cardiovascular-agents and Cerebrovascular-Disorders

Galectin-3 (gal-3), a member of the galectin family, is a glycoprotein with high affinity for β-galactoside. Gal-3 is a cytoplasmically synthesized protein that can shuttle between the cytoplasm and nucleus and can even be transported to the membrane and secreted into the extracellular environment. Cardio/cerebrovascular diseases generally refer to ischemic or hemorrhagic diseases occurring in the heart, brain and systemic tissues, which are characterized by high morbidity, high disability rates and high mortality rates. To date, considerable research has demonstrated that gal-3 expression is aberrantly increased and plays important roles in cardio/cerebrovascular diseases, such as acute ischemic stroke (AIS), myocardial fibrosis, acute coronary syndrome (ACS), and heart failure (HF). Hence, understanding the biological roles of gal-3 in these diseases may be essential for cardio/cerebrovascular disease treatment and diagnosis to improve patient quality of life. In this review, we summarize current research on the roles of gal-3 in human cardiovascular diseases and potential inhibitors of gal-3, which may provide new strategies for disease therapies.

Topics: Animals; Blood Proteins; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Galectins; Humans; Molecular Targeted Therapy; Signal Transduction; Up-Regulation

At present, the prevention and control of cardiovascular diseases (CAVDs) has made initial advancements, although the prevention and control of cerebrovascular diseases (CEVDs) has not yet achieved the desired progress. In this paper, we review the prevention and control of CEVDs and CAVDs, and analyze the differences in prevention effects, and the pathological and physiological structures pertaining to CEVDs and CAVDs. Combined with the different effects of low-dose aspirin in the primary prevention of CEVDs and CAVDs by meta-analysis, aspirin plays a more important role in the primary prevention of CAVDs than CEVDs. We recognize the misunderstandings and blind spots concerning prevention and control of CEVDs, which can be summarized as follows: (1) CEVDs and CAVDs can be controlled by the same methods and drugs; (2) considering the same pathological factors for cardiovascular diseases; (3) a lack of understanding of the particularity of CEVDs; (4) a focus on platelets and neglect of cerebrovascular protection. In summary, our research clarifies the differences in the prevention measures and drugs used for CEVDs and CAVDs. Of particular concern is the serious lack of preventive drugs for CEVDs in clinical use. An ideal drug for the prevention of CEVDs should have protective effects on the blood, the vascular endothelium, the blood-brain barrier (BBB), and other related factors. Our review aims to highlight several issues in the current prevention of CEVDs and CAVDs, and to provide an optimized plan for preventive drug discovery.

Topics: Animals; Aspirin; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Humans; Primary Prevention; Prognosis; Protective Factors; Risk Assessment; Risk Factors

Buyang Huanwu Decoction (BHD) is a multi-herbal composition commonly prescribed in the treatment of cerebrovascular diseases such as stroke. Although studies have been conducted at the cellular (in vitro), animal and human (in vivo) level, there was no detailed analysis on how the composition and proportion of BHD is modified according to target diseases.. The purpose of this study is to investigate the composition and proportion of each herb in BHD to summarize how the original BHD was modified according to the target disease.. Electronic literature searches were performed in three databases, collecting sixty-eight studies for the final analysis. The studies were divided into three types: cell studies, animal experiments and clinical trial. In the analysis, the decoction formula including the composition and the weight proportion of the herbs in BHD used in the studies and the target diseases were examined.. The result showed that in cell studies, the targets were mostly cell differentiation, cell injury and immune activation. In animal studies, cerebrovascular diseases such as cerebral ischemia were the most identified target diseases followed by nervous system and cardiovascular diseases. While the proportions of the herbs in BHD used in these studies were in general similar to the original formula, some studies reduced the amount of Astragali Radix to half of the original amount. Modified BHDs were used in four studies for cerebrovascular and peripheral nerve diseases. However, no significant correlation has been observed between the target diseases and the change of the proportion of the herbs in BHD.. The most commonly used formula was the original composition of BHD, and modified BHDs were reported to be used to treat cerebrovascular and nervous diseases. Further studies about the effects of BHD by composition and proportion of herbs are needed in the future.

Topics: Animals; Cardiovascular Agents; Cerebrovascular Disorders; Drug Compounding; Drugs, Chinese Herbal; Heart Diseases; Humans; Neuroprotective Agents; Peripheral Nervous System Diseases

Alzheimer's disease (AD) is a complex, progressive, neurodegenerative disorder. As with other common chronic diseases, multiple risk factors contribute to the onset and progression of AD. Many researchers have evaluated the epidemiologic and pathophysiological association between AD, cardiovascular diseases (CVDs), and cerebrovascular diseases (CBVDs), including commonly reported risk factors such as diabetes, hypertension, and dyslipidemia. Relevant therapies of CVDs/CBVDs for the attenuation of AD have also been empirically investigated. Considering the challenges of new drug development, in terms of cost and time, multifactorial approaches such as therapeutic repositioning of CVD/CBVD medication should be explored to delay the onset and progression of AD. Thus, in this review, we discuss our current understanding of the association between cardiovascular risk factors and AD, as revealed by clinical and non-clinical studies, as well as the therapeutic implications of CVD/CBVD medication that may attenuate AD. Furthermore, we discuss future directions by evaluating ongoing trials in the field.

Topics: Alzheimer Disease; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Clinical Trials as Topic; Diabetes Mellitus; Disease Progression; Drug Repositioning; Dyslipidemias; Heart Disease Risk Factors; Humans; Hypoglycemic Agents; Neuroprotective Agents

Cerebrovascular and cardiovascular diseases are caused by impairment of the brain and/or heart circulation. Insufficient blood flow results in decreased oxygen delivery (ischemia), which affects mitochondrial functioning and consequently leads to insufficient ATP production. The predominant mitochondrial outer membrane protein, the voltage dependent anion selective channel (VDAC), is considered to be crucial for mitochondrial functioning. In human mitochondria, as in other vertebrates, three isoforms of VDAC (VDAC1-VDAC3) are present, and they likely play different roles.. In this review, we summarize the available data concerning VDAC involvement in cardiovascular and cerebrovascular diseases with regard to VDAC isoforms and discuss the use of possible VDAC-related intervention targets as well as known VDAC-interacting and cytoprotection- conferring molecules in the treatment of cerebrovascular and cardiovascular diseases.. The suitable references on disorders defined as cerebrovascular and cardiovascular diseases as well as VDAC contribution to these conditions were searched using PubMed and ClinicalTrials.gov databases. The review is based on the 138 carefully selected articles.. Mitochondrial dysfunction triggered by changes in VDAC properties undoubtedly contributes to cell death and related diseases, including cerebrovascular and cardiovascular diseases. Thus, beside diagnostic application, modulation of VDAC activity, including its isoforms, is thus of great importance for the development of efficient therapeutic interventions. Moreover, identification of VDAC-interacting molecules that protect against mitochondrial dysfunction and cell death seems to be of great importance.

Topics: Animals; Cardiovascular Agents; Cardiovascular Diseases; Cell Death; Cerebrovascular Disorders; Drug Delivery Systems; Humans; Mitochondria; Nervous System Diseases; Protein Isoforms; Voltage-Dependent Anion Channels

The obstructive sleep apnoea syndrome (OSAS) had become a major public health concern in modern society due to its high prevalence but, above all, to its associated morbidity, especially cardiovascular.. Untreated OSAS is associated with an increased incidence of fatal (myocardial infarction and stroke) (odds ratio: 2.87) and non-fatal cardiovascular events (myocardial infarction, stroke, coronary artery bypass surgery and coronary angiography) (odds ratio: 3.17). Moreover, the prevalence of hypertension in patients with OSAS is high, between 35 and 80%. The pathophysiological mechanisms leading to these complications are mainly due to intermittent hypoxia secondary to repeated episodes of apnoea/hypopnoea during sleep. These mechanisms include sympathetic hyperactivation, impairment of vasomotor reactivity, vascular inflammation, oxidative stress and metabolic disorders. In patients with OSAS, the impact of continuous positive pressure is proven in terms of prevention of cardiovascular events although blood pressure reduction is limited. Obviously these effects are proportional to observance.. OSAS does increase the cardiovascular risk, independently of other risk factors. Although the impact of treatment is relatively low in decreasing blood pressure, it seems essentially effective in preventing cardiovascular morbidity. Therefore, OSAS screening, and the association of specific treatments in cardio-metabolic patients and OSAS patients respectively, should be included in clinical strategies.

Topics: Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Comorbidity; Continuous Positive Airway Pressure; Endothelium, Vascular; Glucose Intolerance; Humans; Hypertension; Hypoxia; Metabolic Syndrome; Nitric Oxide; Obesity; Oxidative Stress; Prevalence; Sleep Apnea, Obstructive; Sympathetic Nervous System; Vasculitis

Intracranial artery stenosis (ICAS) is a narrowing of an intracranial artery, which is a common etiology for ischemic stroke. In this commentary, we review key aspects of the discrimination between non-stroke controls and ischemic stroke patients on the background of phospholipid ω3-fatty acid (DHA, EPA) composition. The discussion is embedded in the presentation of general effects of long-chain ω3 polyunsaturated fatty acids (PUFAs) in cardio-cerebro-vascular diseases (CCVDs) and Alzheimer dementia (AD).. ICAS is a common stroke subtype and has emerged as a major factor in recurrent stroke and vascular mortality. DHA and EPA are important fatty acids to distinguish between NCAS (no cerebral arteriosclerotic stenosis) and ICAS in stroke. The risk of ICAS is inversely correlated with the DHA content in phospholipids. Furthermore, a mechanistic explanation has been proposed for the beneficial effects of PUFAs in CCVDs and AD.. Whereas the beneficial effects of EPA/DHA for cardiovascular diseases and stroke seem to be beyond question, preventive effects in patients with very mild cognitive dysfunction and beginning Alzheimer's disease undoubtedly need confirmation by larger clinical trials. A collaborative international basic science approach is warranted considering cautiously designed studies in order to avoid ethical problems.

