cardiovascular-agents and Vascular-Diseases

In the perioperative phase oxygen delivery and consumption can be influenced by different factors, i.e. type of surgery, anesthetic and cardiovascular drugs, or fluids. By combining near-infrared spectroscopy (NIRS) monitoring of regional tissue oxygen saturation (StO

Topics: Cardiovascular Agents; Humans; Microcirculation; Oxygen; Oxygen Consumption; Perioperative Care; Spectroscopy, Near-Infrared; Vascular Diseases

Chronic venous disease (CVD) is one of the most prevalent diseases worldwide. The health condition of most patients with early stage CVD will worsen over time, and this progression increases the burden as well as the costs of treatment and reduces patient quality of life (QoL). This highlights the importance and the likely cost-effectiveness of treatment of patients with early stage CVD. Options for managing the early stages of CVD include lifestyle changes together with venoactive drugs (VAD); VADs may be used alone or in conjunction with interventional treatment of varices such as sclerotherapy, surgery, or endovenous treatments. Micronized purified flavonoid fraction (MPFF; Daflon

Topics: Animals; Anti-Inflammatory Agents; Cardiovascular Agents; Chronic Disease; Cost-Benefit Analysis; Diosmin; Disease Progression; Flavonoids; Humans; Life Style; Male; Quality of Life; Sclerotherapy; Vascular Diseases; Venous Insufficiency

Bioresorbable scaffolds have emerged as a potential alternative to non-erodible metal implants to alleviate the long-term risk of permanent device vascular implant-related adverse events. Bioresorbable scaffolds provide a temporary mechanical support function until the vessel reaches complete healing, and the implant progressively disappears and vasomotion resumes. A polymer matrix with embedded drugs coated onto the scaffold surface degrades slowly, reducing the size from the exterior toward the interior, and this allows controlled drug release to a local vascular segment. Drug elution from a bioresorbable scaffold system is characterized by a rapid initial release that achieves high concentration along the intimal surface, which is designed to prevail vascular dilation-induced injury and formation of neointimal hyperplasia. This review highlights diverse types of bioresorbable biomaterials as vascular scaffolds, drug release kinetics, adaptive arterial wall remodeling, and complexities in the advancement of vascular scaffolds to treat restenosis.

Topics: Absorbable Implants; Animals; Cardiovascular Agents; Coated Materials, Biocompatible; Delayed-Action Preparations; Drug Liberation; Endovascular Procedures; Humans; Hyperplasia; Kinetics; Neointima; Prosthesis Design; Recurrence; Risk Factors; Treatment Outcome; Vascular Diseases; Vascular Remodeling

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. The majority of cases reported in the literature involve a single vessel; multivessel and left main (LM) coronary artery involvement is rare. We present a case of triple vessel and LM SCAD in a postpartum patient and review the literature regarding percutaneous coronary intervention in the setting of SCAD.

Topics: Acute Coronary Syndrome; Adult; Angina Pectoris; Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Drug-Eluting Stents; Female; Humans; Percutaneous Coronary Intervention; Postpartum Period; Pregnancy; Treatment Outcome; Ultrasonography, Interventional; Vascular Diseases

Nanoparticles promise to advance strategies to treat vascular disease. Since being harnessed by the cancer field to deliver safer and more effective chemotherapeutics, nanoparticles have been translated into applications for cardiovascular disease. Systemic exposure and drug-drug interactions remain a concern for nearly all cardiovascular therapies, including statins, antithrombotic, and thrombolytic agents. Moreover, off-target effects and poor bioavailability have limited the development of completely new approaches to treat vascular disease. Through the rational design of nanoparticles, nano-based delivery systems enable more efficient delivery of a drug to its therapeutic target or even directly to the diseased site, overcoming biological barriers and enhancing a drug's therapeutic index. In addition, advances in molecular imaging have led to the development of theranostic nanoparticles that may simultaneously act as carriers of both therapeutic and imaging payloads. The following is a summary of nanoparticle therapy for atherosclerosis, thrombosis, and restenosis and an overview of recent major advances in the targeted treatment of vascular disease.

Topics: Animals; Cardiovascular Agents; Chemotaxis, Leukocyte; Cholesterol; Drug Carriers; Drug Evaluation, Preclinical; Forecasting; Humans; Inflammation; Macrophages; Mice; Nanoparticles; Neointima; Neovascularization, Pathologic; Plaque, Atherosclerotic; RNA Interference; RNA, Small Interfering; Thrombosis; Vascular Diseases

Patients with systemic lupus erythematosus (SLE) present an increased prevalence of coronary heart disease. The majority of cases of acute coronary syndrome (ACS) in patients with SLE are due to atherosclerosis. Less common causes include thrombosis of an angiographically normal coronary artery and coronary vasculitis. Spontaneous coronary artery dissection (SCAD) is a rare cause of ACS in these patients. We report the case of a 53-year-old female diagnosed of SLE presenting with an ACS caused by SCAD. She was treated medically and her clinical course was favorable. A literature search identified seven additional cases of SCAD associated with SLE. The main clinical features found in these reports are revised. ACS caused by SCAD in SLE patients is a condition likely under-reported in literature. SCAD should be suspected in patients with SLE and ACS, especially in younger women without evident cardiovascular risk factors. An early accurate diagnosis of SCAD is key to provide specific treatment, which differs from that of usual atherosclerotic ACS.

Topics: Acute Coronary Syndrome; Cardiovascular Agents; Coronary Vessel Anomalies; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Middle Aged; Risk Factors; Treatment Outcome; Vascular Diseases

Male and female sexual dysfunction (SD) is considered a multifactorial condition. Numerous studies have shown the involvement of inflammatory processes in this pathological condition. Sexual intercourse requires healthy and functioning vessels to supply the pelvic region in both males and females, generating penile erection and clitoral and vaginal lubrication, respectively. Cardiovascular diseases and associated risk factors may contribute negatively to pelvic blood flow, possibly through immune system activation.. The study aimed to address the correlation between vascular inflammation driven by immune system activation and SD in males and females.. A literature review was performed to identify articles addressing male and female SD and vascular inflammation. Key words included "male and female sexual dysfunction," "vascular inflammation," "iliac and pudendal arteries dysfunction," "genitourinary tract," and "blood flow.". Management of systemic and local inflammation may be a useful alternative to improve SD and reduce the risk of cardiovascular diseases in the future.. Increased levels of cytokines and chemokines have been detected in humans and animals with hypertension, obesity, and diabetic conditions. Chronic activation of the innate immune system, especially by pathogen- or damage-associated molecular patterns, and metabolic-related disorders may act as triggers further contributing to an increased inflammatory condition. Due to the reduced size of vessels, SD and retinal vascular impairments have been shown to be predictive factors for cardiovascular diseases. Therefore, considering that blood flow to the genitalia is essential for sexual function, endothelial dysfunction and vascular remodeling, secondary to chronic immune system activation, may be implicated in male and female vasculogenic SD.. Several conditions appear to play a role in SD. In the present review, we have identified a role for the immune system in generating vascular and tissue impairments contributing to erectile dysfunction and female SD. Calmasini FB, Klee N, Webb RC, et al. Impact of Immune System Activation and Vascular Impairment on Male and Female Sexual Dysfunction. Sex Med Rev 2019;7:604-613.

Topics: Cardiovascular Agents; Cytokines; Diabetes Complications; Dyslipidemias; Female; Genitalia, Female; Genitalia, Male; Gonadal Steroid Hormones; Humans; Hypertension; Immune System Diseases; Immunity, Innate; Male; Obesity; Sexual Dysfunction, Physiological; Vascular Diseases; Vasculitis

In the vascular system, the endothelial surface layer (ESL) as the inner surface of blood vessels affects mechanotransduction, vascular permeability, rheology, thrombogenesis, and leukocyte adhesion. It creates barriers between endothelial cells and blood and neighbouring cells. The glycocalyx, composed of glycoconjugates and proteoglycans, is an integral component of the ESL and a key element in inter- and intracellular communication and tissue homeostasis. In pathophysiological conditions (atherosclerosis, infection, ischemia/reperfusion injury, diabetes, trauma and acute lung injury) glycocalyx-degrading factors, i.e. reactive oxygen and nitrogen species, matrix metalloproteinases, heparanase and sialidases, damage the ESL, thereby impairing endothelial functions. This leads to increased capillary permeability, leucocyte-endothelium interactions, thrombosis and vascular inflammation, the latter further driving glycocalyx destruction. The present review highlights current knowledge on the vasculoprotective role of the ESL, with specific emphasis on its remodelling in inflammatory vascular diseases and discusses its potential as a novel therapeutic target to treat vascular pathologies.

Topics: Animals; Anti-Inflammatory Agents; Cardiovascular Agents; Endothelial Cells; Glycocalyx; Humans; Inflammation; Inflammation Mediators; Signal Transduction; Vascular Diseases; Vascular Remodeling

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.

Topics: American Heart Association; Cardiac Imaging Techniques; Cardiovascular Agents; Consensus; Conservative Treatment; Coronary Artery Bypass; Coronary Vessel Anomalies; Female; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Predictive Value of Tests; Pregnancy; Prevalence; Risk Assessment; Risk Factors; Treatment Outcome; United States; Vascular Diseases

The master mammalian circadian clock (i.e. central clock), located in the suprachiasmatic nucleus of the hypothalamus, orchestrates the synchronization of the daily behavioural and physiological rhythms to better adapt the organism to the external environment in an anticipatory manner. This central clock is entrained by a variety of signals, the best established being light and food. However, circadian cycles are not simply the consequences of these two cues but are generated by endogenous circadian clocks. Indeed, clock machinery is found in mainly all tissues and cell types, including cells of the vascular system such as endothelial cells, fibroblasts, smooth muscle cells and stem cells. This machinery physiologically contributes to modulate the daily vascular function, and its disturbance therefore plays a major role in the pathophysiology of vascular dysfunction. Therapies targeting the circadian rhythm may therefore be of benefit against vascular disease.

Topics: Blood Vessels; Cardiovascular Agents; Circadian Rhythm; Circadian Rhythm Signaling Peptides and Proteins; Drug Chronotherapy; Gene Expression Regulation; Hemodynamics; Humans; Signal Transduction; Suprachiasmatic Nucleus; Vascular Diseases

Under physiological conditions, the arterial endothelium exerts a powerful protective influence to maintain vascular homeostasis. However, during the development of vascular disease, these protective activities are lost, and dysfunctional endothelial cells actually promote disease pathogenesis. Numerous investigations have analyzed the characteristics of dysfunctional endothelium with a view to understanding the processes responsible for the dysfunction and to determining their role in vascular pathology. This review adopts an alternate approach: reviewing the mechanisms that contribute to the initial formation of a healthy protective endothelium and on how those mechanisms may be disrupted, precipitating the appearance of dysfunctional endothelial cells and the progression of vascular disease. This approach, which highlights the role of endothelial adherens junctions and vascular endothelial-cadherin in endothelial maturation and endothelial dysfunction, provides new insight into the remarkable biology of this important cell layer and its role in vascular protection and vascular disease.

Topics: Adherens Junctions; Animals; Antigens, CD; Arteries; Cadherins; Cardiovascular Agents; Drug Design; Endothelial Cells; Endothelium, Vascular; Humans; Molecular Targeted Therapy; Signal Transduction; Vascular Diseases

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndromes and sudden cardiac death. The epidemiology, pathogenesis, and optimal approaches to diagnosis and management are poorly understood. Additionally, SCAD as a syndrome is commonly under-recognized and its prognosis is not well studied. Guidelines on management of SCAD have not yet been established. We present three cases of SCAD that varied in their clinical presentation and describe the different management strategies utilized. This is followed by a review of the clinical features, epidemiology, prognosis, and potential treatment strategies for patients presenting with SCAD.

Topics: Adult; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Vessel Anomalies; Drug-Eluting Stents; Electrocardiography; Female; Humans; Male; Percutaneous Coronary Intervention; Risk Factors; Treatment Outcome; Ultrasonography, Interventional; Vascular Diseases; Young Adult

This essay focuses on nine important lessons learned during more than thirty years of endothelial research. They include: the danger of hiding behind a word, the confusion generated by abbreviations, the need to define the physiological role of the response studied, the local role of endothelium- dependent responses, the strength of pharmacological analyses, endothelial dysfunction as consequence and cause of disease, the importance of rigorous protocols, the primacy of in vivo studies and the importance of serendipity.

