategies, challenges, and opportunities. ACTA ACUST UNITED AC 2014; 67:724-30. [PMID: 25172068 DOI: 10.1016/j.rec.2014.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/22/2014] [Indexed: 11/23/2022]
Abstract
Cardiovascular disease is the leading cause of death in the world, affecting not only industrialized but, above all, low- and middle-income countries, where it has overtaken infectious diseases as the first cause of death and its impact threatens social and economic development. The increased prevalence of cardiovascular disease in recent years together with projected mortality for the coming decades constitute an irrefutable argument for the urgent implementation of well-planned interventions to control the pandemic of cardiovascular diseases, especially in the more economically deprived countries. The combination of behavioral, social, environmental, and biological factors, and others related to health care systems, that contribute to the development of cardiovascular diseases requires a multi-sector strategy that promotes a healthy lifestyle, reduces cardiovascular risk factors, and cuts mortality and morbidity through quality health care services. These proposals should be guided by leaders in the scientific community, government, civil society, private sector, and local communities.
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Rao NS, Oomman A, Bindumathi PL, Sharma V, Rao S, Moodahadu LS, Patnaik A, Kumar BRN. Efficacy and tolerability of fixed dose combination of metoprolol and amlodipine in Indian patients with essential hypertension. J Midlife Health 2014; 4:160-6. [PMID: 24672188 PMCID: PMC3952407 DOI: 10.4103/0976-7800.119000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: This open-labeled, post-marketing study was conducted to assess the efficacy and tolerability of fixed dose combination of amlodipine and metoprolol extended release capsules in mild to moderate hypertension in adult Indian patients. Materials and Methods: Of 101 enrolled patients, 64 drug naïve patients were treated with regimen A (amlodipine 5 mg + metoprolol 25 mg) and those with prior history of hypertension (n = 37) were treated with regimen B (amlodipine 5 mg + metoprolol 50 mg) for 8 weeks. Treatment response was assessed at week 4 and 8. Dose up titration to regimen B was carried out for those who failed to achieve the target blood pressure (BP) at week 4 in regimen A and additional antihypertensives were added to those in regimen B. Safety laboratory tests were performed at baseline and end of study. Results: Mean age (±SD) of patients was 53.36 (±11.26) years and body weight (±SD) 63.40 (10.03) kg. Ninety five patients (94.06%) were only hypertensive and 6 (5.94%) had hypertension with history of coronary artery disease; mean duration (±SD) of hypertension was 42.50 (48.07) months. At baseline, patients had a mean (±SD) systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 154.98 (±7.76) mmHg and 95.55 (±5.70) mmHg respectively. There was a statistically significant (P < 0.001) reduction of 12.16% and 14.69% in SBP, 11.49% and 14.65% in DBP at week 4 and week 8 respectively, compared to baseline. Normalization of overall BP was achieved in 49.49% and 70.71% patients at week 4 and 8, respectively. Peripheral edema was reported in 2.97% (3/101) patients. Conclusion: This combination was safe, efficacious, and well-tolerated in study population.