Topics: Alzheimer Disease; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Constriction, Pathologic; Dementia, Vascular; Diet; Dietary Supplements; Fatty Acids, Omega-3; Humans; Intracranial Arterial Diseases; Nutrition Policy; Stroke

Among patients with atherothrombosis, including coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral arterial disease (PAD), patients with PAD generally have the worse prognosis. The Reduction of Atherothrombosis for Continued Health (REACH) Registry characterized the atherothrombotic risk factor profile, and evaluated treatment intensity and cardiovascular events among different atherothrombotic patient populations worldwide. Two thirds of PAD patients had polyvascular disease, defined as symptomatic involvement of more than one vascular bed. The risk factor profile in patients with CAD, CVD and PAD was very much similar. However, optimal risk factor control by medical treatment and lifestyle interventions was least accomplished in PAD patients. Furthermore, PAD patients and patients with polyvascular disease showed the highest cardiovascular event rates. Of note, therapeutic strategies are similar for all atherothrombotic disease categories, irrespective of the presence of polyvascular disease. Therefore, it is of the utmost importance to achieve optimal risk factor control, particularly for PAD patients and for those with polyvascular disease, in order to prevent future cardiovascular events.

Topics: Aged; Cardiovascular Agents; Cerebrovascular Disorders; Coronary Artery Disease; Europe; Female; Humans; Male; Peripheral Arterial Disease; Practice Guidelines as Topic; Prognosis; Registries; Risk Assessment; Risk Factors; Risk Reduction Behavior

Cardiovascular and cerebrovascular diseases share many pathophysiological traits, often impact one another and share several risk factors, though not always to the same magnitude. Therefore, it is not surprising that many classes of cardiovascular drugs have demonstrated effectiveness in the primary prevention, acute treatment and secondary prevention of stroke. Important advances have been made since 2007 in the use of antiplatelets, anticoagulants, antihypertensives, antiarrhythmics and statins for the treatment of stroke. This review summarizes selected clinical trials of cardiovascular drugs completed from 2007 to 2010 that generated important evidence supporting the efficacy of these drugs in stroke treatment. Ongoing trials and preclinical research of promising agents and treatment strategies are also discussed.

Topics: Anti-Arrhythmia Agents; Anticoagulants; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Clinical Trials as Topic; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Platelet Aggregation Inhibitors; Risk Factors

In November 2009 the first European guidelines were presented regarding preoperative risk assessment and perioperative management in non-cardiac surgery. They were designed by the European Society of Cardiology (ESC) and endorsed by the European Society of Anesthesiology.In a standardized manner, patient-specific clinical variables, their exercise capacity and surgery-specific risk factors are summarized to a recommendation concerning medication and preoperative cardiac evaluation. These guidelines are straightforward and feasible for cardiologists as well as specialists in internal medicine and general practicioners. Nevertheless, some points still lack evidence.

Topics: Activities of Daily Living; Age Factors; Angina Pectoris; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Coronary Angiography; Diabetes Mellitus, Type 1; Electrocardiography; Europe; Evidence-Based Medicine; Exercise Test; Health Status Indicators; Heart Failure; Humans; Metabolic Equivalent; Practice Guidelines as Topic; Preoperative Care; Renal Insufficiency

Cerebrovascular disease is one of the leading causes of morbidity and mortality in developed countries. The identification of at-risk individuals is a high priority so that efficacious preventive measures can be implemented. Subjects with the highest risk of cerebrovascular diseases are those who already have had a stroke or a transient ischemic attack, and those with vascular disease in other territories, either in coronary or peripheral arteries. Other subjects at risk are those with cardiac disease, such as atrial fibrillation, those with hypertension, diabetes and smoking habit, as well as individuals with subclinical vascular disease. Although there is considerable evidence for the efficacy of preventive treatment in this population, the percentage of patients receiving optimum treatment is far from ideal. There is a need to implement strategies in the population directed towards increasing awareness of the need to establish healthy habits and adequate preventive pharmacological treatment that could reduce the incidence of this debilitating disease.

Topics: Arteriosclerosis; Cardiovascular Agents; Cerebrovascular Disorders; Coronary Disease; Evidence-Based Medicine; Health Knowledge, Attitudes, Practice; Humans; Patient Education as Topic; Patient Selection; Peripheral Vascular Diseases; Practice Guidelines as Topic; Recurrence; Registries; Risk Assessment; Risk Factors; Risk Reduction Behavior

Atherosclerosis can affect nearly any part of the arterial system. Therefore, it is considered as a generalized disease. As most probably similar or identical etiopathogenetic mechanisms are involved in different atherosclerotic diseases, a different effect of treatment of risk factors on atherosclerotic lesions in different parts of the vascular system is expected. Until now, great emphasis has been placed on the aggressive pharmacological management of coronary artery disease, less attention has been devoted to the management of cerebrovascular and much less to peripheral arterial disease, despite their significant morbidity and mortality. The data from recent trials have indicated that treatment of patients with antiplatelet drugs, statins, antihypertensive and antidiabetic drugs prevents the progression of coronary atherosclerosis, reduces cardiovascular events and improves prognosis of coronary patients. Subgroup analyses from large studies have also shown that treatment of risk factors for atherosclerosis with drugs reduces cardiovascular events and improves prognosis of cerebrovascular and peripheral arterial occlusive disease. Although some studies indicate that the effects of distinct preventive procedures are to some extent dependent on the locations of atherosclerotic disease, it seems that the success of preventive measures is mostly related to the progression of the disease or the risk of treated population and not on the treated vascular bed.

Topics: Angiotensin-Converting Enzyme Inhibitors; Arterial Occlusive Diseases; Atherosclerosis; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Coronary Artery Disease; Disease Progression; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypoglycemic Agents; Peripheral Vascular Diseases; Platelet Aggregation Inhibitors; Treatment Outcome

Statins are pluripotent agents exhibiting multiple non-lipid-lowering actions. Besides their established role in the management of hypercholesterolemia, statins may also have beneficial actions in other pathological conditions, namely: a) osteoporosis and osteoporosis-related bone fractures, b) cancer, c) solid organ transplantation, d) cerebrovascular events (transient ischemic attack and stroke episodes), e) various neurological disorders, such as Alzheimer's disease, Parkinson's disease and multiple sclerosis, f) cardiac arrhythmias and heart failure, g) renal diseases, h) rheumatoid arthritis, i) autoimmune diseases, j) sepsis, and k) allergic asthma. We reviewed the literature searching for studies that support or oppose the use of statins in each proposed indication. In some of these emerging indications, a role for statin treatment is more firmly set; for others, current evidence is more controversial. Future trials may reveal more convincing evidence that will make statin use necessary in the therapeutic management of several diseases.

Topics: Animals; Anti-Asthmatic Agents; Antineoplastic Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Asthma; Autoimmune Diseases; Bone Density Conservation Agents; Cardiovascular Agents; Cerebrovascular Disorders; Heart Diseases; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Kidney Diseases; Neoplasms; Nervous System Diseases; Neuroprotective Agents; Organ Transplantation; Osteoporosis; Sepsis

To review the antihypertensive, cardiovascular and pleiotropic effects of angiotensin-receptor blockers (ARBs).. ARBs are the most recently approved class of antihypertensive agents. They selectively block the angiotensin II type 1 receptor, thus inhibiting most of the deleterious effects of angiotensin II. In addition to blood-pressure control, other benefits may be gained using ARBs. This is because the renin-angiotensin system plays a crucial role in circulatory homoeostasis, and in patients with atherosclerosis, diabetes or hypertension, angiotensin II contributes to the pathophysiology of disease. Evidence-based medicine includes well-controlled studies with mortality and morbidity endpoints in patients with a variety of conditions including hypertension, type 2 diabetes, stroke, renal disease, heart failure, left-ventricular hypertrophy and coronary heart diseases. In addition to these hard endpoints, it has been shown that treatment with ARBs prevents the development of type 2 diabetes, ameliorates coronary and peripheral vascular endothelial dysfunction and decreases plasma levels of several markers of vascular inflammation.. ARBs are first-line agents for the treatment of hypertension and cardiovascular diseases. Blocking the renin-angiotensin system with these agents has special advantages due to specific vascular and antiatherosclerotic effects, which contribute to a better cardiovascular and renal protection in patients at risk from or with cardiovascular disease.