Topics: Animals; Cardiovascular Agents; Endothelium, Vascular; Humans; Nitric Oxide; Vascular Diseases

Phospholipase D2 (PLD2) is a lipid-signaling enzyme that produces the signaling molecule phosphatidic acid (PA) by catalyzing the hydrolysis of phosphatidylcholine (PC). The molecular characteristics of PLD2, the mechanisms of regulation of its activity, its functions in the signaling pathway involving PA and binding partners, and its role in cellular physiology have been extensively studied over the past decades. Although several potential roles of PLD2 have been proposed based on the results of molecular and cell-based studies, the pathophysiological functions of PLD2 in vivo have not yet been fully investigated at the organismal level. Here, we address accumulated evidences that provide insight into the role of PLD2 in human disease. We summarize recent studies using animal models that provide direct evidence of the function of PLD2 in several pathological conditions such as vascular disease, immunological disease, and neurological disease. In light of the use of recently developed PLD2-specific inhibitors showing potential in alleviating pathological conditions, improving our understanding of the role of PLD2 in human disease would be necessary to target the regulation of PLD2 activity as a therapeutic strategy.

Topics: Animals; Antineoplastic Agents; Cardiovascular Agents; Gene Expression Regulation; Humans; Immune System Diseases; Immunologic Factors; Mice; Neoplasms; Nervous System Diseases; Neuroprotective Agents; Phosphatidic Acids; Phosphatidylcholines; Phospholipase A2 Inhibitors; Phospholipase D; Signal Transduction; Vascular Diseases

Cardiovascular diseases (CVDs) are the leading cause of death worldwide and represent a major problem of public health. Over the years, life expectancy has considerably increased throughout the world, and the prevalence of CVD is inevitably rising with the growing ageing of the population. The normal process of ageing is associated with progressive deterioration in structure and function of the vasculature, commonly called vascular ageing. At the vascular level, extracellular matrix (ECM) ageing leads to molecular alterations in long half-life proteins, such as elastin and collagen, and have critical effects on vascular diseases. This review highlights ECM alterations occurring during vascular ageing with a specific focus on elastin fragmentation and also the contribution of elastin-derived peptides (EDP) in age-related vascular complications. Moreover, current and new pharmacological strategies aiming at minimizing elastin degradation, EDP generation, and associated biological effects are discussed. These strategies may be of major relevance for preventing and/or delaying vascular ageing and its complications.

Topics: Aging; Animals; Arteries; Cardiovascular Agents; Elastin; Extracellular Matrix; Glycoside Hydrolase Inhibitors; Humans; Molecular Targeted Therapy; Neuraminidase; Pancreatic Elastase; Peptide Fragments; Proteolysis; Serine Proteinase Inhibitors; Signal Transduction; Vascular Diseases

Spontaneous coronary artery dissection (SCAD) remains an infrequent, elusive, and challenging clinical entity of unknown etiology eight decades after its initial description. Our understanding of the pathophysiology of SCAD, initially limited to information from early pathological studies, case reports, and very short series, has been enriched recently by relatively large contemporary series of patients studied prospectively. The typical presentation involves a young woman without coronary risk factors suffering an acute coronary syndrome but, actually, most patients are middle-aged and have coronary risk factors. A high number of conditions have been related to SCAD, but fibromuscular dysplasia has shown a major intriguing association with potential pathophysiological implications. SCAD may present (a) with an intimal tear and the classic angiographic 'flap' leading to the appearance of two lumens (true and false), or (b) without an intimal rupture, as an intramural hematoma. An increased clinical awareness together with new diagnostic tools have led to a major surge in the diagnosis of SCAD. High-resolution intracoronary techniques provide unique diagnostic insights into the underlying pathophysiology and facilitate identification of the disease in patients misdiagnosed previously. After the initial acute ischemic insult, most patients stabilize and have a benign clinical course and eventually experience spontaneous healing of the vessel wall during follow-up. However, recurrences may still occur in up to 10-20% of cases. Accordingly, a conservative medical management (watchful waiting strategy) has been recommended as the initial approach. Revascularization remains particularly challenging and may be associated with suboptimal results, acute complications, and poor long-term outcome. Nevertheless, in patients with ongoing or refractory ischemia and adequate anatomy, revascularization should be attempted. Some novel and attractive coronary interventions have been proposed in this uniquely challenging anatomic scenario. This review aims to present a comprehensive and contemporary update on this elusive and intriguing clinical entity.

Topics: Acute Coronary Syndrome; Adult; Age Factors; Aged; Cardiovascular Agents; Conservative Treatment; Coronary Angiography; Coronary Vessel Anomalies; Female; Humans; Male; Middle Aged; Multimodal Imaging; Myocardial Reperfusion; Predictive Value of Tests; Risk Factors; Sex Factors; Tomography, Optical Coherence; Treatment Outcome; Ultrasonography, Interventional; Vascular Diseases; Watchful Waiting

Within the family of endogenous gasotransmitters, nitric oxide (NO) is the smallest gaseous intercellular messenger involved in the modulation of several processes, such as blood flow and platelet aggregation control, essential to maintain vascular homeostasis. NO is produced by nitric oxide synthases (NOS) and its effects are mediated by cGMP-dependent or cGMP-independent mechanisms. Growing evidence suggests a crosstalk between the NO signaling and the occurrence of oxidative stress in the onset and progression of vascular diseases, such as hypertension, heart failure, ischemia, and stroke. For these reasons, NO is considered as an emerging molecular target for developing therapeutic strategies for cardio- and cerebrovascular pathologies. Several natural derived compounds, such as polyphenols, are now proposed as modulators of NO-mediated pathways. The aim of this review is to highlight the experimental evidence on the involvement of nitric oxide in vascular homeostasis focusing on the therapeutic potential of targeting NO with some natural compounds in patients with vascular diseases.

Topics: Animals; Cardiovascular Agents; Cardiovascular System; Diet; Humans; Nitric Oxide; Oxidative Stress; Phytochemicals; Phytotherapy; Plant Preparations; Plants, Medicinal; Polyphenols; Signal Transduction; Vascular Diseases

Acute and chronic inflammation responses characterize the vascular remodelling processes in atherosclerosis, restenosis, pulmonary arterial hypertension, and angiogenesis. The functional and phenotypic changes in diverse vascular cell types are mediated by complex signalling cascades that initiate and control genetic reprogramming. The signalling molecule's signal transducer and activator of transcription 3 (STAT3) plays a key role in the initiation and continuation of these pathophysiological changes. This review highlights the pivotal involvement of STAT3 in pathological vascular remodelling processes and discusses potential translational therapies, which target STAT3 signalling, to prevent and treat cardiovascular diseases. Moreover, current clinical trials using highly effective and selective inhibitors of STAT3 signalling for distinct diseases, such as myelofibrosis and rheumatoid arthritis, are discussed with regard to their vascular (side-) effects and their potential to pave the way for a direct use of these molecules for the prevention or treatment of vascular diseases.

Topics: Animals; Cardiovascular Agents; Drug Discovery; Endothelial Cells; Humans; Molecular Targeted Therapy; Neovascularization, Physiologic; Regeneration; Signal Transduction; STAT3 Transcription Factor; Translational Research, Biomedical; Vascular Diseases

Topics: Cardiovascular Agents; Child; Diet; Exercise Therapy; Humans; Vascular Diseases; Vascular Stiffness

Despite a high level of the development of modern angiology and vascular surgery, the problem of chronic venous insufficiency (CVI) complicating the course of various venous diseases seems to have no tendency towards being solved, thus calling forth permanent search for optimization of methods of treatment and rehabilitation of patients presenting with the above-mentioned syndrome. The article presents a review of contemporary studies dedicated to the problem of correcting CVI. Special attention is paid to the endothelial state in CVI and possibilities of correcting endothelial dysfunction with the use of bioflavonoids, in particular, diosmin. Also presented herein are the results of an original experimental study dedicated to peculiarities of the endothelial functional state, endothelial dysfunction, and correction thereof on the background of the existing CVI.. Несмотря на высокий уровень развития современной ангиологии и сосудистой хирургии, проблема хронической венозной недостаточности (ХВН), осложняющей течение различных заболеваний вен, не имеет тенденции к разрешению, что обусловливает постоянный поиск оптимизации способов лечения и реабилитации пациентов с вышеуказанным синдромом. В статье приводится обзор современных исследований, посвященных проблеме коррекции ХВН. Особое внимание уделяется состоянию эндотелия при ХВН и возможностям коррекции эндотелиальной дисфункции с использованием биофлавоноидов, в частности, диосмина. Представлены результаты оригинального экспериментального исследования, посвященного особенностям функционального состояния эндотелия, эндотелиальной дисфункции и ее коррекции на фоне существующей ХВН.

Topics: Cardiovascular Agents; Chronic Disease; Diosmin; Endothelium, Vascular; Humans; Oxidative Stress; Treatment Outcome; Vascular Diseases; Venous Insufficiency

Perivascular adipose tissue (PVAT) is an active endocrine and paracrine organ that modulates vascular function, with implications for the pathophysiology of cardiovascular disease (CVD). Adipocytes and stromal cells contained within PVAT produce mediators (adipokines, cytokines, reactive oxygen species and gaseous compounds) with a range of paracrine effects modulating vascular smooth muscle cell contraction, proliferation and migration. However, the modulatory effect of PVAT on the vascular system in diseases, such as obesity, hypertension and atherosclerosis, remains poorly characterized. AMP-activated protein kinase (AMPK) regulates adipocyte metabolism, adipose biology and vascular function, and hence may be a potential therapeutic target for metabolic disorders such as type 2 diabetes mellitus (T2DM) and the vascular complications associated with obesity and T2DM. The role of AMPK in PVAT or the actions of PVAT have yet to be established, however. Activation of AMPK by pharmacological agents, such as metformin and thiazolidinediones, may modulate the activity of PVAT surrounding blood vessels and thereby contribute to their beneficial effect in cardiometabolic diseases. This review will provide a current perspective on how PVAT may influence vascular function via AMPK. We will also attempt to demonstrate how modulating AMPK activity using pharmacological agents could be exploited therapeutically to treat cardiometabolic diseases.

Topics: Adipose Tissue, Brown; Adipose Tissue, White; Adiposity; AMP-Activated Protein Kinases; Animals; Autocrine Communication; Cardiovascular Agents; Endothelium, Vascular; Enzyme Activation; Enzyme Activators; Female; Humans; Male; Models, Biological; Muscle, Smooth, Vascular; Paracrine Communication; Signal Transduction; Vascular Diseases

NADPH oxidases (NOXs) are reactive oxygen species (ROS)-generating enzymes implicated in the pathophysiology of vascular diseases such as hypertension and stroke. Endothelial cells express four NOX isoforms including the superoxide-generating enzymes NOX1, NOX2, and NOX5 and the hydrogen peroxide-generating enzyme NOX4. Studies on arteries from patients with coronary artery disease, and in animals with experimentally induced hypertension, diabetes, or atherosclerosis, suggest that NOX1, NOX2, and NOX5 promote endothelial dysfunction, inflammation, and apoptosis in the vessel wall, whereas NOX4 is by contrast vasoprotective in increasing nitric oxide bioavailability and suppressing cell death pathways. Based on these findings and promising preclinical studies with the NOX1/NOX2 antagonist, apocynin, we suggest that the field is poised for clinical evaluation of NOX inhibitors as therapeutics for cardiovascular disease.

Topics: Animals; Cardiovascular Agents; Endothelium, Vascular; Enzyme Inhibitors; Humans; Membrane Glycoproteins; Membrane Proteins; Mice, Knockout; Mice, Transgenic; Models, Biological; Molecular Targeted Therapy; NADPH Oxidase 1; NADPH Oxidase 2; NADPH Oxidase 4; NADPH Oxidase 5; NADPH Oxidases; Vascular Diseases

The endothelium has a central role in the regulation of blood flow through continuous modulation of vascular tone. This is primarily accomplished by balanced release of endothelial relaxing and contractile factors. The healthy endothelial cells are essential for maintenance of vascular homeostasis involving antioxidant, anti-inflammatory, pro-fibrinolytic, anti-adhesive, or anticoagulant effects. Oppositely, endothelial dysfunction is primarily characterized by impaired regulation of vascular tone as a result of reduced endothelial nitric oxide (NO) synthase activity, lack of cofactors for NO synthesis, attenuated NO release, or increased NO degradation. So far, the pharmacological approach in improving/reversal of endothelial dysfunction was shown to be beneficial in clinical trials that have investigated actions of different cardiovascular drugs. The aim of this paper was to summarize some of the latest clinical findings related to therapeutic possibilities for improving endothelial dysfunction in different pathological conditions. In the majority of presented clinical investigations, the assessment of improvement or reversal of endothelial dysfunction was performed through the flow-mediated dilatation measurement, and in some of those endothelial progenitor cells' count was used for the same purpose. Still, given the fast and continuous development of this field, the evidence acquisition included the MEDLINE data base screening and the selection of articles published between 2010 and 2012.