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Affiliation(s)
- N Srinivasa Rao
- Department of General Medicine, Osmania General Hospital and Medical College, Hyderabad, Andhra Pradesh, India
| | - Abraham Oomman
- Department of Cardiology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - P L Bindumathi
- Department of General Medicine, Dr. BR Ambedkar Medical College, Bengaluru, Karnataka, India
| | - Vikram Sharma
- Department of Neurology, St. Theresa's General Hospital, Hyderabad, Andhra Pradesh, India
| | - Satish Rao
- Department of General Medicine, Kasturba Medical College, Mangalore, Karnataka, India
| | | | - Ashis Patnaik
- Global Medical Affairs, Dr. Reddy's Laboratories, Hyderabad, Andhra Pradesh, India
| | - B R Naveen Kumar
- Global Medical Affairs, Dr. Reddy's Laboratories, Hyderabad, Andhra Pradesh, India
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Mensah GA, Moran AE, Roth GA, Narula J. The Global Burden of Cardiovascular Diseases, 1990–2010. Glob Heart 2014; 9:183-4. [DOI: 10.1016/j.gheart.2014.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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25
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Khanna V, Jain M, Singh V, Kanshana JS, Prakash P, Barthwal MK, Murthy PSR, Dikshit M. Cholesterol diet withdrawal leads to an initial plaque instability and subsequent regression of accelerated iliac artery atherosclerosis in rabbits. PLoS One 2013; 8:e77037. [PMID: 24146955 PMCID: PMC3798418 DOI: 10.1371/journal.pone.0077037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/05/2013] [Indexed: 11/19/2022] Open
Abstract
Effect of long term cholesterol diet withdrawal on accelerated atherosclerosis in iliac artery of New Zealand White (NZW) rabbits has not been explored so far. Atherosclerosis was thus induced in rabbits by a combination of balloon injury and atherogenic diet (AD) (1% cholesterol and 6% peanut oil) feeding for 8 weeks (baseline) followed by chow diet (CD) feeding for 4, 8, 16, 32, 50 and 64 weeks. The plaque characterization was done using histology, real time RT-PCR and vasoreactivity studies. Significant elevation in plasma lipids with AD feeding was normalized following 16 weeks of CD feeding. However, baseline comparison showed advanced plaque features even after 8 weeks of CD period with significant elevation in intima/media thickness ratio and plaque area later showing reduction at 50 and 64 weeks CD periods. Lesion lipid accumulation and CD68 positivity was maintained till 16 weeks of CD feeding which significantly reduced from 32 to 64 weeks CD periods. Baseline comparison showed significant increase in ground substance, MMP-9 and significant decrease in α-actin and collagen content at 8 weeks CD period indicating features of unstable plaque. These features regressed up to 64 weeks of CD. Partial restoration of functional vasoconstriction and vasorelaxation was seen after 64 weeks of CD feeding. mRNA expression of MCP-1, VCAM-1, collagen type I and III, MMP-9, TIMP-1, IFN-γ, TNF-α, IL-10 and eNOS supported the above findings. The study thus reveals insights into initial plaque instability and subsequent regression on AD withdrawal in this model. These results are suggestive of an appropriate window for drug intervention for plaque stability/regression and restenosis as well as improves understanding of plaque regression phenomenon in this model.
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Affiliation(s)
- Vivek Khanna
- Pharmacology Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension, Lucknow, Uttar Pradesh, India
| | - Manish Jain
- Pharmacology Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension, Lucknow, Uttar Pradesh, India
| | - Vishal Singh
- Pharmacology Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension, Lucknow, Uttar Pradesh, India
| | - Jitendra S. Kanshana
- Pharmacology Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension, Lucknow, Uttar Pradesh, India
| | - Prem Prakash
- Pharmacology Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension, Lucknow, Uttar Pradesh, India
| | - Manoj K. Barthwal
- Pharmacology Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension, Lucknow, Uttar Pradesh, India
| | - Puvvada S. R. Murthy
- Toxicology Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension, Lucknow, Uttar Pradesh, India
| | - Madhu Dikshit
- Pharmacology Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension, Lucknow, Uttar Pradesh, India
- * E-mail:
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Barazza A, Blachford C, Even-Or O, Joaquin VA, Briley-Saebo KC, Chen W, Jiang XC, Mulder WJM, Cormode DP, Fayad ZA, Fisher EA. The complex fate in plasma of gadolinium incorporated into high-density lipoproteins used for magnetic imaging of atherosclerotic plaques. Bioconjug Chem 2013; 24:1039-48. [PMID: 23617731 DOI: 10.1021/bc400105j] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We have previously reported enhancing the imaging of atherosclerotic plaques in mice using reconstituted high density lipoproteins (HDL) as nanocarriers for the MRI contrast agent gadolinium (Gd). This study focuses on the underlying mechanisms of Gd delivery to atherosclerotic plaques. HDL, LDL, and VLDL particles containing Gd chelated to phosphatidyl ethanolamine (DTPA-DMPE) and a lipidic fluorophore were used to demonstrate the transfer of Gd-phospholipids among plasma lipoproteins in vitro and in vivo. To determine the basis of this transfer, the roles of phospholipid transfer protein (PLTP) and lipoprotein lipase (LpL) in mediating the migration of Gd-DTPA-DMPE among lipoproteins were investigated. The results indicated that neither was an important factor, suggesting that spontaneous transfer of Gd-DTPA-DMPE was the most probable mechanism. Finally, two independent mouse models were used to quantify the relative contributions of HDL and LDL reconstituted with Gd-DTPA-DMPE to plaque imaging enhancement by MR. Both sets of results suggested that Gd-DTPA-DMPE originally associated with LDL was about twice as effective as that injected in the form of Gd-HDL, and that some of Gd-HDL's effectiveness in vivo is indirect through transfer of the imaging agent to LDL. In conclusion, the fate of Gd-DTPA-DMPE associated with a particular type of lipoprotein is complex, and includes its transfer to other lipoprotein species that are then cleared from the plasma into tissues.