Topics: Angiotensin II Type 1 Receptor Blockers; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Coronary Disease; Diabetes Mellitus, Type 2; Endothelium, Vascular; Heart Failure; Humans; Hypertension; Hypertrophy, Left Ventricular; Kidney Diseases

One of every four persons in the Western industrialised nations has cardiovascular disease. The perioperative setting in those patients is associated with the risk of myocardial ischaemia (PMI) and myocardial infarction, and also with the risk of perioperative stroke and dysfunction of the central nervous system (CNS). Perioperative cardiovascular morbidity represents a major healthcare challenge. The relevance of PMI is well documented. It has been demonstrated in early trials that both myocardial ischaemia and infarction are preventable in high-risk patients undergoing surgery, and that therapeutic agents such as adenosine-related agents, alpha 2-agonists, and other stress modulators can be safely administered to these patients. Regarding perioperative stroke, approximately 3 to 7% of patients undergoing cardiac surgery suffer stroke, with an additional 30% or more suffering in-hospital CNS dysfunction, and 10% suffering moderately severe long-term CNS dysfunction. Few data are available for noncardiac surgery. The number of outcome studies addressing prophylactic or therapeutic options in these patients is quite limited. In fact, only one recent study has established that perioperative stroke is preventable with the use of an adenosine-regulating agent. Thus, it appears that it may be possible to prevent stroke, even though these results require confirmation. Because of the aging of our population, and the medical, financial and social impact of cardiovascular disease, the development of anti-ischaemic therapy, particularly in the surgical patient, will be a critical area of medical research for the next several decades.

Topics: Anesthesia, General; Brain Damage, Chronic; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Humans; Intraoperative Complications; Myocardial Infarction; Myocardial Ischemia; Postoperative Complications; Premedication; Risk Factors

A number of therapeutic options are available to clinicians caring for patients with ischemic cerebrovascular diseases. The efficacy of some strategies that aim at mitigating the effects of cerebral infarction are presented. The optimal role of carotid surgery, platelet-antiaggregant drugs and anticoagulation in the prevention of stroke are analysed.

Topics: Brain Ischemia; Cardiovascular Agents; Carotid Artery Diseases; Cerebrovascular Disorders; Combined Modality Therapy; Drug Therapy, Combination; Endarterectomy; Humans

Despite advances in the understanding of the mechanism of cerebral injury during focal ischaemia, the best treatment of cerebral ischaemia is still prevention. The pathophysiological mechanisms that contribute to cerebral ischaemia are discussed relative to the many therapeutic interventions that have been attempted. It is our impression that the treatment of such a complex multifactor process will require multimodal therapy, as most of the unifactorial therapies used to date have proven relatively unsuccessful in improving neurological outcome and survival.

Topics: Cardiovascular Agents; Cerebrovascular Disorders; Humans

Acute, severe increases in arterial blood pressure cause sustained cerebral arteriolar dilation, abnormal reactivity to carbon dioxide and to changes in blood pressure, abolition of endothelium-dependent dilation from acetylcholine, discrete morphological lesions of the endothelium and vascular smooth muscle, and breakdown of the blood-brain barrier to plasma proteins. The dilation, abnormal reactivity, and morphological abnormalities are inhibited by pretreatment with cyclooxygenase inhibitors or with free radical scavengers. Superoxide dismutase-inhibitable reduction of nitroblue tetrazolium applied to the brain surface was detectable both during hypertension and one hour after hypertension subsided. Nitroblue tetrazolium reduction is also reduced by inhibitors of the anion channel. The abnormalities seen after hypertension are reproduced by topical application of arachidonate. The results are consistent with the view that acute hypertension induces generation of superoxide anion radical in association with accelerated arachidonate metabolism via cyclooxygenase. This radical enters cerebral extracellular space via the anion channel and gives rise to hydrogen peroxide and hydroxyl radical. All three radicals are capable of causing vasodilation by relaxation of cerebral vascular smooth muscle. The hydroxyl radical is the most likely candidate for vascular wall damage. The significance of this mechanism in chronic experimental hypertension or its relevance to human disease is not known.

Topics: Animals; Arachidonic Acid; Arachidonic Acids; Arterioles; Blood Proteins; Blood-Brain Barrier; Bradykinin; Brain; Brain Injuries; Cardiovascular Agents; Catalase; Cerebrovascular Circulation; Cerebrovascular Disorders; Cyclooxygenase Inhibitors; Endothelium; Free Radicals; Hydrogen Peroxide; Hydroxides; Hydroxyl Radical; Hypertension; Leukocytes; Leukotrienes; Lipid Peroxides; Muscle, Smooth, Vascular; Peroxidases; Prostaglandin-Endoperoxide Synthases; Prostaglandins G; Superoxide Dismutase; Superoxides; Vasodilation; Xanthine Oxidase

The strategy of primary prevention of coronary heart disease (CHD) needs reconsideration. Recent results of trials of reducing the risk of CHD in those at moderate risk have been inconclusive and disappointing. More may be expected from intervention in those at high risk, and a selective policy is advocated. But, in those at high risk, it is usually necessary to give drugs in order to reduce the risk from hypertension and hypercholesterolaemia. Many currently used and popular drugs have never been submitted to rigourous long-term testing of their safety, although it was only through formal clinical trials that the adverse effects of clofibrate and of thiazides were identified. More, not fewer, clinical trials are needed if we are to avoid new tragedies. A plea is made for the urgent establishment of drug data banks to permit accurate monitoring of changes in the incidence of commonly occurring diseases in relation to the increasing use of drugs for primary prevention of vascular diseases and for social convenience.

Topics: Adrenergic beta-Antagonists; Cardiovascular Agents; Cerebrovascular Disorders; Cholesterol; Clofibrate; Coronary Disease; Diuretics; Humans; Hypertension; Information Systems; Lipids; Risk; Thrombosis

Most patients with comorbid sleep apnea (OSA), cardiovascular (CV) disease, and/or cerebrovascular (CeV) disease simultaneously take medications. Whether OSA and continuous positive airway pressure (CPAP) interact with CV/CeV medications remains unknown. This study aimed to determine the interaction among OSA, CPAP, and CV/CeV medications; the effects of medications on major adverse cardiac and cerebrovascular events, and survival in patients with comorbid OSA and CV/CeV.. This was a post hoc analysis of the data from one center of the Sleep Apnea Cardiovascular Endpoints Study. Participants (aged 45-75 years) with comorbid OSA and CV/CeV were randomized to receive usual care with or without CPAP from December 2008 to November 2013. The primary endpoint was death and the secondary endpoint was a composite of death, myocardial infarction, stroke, hospitalization for unstable angina, heart failure, and transient ischemic attack.. In total, 131 patients were analyzed. Sixty-three were in the CPAP group and 68 were in the usual care group, 41 had good adherence to CPAP (65.1%), and the median follow-up time was 43.0 (35.0, 54.0) months. In Cox regression analysis, ACE inhibitors and nitrates were independent factors for decreased survival in patients with comorbid OSA and CV/CeV (chi-square = 22.932, P = 0.003; ACE inhibitors: OR 7.241, P = 0.048, 95% CI 1.016-51.628; nitrates: OR 18.012, P = 0.011, 95% CI 1.923-168.750). ACE inhibitors increased mortality and secondary endpoints in the CPAP group (chi-square = 4.134, P = 0.042) but not in patients with good CPAP adherence. Clopidogrel and nitrates decreased survival in usual care group (clopidogrel: chi-square = 5.312, P = 0.021; nitrates: chi-square = 6.417, P = 0.011), but not in CPAP group.. OSA may predispose patients with CV/CeV and CV/CeV medications to a negative effect. CPAP treatment may neutralize the negative effects of OSA by relieving chronic intermittent hypoxia. Trial registration ClinicalTrials.gov (NCT00738179, first registration date: 20/08/2008).

Topics: Adrenergic beta-Antagonists; Aged; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Comorbidity; Continuous Positive Airway Pressure; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypoglycemic Agents; Male; Middle Aged; Nitrates; Proportional Hazards Models; Risk Factors; Sleep Apnea, Obstructive; Survival Analysis

The aim of this study was to determine whether high-risk patients with left main coronary artery disease (LMCAD) and prior cerebrovascular disease (CEVD) preferentially benefit from revascularization by percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG).. Patients with known CEVD requiring revascularization are often referred to PCI rather than CABG. There is a paucity of data regarding the impact of CEVD in patients with LMCAD undergoing revascularization.. In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, patients with LMCAD and low or intermediate SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) scores were randomized to PCI with everolimus-eluting stents versus CABG. The effects of prior CEVD, defined as prior stroke, transient ischemic attack, or carotid artery disease, on 30-day and 3-year event rates were assessed.. Prior CEVD was present in 233 of 1,898 patients (12.3%). These patients were older and had higher rates of comorbidities, including hypertension, diabetes, peripheral vascular disease, anemia, chronic kidney disease, and prior PCI, compared with those without prior CEVD. Patients with prior CEVD had higher rates of stroke at 30 days (2.2% vs. 0.8%; p = 0.05) and 3 years (6.4% vs. 2.2%; p = 0.0003) and higher 3-year rates of the primary endpoint of all-cause death, stroke, or myocardial infarction (25.0% vs. 13.6%; p < 0.0001). The relative effects of PCI versus CABG on the 30-day and 3-year rates of stroke (p. Patients with LMCAD and prior CEVD compared with those without CEVD have higher rates of stroke and reduced event-free survival after revascularization. Data from the EXCEL trial do not a priori support a preferential role of PCI over CABG in patients with known CEVD.