Topics: Cardiovascular Agents; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Endothelium, Vascular; Female; Glucose Tolerance Test; Humans; Male; Nitric Oxide; Nitric Oxide Synthase Type III; Obesity; Polycystic Ovary Syndrome; Renal Dialysis; Risk Factors; Signal Transduction; Stem Cells; Vascular Diseases

The endothelium, a highly active structure, regulates vascular homeostasis through the release of numerous vasoactive factors that control vascular tone and vascular smooth cell proliferation. A larger number of medicinal plants and their isolated chemical constituents have been shown to beneficially affect the endothelium. For example, flavonoids in black tea, green tea, and concord grape cause a vasodilation possibly through their antioxidant properties. Allicin, a by-product of the enzyme alliinase, has been proposed to be the main active metabolite and responsible for most of the biological activities of garlic, including a dose-dependent dilation on the isolated coronaries. Thymoquinone, the principal phytochemical compound found in the volatile oil of the black seed, and the hawthorn extract have also been shown to improve aging-related impairment of endothelium-dependent relaxations in animal models. In this review, the effect of some of the natural products, including Camellia sinensis (black tea and green tea), Vitis labrusca (concord grape), Allium sativum (garlic), and Nigella sativa (black seed) and Crataegus ssp (hawthorn extract), is explored. The molecular mechanisms behind these potential therapeutic effects are also discussed.

Topics: Animals; Biological Products; Cardiovascular Agents; Dietary Supplements; Endothelium, Vascular; Humans; Models, Biological; Phytotherapy; Plant Extracts; Vascular Diseases

Increasing evidence suggests that microRNAs(miRs) play a crucial role in the cardiovascular system, and recent studies have revealed a significant role of miRs in vascular biology and disease, miR-145 is one of the most-studied miRs, and especially in the vascular smooth muscle cell (VSMCs) proliferation, differentiation, and phenotypic switching. In cardiovascular system, miR-145 is not only important for heart and vascular development but also plays an essential role in cardiac pathological factors, such as hypertrophy, and ischemia. However, its potential role in microvasculature has not been systematically evaluated yet. We are just beginning to understand the regulation of miR in vascular biology. In particular, the miR biogenesis and regulatory pathways in the vascular system have not yet been well characterized, This review focuses on the basic biology and mechanism of action of miR-145 specifically pertaining to microvascular development, pericyte and disease, In addition it addresses the potential for miR-145 to be used therapeutically in the treatment of microvascular disease.

Topics: Animals; Capillaries; Cardiovascular Agents; Humans; Microcirculation; MicroRNAs; Neovascularization, Physiologic; Vascular Diseases

The purpose of this study was to quantify the effect of coenzyme Q10 on arterial endothelial function in patients with and without established cardiovascular disease.. Endothelial dysfunction has been implicated in the pathogenesis of atherosclerosis.. The search included MEDLINE, Cochrane Library, Scopus, and EMBASE to identify studies up to 1 July 2011. Eligible studies were randomized controlled trials on the effects of coenzyme Q10 compared with placebo on endothelial function. Two reviewers extracted data on study characteristics, methods, and outcomes. Five eligible trials enrolled a total of 194 patients. Meta-analysis using random-effects model showed treatment with coenzyme Q10 significantly improvement in endothelial function assessed peripherally by flow-mediated dilatation (SMD 1.70, 95% CI: 1.00-2.4, p<0.0001). However, the endothelial function assessed peripherally by nitrate-mediated arterial dilatation was not significantly improved by using fix-effects model (SMD -0.19, 95% CI: -1.75 to 1.38, p = 0.81).. Coenzyme Q10 supplementation is associated with significant improvement in endothelial function. The current study supports a role for CoQ10 supplementation in patients with endothelial dysfunction.

Topics: Adult; Aged; Cardiovascular Agents; Endothelium, Vascular; Evidence-Based Medicine; Female; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Treatment Outcome; Ubiquinone; Vascular Diseases; Vasodilation

Endothelial dysfunction represents an important step in the pathogenesis of atherosclerosis. All vascular risk factors can induce endothelial dysfunction, which in turn results in the loss of the protective effects of the endothelium culminating in the development of atherosclerosis. Dyslipidemia is a major vascular risk factor and is associated with endothelial dysfunction. Several studies showed that lipid-lowering agents exert beneficial effects on endothelial function in different populations at increased vascular risk, including patients without dyslipidemia. Therefore, other actions besides lipid-profile modification appear to be implicated in this benefit. However, it is unclear whether the improvement in endothelial function independently contributes to the vascular risk reduction during lipid-lowering treatment (e.g. with statins). It is also unclear whether the assessment of endothelial function would help identify patients who require more aggressive lipid-lowering treatment.

Topics: Animals; Cardiovascular Agents; Endothelium, Vascular; Fatty Acids, Omega-3; Humans; Hypolipidemic Agents; Risk Factors; Vascular Diseases

The morbidity and mortality associated with vascular surgery procedures are largely the results of cardiac events. National guidelines have been regularly proposed and updated by the American College of Cardiology (ACC)/American Heart Association (AHA) to ensure optimal perioperative management and risk stratification. Controversy remains between experts and other cardiology societies regarding several patient care issues including revascularization before surgery, timing of β-blocker therapy, and the administration of antiplatelet therapy. Several landmark articles recently published have helped to modify the guidelines in the hope of improving vascular patient outcomes. In this review, we searched all recent available literature pertaining to perioperative cardiac evaluation before major vascular surgery. We propose an algorithm for preoperative cardiac evaluation, which is a modification to the AHA recommendations. Incorporated in this algorithm are recent published pivotal articles that can help in guiding physicians caring for the vascular patient requiring major operative or endovascular interventions.

Topics: Algorithms; Anesthesia; Cardiac Surgical Procedures; Cardiovascular Agents; Endovascular Procedures; Heart Diseases; Heart Function Tests; Humans; Practice Guidelines as Topic; Predictive Value of Tests; Preoperative Care; Risk Assessment; Risk Factors; Treatment Outcome; Vascular Diseases; Vascular Surgical Procedures

In the last two decades a tremendous development has been noticed in our understanding of the purinergic system, consisting of heterogeneously expressed purinoceptor subtypes and its classical agonists: e.g., adenosine triphosphate, uridine triphosphate or complex dinucleoside polyphosphates. These agonists exert multiple effects on the vascular system: they regulate the relaxation and constriction of arterial blood vessels, lead to proliferation and migration in endothelial cells and vascular smooth muscle cells, and mediate potent proinflammatory responses or phenotypic cell changes. This review focuses on the P2 purinoceptor subtype P2Y and its pleiotropic effects in the vascular wall under physiological and pathophysiological condition. Various experimental and clinical studies provide evidence that pharmacological targeting of P2Y might be effective in reducing vascular alterations under disease conditions.

Topics: Animals; Cardiovascular Agents; Drug Design; Humans; Ligands; Purinergic P2Y Receptor Antagonists; Receptors, Purinergic P2Y; Signal Transduction; Vascular Diseases

Topics: Cardiovascular Agents; Chronic Disease; Hematologic Agents; Humans; Vascular Diseases

Epidemiological studies have indicated that regular intake of fruit and vegetables and beverages such as red wine and tea, which contain high levels of polyphenols, is associated with a reduced risk of cardiovascular diseases. The beneficial effect of polyphenol-rich natural products has been attributable, at least in part, to their direct effect on blood vessels, and in particular on endothelial cells. Indeed, polyphenols from tea, grapes, berries, and plants have been shown to activate endothelial cells to increase the formation of potent vasoprotective factors including nitric oxide (NO) and endothelium-derived hyperpolarizing factor. Experimental and clinical studies have also indicated that chronic intake of several polyphenol-rich natural products is able to improve endothelial dysfunction and to decrease vascular oxidative stress associated with major cardiovascular diseases such as hypertension. Altogether, these observations suggest that polyphenol-rich sources of natural products have the potential to improve the function of blood vessels and, hence, to protect the vascular system.

Topics: Animals; Biological Factors; Biological Products; Cardiovascular Agents; Endothelial Cells; Flavonoids; Fruit; Humans; Nitric Oxide; Oxidative Stress; Phenols; Polyphenols; Reactive Oxygen Species; Vascular Diseases; Vitis; Wine

The prevalence of vascular cognitive impairment (VCI) is likely to increase as the population ages and cardiovascular disease survival improves. We provide an overview of the definition and disease mechanisms of VCI and present a systematic literature review of the current evidence for the pharmacologic and nonpharmacologic therapies used to treat the VCI symptoms of cognitive dysfunction or to modify VCI through primary and secondary prevention. The Cochrane Database of Systematic Reviews was searched from 2005 to October 2010 using the keywords "vascular dementia" or "vascular cognitive impairment and therapy." MEDLINE was searched for English-language articles published within the last 10 years using the combined Medical Subject Headings (MeSH) "therapeutics and dementia," "vascular" or "vascular cognitive impairment." Although cholinesterase inhibitors and memantine produce small cognitive improvements in patients with VCI, these drugs do not improve global clinical outcomes and have adverse effects and costs. Selective serotonin reuptake inhibitors and dihydropyridine calcium channel blockers may improve short-term cognitive function in patients with VCI. Anti-hypertensive therapy with an ACE inhibitor-based regimen and statins may prevent the major subtype of VCI known as poststroke cognitive decline. Clinical and effectiveness studies with long-term follow-up are needed to determine the benefits and risks of pharmacologic and nonpharmacologic therapies to prevent and treat VCI. Given its growing health, social, and economic burden, the prevention and treatment of VCI are critical priorities for clinical care and research.

Topics: Cardiovascular Agents; Cholinesterase Inhibitors; Cognition Disorders; Cognitive Behavioral Therapy; Dementia; Excitatory Amino Acid Antagonists; Humans; MEDLINE; Randomized Controlled Trials as Topic; Risk Factors; Vascular Diseases; Vitamins

Many randomized controlled trials (RCTs) were conducted to evaluate the efficacy of DanShen (Salvia miltiorrhizae, an herbal medicine) on ischemic vascular diseases (IVD). However, there has been no systematic evaluation of the quality of DanShen RCTs so far. The aims of this study were (1) to assess the quality of DanShen RCTs on IVD published in mainland China from 1998 to 2007 and (2) to explore the factors correlating with the quality.. A number of Chinese databases were searched, and most of DanShen RCTs on IVD were collected. According to CONSORT for TCM (Consolidated Standards for Reporting of Trials for Traditional Chinese Medicine) and the Jadad scale, the quality assessment and data abstraction were performed independently by two reviewers. One-way analysis of variance and Pearson correlation analysis were applied to explore the association between basic characteristic and the quality of the RCTs.. One hundred and fifty (150) DanShen RCTs were identified finally. The mean (standard deviation) score of 150 DanShen RCTs assessed by CONSORT for TCM was 23.87 (3.68), and 1.94 (0.82) by the Jadad scale, respectively. Only 6.7% (10/150) of RCTs were identified with high quality (Jadad score > or =4). Authors' affiliation, publication journal, sample size, and follow-up time were correlated with the quality of DanShen RCTs.. The quality of DanShen RCTs in mainland China has not been improved significantly over recent years, and the overall quality of DanShen RCTs is still poor.