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Affiliation(s)
- Alessandra Barazza
- Leon H. Charney Division of Cardiology and Marc and Ruti Bell Program in Vascular Biology, Department of Medicine, New York University School of Medicine, Smilow 7, 522 First Avenue, New York, New York 10016, United States
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Nasir K, Clouse M. Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals. Radiology 2012; 264:637-49. [PMID: 22919038 DOI: 10.1148/radiol.12110810] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Arteriosclerotic cardiovascular disease is the leading cause of death in the United States, with coronary artery disease (CAD) accounting for half of all cardiovascular disease deaths. Current risk assessment approaches for coronary heart disease, such as the Framingham risk score, substantially misclassify intermediate- to long-term risk for the occurrence of CAD in asymptomatic individuals. A screening modality such as a simple non-contrast-enhanced, or noncontrast, computed tomographic (CT) detection of coronary artery calcium (CAC) improves the ability to accurately predict risk in vulnerable groups and adds information above and beyond global risk assessment as shown by the recent Multi-Ethnic Study of Atherosclerosis. In addition, absence of CAC is associated with a very low risk of future CAD and as a result can be used to identify a group among which further testing and pharmacotherapies can be avoided. The Expert Consensus Document by the American College of Cardiology Foundation and the American Heart Association now recommends screening individuals at intermediate risk but did not find enough evidence to recommend CAC testing and further stratification of those in the low- or high-risk categories for CAD. In addition, emerging guidelines have suggested that absence of CAC can act as a "gatekeeper" for further testing among low- and intermediate-risk patients presenting with chest pain. This review of the current literature outlines the role of CAC testing in both asymptomatic and symptomatic individuals.
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Affiliation(s)
- Khurram Nasir
- Center for Prevention and Wellness, Baptist Health South Florida, 1691 Michigan Ave, Suite 500, Miami Beach, FL 33139, USA.
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Diabetes and coronary heart disease: a risk factor for the global epidemic. Int J Hypertens 2012; 2012:697240. [PMID: 23119148 PMCID: PMC3483823 DOI: 10.1155/2012/697240] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 09/08/2012] [Indexed: 01/13/2023] Open
Abstract
Cardiovascular disease remains a leading cause of death in the United States and the world. In this we will paper focus on type 2 diabetes mellitus as a risk factor for coronary heart disease, review the mechanisms of atherogenesis in diabetics, the impact of hypertension and the treatment goals in diabetics, the guidelines for screening, and review the epidemiologic consequences of diabetes and heart disease on a global scale. The underlying premise to consider diabetes a cardiovascular disease equivalent will be explored as well as the recommendations for screening and cardiac testing for asymptomatic diabetic patients.