Topics: Aged; Cardiovascular Agents; Cerebrovascular Disorders; Clinical Decision-Making; Coronary Artery Bypass; Coronary Artery Disease; Drug-Eluting Stents; Everolimus; Female; Humans; Male; Middle Aged; Patient Selection; Percutaneous Coronary Intervention; Progression-Free Survival; Risk Assessment; Risk Factors; Time Factors

To study the therapeutic efficacy and safety of Ginkgo special extract EGb 761 in the treatment of cognitive and non-cognitive symptoms (anxiety, depression, sleep disorders, activity) in patients with discirculatory encephalopathy (DE) and cognitive impairment.. The study enrolled 45 patients with DE (mean age 60,8±5,9 years). Patients were randomized to treatment with EGb 761 (30 patients) or other drugs (15 patients). Patients underwent neurological examinations, along with cognitive and neuropsychological testing (FAB, MMSE, HADS and other tests). EGb 761 was used in dose 240 mg per day during 24 weeks.. By the end of the study, the levels of anxiety and depression decreased (p<0,05) to the 12th and 24th week, respectively.. The results indicate the efficacy and good tolerability of EGb 761 in the treatment of mental disorders in DE patients with cognitive impairment. The best effect was observed in relation to anxiety.

Topics: Aged; Anxiety Disorders; Cardiovascular Agents; Cerebrovascular Disorders; Cognition Disorders; Depressive Disorder; Female; Ginkgo biloba; Humans; Male; Middle Aged; Plant Extracts; Treatment Outcome

Ischaemia in different arterial territories before acute myocardial infarction (AMI) may influence post-AMI outcomes. No studies have evaluated prospectively collected information on ischaemia and its effect on short- and long-term coronary mortality. The objective of this study was to compare patients with and without prospectively measured ischaemic presentations before AMI in terms of infarct characteristics and coronary mortality.. As part of the CALIBER programme, we linked data from primary care, hospital admissions, the national acute coronary syndrome registry and cause-specific mortality to identify patients with first AMI (n = 16,439). We analysed time from AMI to coronary mortality (n = 5283 deaths) using Cox regression (median 2.6 years follow-up), comparing patients with and without recent ischaemic presentations. Patients with ischaemic presentations in the 90 days before AMI experienced lower coronary mortality in the first 7 days after AMI compared with those with no prior ischaemic presentations, after adjusting for age, sex, smoking, diabetes, blood pressure and cardiovascular medications [HR: 0.64 (95% CI: 0.57-0.73) P < 0.001], but subsequent mortality was higher [HR: 1.42 (1.13-1.77) P = 0.001]. Patients with ischaemic presentations closer in time to AMI had the lowest seven day mortality (P-trend = 0.001).. In the first large prospective study of ischaemic presentations prior to AMI, we have shown that those occurring closest to AMI are associated with lower short-term coronary mortality following AMI, which could represent a natural ischaemic preconditioning effect, observed in a clinical setting.. Clinicaltrials.gov identifier NCT01604486.

Topics: Aged; Aged, 80 and over; Angina Pectoris; Atherosclerosis; Cardiovascular Agents; Cerebrovascular Disorders; Electronic Health Records; Female; Follow-Up Studies; Humans; Ischemia; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Peripheral Arterial Disease; Prognosis; Prospective Studies; Risk Factors

There are few data that demonstrate a significant effect of aspirin therapy for diabetic patients. To clarify the effect of the primary prevention of aspirin therapy in diabetic patients, the relationship between blood pressure (BP) and the incidence of atherosclerotic events was investigated in participants in the Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial.. We divided the JPAD participants according to their systolic (SBP) and diastolic (DBP) BPs at enrollment (SBP ≥140 mmHg and/or DBP ≥90 mmHg: unattained group, SBP <140 mmHg and DBP <90 mmHg: attained group). The incidence of the primary atherosclerotic events, especially cerebrovascular events, was higher in the unattained group than in the attained group. The incidence of cerebrovascular events was higher in the unattained group than in the attained group in patients without aspirin therapy; however, the incidence of cerebrovascular events in the unattained group was as low as the incidence in the attained group in patients undergoing aspirin therapy. Cox proportional hazards analysis revealed that BP level was an independent predictor for cerebrovascular events in diabetic patients.. Aspirin therapy may reduce cerebrovascular events in diabetic patients with higher BP. Aspirin therapy could be an additional strategy as primary prevention for diabetic patients with higher BP.

Topics: Aged; Aspirin; Blood Pressure; Cardiovascular Agents; Cerebrovascular Disorders; Chi-Square Distribution; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Female; Humans; Hypertension; Incidence; Japan; Kaplan-Meier Estimate; Male; Middle Aged; Primary Prevention; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; Treatment Outcome

To discuss the clinical effects of Western medicine therapy assisted by Ginkgo biloba tablet (GBT) on patients with vascular cognitive impairment of none dementia (VCIND).. A total of 80 patients with VCIND were divided into two groups randomly: Conventional treatment group (control group) and combined treatment group. Conventional treatment group was given conventional treatment with anti-platelet aggregation. In this group, 75 mg aspirin was given three times a day for 3 months. While in combined treatment group, 19.2 mg GBT was given three times a day for 3 months together with conventional treatment (anti-platelet aggregation drugs). Montreal cognitive assessment (MoCA) and transcranial Doppler (TCD) were used to observe changes of cognitive ability and cerebral blood flow in VCIND patients before and after treatment in both groups. Then the clinical data were analyzed so as to compare the efficacy in two groups.. After 3 month-treatment in combined treatment group, the scores of executive ability, attention, abstract, delayed memory, orientation in the MoCA were significantly increased compared with those before treatment and those in control group after treatment. Besides, blood flow velocity of anterior cerebral artery increased significantly than that before treatment and that in control group after treatment.. GBT tablet can improve the therapeutic efficacy as well improve cognitive ability and cerebral blood flow supply of patients with VCIND.

Topics: Aged; Aspirin; Blood Flow Velocity; Cardiovascular Agents; Cerebrovascular Disorders; Cognition Disorders; Drug Administration Schedule; Drug Therapy, Combination; Female; Ginkgo biloba; Humans; Male; Medicine, Chinese Traditional; Middle Aged; Plant Extracts; Platelet Aggregation Inhibitors; Psychological Tests; Treatment Outcome

The long-term impact of treating bifurcation lesions on the overall outcome of patients with multivessel coronary disease treated percutaneously with drug-eluting stents is unknown. This analysis determined the influence of bifurcation treatment using sirolimus-eluting stents on 3-year clinical outcomes.. Of the 607 patients (2,160 lesions) in the ARTS II study, 324 patients underwent revascularisation procedures involving treatment of at least one bifurcation (465 lesions). Three-year outcomes were compared to those without bifurcations. Despite more diffuse and complex disease in the bifurcation group, survival free of adverse events was equivalent in the two groups. At 3-years, there was no difference in rate of overall MACCE (20.2% vs. 18.5%, p=NS) or any of the component events between the bifurcation and the non-bifurcation group. There was a trend for a higher rate of definite stent thrombosis in the bifurcation group (4.6 vs 2.1%, p=0.1), but in multivariate analysis the CK value post-procedure served as the only independent predictor of definite stent thrombosis (p=0.015), with the presence of a bifurcation lesion of borderline significance (p=0.056).. In multivessel disease treated by PCI with DES, the presence of bifurcation disease had no adverse influence on 3-year clinical outcomes.

Topics: Aged; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Cerebrovascular Disorders; Chi-Square Distribution; Coronary Angiography; Coronary Stenosis; Drug-Eluting Stents; Female; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Myocardial Infarction; Prosthesis Design; Risk Assessment; Risk Factors; Severity of Illness Index; Sirolimus; Thrombosis; Time Factors; Treatment Outcome

We aimed to assess the safety and efficacy of lubeluzole in patients with a clinical diagnosis of acute (< 6 hours) ischemic stroke in the carotid artery territory.. A randomized, double-blind, placebo-controlled multicenter trial was conducted in 232 patients. Because treatment was administered within 6 hours and a CT scan was not mandatory before the start of treatment, 39 patients with either an intracerebral hemorrhage or ischemic stroke in the vertebrobasilar circulation were excluded from the primary efficacy analysis as prespecified in the protocol. Of the 193 patients with acute ischemic stroke in the carotid artery territory (target population), 61 received placebo, 66 lubeluzole 7.5 mg over 1 hour followed by 10 mg/d for 5 days, and 66 lubeluzole 15 mg over 1 hour followed by 20 mg/d for 5 days.. The trial, initially aimed at a patient inclusion of 270, was terminated prematurely according to the advice of the Safety Committee because of an imbalance in mortality between the treatment groups. Mortality rates at the final follow-up of 28 days for placebo, lubeluzole 10 mg/d, and lubeluzole 20 mg/d were, respectively, 18%, 6%, and 35% in the target population, results that were confirmed in the intent-to-treat population. Multivariate logistic regression analysis showed that the lower mortality in the lubeluzole 10 mg/d group was significantly in favor of the 10 mg/d treatment (P = .019). The higher mortality rate in the 20 mg/d group could be explained, at least in part, by an imbalance at randomization that led to a higher number of patients in that group with severe ischemic stroke. A total of 26 of 66 patients (39%) who received lubeluzole 10 mg/d had a score on the Barthel Index of > 70 at day 28, indicating no or mild disability, compared with 21 of 61 (34%) in the placebo group and 19 of 66 (29%) in the lubeluzole 20 mg/d group (P = NS).. In patients with acute ischemic stroke, the dosage regimen of 7.5 mg over 1 hour followed by 10 mg/d of intravenous lubeluzole is safe and statistically significantly reduced mortality. Further clinical trials in a larger number of patients are ongoing to confirm efficacy.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Brain Ischemia; Cardiovascular Agents; Carotid Artery Diseases; Cerebrovascular Disorders; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Injections, Intravenous; Logistic Models; Male; Middle Aged; Multivariate Analysis; Piperidines; Placebos; Safety; Thiazoles