Topics: Analysis of Variance; Cardiovascular Agents; Drugs, Chinese Herbal; Humans; Ischemia; Phenanthrolines; Randomized Controlled Trials as Topic; Salvia miltiorrhiza; Vascular Diseases

The metabolic syndrome of vascular risk is threatening large numbers of ever-younger people. To date, the syndrome has been chiefly viewed as a potential risk marker that confers a heightened probability of developing type 2 diabetes and occlusive atherothrombotic disease of large- and medium-sized arteries. Accumulating evidence suggests that the components of the metabolic syndrome may also adversely affect the microvasculature through several inter-related mechanisms. These include the following observations: classic risk factors for macrovascular disease such as high blood pressure and dyslipidaemia also accelerate microvascular complications of diabetes, lesser disturbances of glucose metabolism (i.e. impaired glucose tolerance) may be associated with some forms of microvascular dysfunction, non-glucose intermediary metabolites may promote renovascular hypertension thereby damaging the microvasculature, and insulin resistance appears to be directly associated with microvascular dysfunction. In turn, microvascular complications such as nephropathy and autonomic neuropathy may promote the development and progression of atherosclerosis. We argue that the vascular implications of the metabolic syndrome should be broadened to include the microvasculature. The hypothesis that vascular events can be prevented, or at least deferred, through earlier therapeutic intervention in pre-diabetic subjects with glucose intolerance is amenable to testing in clinical trials.

Topics: Anti-Obesity Agents; Antihypertensive Agents; Atherosclerosis; Cardiovascular Agents; Disease Progression; Glucose Intolerance; Humans; Hypoglycemic Agents; Hypolipidemic Agents; Insulin Resistance; Metabolic Syndrome; Microcirculation; Prediabetic State; Risk Assessment; Risk Factors; Signal Transduction; Vascular Diseases

After a stroke or transient ischaemic attack (TIA) there is a high risk of stroke, particularly in the early days and weeks, and of other serious vascular events. Several preventive medical treatments can reduce these risks; starting them as early as possible will maximise the absolute risk reduction, as long as the diagnosis is secure, there is no known or suspected net harm from treatment, and they are acceptable to the patient. Medical treatments with clear evidence of benefit include: lowering blood pressure after all types of stroke or TIA; lowering blood cholesterol with a statin after ischaemic stroke or TIA; antiplatelet treatment after ischaemic stroke or TIA; and warfarin instead of antiplatelet treatment in patients with ischaemic stroke or TIA who have atrial fibrillation and no contraindications to anticoagulation. Lifestyle changes (for example, stopping smoking, reducing excess alcohol intake, adopting a healthy diet) and careful management of diabetes are also important.

Topics: Blood Pressure; Cardiovascular Agents; Cholesterol; Fibrinolytic Agents; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Ischemic Attack, Transient; Myocardial Infarction; Recurrence; Risk Factors; Stroke; Vascular Diseases

Guanosine-dependent cyclic nucleotide second messenger signaling has been implicated as a pivotal mediator of vascular function under both homeostatic eutrophic conditions as well as in the inimical environs of injury and/or disease. This biological system is highly regulated through reciprocal, complimentary, and often redundant upstream and downstream molecular and cellular elements and feedback controls. Key endogenous factors of the guanosine-dependent cyclic nucleotide cascade include upstream gaseous activating ligands (nitric oxide, carbon monoxide), downstream substrates (cGMP-gated ion channels, cGMP-dependent protein kinases), and cGMP hydrolyzing phosphodiesterases. This intricate system also has capacity to "cross-talk" with parallel adenosine-dependent cyclic nucleotide machinery. Numerous complexes of ligands, enzymes, cofactors, and substrates present significant targets for pharmacologic modulation at the cellular, genetic, and/or molecular level eventuating therapeutically as constructive functional responses observed in vascular physiology and/or pathophysiology. Interestingly, emerging evidence based largely on transgenic mouse models challenges the historically accepted concept that this signaling system functions principally as a therapeutic modality in cardiac and vascular tissues. The general purpose of this update is to provide current information on recently described neoteric agents that impact multifaceted and critical cGMP-dependent signaling in the vascular system. Emphasis will be placed on novel agents that exert significant and often multiple actions on upstream and downstream sites and are capable of eliciting robust effects on guanosine-dependent cellular actions. Individual sections will be devoted to agents that rely on an intact and functional cyclase heme and those that operate independently of the sGC heme. Attention will be placed on the physiologic and pathophysiologic clinical manifestations of these pharmacologic regimens. This review will conclude with some thoughts for future directions for study and continued discovery of novel sGC/cGMP controllers in the vascular system at the basic science and clinical levels.

Topics: Animals; Cardiovascular Agents; Clinical Trials as Topic; Drug Design; Drug Evaluation, Preclinical; Guanosine Monophosphate; Guanylate Cyclase; Humans; Muscle, Smooth, Vascular; Receptors, Cytoplasmic and Nuclear; Soluble Guanylyl Cyclase; Vascular Diseases

Fibromuscular dysplasia (FMD), formerly called fibromuscular fibroplasia, is a group of nonatherosclerotic, noninflammatory arterial diseases that most commonly involve the renal and carotid arteries. The prevalence of symptomatic renal artery FMD is about 4/1000 and the prevalence of cervicocranial FMD is probably half that. Histological classification discriminates three main subtypes, intimal, medial and perimedial, which may be associated in a single patient. Angiographic classification includes the multifocal type, with multiple stenoses and the 'string-of-beads' appearance that is related to medial FMD, and tubular and focal types, which are not clearly related to specific histological lesions. Renovascular hypertension is the most common manifestation of renal artery FMD. Multifocal stenoses with the 'string-of-beads' appearance are observed at angiography in more than 80% of cases, mostly in women aged between 30 and 50 years; they generally involve the middle and distal two-thirds of the main renal artery and in some case also renal artery branches. Cervicocranial FMD can be complicated by dissection with headache, Horner's syndrome or stroke, or can be associated with intracerebral aneurysms with a risk of subarachnoid or intracerebral hemorrhage. The etiology of FMD is unknown, although various hormonal and mechanical factors have been suggested. Subclinical lesions are found at arterial sites distant from the stenotic arteries, and this suggests that FMD is a systemic arterial disease. It appears to be familial in 10% of cases. Noninvasive diagnostic tests include, in increasing order of accuracy, ultrasonography, magnetic resonance angiography and computed tomography angiography. The gold standard for diagnosing FMD is catheter angiography, but this invasive procedure is only used for patients in whom it is clinically pertinent to proceed with revascularization during the same procedure. Differential diagnosis include atherosclerotic stenoses and stenoses associated with vascular Ehlers-Danlos and Williams' syndromes, and type 1 neurofibromatosis. Management of cases with renovascular hypertension includes antihypertensive therapy, percutaneous angioplasty of severe stenoses, and reconstructive surgery in cases with complex FMD that extends to segmental arteries. The therapeutic options for securing ruptured intracerebral aneurysms are microvascular neurosurgical clipping and endovascular coiling. Stenosis progression in renal artery FMD is s

Topics: Adult; Age Distribution; Angiography; Aortic Dissection; Cardiovascular Agents; Carotid Arteries; Causality; Comorbidity; Diagnosis, Differential; Female; Fibromuscular Dysplasia; Humans; Male; Prevalence; Prognosis; Renal Artery; Sex Distribution; Vascular Diseases

Skin blood flow oscillation, the so called flowmotion, is a consequence of the arteriolar diameter oscillations, i.e. vasomotion, and it is thought to play a critical role in favoring the optimal distribution of blood flow in the skin microvascular bed. Investigation of skin blood flowmotion, using spectral analysis of the skin laser Doppler flowmetry (LDF) signal, showed different flowmotion waves of endothelial, sympathetic or myogenic mediated vasomotion origin. Using this method in peripheral arterial obstructive disease (PAOD) patients an impairment of all the three flowmotion waves was found at level of the diseased leg following ischemia in the II stage of the disease and basally in critical limb ischemia. In patients with essential arterial hypertension (EHT) forearm skin blood flowmotion showed a post-ischemic impairment of myogenic and sympathetic components in newly diagnosed patients, and of endothelial and sympathetic components in long standing patients. In diabetic patients there was a selective impairment of skin flowmotion wave mediated by sympathetic activity in basal conditions. Investigation of skin blood flowmotion in response to different vasoactive substances demonstrated an important role of nitric oxide (NO) in controlling the endothelial component of vasomotion and an insulin action on smooth muscle cells of skin microvessels. All these data suggest that the study of skin blood flowmotion can become a method to early and easily detect skin microvascular impairment in vascular diseases and to investigate the mechanisms of substances active on skin microvascular bed.

Topics: Cardiovascular Agents; Humans; Laser-Doppler Flowmetry; Microcirculation; Regional Blood Flow; Skin; Vascular Diseases

Topics: Alzheimer Disease; Cardiovascular Agents; Humans; Treatment Outcome; Vascular Diseases

Recent data on the pathogenesis of atherosclerosis have revealed various mechanisms damaging the vessel wall by the reactive oxidative substances, mainly by the oxidised LDL, which lead to an inflammation process, resulting in the thickening of the arterial wall and atherosclerotic plaque formation. In these events the oxidative free radicals exert a lot of harmful effects: by the further oxidation of lipids, activation of smooth cells and macrophages, inducing apoptosis and necrosis of endothelial cells. These mechanisms can be blocked by some drugs at several points as listed in the paper. The results of observational studies and clinical trials by vitamin E, angiotensin convertase enzyme inhibitors, angiotensin type-1 receptor blockers, calcium channel blockers and statin treatment are reviewed and evaluated. Possibilities of appropriate antioxidant substitution modes are put forward. Achievements in the regression of atherosclerotic plaques are discussed, since these therapeutic modalities render atherosclerosis a treatable disease.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Animals; Antioxidants; Arteriosclerosis; Calcium Channel Blockers; Cardiovascular Agents; Drug Therapy, Combination; Feeding Behavior; Fishes; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Mediterranean Region; Reactive Oxygen Species; Tea; Vascular Diseases; Vitamin E; Wine

Topics: Antihypertensive Agents; Arterioles; Arteriosclerosis; Basement Membrane; Bone Remodeling; Calcinosis; Calcium; Cardiovascular Agents; Cardiovascular Diseases; Chronic Kidney Disease-Mineral and Bone Disorder; Diagnostic Tests, Routine; Disease Progression; Humans; Hyperparathyroidism; Hypertension; Hypertrophy, Left Ventricular; Kidney Transplantation; Osteoblasts; Renal Dialysis; Uremia; Vascular Diseases; Venules; Vitamin D

The incidence of drug-induced liver disease appears to be increasing, reflecting the increasing number of new agents that have been introduced into clinical use over the past several decades. Among the topics covered, the author discusses incidence, diagnosis, risk factors, clinical presentations, hepatitis, and vascular injury. The author also reviews the hepatic injury seen with commonly prescribed drugs, emphasizing newer developments in the field and recent publications and reports.

Topics: Acetaminophen; Alanine Transaminase; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Aspartate Aminotransferases; Cardiovascular Agents; Chemical and Drug Induced Liver Injury; Cholestasis; Humans; Hypoglycemic Agents; Incidence; Liver; Liver Diseases; Prognosis; Risk Factors; Vascular Diseases

Topics: Cardiovascular Agents; Clinical Trials as Topic; Fatty Acids, Omega-3; Female; Humans; Male; Recurrence; Thrombosis; Vascular Diseases

The first cause of low-dose acetylsalicylic-acid (ASA) inefficacy is poor adherence to treatment. No non-invasive technique is available to assess ASA intake. Current-induced vasodilation (CIV) was found abolished in healthy volunteers after low-dose ASA intake. We tested clinical characteristics, treatments, and comorbid conditions influencing CIV amplitude in vascular patients.. CIV was tested in 400 patients (277 males and 123 females, aged 65.4 ± 13.4 years). We focused on clinical characteristics, treatments, and comorbid conditions as covariates of CIV amplitude. We studied the CIV amplitude to covariate relationships with multivariate linear regression and receiver operating characteristics (ROC).. The multivariate linear model determined that ASA intake within the last 48 h and the interaction between ASA intake and body mass index (BMI) were the sole covariates associated with CIV amplitude. For the whole population, the area under the ROC curve (AUC) for CIV to predict ASA intake was 0.853 [95% confidence interval (CI): 0.814-0.892]. Considering separately the areas observed for non-obese (BMI ≤30, n = 303) and obese (BMI>30, n = 93) patients, the AUC [95% CI] was 0.873 [0.832-0.915] and 0.776 [0.675-0.878], respectively (p = 0.083).. ASA is the only drug that affects the amplitude of CIV response observed after galvanic current application to the skin of vascular patients. CIV depends on BMI but not age or gender. As such, CIV appears to be a potential objective marker of ASA intake and could facilitate future non-invasive assessments of adherence to ASA treatment.