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Willie MM, Gantsho M. Visit to general practitioners as a proxy for accessing chronic benefits by members of medical schemes, South Africa. Afr J Prim Health Care Fam Med 2012. [PMCID: PMC4565034 DOI: 10.4102/phcfm.v4i1.419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Objectives Method Results Conclusion
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30
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Affiliation(s)
- Darwin R Labarthe
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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31
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Jack L, Grim M, Auld ME. Health Promotion Practice Expands Focus on Global Health Promotion. Health Promot Pract 2012; 13:289-92. [DOI: 10.1177/1524839912443244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Leonard Jack
- Xavier University of Louisiana, New Orleans, LA, USA
| | | | - M. Elaine Auld
- Society for Public Health Education, Washington, DC, USA
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Jahangir E, Comandé D, Rubinstein A. Cardiovascular disease research in Latin America: a comparative bibliometric analysis. World J Cardiol 2011; 3:383-7. [PMID: 22216374 PMCID: PMC3247684 DOI: 10.4330/wjc.v3.i12.383] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 11/08/2011] [Accepted: 11/15/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the number of publications in cardiovascular disease (CVD) in Latin America and the Caribbean over the last decade. METHODS We performed a bibliometric analysis in PubMed from 2001 to 2010 for Latin America and the Caribbean, the United States, Canada, Europe, China, and India. RESULTS Latin America published 4% of articles compared with 26% from the United States/Canada and 42% from Europe. In CVD, Latin America published 4% of articles vs 23% from the United States/Canada and 40% from Europe. The number of publications in CVD in Latin America increased from 41 in 2001 to 726 in 2010. CONCLUSION Latin America, while publishing more articles than previously, lags behind developed countries. Further advances in research infrastructure are necessary to develop prevention strategies for this region.
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Affiliation(s)
- Eiman Jahangir
- Eiman Jahangir, Daniel Comandé, Adolfo Rubinstein, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, C1414CPV, Argentina.
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Khanolkar AR, Byberg L, Koupil I. Parental influences on cardiovascular risk factors in Swedish children aged 5–14 years. Eur J Public Health 2011; 22:840-7. [DOI: 10.1093/eurpub/ckr180] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Browne JL, Grobbee DE. Cardiovascular prevention and international health: time for action. ACTA ACUST UNITED AC 2011; 18:547-9. [DOI: 10.1177/1741826711414116] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joyce L Browne
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
BACKGROUND Although stroke and ischemic heart disease (IHD) have several well-established risk factors in common, the extent of global variation in the relative burdens of these forms of vascular disease and reasons for any observed variation are poorly understood. METHODS AND RESULTS We analyzed mortality and disability-adjusted life-year loss rates from stroke and IHD, as well as national estimates of vascular risk factors that have been developed by the World Health Organization Burden of Disease Program. National income data were derived from World Bank estimates. We used linear regression for univariable analysis and the Cuzick test for trends. Among 192 World Health Organization member countries, stroke mortality rates exceeded IHD rates in 74 countries (39%), and stroke disability-adjusted life-year loss rates exceeded IHD rates in 62 countries (32%). Stroke mortality ranged from 12.7% higher to 27.2% lower than IHD, and stroke disability-adjusted life-year loss rates ranged from 6.2% higher to 10.2% lower than IHD. Stroke burden was disproportionately higher in China, Africa, and South America, whereas IHD burden was higher in the Middle East, North America, Australia, and much of Europe. Lower national income was associated with higher relative mortality (P<0.001) and burden of disease (P=0.001) from stroke. Diabetes mellitus prevalence and mean serum cholesterol were each associated with greater relative burdens from IHD even after adjustment for national income. CONCLUSIONS There is substantial global variation in the relative burden of stroke compared with IHD. The disproportionate burden from stroke for many lower-income countries suggests that distinct interventions may be required.
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Affiliation(s)
- Anthony S Kim
- Department of Neurology, University of California, San Francisco, CA 94143-0114, USA.