Stroke is one of the leading causes of death and disability globally, while intravenous thrombolysis with recombinant tissue plasminogen activator remains the only Food and Drug Administration (FDA)-approved therapy for ischemic stroke. The attempts to develop new treatments for acute ischemic stroke meet costly and spectacularly disappointing results, which requires both long time and high costs, whereas repurposing of safe existing drugs to new indications provides a cost-effective and not time-consuming alternative. Vascular protection is a promising strategy for improving stroke outcome, as vascular function is critical to both cardiovascular diseases (CVD) and ischemic cerebrovascular disease (ICD). Vascular function related biological processes and pathways maybe the critical associations between CVD and ICD. In this study, a multi-database, in silico target identification, gene function enrichment, and network pharmacology analysis integration approach was proposed and applied to investigate the FDA-approved CVD drugs repurposing for ICD. A list of 119 candidate drugs can be obtained for further investigation of their potential in ICD treatment. As a pleiotropic drug with multi-target, carvedilol was set an example to investigate its promising potential for ICD therapy. Our results indicated that the mode of action of carvedilol for ICD treatment may tightly associated with vascular function regulation and the mechanism is multi-target and multi-signaling pathway related. The disease-disease association network-assisted prediction needs further investigations. In summary, the proposed methods herein may provide a promising alternative to inferring novel disease indications for known drugs.

Topics: Brain Ischemia; Cardiovascular Agents; Cerebrovascular Disorders; Databases, Factual; Drug Repositioning; Gene Regulatory Networks; Humans

Cilostazol has been associated with spontaneous reports of cardiovascular adverse events and serious bleeding. The objective of this study is to determine the relative risk of cardiovascular adverse events or haemorrhages in patients with peripheral artery disease treated with cilostazol in comparison to pentoxifylline users.. Population-based cohort study including all individuals older than 40 who initiated cilostazol or pentoxifylline during 2009-2011 in SIDIAP database. The two treatment groups were matched through propensity score (PS).. Nine thousand one hundred twenty-nine patients met inclusion criteria and after PS matching, there were 2905 patients in each group. 76% of patients were men, with similar mean ages in both groups (68.8 for cilostazol and 69.4 for pentoxifylline). There were no differences in bleeding, cerebrovascular and cardiovascular events between both groups.. Patients treated with cilostazol were different from those treated with pentoxifylline at baseline, so they were matched through PS. We did not find differences between treatment groups in the incidence of bleeding or cardiovascular and cerebrovascular events. Cilostazol should be used with precaution in elderly polymedicated patients.

Topics: Age Factors; Aged; Aged, 80 and over; Cardiovascular Agents; Cerebrovascular Disorders; Cilostazol; Databases, Factual; Drug Interactions; Electronic Health Records; Female; Hemorrhage; Humans; Incidence; Male; Middle Aged; Patient Safety; Pentoxifylline; Peripheral Arterial Disease; Phosphodiesterase 3 Inhibitors; Polypharmacy; Primary Health Care; Retrospective Studies; Risk Assessment; Risk Factors; Spain; Time Factors; Treatment Outcome

To assess long-term clinical outcomes of consecutive high-risk patients with severe aortic stenosis according to treatment allocation to transcatheter aortic valve implantation (TAVI), surgical aortic valve replacement (SAVR) or medical treatment (MT).. Patients with severe aortic stenosis were consecutively enrolled into a prospective single centre registry.. Among 442 patients (median age 83 years, median STS-score 4.7) allocated to MT (n=78), SAVR (n=107), or TAVI (n=257) all-cause mortality amounted to 81%, 37% and 43% after a median duration of follow-up of 3.9 years (p<0.001). Rates of major adverse cerebro-cardiovascular events were lower in patients undergoing SAVR or TAVI as compared with MT (SAVR vs MT: HR 0.31, 95% CI 0.21 to 0.46) (TAVI vs MT: HR 0.34, 95% CI 0.25 to 0.46), with no significant difference between SAVR and TAVI (HR 0.88, 95% CI 0.62 to 1.25). Whereas SAVR (HR 0.39, 95% CI 0.24 to 0.61), TAVI (HR 0.37, 95% CI 0.26 to 0.52), and female gender (HR 0.72, 95% CI 0.53 to 0.99) were associated with improved survival, body mass index ≤20 kg/m(2) (HR 1.60, 95% CI 1.04 to 2.47), diabetes (HR 1.48, 95% CI 1.03 to 2.12), peripheral vascular disease (HR 2.01, 95% CI 1.44 to 2.81), atrial fibrillation (HR 1.74, 95% CI 1.28 to 2.37) and pulmonary hypertension (HR 1.43, 95% CI 1.03 to 2.00) were identified as independent predictors of mortality.. Among high-risk patients with severe aortic stenosis, long-term clinical outcome through 5 years was comparable between patients allocated to SAVR or TAVI. In contrast, patients with MT had a dismal prognosis.

Topics: Age Factors; Aged; Aged, 80 and over; Aortic Valve Stenosis; Cardiac Catheterization; Cardiovascular Agents; Cerebrovascular Disorders; Comorbidity; Female; Heart Valve Prosthesis Implantation; Humans; Kaplan-Meier Estimate; Male; Proportional Hazards Models; Prospective Studies; Registries; Risk Factors; Severity of Illness Index; Sex Factors; Switzerland; Time Factors; Treatment Outcome

Coronary angiography holds a central role in the diagnosis of coronary heart disease. We studied temporal trends in referral patterns 2000-09.. We identified 156 496 first-time coronary angiographies in 2000-09 in nationwide registries. Trends were analyzed in 2-year intervals. Numbers of acute (5943-10 707) and elective (17 294-25 550) procedures increased between 2000-01 and 2008-09. Mean age increased from 61.8 to 63.9 years (P < 0.001) and the proportion of females increased from 33 to 37% (P < 0.001). An increase in the number of patients with prior chronic heart failure (2866 vs. 3197), cerebrovascular disease (1790 vs. 2906), diabetes (2527 vs. 4593), and arrhythmias (2985 vs. 4733) was observed. The proportion of acute patients examined the same day as hospitalized increased from 56.6 to 83.1%. Odds ratios (95% confidence interval) for treatment with statins [3.42(3.27;3.57)], RAS-inhibitors [1.85(1.77;1.93)], and acetylsalicylic acid [1.43(1.37;1.49)] at the time of coronary angiography increased towards 2008-09. Elective patients received medical treatment more often than acute patients (P < 0.001).. During a 10-year period, there was an increase in the mean age of patients and the proportion of female patients, and a 56% increase in number of coronary angiographies performed. The use of prophylactic cardiovascular drugs among these high-risk patients increased during our study period.

Topics: Adult; Aged; Cardiovascular Agents; Cerebrovascular Disorders; Comorbidity; Coronary Angiography; Coronary Disease; Denmark; Follow-Up Studies; Forecasting; Heart Failure; Humans; Middle Aged; Population Surveillance; Retrospective Studies

To investigate the effects of n-3 polyunsaturated fatty acids on cerebral circulation, ovariectomized (OVX) rats were administered with phospholipids in krill oil (KPL) or triglycerides in fish oil (FTG); effects on the Ca(2+) regulating system in their basilar artery (BA) were then analyzed.. The rats were divided into 4 groups: control, OVX, OVX given KPL (OVXP), and OVX given FTG (OVXT) orally, daily for 2weeks. Time dependent relaxation (TDR) of contractile response to 5HT in BA was determined myographically, Na(+)/Ca(2+) exchanger (NCX) 1 mRNA expression was determined by real time PCR, and nucleotides were analyzed by HPLC.. The level of TDR in OVX that was significantly lower in the control was inhibited by l-NAME and indomethacin; TEA inhibited TDR totally in the control but only partly in OVXP and OVXT. Relaxation induced by the addition of 5mM KCl to the BA pre-contracted with 5-HT was inhibited by TEA in the controls, OVXP and OVXT, but not in OVX. Overexpression of NCX1 mRNA in the BA from OVX was significantly inhibited by FTG. The ratio of ADP/ATP in cerebral arteries from OVX was significantly inhibited by KPL and FTG. Levels of triglyceride and arachidonic acid in the plasma of OVX increased, but were significantly inhibited by KPL and FTG.. Ovarian dysfunction affects Ca(2+) activated-, ATP-sensitive-K(+) channels and NCX1, which play crucial roles in the autoregulation of cerebral blood flow. Also, KPL may become as good a supplement as FTG for postmenopausal women.