Topics: Aged; Aspirin; Body Mass Index; Cardiovascular Agents; Drug Monitoring; Female; Galvanic Skin Response; Humans; Male; Medication Adherence; Middle Aged; Polypharmacy; Predictive Value of Tests; Skin; Transcutaneous Electric Nerve Stimulation; Vascular Diseases; Vasodilation

Rheumatoid arthritis is a systemic inflammatory condition associated with increased cardiovascular risk that may be due to underlying endothelial dysfunction and subsequent aortic stiffening. We hypothesized that supplementation with tetrahydrobiopterin (BH4) would recouple endothelial nitric oxide synthase and thus improve endothelial function and consequently reduce aortic stiffness.. We conducted 2 randomized, double-blinded, placebo-controlled crossover studies examining 2 separate regimens: an acute regimen, with a single dose of BH4 400 mg versus placebo (n=18), and a short-term regimen, composed of a 1-week treatment with BH4 400 mg once daily versus placebo (n=15). Flow-mediated dilatation and aortic pulse wave velocity were studied 4 times, before and after each treatment phase. Acute BH4 supplementation led to an improvement of flow-mediated dilatation, whereas placebo had no effect (mean±SD of effect difference 2.56±4.79%; P=0.03). Similarly, 1-week treatment with BH4 improved endothelial function, but there was no change with placebo (mean±SD of effect difference 3.50±5.05%; P=0.02). There was no change in aortic pulse wave velocity following acute or short-term BH4 supplementation or placebo (mean±SD of effect difference: acute 0.09±0.67 m/s, P=0.6; short-term 0.03±1.46 m/s, P=0.9).. Both acute and short-term supplementation with oral BH4 improved endothelial function but not aortic stiffness. This result suggests that BH4 supplementation may be beneficial for patients with rheumatoid arthritis by improving endothelial dysfunction and potentially reducing risk of cardiovascular disease. There appears to be no causal relationship between endothelial function and aortic stiffness, suggesting that they occur in parallel, although they may share common risk factors such as inflammation.

Topics: Administration, Oral; Adult; Aged; Arthritis, Rheumatoid; Biomarkers; Biopterins; Cardiovascular Agents; Cross-Over Studies; Dietary Supplements; Double-Blind Method; Drug Administration Schedule; Endothelium, Vascular; England; Female; Humans; Inflammation Mediators; Male; Middle Aged; Nitric Oxide Synthase Type III; Pilot Projects; Pulse Wave Analysis; Time Factors; Treatment Outcome; Vascular Diseases; Vascular Stiffness; Vasodilation; Young Adult

To evaluate changes on venous diameter and perimeter of lower limbs in chronic venous disorder (CVD) patients after different clinical treatments for four weeks.. Fifty-two female patients classified as C2,s or C2,3,s (CEAP classification) were allocated consecutively in three groups: Cirkan (40 mg of the root extract of Ruscus aculeatus + 100 mg of flavonoid hesperidine methylchalcone + 200 mg of vitamin C per pill); elastic compression stockings (ECS) and no treatment (NT). Diameters were determined by duplex ultrasound and perimeter with Leg-O-Meter.. After treatment, Cirkan significantly decreased popliteal vein and great saphenous vein (GSV) diameters bilaterally and ECS decreased popliteal vein diameter bilaterally and GSV and varices only on the left limb. Perimeters changed only with ECS. Clinical scores changed between Cirkan x NT and ECS x Cirkan. Disability score varied for ECS x NT and Cirkan x NT. chi2 test detected different distribution frequency for C3 and C2 classes according to treatment: ECS (both limbs) and Cirkan (only left limb). Varices and anatomical scores did not change.. ECS emerges as the most effective clinical treatment tested but improvements with Cirkan on vein diameter and CEAP class were also observed. Clinical scores improved due to pain relief and edema reduction (ECS). These findings point to a positive effect of Cirkan, suggesting that venotonic drugs should be taken into account in the treatment of CVD.

Topics: Adult; Anthropometry; Ascorbic Acid; Brazil; Cardiovascular Agents; Chi-Square Distribution; Chronic Disease; Chymotrypsin; Disability Evaluation; Drug Combinations; Female; Hesperidin; Humans; Lower Extremity; Middle Aged; Pain; Pain Measurement; Phytosterols; Popliteal Vein; Saphenous Vein; Stockings, Compression; Time Factors; Treatment Outcome; Trypsin; Ultrasonography, Doppler, Duplex; Vascular Diseases

Diabetes is an important risk factor for stroke. We conducted analyses in patients who had entered the PROspective pioglitAzone Clinical Trial In macroVascular Events (PROactive) with a history of stroke or without stroke.. The prospective, double-blind PROactive (mean duration, 34.5 months) randomized 5238 patients with type 2 diabetes and a history of macrovascular disease to pioglitazone (titrated to 45 mg) or placebo, in addition to current diabetes and cardiovascular medications. Cardiovascular end-point events were independently adjudicated. This analysis evaluated the risk of stroke and other cardiovascular outcomes in patients with (n=984) and without (n=4254) prior stroke.. In patients with previous stroke (n=486 in the pioglitazone group and n=498 in the placebo group), there was a trend of benefit with pioglitazone for the primary end point of all-cause death, nonfatal myocardial infarction, acute coronary syndrome, and cardiac intervention (including coronary artery bypass graft or percutaneous coronary intervention), stroke, major leg amputation, or bypass surgery or leg revascularization (hazard ratio[HR]=0.78, event rate=20.2% pioglitazone vs 25.3% placebo; 95% CI=0.60-1.02; P=0.0670) and for the main secondary end point of all-cause death, nonfatal myocardial infarction, or nonfatal stroke (HR=0.78, event rate=15.6% pioglitazone vs 19.7% placebo; 95% CI=0.58-1.06; P=0.1095). Pioglitazone reduced fatal or nonfatal stroke (HR=0.53, event rate=5.6% pioglitazone vs 10.2% placebo; 95% CI=0.34-0.85; P=0.0085) and cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke (HR=0.72, event rate=13.0% pioglitazone vs 17.7% placebo; 95% CI=0.52-1.00; P=0.0467). Higher event rates were observed in patients with prior stroke compared with those without prior stroke. In patients without prior stroke, no treatment effect was observed for a first stroke.. In a subgroup analysis from PROactive, pioglitazone reduced the risk of recurrent stroke significantly in high-risk patients with type 2 diabetes.

Topics: Adult; Aged; Cardiovascular Agents; Diabetes Mellitus, Type 2; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pioglitazone; Prospective Studies; Stroke; Thiazolidinediones; Vascular Diseases

Topics: Alprostadil; Amputation, Surgical; Cardiovascular Agents; Clinical Trials as Topic; Epoprostenol; Humans; Iloprost; Infusions, Intravenous; Leg Ulcer; Vascular Diseases

In 2 randomized, double-blind studies, 109 diabetic patients with trophic lesions and 101 non-diabetics suffering from peripheral vascular disease (PVD) stage IV (Fontaine) received daily 6-hour i.v. infusions of iloprost (less than or equal to 2ng/kg/min) or of placebo over 28 days. Iloprost treatment was superior to placebo, showing ulcer healing in more than 60% of patients compared to less than 25% in the control group. The beneficial effects were sustained during a 1 year follow-up period. Platelet activation, adhesion, aggregation and release reaction on atherosclerotic lesions, impaired microvascular perfusion, loss of microvascular barrier function, increased white blood cell - vessel wall interaction and hemorheological disturbances are all believed to play a role in PVD. Stable PGI2-mimetics inhibit platelet activation by all endogenous mediators as well as platelet release of mitogenic factors (PDGF).

Topics: Animals; Blood Platelets; Cardiovascular Agents; Clinical Trials as Topic; Diabetic Angiopathies; Disease Models, Animal; Double-Blind Method; Epoprostenol; Humans; Iloprost; Infusions, Intravenous; Microcirculation; Random Allocation; Rats; Thrombosis; Ulcer; Vascular Diseases

Topics: Adenosine Diphosphate; Blood Platelets; Cardiovascular Agents; Clinical Trials as Topic; Collagen; Epoprostenol; Humans; Iloprost; Male; Pain; Platelet Aggregation; Random Allocation; Vascular Diseases

Topics: Cardiovascular Agents; Coated Materials, Biocompatible; Constriction, Pathologic; Femoral Artery; Humans; Paclitaxel; Peripheral Arterial Disease; Popliteal Artery; Treatment Outcome; Vascular Diseases

To investigate the effect of Yiqifumai injection (YQFM), a compound Chinese medicine, and its main active ingredients on lipopolysaccharide (LPS)-induced microvascular disturbance in mesentery and ileum.. Rats were infused with LPS (5 mg/kg/h) for 90 min. Thirty minutes after initiation of LPS administration, YQFM (160 mg/kg/h), Rb1 (5 mg/kg/h), Sch (2.5 mg/kg/h), or Rb1+Sch (5 mg/kg/h + 2.5 mg/kg/h) was infused until 90 min. Human umbilical vein endothelial cells (HUVECs) were incubated with LPS (100 ng/ml) for 90 min. YQFM (1 mg/ml), Rb1 (100 µM), Sch (100 µM), or Rb1+Sch (200 µM) was added 30 min after initiation of LPS stimulation.. Yiqifumai injection and Rb1+Sch inhibited mesenteric venule hyperpermeability, suppressed microvillar erosion and submucosal edema, and protected claudin-5 from downregulation and interleukin-1β from upregulation in ileal tissues after LPS. Study in HUVECs confirmed the effect of YQFM and Rb1+Sch on JAM-1 after LPS and revealed a similar effect on other junction proteins. Moreover, YQFM and Rb1+Sch attenuated the dysfunctional energy metabolism and the activation of TLR-4/Src/NF-κB signaling with Rb1 and Sch being partially effective.. These results demonstrated the beneficial effect of post-treatment with YQFM, which is attributable to its main ingredient Rb1 and Sch, and likely mediated by targeting TLR-4/Src/NF-κB signaling pathway.

Topics: Animals; Cardiovascular Agents; Drugs, Chinese Herbal; Human Umbilical Vein Endothelial Cells; Humans; Ileum; Lipopolysaccharides; Mesentery; Microvessels; NF-kappa B; Rats; Toll-Like Receptor 4; Vascular Diseases

To define a consensual approach for the conservative treatment of patients C0s-C3.. The project was structured into two phases. The first one involved a group of Italian specialists in angiology and/or vascular surgery with the aim to compare their therapeutic choices in the management of patients in CEAP C0s-C3. The second phase used a Delphi consensus in order to elaborate practical statements on the conservative management of these patients.. The first phase involved a group of 166 Italian specialists while the second phase involved a Steering Committee of 6 specialists and a panel of 20 specialists. At the end of the third round, a consensus >80% was reached on seven assertions.. Seven statements have been drafted by a group of Italian specialists to provide physicians with practical guidance for the conservative treatment of C0s-C3 patients. Outstanding issues on the management of these patients were identified, confirming the urgent need of further research.