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Aleixandre Benavent R, Alonso Arroyo A, Anguita Sánchez M, Bolaños Pizarro M, Heras M, González Alcalde G, Macaya Miguel C, Navarro Molina C, Castelló Cogollos L, Valderrama Zurián JC, Chorro Gascó FJ, Bertomeu Martínez V, Salvador Taboada MJ, Plaza Celemín L, Pérez-Villacastín J, Cequier Fillat A, Varela Román A, Laraudogoitia Zaldumbide E, Morell Cabedo S. [Evolution and scientific impact of research grants from the spanish society of cardiology and spanish heart foundation (2000-2006)]. Rev Esp Cardiol 2011; 64:904-15. [PMID: 21723655 DOI: 10.1016/j.recesp.2011.03.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 03/14/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Sociedad Española de Cardiología (Spanish Society of Cardiology) every year awards grants to finance research in the field of cardiovascular diseases. The aim of this study is to identify the impact of these investments during the period 2000-2006 from the subsequently published articles in scientific journals. METHODS Using the identifying data of each project as search terms, all articles that resulted from these grants were located in the Spanish Índice Médico Español and Índice Bibliográfico Español en Ciencias de la Salud databases, and in Science Citation Index-Expanded and Scopus. Descriptive statistical analysis of these articles included type of grant, number and amount awarded per year, and the recipient's sex and institutional affiliation. RESULTS The Sociedad Española de Cardiología awarded €3,270,877 to 207 recipients, an average annual total of €467,268. We identified 231 publications that resulted from 123 (59.42%) of these grants. The average number of articles per grant awarded was 1.12, and 1.9 when taking into account only the awards that led to publication. CONCLUSIONS During the period 2000 to 2006, the Sociedad Española de Cardiología/ Fundación Española del Corazón (Spanish Heart Foundation) provided about €500,000 per year to fund research grants, thereby contributing to the fight against cardiovascular diseases. Almost 60% of grants have led to publications, 73% of which were published in international journals, and 91.34% in national or international journals with an impact factor in the Journal Citation Reports.
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Affiliation(s)
- Rafael Aleixandre Benavent
- Unidad de Información e Investigación Social y Sanitaria-UISYS, CSIC-Universidad de Valencia, Valencia, España.
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Fuster V, Sanz G. Compuestos de dosis fija en la prevención secundaria de la cardiopatía isquémica. Rev Esp Cardiol 2011; 64 Suppl 2:3-9. [DOI: 10.1016/j.recesp.2011.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 02/20/2011] [Indexed: 10/17/2022]
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38
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Hernández-Leiva E. Epidemiología del síndrome coronario agudo y la insuficiencia cardiaca en Latinoamérica. Rev Esp Cardiol 2011; 64 Suppl 2:34-43. [DOI: 10.1016/j.recesp.2011.01.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 01/23/2011] [Indexed: 11/25/2022]
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Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide, and its prevalence is likely to increase in the near future. The morbidity and mortality associated with CVD causes an enormous economic burden, which has become a major problem for many societies across the globe. The current prevention strategies are aimed at identifying and reducing established risk factors for atherosclerosis including hypertension, hypercholesterolemia, diabetes, obesity, smoking, and sedentary lifestyle. However, some of our prevention goals, such as reducing LDL cholesterol, change dramatically once a subject has been diagnosed with coronary atherosclerosis. At the present time, atherosclerosis is frequently diagnosed relatively late in the course of the disease, when a patient develops symptoms or presents with acute events such as an acute coronary syndrome or a stroke. Several studies have demonstrated that novel noninvasive imaging techniques have the potential to identify subclinical atherosclerosis and high-risk plaques. Early detection of subclinical atherosclerosis may enable clinicians to improve the control of cardiovascular risk factors in affected patients earlier, thereby helping to prevent some of the manifestations of CVD.