Topics: Adipose Tissue; Animals; Calcium; Cardiovascular Agents; Cerebral Arteries; Cerebral Cortex; Cerebrovascular Disorders; Drug Evaluation, Preclinical; Euphausiacea; Fatty Acids, Omega-3; Female; Gene Expression; Homeostasis; In Vitro Techniques; NG-Nitroarginine Methyl Ester; Ovariectomy; Postmenopause; Potassium Channels, Tandem Pore Domain; Rats; Rats, Wistar; Serotonin; Serotonin Agents; Sodium-Calcium Exchanger; Triglycerides; Vasoconstriction; Vasodilation

We studied all patients admitted to hospital with first onset atrial fibrillation (AF) to determine the probability of spontaneous conversion to sinus rhythm and to identify factors predictive of such a conversion.. We retrospectively reviewed charts of 438 consecutive patients admitted to hospital with first onset AF from 1 January 2006 to 31 December 2009. The patients were divided into two groups, recent onset AF defined as AF < 48 h or longer lasting AF, defined as AF > 48 h.. Spontaneous conversion occurred in 54% (n = 203; 95% confidence interval: 49-59%). In the group with first onset AF < 48 h, spontaneous conversion occurred in 77%, compared with 36% in the group with first onset AF > 48 h. Logistic regression analysis identified duration of AF as a highly significant predictor of spontaneous conversion to sinus rhythm (odds ratio 5.9; 95% confidence interval: 4.0-8.6, P < 0.001).. Spontaneous conversion occurred in 54%, increasing to 77% when AF had persisted less than 48 h.

Topics: Age of Onset; Aged; Atrial Fibrillation; Cardiovascular Agents; Cerebrovascular Disorders; Comorbidity; Diabetes Mellitus; Echocardiography; Electric Countershock; Electrocardiography; Female; Humans; Hypertension; Infections; Inpatients; Male; Middle Aged; Remission, Spontaneous; Retrospective Studies; Risk Factors; Stroke Volume; Time Factors

Topics: Aspirin; Blood Pressure; Cardiovascular Agents; Cerebrovascular Disorders; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Female; Humans; Hypertension; Male; Primary Prevention

The up-to-date key positions and the future prospects of cardioneurology were analyzed. The wide range of questions of cardioneurology was represented and the necessity of the interdisciplinary approach to the diagnostics, treating and prevention of the cerebrovascular diseases were proved. It was pointed that the studied problems are the priority directions in angioneurology and have great social and clinical importance.

Topics: Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Comorbidity; Disease Progression; Forecasting; Health Promotion; Humans; Patient Care Team; Preventive Medicine; Primary Prevention; Prognosis; Risk Factors; Secondary Prevention

Effects of carotid artery stenting (CAS) on patients with chronic internal carotid artery occlusion are unknown.. This study included 21 patients who underwent successful CAS treatment and 41 patients who received optimal medical therapy. Modified Rankin Scale (mRS) and cardiocerebral vascular events were compared between CAS and medical therapy group.. The mRS in CAS group was lower than in control group during a 2-year follow up (P<0.05 or 0.01). The combined cerebrovascular events and mortality in study group was lower than in the control group (33.4% vs. 56.1%, P=0.045), but there was no statistically significant difference in the cerebrovascular event (28.6% vs. 46.3%, P=0.088) or mortality rate (4.8% vs. 9.8%, P=0.247) between the two groups. Cox regression analysis revealed that smoking (RR=3.189, 95% CI 1.020-9.968, P=0.046), diabetes (RR=2.717, 95% CI 1.113-6.631, P=0.028), and baseline National Institute of Health stroke scale (RR=2.984, 95% CI 1.049-8.485, P=0.040) were independent risk factors for major cerebrovascular events following CAS.. CAS was superior to drug therapy in achieving better functional outcomes in patients with chronic internal carotid artery occlusion. However, CAS was not associated with a statistically significant reduction in cerebrovascular events or mortality. Larger and randomized clinical trials are required to ascertain the long-term benefits of CAS in patients with chronic internal carotid artery occlusion.

Topics: Aged; Analysis of Variance; Angioplasty; Cardiovascular Agents; Carotid Artery, Internal; Carotid Stenosis; Case-Control Studies; Cerebrovascular Disorders; Chi-Square Distribution; China; Chronic Disease; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Proportional Hazards Models; Risk Assessment; Risk Factors; Stents; Time Factors; Treatment Outcome

Cerebrovascular pathology has long moved from the category of a single medical problem in the social problem. Progression of vascular lesions of the brain results in significant disability, and in the later stages interfere with the ability to self-service and significantly reduces the quality of life. The key link is ischemic brain damage, or glutamate cascade, which many researchers believe trigger excitotoxic damage and a major cause of neuronal death. One important component of effective control of the effects of ischemic disorders is complex neuro-cytoprotective therapy. To correct for the effects of both acute and chronic ischemia of the brain need to effectively act in several directions simultaneously, normalizing metabolic changes, eliminating the cytokine imbalance transcription violations, reducing the severity of oxidative stress and excitotoxicity.

Topics: Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Circulation; Cerebrovascular Disorders; Energy Metabolism; Humans; Hypoxia; Ischemia; Methylhydrazines; Randomized Controlled Trials as Topic

Topics: Antihypertensive Agents; Asymptomatic Diseases; Cardiovascular Agents; Carotid Artery Diseases; Cerebrovascular Disorders; Endarterectomy, Carotid; Evidence-Based Medicine; Fibrinolytic Agents; Germany; Guideline Adherence; Humans; Hypoglycemic Agents; Hypolipidemic Agents; National Health Programs; Outcome and Process Assessment, Health Care; Practice Guidelines as Topic; Practice Patterns, Physicians'; Risk Assessment; Risk Factors; Treatment Outcome

Topics: Antihypertensive Agents; Asymptomatic Diseases; Cardiovascular Agents; Carotid Artery Diseases; Cerebrovascular Disorders; Endarterectomy, Carotid; Evidence-Based Medicine; Fibrinolytic Agents; Germany; Guideline Adherence; Humans; Hypoglycemic Agents; Hypolipidemic Agents; National Health Programs; Outcome and Process Assessment, Health Care; Practice Guidelines as Topic; Practice Patterns, Physicians'; Risk Assessment; Risk Factors; Treatment Outcome

The optimal treatment of asymptomatic carotid disease is being debated again. The conclusions of the large randomised controlled trials of the early 1980s and 1990s are increasingly being questioned due to advances in modern medical treatment. This study investigates how patients are actually managed medically related to general risk factors prior to carotid endarterectomy in a German health-care region.. A prospective data bank including 95 consecutive patients was used. The effectiveness of lipid lowering and diabetes management were investigated as well as the use of anti-thrombotic and blood pressure medication.. A total of 108 carotid endarterectomies in 95 patients were performed between January 2009 and March 2010. All 95 patients (70 male, 25 female; 39 symptomatic/56 asymptomatic) were included in the study. Nearly half (54%) of the patients were on statins; of these, 45% had low-density lipoprotein (LDL) levels >100 mg dl(-1). Of 32 patients with diabetes, one had glycohaemoglobin (HbA(1c)) <6.0. Overall, four patients were on clopidogrel. Three patients were severely hypertensive (systolic blood pressure >180 mmHg).. The best medical therapy for carotid disease is not optimal in the part of the German health-care system observed in this study. We strongly advocate similar audits in other health-care areas and systems.

Topics: Aged; Aged, 80 and over; Antihypertensive Agents; Asymptomatic Diseases; Cardiovascular Agents; Carotid Artery Diseases; Cerebrovascular Disorders; Chi-Square Distribution; Clinical Audit; Endarterectomy, Carotid; Evidence-Based Medicine; Female; Fibrinolytic Agents; Germany; Guideline Adherence; Humans; Hypoglycemic Agents; Hypolipidemic Agents; Male; Middle Aged; National Health Programs; Outcome and Process Assessment, Health Care; Practice Guidelines as Topic; Practice Patterns, Physicians'; Prospective Studies; Risk Assessment; Risk Factors; Treatment Outcome

To evaluate the angiographic and clinical outcome of patients undergoing paclitaxel-eluting stent (PES) implantation for unprotected left main coronary artery (ULMCA) stenosis in a "real-world" multicentre, prospective registry. Percutaneous coronary intervention (PCI) is an increasingly utilised method of revascularisation in patients with ULMCA.. A prospective registry including all patients with a significant (>50%) ULMCA stenosis. Of 151 such patients, the target lesion involved the distal bifurcation in 100 patients (66%), which was treated predominantly by a "provisional T-stenting" strategy. In the distal ULMCA disease group, 72% had only one stent implantation while 28% had multiple (either two or three) stents implanted. At a median follow-up of 1,123±80 days, cardiac death occurred in five patients (3.3%) and major adverse cardiac and cerebrovascular events (MACCE) in 32 patients (21.2%). The three-year survival rate was 93.3%.. In the drug-eluting stent era, paclitaxel-eluting stent implantation of ULMCA stenosis provided excellent immediate and long-term results in this selected population, suggesting that this approach may be considered as a safe and effective alternative to CABG for selected patients with ULMCA who are treated in experienced institutions performing large numbers of PCI procedures.