Topics: Cardiovascular Agents; Chronic Disease; Consensus; Conservative Treatment; Delphi Technique; Diet, Healthy; Exercise; Healthy Lifestyle; Humans; Italy; Risk Reduction Behavior; Smoking Cessation; Stockings, Compression; Treatment Outcome; Vascular Diseases; Veins

Vascular risk factors are associated with increased risk of Alzheimer disease (AD), but it is unclear whether there is a direct association of these risk factors with AD pathogenesis.. To assess the associations of vascular risk factors with AD pathogenesis in asymptomatic individuals, and to test whether this association is moderated among individuals who use vascular medications.. This cross-sectional study used data from the Presymptomatic Evaluation of Experimental or Novel Treatments for Alzheimer Disease (PREVENT-AD) cohort of cognitively unimpaired individuals aged 55 to 82 years with a parental or multiple-sibling history of sporadic AD, who were recruited via advertisement from the greater Montreal, Quebec, Canada, metropolitan area. Participants were enrolled between September 9, 2011, to May, 3, 2017, and stratified by use vs no use of vascular medications. Data were analyzed July 1, 2018, to April 5, 2019.. Principal analyses investigated associations of total, high-density lipoprotein, and low-density lipoprotein cholesterol levels, systolic and diastolic blood pressure, pulse pressure, and a combined vascular risk score (measured using the Framingham Coronary Risk Profile) with global β-amyloid peptide (Aβ) and entorhinal tau burden as measured by positron emission tomography (PET). Potential moderating associations of use of vascular medications with these associations were examined. Secondary similar analyses considered cerebrospinal fluid (CSF) Aβ1-42 and phosphorylated tau levels.. Among 215 participants (mean [SD] age, 62.3 [5.0] years; 161 [74.8%] women), 120 participants underwent PET, including 75 participants (62.5%) who were not using vascular medications, and 162 participants underwent CSF assessment, including 113 participants (69.8%) who were not using vascular medications. There was an overlap of 67 participants who underwent PET and CSF assessment. Interaction analyses showed that among participants not using vascular medications, higher Aβ deposition as measured by PET was associated with higher total cholesterol level (β = -0.002 [SE, 0.001]; P = .02), low-density lipoprotein cholesterol level (β = -0.002 [SE, 0.001]; P = .006), systolic blood pressure (β = -0.006 [SE, 0.002]; P = .02), pulse pressure (β = -0.007 [SE, 0.002]; P = .004), and Framingham Coronary Risk Profile score (β = -0.038 [SE, 0.011]; P = .001), but such associations were absent in participants who used vascular medications. Interactions were also found between vascular medication use and high-density lipoprotein cholesterol (β = -3.302 [SE, 1.540]; P = .03), low-density lipoprotein cholesterol (β = 1.546 [SE, 0.754]; P = .04), and Framingham Coronary Risk Profile score (β = 23.102 [SE, 10.993]; P = .04) on Aβ1-42 burden as measured in CSF. Higher Framingham Coronary Risk Profile scores were associated with reduced tau burden among participants using vascular medications but not among participants not using vascular medications (interaction, β = -0.010 [SE, 0.005]; P = .046).. These findings corroborate previously reported associations of vascular risk factors with Aβ burden but not tau burden. However, these associations were found only among individuals who were not using vascular medications. These results suggest that medication use or other control of vascular risk factors should be considered in Alzheimer disease prevention trials.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Amyloid beta-Peptides; Cardiovascular Agents; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Quebec; Risk Factors; tau Proteins; Vascular Diseases

Topics: Adult; Aged; California; Cardiovascular Agents; Clinical Decision-Making; Coronary Vessel Anomalies; Defibrillators, Implantable; Electric Countershock; Female; Humans; Incidence; Male; Middle Aged; Percutaneous Coronary Intervention; Recurrence; Retrospective Studies; Risk Factors; ST Elevation Myocardial Infarction; Tachycardia, Ventricular; Time Factors; Treatment Outcome; Vascular Diseases; Ventricular Fibrillation

The consumption of cocoa products rich in (-)-epicatechin is associated with reduced cardiovascular risk and improved vascular function. However, little is known about (-)-epicatechin's effects on aged endothelium. In order to characterize the health restoring effects of (-)-epicatechin on aged endothelium and identify the underlying mechanisms, we utilized high passage number (i.e. aged) bovine coronary artery endothelial cells and aortas of 3 and 18 month old rats. We evaluated cell senescence (β-galactosidase), nitric oxide (NO) production through the endothelial nitric oxide synthase pathway, mitochondria related endpoints, citrate synthase activity and vascular relaxation. Cells were treated with water or (-)-epicatechin (1 μM) for 48 h and rats orally with either water or (-)-epicatechin (1 mg kg-1 day-1) for 15 days. Senescence associated β-galactosidase levels doubled in aged cells while those treated with (-)-epicatechin only evidenced an ∼40% increase. NO levels in cells decreased by ∼33% with aging and (-)-epicatechin normalized them. Endothelial nitric oxide synthase phosphorylation levels paralleled these results. Aging increased total protein and synthase acetylation levels and (-)-epicatechin partially restored them to those of young cells by stimulating sirtuin-1 binding to the synthase. Phosphorylated sirtuin-1, mitofilin, oxidative phosphorylation complexes and transcriptional factor for mitochondria were reduced by ∼40% with aging and were restored by (-)-epicatechin. (-)-Epicatechin enhanced acetylcholine induced aged aorta vasodilation and stimulated NO levels while reducing blood pressure. In conclusion, (-)-epicatechin reverses endothelial cell aging and restores key control elements of vascular function. These actions may partly explain the epidemiological evidence for the beneficial effects of cocoa consumption on the incidence of cardiac and vascular diseases.

Topics: Acetylation; Aging; Animals; Antioxidants; Aorta, Thoracic; Biomarkers; Cardiovascular Agents; Catechin; Cattle; Cells, Cultured; Cellular Senescence; Coronary Vessels; Dietary Supplements; Endothelium, Vascular; Male; Nitric Oxide; Nitric Oxide Synthase Type III; Oxidative Stress; Phosphorylation; Protein Processing, Post-Translational; Rats, Wistar; Sirtuin 1; Vascular Diseases

Topics: Animals; Cardiovascular Agents; Drug Discovery; Humans; Vascular Diseases; Vascular Surgical Procedures

Topics: Absorbable Implants; Angioplasty, Balloon, Coronary; Cardiac Catheters; Cardiovascular Agents; Coated Materials, Biocompatible; Coronary Vessel Anomalies; Health Care Surveys; Humans; Practice Patterns, Physicians'; Prosthesis Design; Stents; Treatment Outcome; Vascular Diseases

We sought to assess the angiographic and long-term clinical outcomes in a predominantly medically treated population with spontaneous coronary artery dissection (SCAD).. There are little data on the angiographic and long-term outcome in patients with SCAD.. We studied 64 patients with SCAD (mean age 53 years, 94% females, three peripartum) with acute coronary syndrome who were treated using coronary bypass grafting (n = 1), percutaneous coronary intervention (n = 7), or medical therapy (n = 56). A repeat angiogram was performed in 40/64 (63%) patients. The median clinical follow-up was 4.5 years.. Five (8%) patients had a major cardiac event. One patient with peripartum left main SCAD and cardiogenic shock died during PCI. One patient with conservatively treated SCAD of the posterior descending artery suffered out-of-hospital cardiac arrest 16 days after the initial angiogram but survived. Three patients experienced a second SCAD in another vessel 3.7, 4.7, and 7.9 years after the index event while the initial dissection had healed. Thirty medically treated patients underwent a scheduled repeat angiogram showing healing of the dissection in all but one patient. After a median follow-up of 4.5 (1.8-8.4) years, all 63 patients surviving the index event were alive and free of symptoms suggestive of myocardial ischemia.. In general, the long-term outcome of patients with SCAD is excellent, and medical therapy can be safely applied in the majority of patients. However, SCAD can be a life-threatening and sometimes catastrophic event, and some patients experience early or late complications including SCAD of another vessel. © 2015 Wiley Periodicals, Inc.

Topics: Acute Coronary Syndrome; Adult; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Vessel Anomalies; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Out-of-Hospital Cardiac Arrest; Percutaneous Coronary Intervention; Predictive Value of Tests; Pregnancy; Recurrence; Registries; Risk Assessment; Risk Factors; Shock, Cardiogenic; Switzerland; Time Factors; Treatment Outcome; Vascular Diseases

Topics: Adult; Allografts; Angina Pectoris; Cardiovascular Agents; Drug Therapy, Combination; Heart Transplantation; Humans; Male; Ranolazine; Vascular Diseases

In cigarette smokers endothelial dysfunction, measured by flow-mediated dilation (FMD), precedes cardiovascular disease (CVD) and can be improved by supplementation with n - 3 polyunsaturated fatty acids (PUFAs). We developed a mouse model of cigarette smoke (CS)-induced endothelial dysfunction that resembles impaired FMD observed in human cigarette smokers and investigated the mechanism by which n - 3 PUFAs mediate vasoprotection. We hypothesized that loss of nitric oxide (NO)-dependent vasodilation in CS-exposed mice would be prevented by dietary n - 3 PUFAs via a decrease in oxidative stress. C57BL/6 mice were fed a chow or n - 3 PUFA diet for 8 weeks and then exposed to mainstream CS or filtered air for 5 days, 2 h/day. Mesenteric arterioles were preconstricted with U46619 and dilated by stepwise increases in pressure (0-40 mmHg), resulting in increases in flow, ± inhibitor of NO production or antioxidant, Tempol. Markers of oxidative stress were measured in lung and heart. CS-exposed mice on a chow diet had impaired FMD, resulting from loss of NO-dependent dilation, compared with air exposed mice. Tempol restored FMD by normalizing NO-dependent dilation and increasing NO-independent dilation. CS-exposed mice on the n - 3 PUFA diet had normal FMD, resulting from a significant increase in NO-independent dilation, compared with CS-exposed mice on a chow diet. Furthermore, n - 3 PUFAs decreased two CS-induced markers of oxidative stress, 8-epiprostaglandin-F2α levels and heme oxygenase-1 mRNA, and significantly attenuated CS-induced cytochrome P4501A1 mRNA expression. These data demonstrate that dietary n - 3 PUFAs can protect against CS-induced vascular dysfunction via multiple mechanisms, including increasing NO-independent vasodilation and decreasing oxidative stress.

Topics: Animals; Antioxidants; Arterioles; Atmosphere Exposure Chambers; Biomarkers; Cardiovascular Agents; Cigarette Smoking; Dietary Supplements; Endothelium, Vascular; Fatty Acids, Omega-3; Gene Expression Regulation, Enzymologic; Heart Ventricles; Lung; Male; Mesenteric Arteries; Mice, Inbred C57BL; Oxidative Stress; Random Allocation; Smoke; Vascular Diseases; Vascular Resistance; Vasodilation

The terms "personalized" or "precision" medicine are being used commonly in some branches of medicine but have yet to be widely adopted in vascular surgery. Despite this, personalized vascular therapy occurs on a daily basis in every vascular specialist's office as we strive to make informed recommendations at the individual patient level. The following is a description of several of the areas where advances in personalized vascular care have been achieved, including custom devices, personalized predictions, pharmacogenetics and surgicogenetics.

Topics: Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Decision Support Techniques; Endovascular Procedures; Humans; Patient Selection; Pharmacogenomic Testing; Precision Medicine; Predictive Value of Tests; Prosthesis Design; Risk Factors; Vascular Diseases

: Spontaneous coronary artery dissection (SCAD) is a rare and poorly understood cause of acute coronary syndrome in relatively young patients. Nowadays, the optimal treatment of SCAD is uncertain. A conservative approach seems to be preferable, but in particular conditions, an invasive strategy is necessary. The poor rate of procedural success, the high risk of procedural complications and the uncertain long and mid-term results make the interventional treatment of SCAD a challenge. We report a case of a young male patient presenting with SCAD successfully treated with a sirolimus-eluting self-expanding coronary stent. To our knowledge, the use of self-expanding coronary stent for SCAD has never been described yet and we discuss about the rationale of a possible larger use in clinical practice.

Topics: Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Drug-Eluting Stents; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Prosthesis Design; Sirolimus; ST Elevation Myocardial Infarction; Tomography, Optical Coherence; Treatment Outcome; Vascular Diseases

Effective diet/drug combinations may show additive or synergistic effects in reducing endothelial risk factors vis-à-vis monotherapies. The study evaluated the effect of combined therapy of Telmisartan and omega 3-fatty acids in sodium arsenite-induced vascular endothelial dysfunction (VED) in rats.. Forty-eight male Wistar rats (180-220 g) were randomized into eight groups; control, sodium arsenite (1.5 mg/kg/day) exposed, sodium arsenite exposure followed by treatment with Telmisartan, omega 3-fatty acids, the combination and/or endothelial modulators for 2 weeks depending on the allocated group. VED was assessed by estimating vascular reactivity. Serum thiobarbituric acid-reactive substances (TBARS), nitrite/nitrate levels, reduced glutathione (GSH) levels, superoxide dismutase (SOD) activity, serum cholesterol and triglyceride levels were also determined.. Sodium arsenite produced VED by attenuating acetylcholine-induced endothelial relaxation (% Rmax= 45.36), decreasing levels of serum nitrite/nitrate (9.28 μM/mg protein), GSH (16.06 μg/mg of protein), SOD activity (30.69 units/mg protein) and increasing TBARS (0.19 µM/mg protein) compared with control group. The combined therapy with Telmisartan (10 mg/kg/day) and omega 3-fatty acids (180 mg/kg/day) (% Rmax = 80.93, 13.09 µM/mg protein, 25.93 μg/mg of protein, 57.84 units/mg protein and 0.08 µM/mg protein, respectively) significantly abolished the respective derangements induced by sodium arsenite. Further, this combination significantly prevented rise in serum cholesterol and triglyceride levels that was induced by sodium arsenite. However, the ameliorative effects of this combination were abated by N-omega-nitro-L-arginine methyl ester (L-NAME) and glibenclamide.. Combined therapy of Telmisartan and omega 3-fatty acids attenuated VED, by activating enzyme nitric oxide synthase (eNOS) through opening of ATP-sensitive K(+) channels.