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Affiliation(s)
- Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Cormode DP, Chandrasekar R, Delshad A, Briley-Saebo KC, Calcagno C, Barazza A, Mulder WJM, Fisher EA, Fayad ZA. Comparison of synthetic high density lipoprotein (HDL) contrast agents for MR imaging of atherosclerosis. Bioconjug Chem 2010; 20:937-43. [PMID: 19378935 DOI: 10.1021/bc800520d] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Determining arterial macrophage expression is an important goal in the molecular imaging of atherosclerosis. Here, we compare the efficacy of two synthetic, high density lipoprotein (HDL) based contrast agents for magnetic resonance imaging (MRI) of macrophage burden. Each form of HDL was labeled with gadolinium and rhodamine to allow MRI and fluorescence microscopy. Either the 37 or 18 amino acid peptide replaced the apolipoprotein A-I in these agents, which were termed 37pA-Gd or 18A-Gd. The diameters of 37pA-Gd and 18A-Gd are 7.6 and 8.0 nm, respectively, while the longitudinal relaxivities are 9.8 and 10.0 (mM s)(-1). 37pA has better lipid binding properties. In vitro tests with J774A.1 macrophages proved the particles possessed the functionality of HDL by eliciting cholesterol efflux and were taken up in a receptor-like fashion by the cells. Both agents produced enhancements in atherosclerotic plaques of apolipoprotein E knockout mice of approximately 90% (n = 7 per agent) and are macrophage specific as evidenced by confocal microscopy on aortic sections. The half-lives of 37pA-Gd and 18A-Gd are 2.6 and 2.1 h, respectively. Despite the more favorable lipid interactions of 37pA, both agents gave similar, excellent contrast for the detection of atherosclerotic macrophages using MRI.
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Affiliation(s)
- David P Cormode
- Translational and Molecular Imaging Institute, Mount Sinai School of Medicine, New York, NY 10029, USA
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Affiliation(s)
- Valentin Fuster
- Mount Sinai School of Medicine, The Zena and Michael A. Wiener Cardiovascular Institute, 1 Gustave L. Levy Place, Box 1030 New York, NY 10029, USA.
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Rich S, Herskowitz A. Targeting Pulmonary Vascular Disease To Improve Global Health. Chest 2010; 137:1S-5S. [DOI: 10.1378/chest.09-2813] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Gersh BJ, Sliwa K, Mayosi BM, Yusuf S. Novel therapeutic concepts: the epidemic of cardiovascular disease in the developing world: global implications. Eur Heart J 2010; 31:642-8. [PMID: 20176800 DOI: 10.1093/eurheartj/ehq030] [Citation(s) in RCA: 275] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The epidemic of cardiovascular disease (CVD) is a global phenomenon, and the magnitude of its increase in incidence and prevalence in low- and middle-income countries (LIMIC) has potentially major implications for those high-income countries that characterize much of the developed world. Cardiovascular disease remains the leading cause of death in the world and approximately 80% of all cardiovascular-related deaths occur in LIMIC and at a younger age in comparison to high-income countries. The economic impact in regard to loss of productive years of life and the need to divert scarce resources to tertiary care is substantial. The 'epidemiologic transition' provides a useful framework for understanding changes in the patterns of disease as a result of societal and socioeconomic developments in different countries and regions of the world. A burning but as yet unanswered question is whether gains made over the last four decades in reducing cardiovascular mortality in high-income countries will be offset by changes in risk factor profiles, and in particular obesity and diabetes. Much of the population attributable risk of myocardial infarction is accountable on the basis of nine modifiable traditional risk factors, irrespective of geography. Developing societies are faced with a hostile cardiovascular environment, characterized by changes in diet, exercise, the effects of tobacco, socioeconomic stressors, and economic constraints at both the national and personal level in addition to exposure to potential novel risk factors and perhaps a genetic or programmed foetal vulnerability to CVD in later life. There are major challenges for primary and secondary prevention including lack of data, limited national resources, and the lack of prediction models in certain populations. There are two major approaches to prevention: public health/community-based strategies and clinic-based with a targeted approach to high-risk patients and combinations of these. There are concerns that in comparison with communicable diseases, cardiovascular and chronic diseases have a relatively low priority in the global health agenda and that this requires additional emphasis. The human race has had long experience and a fine tradition in surviving adversity, but we now face a task for which we have little experience, the task of surviving prosperity Alan Gregg 1890-1957, Rockefeller Foundation.
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Affiliation(s)
- Bernard J Gersh
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905-0001, USA.