Topics: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Cerebrovascular Disorders; Chi-Square Distribution; Coronary Angiography; Coronary Restenosis; Coronary Stenosis; Disease-Free Survival; Drug-Eluting Stents; Female; France; Hospital Mortality; Humans; Logistic Models; Male; Middle Aged; Myocardial Infarction; Paclitaxel; Prospective Studies; Prosthesis Design; Registries; Risk Assessment; Risk Factors; Severity of Illness Index; Survival Analysis; Survival Rate; Time Factors; Treatment Outcome

Conflicting patient outcomes have been reported after the use of sirolimus-eluting stents or bare-metal stents. In this nonrandomized study, we examine the outcomes after placement of sirolimus-eluting versus bare-metal stents in an unselected population of patients who underwent percutaneous coronary revascularization.We used THIRD-base, a longitudinal data registry of patients who underwent revascularization at our institution, to compare demographics and outcomes in patients treated with a sirolimus-eluting or bare-metal stent from January 2001 through June 2006. Outcome measures included major acute coronary and cerebral events at 30 days, target-vessel failure at 9 months and at 3 years, and stent thrombosis. Target-vessel failure was defined as the composite of all-cause death, recurrent myocardial infarction in the treated vessel distribution, and target-vessel revascularization. Logistic regression and Cox proportional regression models were used to determine the predictors of outcome.Of the 6,425 patients analyzed, 2,581 patients (40.2%) received only sirolimus-eluting stents, and 3,844 patients (59.8%) received only bare-metal stents. Early major acute coronary and cerebral events and stent thrombosis at 30 days and 9 months were similar in both groups. Target-vessel failure was less frequent in sirolimus-eluting stent patients than in bare-metal stent patients at 9 months (4.84% vs 11.81%, P < 0.0001) and at 3 years (29% vs 32%, P < 0.0001).Use of sirolimus-eluting stents improved target-vessel failure survival at 9 months and at 3 years. Late adverse events were determined by known risk factors for atherosclerosis, not by stent type.

Topics: Aged; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Cerebrovascular Disorders; Chi-Square Distribution; Coronary Artery Disease; Drug-Eluting Stents; Female; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Metals; Middle Aged; Myocardial Infarction; Patient Selection; Propensity Score; Proportional Hazards Models; Prosthesis Design; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Sirolimus; Stents; Texas; Thrombosis; Time Factors; Treatment Outcome

Patients with peripheral atherosclerotic disease often have multiple affected vascular beds (AVB), however, data on long-term follow-up and medical therapy are scarce. We assessed the prevalence and prognostic implications of polyvascular disease on long-term outcome in symptomatic peripheral arterial disease (PAD) patients.. Two thousand nine hundred and thirty-three consecutive patients were screened prior to surgery for concomitant documented cerebrovascular disease and coronary artery disease. The number of AVB was determined. Cardiovascular medication as recommended by guidelines was noted at discharge. Single, two, and three AVB were detected in 1369 (46%), 1249 (43%), and 315 (11%) patients, respectively. During a median follow-up of 6 years, 1398 (48%) patients died, of which 54% secondary to cardiovascular cause. After adjustment for baseline cardiac risk factors and discharge-medication, the presence of 2-AVB or 3-AVB was associated with all-cause mortality (HR 1.3 95% CI 1.2-1.5; HR 1.8 95% CI 1.5-2.2) and cardiovascular mortality (HR 1.5 95% CI 1.2-1.7; HR 2.0 95% CI 1.6-2.5) during long-term follow-up, respectively. Patients with 2- and 3-AVB received extended medical treatment compared with 1-AVB at the time of discharge.. Polyvascular atherosclerotic disease in PAD patients is independently associated with an increased risk for all-cause and cardiovascular mortality during long-term follow-up.

Topics: Aged; Cardiovascular Agents; Cerebrovascular Disorders; Coronary Artery Disease; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Peripheral Arterial Disease; Postoperative Care; Prognosis; Retrospective Studies; Risk Factors

This study aimed to validate the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score representing angiographic complexity after unprotected left main coronary artery (ULMCA) revascularization.. The validity of the SYNTAX score has been adequately evaluated.. The SYNTAX scores were calculated for 1,580 patients in a large multicenter registry who underwent percutaneous coronary intervention (PCI) (n = 819) or coronary artery bypass graft (CABG) (n = 761) for ULMCA stenosis. The outcomes of interests were 3-year incidences of major adverse vascular events (MAVE), including death, Q-wave myocardial infarction, and stroke and major adverse cardiac and cerebrovascular events (MACCE), including MAVE and target vessel revascularization of ULMCA.. The incidence of 3-year MAVE was 6.2% in the lowest (< or =23), 7.1% in the intermediate (23 to approximately 36), and 17.4% in the highest (>36) SYNTAX score tertile groups after PCI (p = 0.010). However, the incidences of MAVE in the CABG group and MACCE in the PCI and CABG groups did not differ among the SYNTAX tertiles. In subgroups, the MAVE (p = 0.005) and MACCE (p = 0.007) rates according to the SYNTAX score tertiles were significantly different in patients receiving drug-eluting stent, not in those receiving bare-metal stent. When compared with the clinical EuroSCORE (European System for Cardiac Operative Risk Evaluation), the C-indexes of SYNTAX score and EuroSCORE were 0.59 and 0.67, respectively, for discrimination of MAVE and 0.53 and 0.57, respectively, for MACCE.. The angiographic SYNTAX score seems to play a partial role in predicting long-term adverse events after PCI for ULMCA stenosis. A complementary consideration of patient's clinical risk might improve the predictive ability of risk score.

Topics: Aged; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Cerebrovascular Disorders; Coronary Angiography; Coronary Artery Bypass; Coronary Stenosis; Drug-Eluting Stents; Female; Health Status Indicators; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Paclitaxel; Predictive Value of Tests; Proportional Hazards Models; Prosthesis Design; Registries; Reproducibility of Results; Republic of Korea; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome

Topics: Adult; Aged; Anesthesia; Biomarkers; Blood Glucose; Cardiac Catheterization; Cardiovascular Agents; Cerebrovascular Disorders; Coronary Angiography; Echocardiography; Electric Countershock; Electrocardiography; Heart Diseases; Humans; Intraoperative Complications; Lung Diseases; Middle Aged; Myocardial Revascularization; Pain, Postoperative; Preoperative Care; Risk Assessment; Young Adult

The aim of the present study was to compare the effects of drug-eluting stents (DES) and coronary artery bypass grafting (CABG) in patients suffering from chronic stable angina with multivessel disease, involving significant proximal stenosis in the left anterior descending artery (LAD).. All consecutive patients suffering from chronic stable angina with multivessel disease involving significant proximal LAD stenosis underwent DES implantation (n=600) or CABG (n=709) at our institution. At 2 years, the unadjusted mortality was significantly lower in the DES group than in the CABG group (2.2% vs 5.2%, P=0.004), but the adjusted risk of death was similar (odds ratio (OR) 0.74, 95%CI 0.28-1.97, P=0.555). Furthermore, both the adjusted rate of nonfatal myocardial infarction and cerebrovascular events was also comparable. However, the unadjusted and adjusted risk of major adverse cardiac cerebrovascular events in the DES was significantly higher than in the CABG (13.3% vs 9.6%, OR 2.71, 95%CI 1.56-4.74, P<0.001), which is probably attributed to the higher subsequent revascularization rate after DES implantation.. DES showed comparable long-term mortality for the treatment of multivessel disease involving significant proximal stenosis in LAD in comparison with CABG.

Topics: Aged; Angina Pectoris; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Cerebrovascular Disorders; Chronic Disease; Coronary Angiography; Coronary Artery Bypass; Coronary Stenosis; Drug-Eluting Stents; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Odds Ratio; Paclitaxel; Platelet Aggregation Inhibitors; Proportional Hazards Models; Registries; Reoperation; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sirolimus; Time Factors; Treatment Outcome

To perform an ecological study in an effort to generate questions concerning the preventive impact of various cardiovascular drugs on mortality from stroke and ischaemic heart disease (IHD) in the community, and to explore the association between sales of nitrates and mortality from stroke and IHD.. Out-patient drug utilization (sales) of blood pressure lowering drugs, lipid lowering drugs and nitrates were categorized in four groups of equal size by quartiles and compared with mortality from IHD and stroke, using the group of municipalities with the lowest utilization as reference, from 1989 to 1993 in 283 of Sweden's 288 municipalities, by Poisson regression. Adjustments were made for population size, age and gender proportions, the utilization rate of cardiovascular drugs other than the tested drug group and location of the municipality.. Compared with the group of municipalities with the lowest sales and adjusting only for population size, mortality from IHD and stroke increased with the extent of utilization of blood pressure lowering drugs and nitrates. In contrast, mortality decreased with increased utilization of lipid lowering drugs. After further adjustments by percentage of men, age structure, geographical location (mid-points) of the municipalities, and, as a proxy for cardiovascular disease, the sales of cardiovascular drugs other than the tested drug group, the increased risk associated with blood pressure lowering drugs disappeared, and there was a dose-response association between sales of diuretics and old antihypertensives and decreasing mortality, sales of nitrates continued to be associated with an increased risk, and the low mortality risk associated with sales of lipid lowering drugs persisted.. Lipid lowering drugs may have a preventive impact in the general population, but the preventive impact of blood pressure lowering drugs, with the exception of diuretics and old antihypertensives, may be low in many municipalities. The safety of nitrates needs more investigation at the individual level.