Topics: Animals; Aorta, Thoracic; Arsenites; Benzimidazoles; Benzoates; Cardiovascular Agents; Cholesterol; Endothelium, Vascular; Fatty Acids, Omega-3; Glyburide; KATP Channels; Male; NG-Nitroarginine Methyl Ester; Nitric Oxide Synthase Type III; Oxidative Stress; Rats, Wistar; Sodium Compounds; Telmisartan; Thiobarbituric Acid Reactive Substances; Triglycerides; Vascular Diseases; Vasodilation

Topics: Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Coronary Vessels; Cough; Cystic Fibrosis; Disease Management; Electrocardiography; Female; Humans; Middle Aged; Respiratory Function Tests; Risk Factors; Treatment Outcome; Vascular Diseases

Topics: Cardiovascular Agents; Chronic Disease; Evidence-Based Medicine; Hemodynamics; Humans; Lower Extremity; Predictive Value of Tests; Sclerotherapy; Severity of Illness Index; Stockings, Compression; Treatment Outcome; Vascular Diseases; Vascular Surgical Procedures; Veins

Medication errors may occur at any stage during the medication process and can lead to preventable adverse drug events and patients' harm. Pharmacists' support for reconcilable medication has been shown to be effective, rectifying errors and inaccuracies of the drug treatment and in the increase of medication safety. However, none of the previous studies focused on vascular patients. We investigated the nature and frequency of drug-related problems (DRPs) including the amount of potentially inappropriate medication (PIM) prescribed for elderly patients suffering from vascular diseases and the influence of pharmacists in the improvement of cardiovascular medication.. After the patients' routine admission process, medication reconciliation was performed. Therefore, a pharmacist obtained an accurate medication use history. The patients' drug therapy was critically screened for DRPs and referring to this, intervention was made by the pharmacist and communicated to the physician if necessary. Potentially inappropriate medication in the elderly was reviewed through a retrospective analysis using the Priscus-List. DRPs were documented anonymously and classified.. We identified 138 DRPs among 105 patients. Sixty-five patients experienced at least 1 DRP, accordingly 1.3 DRPs per patient. In total, 43 unintended discrepancies between current medication and admission medication were detected with an overall rate of 0.41 per patient; 100 interventions were made of which 56 resulted in explicit recommendations for prescription changes. Drug classes frequently affected by DRPs were antihypertensive in 23.9%, antithrombotic agents in 19.3% and lipid lowering agents in 12.1%. In a retrospective analysis of the home medication, 12 definite PIM were identified in 49 elderly patients.. DRPs are common in the medication of vascular surgery patients and may be improved by pharmacists.

Topics: Age Factors; Aged; Cardiovascular Agents; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Humans; Inappropriate Prescribing; Medication Reconciliation; Middle Aged; Patient Admission; Pharmacists; Pharmacy Service, Hospital; Polypharmacy; Preoperative Care; Prospective Studies; Retrospective Studies; Risk Factors; Vascular Diseases; Vascular Surgical Procedures

Topics: Adult; Cardiovascular Agents; Coronary Vessel Anomalies; Electrocardiography; Humans; Male; Radiography; Severity of Illness Index; Treatment Outcome; Vascular Diseases

Obesity is of importance among the risk factors predisposing for chronic venous disorders (CVD). Little is known how obesity affects the management of CVD. As the data concerning the treatments of CVD in the obese are incomplete, we performed an analysis of the different CVD therapies managements with respect to body mass index and the obesity.. We analyzed 9797 CVD patients from of a previous large national CVD survey, in regard to their Body Mass Index (BMI), CVD class and CVD therapies. Among them 2213 patients presented class I, 516 class II or morbid obesity.. BMI was significantly associated with the method of CVD therapy. Logistic regression showed that venoactive drugs are preferentially used except in class I obesity patients but also when therapy is managed by general practitioner. Logistic regression analysis showed that class II and morbid obesity is associated with more frequent prevalence of previous surgical procedures related to CVD (OR=2.62 with 95% confidence interval of [2.16-3.17]) and topical agent use, (OR=1.77, [1.38-2.25]) but with a significant decreased compliance with compression therapy (OR=0.74, [0.61 - 0.89]), regardless of the clinical course of the disease, and socio-demographic factors. While class I obesity increased the adherence with VADs.. The therapy of CVD is affected by body mass index. Class II and morbid obese CVD patients are less frequently compliant with compression therapy but are willing to accept surgical procedures and the use of topical agents.

Topics: Administration, Topical; Adult; Aged; Body Mass Index; Cardiovascular Agents; Chi-Square Distribution; Chronic Disease; Comorbidity; Compression Bandages; Cross-Sectional Studies; Female; Health Care Surveys; Health Knowledge, Attitudes, Practice; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Obesity; Odds Ratio; Patient Compliance; Poland; Risk Factors; Severity of Illness Index; Treatment Outcome; Vascular Diseases; Vascular Surgical Procedures; Veins

With the overall goal of enhancing the effectiveness and efficiency of vascular care, the Society for Vascular Surgery (SVS) recently completed a process by which it identified its top clinical research priorities to address critical gaps in knowledge guiding practitioners in prevention and treatment of vascular disease. After a survey of the SVS membership, a panel of SVS committee members and opinion leaders considered 53 distinct research questions through a structured process that resulted in identification of nine clinical issues that were felt to merit immediate attention by vascular investigators and external funding agencies. These are, in order of priority: (1) define optimal management of asymptomatic carotid stenosis, (2) compare the effectiveness of medical vs invasive treatment (open or endovascular) of vasculogenic claudication, (3) compare effectiveness of open vs endovascular infrainguinal revascularization as initial treatment of critical limb ischemia, (4) develop and compare the effectiveness of clinical strategies to reduce cardiovascular and other perioperative complications (eg, wound) after vascular intervention, (5) compare the effectiveness of strategies to enhance arteriovenous fistula maturation and durability, (6) develop best practices for management of chronic venous ulcer, (7) define optimal adjunctive medical therapy to enhance the success of lower extremity revascularization, (8) identify and evaluate medical therapy to prevent abdominal aortic aneurysm growth, and (9) evaluate ultrasound vs computed tomographic angiography surveillance after endovascular aneurysm repair.

Topics: Biomedical Research; Cardiovascular Agents; Comparative Effectiveness Research; Diagnostic Imaging; Endovascular Procedures; Health Priorities; Humans; Organizational Objectives; Research Support as Topic; Societies, Medical; Surveys and Questionnaires; Vascular Diseases; Vascular Surgical Procedures

24th Annual Meeting of the American Venous Forum Orlando, FL, USA, 8-11 February 2012: The American Venous Forum unites authorities on all facets of venous disease, the pathophysiology of venous disease and its treatment. The goal of this meeting was to educate attendees about current and novel clinical strategies to effectively manage venous disease.

Topics: Animals; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Humans; Pharmacology, Clinical; Stents; United States; Vascular Diseases; Venous Insufficiency

A functionally compromised vascular endothelium is associated with tissue-damaging responses including inflammation, immune stimulation, oxidative stress and platelet activation/aggregation and can lead to severe end-organ damage, as implicated in the pathology of several cardiac, cerebral and renal disorders. Multiple noninvasive techniques are available for assessing endothelial dysfunction in clinical settings. Diverse interventions have been identified as having therapeutic potential for treating endothelial dysfunction and preventing its pathophysiological sequellae.. Evaluation techniques and interventional treatment approaches for endothelial dysfunction, with particular reference to prevalent cardiovascular and metabolic disorders such as coronary artery disease and diabetes. Limitations of the current treatments and avenues for improved endothelium-targeted therapies.. Beneficial pleiotropic effects of various agents (cardiovascular medicines, antioxidants, nutritional supplements) on vascular endothelial function in humans notwithstanding, a growing body of preclinical data suggests that protein-, cell- and gene-based approaches hold promise for selective therapeutic targeting of the dysfunctional vascular endothelium. Additional efficacy data in appropriate animal models of vascular injury and cardiometabolic disease, further refinement of delivery modalities and continued investigation of the mechanisms underlying endothelial repair and regeneration should help identify the most promising therapeutic approaches for improving endothelial function that merit evaluation in human trials.

Topics: Animals; Biological Products; Cardiovascular Agents; Endothelium, Vascular; Genetic Therapy; Humans; Regeneration; Stem Cell Transplantation; Treatment Outcome; Vascular Diseases

Vascular disease is the most prevalent condition in patients aged >60 years, leading to increasing complications associated with their comorbid conditions. Poor medical compliance could be one reason why the rate of complications may be higher in this patient population, particularly the uninsured. This study was conducted to better assess rates of medication compliance in vascular surgical patients.. Consecutive patients seen in vascular clinics at a busy tertiary academic center were prospectively studied. Physicians and physician assistants used a standardized questionnaire to collect patient data and evaluated patients for coexisting medical conditions and medication use. Optimal medical therapy was defined according to the 2006 American Heart Association (AHA)/American College of Cardiology (ACC) "Guidelines for Secondary Prevention for Atherosclerotic Vascular Disease." Data were analyzed using multivariate regression.. During the 4-month study period, 180 consecutive patients (47% men) were seen in vascular surgery clinics. Most patients (79%) were nonsmokers and only 21% admitted to smoking. Comorbid conditions surveyed included hypertension in 141, diabetes mellitus in 56, coronary artery disease in 24, hypercholesterolemia in 89, and chronic renal failure in 13; of these, 61% were insured and 39% had no insurance. Overall, only 31% of all patients were receiving adequate medical therapy for their comorbid conditions, and about 66% were receiving suboptimal medical treatment for their vascular disease. Uninsured patients were less likely (19%) than insured patients (39%) to receive optimal medical therapy (P = .012). Lack of insurance was a predictor of suboptimal medical therapy for hypertension (odds ratio [OR], 3.13; 95% confidence interval [CI], 1.20-8.16; P = .016), hypercholesterolemia (OR, 5.1; 95% CI, 1.87-13.88; P = .001), peripheral arterial disease (OR, 13.32; 95% CI, 2.84-62.54, P < .001), and any disease overall (OR, 2.43; 95% CI, 1.21-4.88, P = .012). Overall, men and women were equally likely (68%) to receive suboptimal medical therapy; however, women were significantly more likely to be undertreated for coronary artery disease (OR, 0.022; 95% CI, 0.0017-0.293; P < .001).. Compliance with optimal medical therapy for secondary risk factor management amongst our vascular surgery patients is low. Uninsured patients are less likely to receive optimal medical therapy than their insured counterparts. This survey provides sobering statistics regarding medical compliance in our population. This issue deserves further study and may indirectly affect outcomes in minority groups that are disproportionately represented in our uninsured patients.

Topics: Academic Medical Centers; Aged; Cardiovascular Agents; Comorbidity; Ethnicity; Female; Florida; Guideline Adherence; Health Services Accessibility; Healthcare Disparities; Humans; Insurance, Health; Male; Medically Uninsured; Middle Aged; Odds Ratio; Outcome and Process Assessment, Health Care; Patient Compliance; Practice Guidelines as Topic; Prospective Studies; Risk Assessment; Risk Factors; Sex Factors; Surveys and Questionnaires; Treatment Outcome; Vascular Diseases

Previous work from our laboratory demonstrated the involvement of "intrinsic" mitochondrial apoptotic signaling in vascular hyperpermeability. The objective of this study was to determine if 17beta-estradiol, a known inhibitor of apoptosis, would attenuate microvascular endothelial cell hyperpermeability.. Rat lung microvascular endothelial cell monolayers were treated with 17beta-estradiol or estrogen-receptor antagonist ICI 182780 after transfection with BAK peptide (5 microg/mL). Fluorescein isothiocyanate (FITC)-albumin was used to determine the change in permeability. Mitochondrial reactive oxygen species (ROS) formation and transmembrane potential were determined using 123 dihydrorhodamine and JC-1, respectively. Cytosolic cytochrome c levels and caspase-3 activity were determined using enzyme-linked immunosorbent assay and fluorometric assay respectively.. 17beta-estradiol (10 nm) attenuated BAK-induced hyperpermeability (P < .05), ROS formation, cytochrome c release, and caspase-3 activation. The estrogen receptor antagonist ICI 182780 blocked the protective effect of 17beta-estradiol on hyperpermeability (P < .05).. 17beta-estradiol attenuates BAK-induced hyperpermeability in rat lung microvascular endothelial cells by way of an estrogen-receptor mediated pathway.