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Moreno PR, Sanz J, Fuster V. Promoting mechanisms of vascular health: circulating progenitor cells, angiogenesis, and reverse cholesterol transport. J Am Coll Cardiol 2009; 53:2315-23. [PMID: 19539140 DOI: 10.1016/j.jacc.2009.02.057] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 01/27/2009] [Accepted: 02/06/2009] [Indexed: 12/20/2022]
Abstract
To understand and promote vascular health, we must reduce the aggression to the vessel wall and enhance the physiologic mechanisms leading to restoration of vessel wall function. Three main defense mechanisms are responsible for maintaining cardiovascular homeostasis: the regenerative production of endothelial progenitor cells, vessel wall angiogenesis, and macrophage-mediated reverse cholesterol transport. Endothelial progenitor cells can restore vessel wall function and reduce atherosclerosis. In patients with risk factors, high levels of circulating progenitor cells increase event-free survival from cardiovascular events. Mobilization of progenitor cells includes physical and pharmacological approaches, of which exercise and statin therapy have great potential. Angiogenesis is a pivotal defense mechanism to counteract hypoxia and is needed for plaque regression. However, neovessels are susceptible for intraplaque hemorrhage, particularly in diabetes mellitus. In these patients, the haptoglobin 2-2 genotype is the more affected, and may benefit from an antioxidant approach. Finally, the reverse cholesterol transport system is the main mechanism for plaque regression. In addition to high-density lipoprotein cholesterol, apolipoprotein A-I therapies and the promotion of cholesterol efflux from macrophages by the ABCA1 and ABCG1 transporter systems hold great promise and may be available for therapeutic application in the near future.
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Affiliation(s)
- Pedro R Moreno
- Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Cardiovascular Health Center, The Mount Sinai School of Medicine, New York, New York 10029, USA
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Sipido KR, Tedgui A, Kristensen SD, Pasterkamp G, Schunkert H, Wehling M, Steg PG, Eisert W, Rademakers F, Casadei B, Fuster V, Cerbai E, Hasenfuss G, Fernandez-Aviles F, Garcia-Dorado D, Vidal M, Hallen M, Dambrauskaite V. Identifying needs and opportunities for advancing translational research in cardiovascular disease. Cardiovasc Res 2009; 83:425-35. [PMID: 19502281 DOI: 10.1093/cvr/cvp165] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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van der Zee S, Fuster V. Enfermedades cardiovasculares y nefropatía crónica: del tratamiento al fomento de la salud. Med Clin (Barc) 2009; 132 Suppl 1:33-7. [DOI: 10.1016/s0025-7753(09)70960-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fixed-dose combination therapy and secondary cardiovascular prevention: rationale, selection of drugs and target population. ACTA ACUST UNITED AC 2008; 6:101-10. [PMID: 19104519 DOI: 10.1038/ncpcardio1419] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 10/23/2008] [Indexed: 12/22/2022]
Abstract
Ischemic heart disease and stroke are the leading causes of death worldwide. A large proportion of individuals at high 10-year risk of a cardiovascular event live in low-income and middle-income countries, and the large majority of all cardiovascular events occur in developing countries. A large amount of evidence supports the use of pharmacological treatment for the prevention of cardiovascular death in this population, including antiplatelet drugs, beta blockers, lipid-lowering agents and angiotensin-converting-enzyme inhibitors. However, the efficacy of cardiovascular prevention is hampered by several problems, including inadequate prescription of medication, poor adherence to treatment, limited availability of medications and unaffordable cost of treatment. Here we examine the use of fixed-dose combination therapy (a 'polypill'), and how this therapy could improve adherence to treatment, reduce the cost and improve treatment affordability in low-income countries.
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Stevens GR, Kalman J. Heart failure in women: An equal opportunity player in the expanding epidemic of heart failure. CURRENT CARDIOVASCULAR RISK REPORTS 2008. [DOI: 10.1007/s12170-008-0040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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50
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Sanz J, Moreno PR, Fuster V. The Year in Atherothrombosis. J Am Coll Cardiol 2008; 51:944-55. [DOI: 10.1016/j.jacc.2007.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 12/13/2007] [Indexed: 01/07/2023]
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