Topics: Antihypertensive Agents; Cardiovascular Agents; Cerebrovascular Disorders; Data Collection; Female; Humans; Hyperlipidemias; Hypertension; Hypolipidemic Agents; Male; Myocardial Ischemia; Nitrates; Sweden

Topics: Acute Disease; Brain Ischemia; Cardiovascular Agents; Cerebrovascular Disorders; Humans; Piperidines; Thiazoles

In search of a better treatment for acute ischemic stroke, we evaluated the use of lubeluzole and hemodilution with diaspirin cross-linked hemoglobin (DCLHb) therapy to test whether treatment with two complementary acting compounds provides more potent protection than either treatment alone.. We used unilateral reversible middle cerebral artery (MCA) and common carotid artery (CCA) occlusion of various durations in Long-Evans rats to produce ischemic cortical lesions. We calculated the average maximal lesion volume (Volmax) and the time required to produce half maximal lesion size (T50) in control animals (n = 31) and evaluated the effects on cerebral perfusion and infarct size of treatment with lubeluzole (n = 23), hemodilution (to 30% hematocrit) with albumin (n = 17) or DCLHb (n = 23), and combined lubeluzole + DCLHb therapy initiated 15 minutes after MCA/CCA occlusion.. The Volmax produced by MCA/CCA occlusion in control animals was 138.5 +/- 7.7 mm3, and T50 was 98.5 +/- 10.2 minutes. Lubeluzole alone reduced Volmax by 53% with no significant effect on T50. In contrast to lubeluzole, DCLHb hemodilution prolonged T50 by 68% with no significant effect on Volmax. Prolongation of T50 by DCLHb was not due to hemodilution itself, since a similar degree of hemodilution with albumin had no effect. Finally, combined lubeluzole+DCLHb rescued 72% of the tissue and augmented the effect of lubeluzole alone by 40% (Volmax, 66.3 +/- 13.0 versus 39.4 +/- 12.2 mm3) while prolonging T50 by 31%.. Combination therapy for acute stroke using compounds with complementary action can result in more complete attenuation of neuronal damage and demonstrates the possible clinical utility of combined neuroprotective and reperfusion therapies.

Topics: Animals; Aspirin; Cardiovascular Agents; Cerebral Infarction; Cerebrovascular Disorders; Drug Therapy, Combination; Hemodilution; Hemoglobins; Male; Neuroprotective Agents; Piperidines; Rats; Rats, Inbred Strains; Reperfusion; Thiazoles

Recent studies indicate that centrally released arginine vasopressin (AVP) facilitates brain water permeability in normal and pathological conditions. The effects of central administration of arginine vasopressin (AVP) receptor antagonists on vasogenic brain edema were studied in rats. V1 or V2 receptor antagonists were stereotactically injected into the lateral ventricle 10 min prior to or 1 h after cold brain injury. The injury resulted in significant increases in the mean water content of the lesion and the contralateral hemispheres by 1.15 and 0.38%, respectively. Twenty-four hours after injury, the brain water and sodium contents, the brain swelling, and plasma osmolality were measured. V1 receptor antagonist of 50 ng significantly decreased the brain water and sodium contents and the brain swelling in the adjacent cortex of the lesion without changes in serum osmolality. On the other hand, 5 ng of V1 receptor antagonist and V2 receptor antagonist had no effect on edema. The V1 receptor of AVP is thought to act predominantly on water permeability of the brain. Peptide therapy may become an additional tool for brain edema treatment.

Topics: Animals; Antidiuretic Hormone Receptor Antagonists; Arginine Vasopressin; Blood Pressure; Body Water; Brain Chemistry; Brain Edema; Cardiovascular Agents; Cerebrovascular Disorders; Cold Temperature; Injections, Intraventricular; Male; Rats; Rats, Sprague-Dawley

To determine the prevalence of cardiovascular disease among elderly people and to investigate the use of cardiovascular medication in this group.. Cross-sectional study.. A quarter in Rotterdam, the Netherlands.. As a part of the 'Rotterdam elderly study', the cardiovascular anamnesis of 7.983 responding persons > or = 55 years (3105 men and 4878 women) was obtained by means of a questionnaire.. Twelve and 4% of men and women, respectively, had at some time had a myocardial infarction, and 5 and 4% a stroke. Almost 7% of both sexes had anamnestic symptoms of angina pectoris. Coronary bypass surgery and percutaneous transluminal coronary angioplasty were done in 4% and 1% of men and 1% and 0.5% of women, respectively. Of all participants 43% used at least one drug for cardiovascular purposes. Half of these used two or more, and a quarter used three or more drugs. Among women, diuretics were the most commonly used drug for cardiovascular purposes (21%), whereas among men beta-blocking agents were most common (15%).. Cardiovascular diseases are common among elderly men and women. Many of them take at least one drug for cardiovascular purposes.

Topics: Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Cohort Studies; Coronary Artery Bypass; Cross-Sectional Studies; Drug Utilization; Female; Humans; Male; Middle Aged; Myocardial Infarction; Netherlands; Prevalence

The effects of the endogenous pressor agents noradrenaline (NA), and angiotensin II (Ang II), and of the hypotensive agents acetylcholine (ACh) and adenosine (ADS), on blood pressure and heart rate in conscious and unrestrained stroke-prone spontaneously hypertensive rats (SHR-SP) and normotensive Wistar Kyoto rats (WKY) of different ages (4-9 weeks old) were investigated. Pressor responses to NA were enhanced in 7- and 9- week-old SHR-SP compared with those in WKY, but pressor responses to Ang II in SHR-SP were not different from those in WKY at all ages. The bradycardias following pressor responses to NA and Ang II were markedly attenuated in SHR-SP, especially older ones. Hypotensive responses to ACH were enhanced in SHR-SP, particularly at 9 weeks of age. However, hypotensive responses to ADS were attenuated in SHR-SP, especially at 7 weeks of age. Transient fall of heart rate due to ADS was also attenuated in 7- and 9- week-old SHR-SP. These alterations of hemodynamic or cardiovascular responses in SHR-SP became more evident in the established stages of hypertension. These results suggest intimate relationships of the enhanced pressor responses to NA, attenuated bradycardias following pressor effects with NA or Ang II, and the attenuated hypotensive responses to ADS with the development or the maintenance of hypertension in SHR-SP.

Topics: Acetylcholine; Adenosine; Age Factors; Angiotensin II; Animals; Blood Pressure; Cardiovascular Agents; Cerebrovascular Disorders; Heart Rate; Hemodynamics; Hypertension; Male; Norepinephrine; Rats; Rats, Inbred SHR; Rats, Inbred WKY

The authors examined peculiarities of the central and cerebral hemodynamics before and after treatment in 108 patients with cerebral infarction and acute or chronic ischemic heart disease (IHD). When myocardial and cerebral infarctions were combined, as well as in most cases of cerebral ischemia in the post-infarction period, the heart worked in conditions of hypodynamia. Disorders of the cerebral circulation were expressed in hypo- and hyperperfusion of the cerebral vessels. Patients with acute versus chronic IHD displayed differences in changes of hemocirculatory parameters in the process of treatment.

Topics: Adult; Aged; Cardiovascular Agents; Cerebral Infarction; Cerebrovascular Disorders; Coronary Disease; Female; Hemodynamics; Humans; Male; Middle Aged

Topics: Aged; Cardiovascular Agents; Cerebrovascular Circulation; Cerebrovascular Disorders; Hemodynamics; Humans; Middle Aged

Stroke-prone spontaneously hypertensive rats (SHRSP) were treated with food admixed, 6,7-dimethoxy-1-(3,4-dimethoxybenzyl)-4-([4-(2-methoxyphenyl)-1- piperazinyl]methyl)isoquinoline (Ro 22-4839), a novel cerebral circulation improver, for a period of 15 weeks starting from 5 weeks of age at an average daily dose of 30.6 or 66.0 mg/kg. As compared with normotensive Wistar Kyoto rats, SHRSP in the control group rapidly developed severe hypertension (244 mmHg at the end of the experiments) accompanied with deterioration of cardiovascular parameters including left ventricular hypertrophy, reduction in pumping ability and increase in peripheral vascular tone. At 20 weeks of age (i.e. at the end of experiments), 75% of SHRSP developed stroke signs and concomitant cerebral edema evidenced by the increases in water and sodium contents in the brain. These stroke symptoms were accompanied with a profound externalized shape change of erythrocytes after in vitro treatment with Ca2+ and ionophore A23187, an increased plasma level of thiobarbituric acid reacting substance (TBARS), a measure of lipid peroxides, and a decreased sensitivity of platelets to ADP. The long-term treatment with Ro 22-4839 prevented the progress of stroke and cerebral edema, although the deteriorated cardiovascular parameters were not prevented by the treatment. This compound was also found to prevent the hypersusceptibility of erythrocyte membrane to Ca2+-ionophore and Ca2+, the hypoaggregability of platelets and the elevated plasma TBARS in SHRSP. These results indicate that the beneficial effects of Ro 22-4839 in SHRSP may be attributable to its calmodulin antagonistic and anti-lipid peroxidative actions but not to its hypotensive action.

Topics: Animals; Brain; Cardiovascular Agents; Cerebrovascular Disorders; Erythrocyte Deformability; Heart; Hemodynamics; Isoquinolines; Lipid Peroxides; Male; Platelet Aggregation; Rats; Rats, Inbred SHR; Rats, Inbred WKY

Topics: Cardiovascular Agents; Cerebrovascular Disorders; Ischemia; Isoxsuprine; Muscle Relaxants, Central; Phenethylamines; Vasodilator Agents

Topics: Brain; Cardiovascular Agents; Cerebrovascular Disorders; Ergoloid Mesylates; Ergot Alkaloids; Humans; Procaine; Vascular Diseases