Topics: Animals; Capillary Permeability; Cardiovascular Agents; Cells, Cultured; Endothelial Cells; Estradiol; Lung; Rats; Vascular Diseases

To assess self-management of chronic venous disorders (CVDs) in a selected Italian population and the pattern of prescription by selected Italian phlebologists.. Cross-sectional study carried out between 2003 and 2005.. Non-random, transverse sample of men and women recruited by advertising.. Assessment of therapeutic habits of respondents, treatment advice given by phlebologists related to socio-demographic variables and severity of the disease. Multivariate odds ratios for sex, age, class, region, family history and severity of the disease.. Women undergo CVD therapy more than men (odds ratio (OR): 2.37 for medical treatment; 1.29 for surgical treatment and 5.72 for sclerotherapy). Young people prefer drug treatment to compression stockings. Drug therapy for CVD is 1.5 times more likely in southern Italian respondents, as is compression stockings (OR: 1.91). Surgical therapy is more frequent in Northern Italy (OR for Central Italy: 0.79; Southern Italy and Islands: 0.76). Family history of CVD leads people to early treatment of symptoms.. This study provides insight into self-medication of CVD in Italy and the prescribing patterns of Italian phlebologists in the treatment of CVD. It shows that the population interviewed is able to practise responsible self-medication of their CVD problems.

Topics: Adult; Age Factors; Cardiovascular Agents; Chronic Disease; Cross-Sectional Studies; Drug Prescriptions; Drug Utilization; Female; Health Care Surveys; Health Knowledge, Attitudes, Practice; Humans; Italy; Male; Middle Aged; Odds Ratio; Patient Satisfaction; Practice Guidelines as Topic; Practice Patterns, Physicians'; Residence Characteristics; Sclerotherapy; Self Care; Sex Factors; Stockings, Compression; Time Factors; Vascular Diseases; Vascular Surgical Procedures; Veins

Topics: Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Clinical Trials as Topic; Coronary Thrombosis; Endothelium, Vascular; Humans; Hypersensitivity; Regeneration; Stents; Vascular Diseases; Wound Healing

Topics: Animals; Anti-Arrhythmia Agents; Cardiovascular Agents; Crataegus; Heart Diseases; Humans; Phytotherapy; Plant Extracts; Vascular Diseases

Vascular remodeling, often accelerated after cardiovascular procedures, may result in stenosis or aneurysm formation. The bone-associated protein osteopontin has been suggested to be involved in vascular remodeling, yet the effect of locally applied osteopontin in an acute vascular injury model of aortic calcification has not been examined.. Vascular healing of rabbit thoracic aortas treated locally with recombinant osteopontin (dose: 1 microg; n = 16) or albumin (control, n = 16) after acute injury created by end-to-end anastomosis was evaluated. Matrix metalloproteinase-2 level was quantified by gelatin zymography. Proliferation of smooth muscle cells was detected by immunostaining for proliferative cell nuclear antigen.. Osteopontin-treated aortas showed significantly diminished vascular remodeling with less calcification (P = .001) and reduced anastomotic luminal stenosis (4% vs 28%, P = .002) compared with controls 2 months postsurgery. Moreover, osteopontin-treated aortas revealed a thickened adventitia with increased fibrosis (P = .006). Matrix metalloproteinase-2 level was up-regulated 2-fold with osteopontin treatment compared with control at 1 week, returning to baseline by 1 month. Staining for proliferation cell nuclear antigen disclosed an increase in proliferation cell nuclear antigen-positive smooth muscle cells in the media of osteopontin-treated aortas at 1 week, normalizing by 1 month.. These data suggest a beneficial effect of locally applied osteopontin after acute injury possibly by altering matrix metalloproteinase-2 activity and smooth muscle cell proliferation. Brief application of osteopontin may effectively enhance vascular healing by reducing calcification and thus maintaining luminal integrity. The role of the osteopontin-related increase in adventitial fibrosis on vascular healing has to be explored.

Topics: Animals; Aorta, Thoracic; Calcinosis; Cardiovascular Agents; Constriction, Pathologic; Male; Matrix Metalloproteinase 2; Models, Animal; Osteopontin; Rabbits; Sialoglycoproteins; Vascular Diseases; Wound Healing

Propionyl carnitine, a derivative of carnitine, has metabolic and cardiovascular effects similar to carnitine but with more pronounced peripheral haemodynamic activity. In these experiments we propose to prove that the administration of propionyl carnitine could prevent the experimental tail thrombosis in the rat induced by endothelin (ET-1), serotonin and K-carrageenin. In this new test of experimental thrombosis, propionyl carnitine was able to reduce the extent of tail thrombosis in a more significant manner than that of carnitine. A possible explanation of this antithrombotic effect of propionyl carnitine is its capacity to counteract the vasoconstrictor activity of endothelin modulating the release of prostanoids induced by endothelin itself.

Topics: Animals; Cardiovascular Agents; Carnitine; Carrageenan; Endothelins; Male; Rats; Rats, Wistar; Regional Blood Flow; Serotonin; Tail; Thrombosis; Vascular Diseases

Topics: Animals; Cardiovascular Agents; Ear; Epoprostenol; Iloprost; Ischemia; Mice; Mice, Hairless; Necrosis; Perfusion; Vascular Diseases

Two unfractionated heparins (UH), a porcine intestinal mucosal heparin (PIM), a bovine lung heparin (BLH) and a low molecular weight heparin (LMWH), CY 222, were assessed for their capacity to enhance platelet aggregation in vitro. Their potential proaggregatory effect was investigated in four systems: (a) enhancement of submaximal platelet aggregation induced by conventional agonists in platelet rich plasma and (b) in whole blood; (c) reversal of inhibition of platelet aggregation induced by iloprost, a stable analogue of prostacyclin; (d) the direct aggregatory effect of these anticoagulants on hyperactive platelets prepared from patients with severe peripheral vascular disease or anorexia nervosa. Whereas BLH and PIM, at therapeutic concentrations, had a proaggregatory effect in all four systems, CY 222 had no significant effect when compared with the controls. BLH was more potent than PIM in three of the four systems studied. These observations confirm that conventional UH are more proaggregatory than LMWH, and thus the latter may be potentially safer. These observations are also consistent with the fact that BLH administration causes thrombocytopenia more frequently than PIM. The direct activation by UH of platelets from patients not previously exposed to heparin also challenges the hypothesis that heparin-induced platelet activation and thrombocytopenia is solely mediated by classical heparin-dependent immune mechanisms.

Topics: Adult; Anorexia Nervosa; Cardiovascular Agents; Epoprostenol; Female; Heparin; Heparin, Low-Molecular-Weight; Humans; Iloprost; Male; Platelet Aggregation; Vascular Diseases

I propose an analogy between vascular diseases of the inner ear and those of other organs like brain, heart or peripheral vessel diseases in which functional and organic alteration can be objectively demonstrated. Symptomatic disturbances of inner ear circulation are monoform in its clinical appearance and the term of 'otangina' is proposed for the functional result. Three types of vascular distribution are discussed for the different regulatory entities, (I) the proximal cerebral vascular type, (II) the predistal innervated regulatory type and the (III) capillary regulatory type. The formal etiology of inner ear vascular diseases is is developed on the base of organic vascular lesions, i.e. arteriosclerosis, functional alterations, i.e. vasospastic disease, and finally change in the microcirculation by alterations of the rheology of the blood. Hypertension is portrayed as a main example for cardiovascular risk factors with respect to inner ear circulatory damage but diabetes mellitus, cigarette smoking and other metabolic diseases leading to vascular disturbances have to be considered. From these considerations I have developed a basic program for the diagnosis of vascular metabolic risk factors which should be realized before any treatment is advocated. I have critically evaluated the benefit and possible hazardous effects of so called 'vasoactive' and 'cephalotropic' drugs. For most inner ear circulatory disease such therapy is contraindicated. The models of drug treatment of acute deafness and the chronic or persistent inner ear deafness should be evaluated in prospective studies.

Topics: Arteriosclerosis; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Complications; Ear Diseases; Ear, Inner; Humans; Hypercholesterolemia; Male; Parasympathomimetics; Sympathomimetics; Vascular Diseases

Topics: Adult; Cardiovascular Agents; Diosmin; Edema; Female; Flavonoids; Humans; Male; Middle Aged; Muscle Cramp; Pain; Vascular Diseases

Topics: Cardiovascular Agents; Drug Therapy; Humans; Varicose Veins; Vascular Diseases

Topics: Aged; Cardiovascular Agents; Dihydroergotoxine; Ergoloid Mesylates; Ergot Alkaloids; Geriatrics; Humans; Vascular Diseases

Topics: Adolescent; Cardiovascular Agents; Ergot Alkaloids; Ischemia; Leg; Lower Extremity; Methysergide; Migraine Disorders; Toxicology; Vascular Diseases

Topics: Atmospheric Pressure; Cardiovascular Agents; Ergot Alkaloids; Foot Diseases; Gangrene; Humans; Hyperbaric Oxygenation; Oxygen; Toxicology; Vascular Diseases

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

Topics: Albumins; Cardiovascular Agents; Iodine; Peripheral Vascular Diseases; Serum Albumin; Vascular Diseases; Vasodilator Agents

Topics: Cardiovascular Agents; Humans; Muscle Cramp; Muscle Relaxants, Central; Peripheral Vascular Diseases; Sleep-Wake Transition Disorders; Vascular Diseases

Topics: Arteriosclerosis; Cardiovascular Agents; Muscle Relaxants, Central; Peripheral Vascular Diseases; Scleroderma, Systemic; Vascular Diseases; Vasodilator Agents

Topics: Cardiovascular Agents; Cyclandelate; Muscle Relaxants, Central; Peripheral Vascular Diseases; Vascular Diseases; Vasodilator Agents

Topics: Arteries; Cardiovascular Agents; Disease; Ergot Alkaloids; Ergotamine; Humans; Suppositories; Vascular Diseases

Topics: Cardiovascular Agents; Isoxsuprine; Muscle Relaxants, Central; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Ergot Alkaloids; Peripheral Vascular Diseases; Vascular Diseases; Vasodilator Agents

Topics: Cardiovascular Agents; Muscle Relaxants, Central; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Cyclandelate; Muscle Relaxants, Central; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Leg; Oxytocics; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Enzyme Therapy; Enzymes; Humans; Peripheral Arterial Disease; Peripheral Vascular Diseases; Vascular Diseases; Vasodilator Agents

Topics: Cardiovascular Agents; Isoxsuprine; Muscle Relaxants, Central; Parasympatholytics; Peripheral Vascular Diseases; Vascular Diseases; Vasodilation; Vasodilator Agents

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Peripheral Arterial Disease; Peripheral Vascular Diseases; Vascular Diseases

Topics: Arteries; Cardiovascular Agents; Disease; Ergot Alkaloids; Humans; Vascular Diseases

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Heparin; Histamine H1 Antagonists; Humans; Hydrocortisone; Penicillins; Peripheral Arterial Disease; Peripheral Vascular Diseases; Vascular Diseases

Topics: Animals; Behavior, Animal; Cardiovascular Agents; Ergot Alkaloids; Gout; Peripheral Vascular Diseases; Social Behavior; Vascular Diseases

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Oxytocics; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Oxytocics; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Cyclandelate; Muscle Relaxants, Central; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Humans; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Heart Failure; Hypertension; Muscle Relaxants, Central; Vascular Diseases

Topics: Alkaloids; Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Cyclandelate; Muscle Relaxants, Central; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Ergot Alkaloids; Oxytocics; Peripheral Vascular Diseases; Vascular Diseases

Topics: Alkaloids; Cardiovascular Agents; Ergot Alkaloids; Peripheral Vascular Diseases; Treatment Outcome; Vascular Diseases

Topics: Cardiovascular Agents; Ergot Alkaloids; Oxytocics; Peripheral Arterial Disease; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Ergot Alkaloids; Peripheral Vascular Diseases; Vascular Diseases

Topics: Cardiovascular Agents; Cardiovascular Diseases; Dihydroergotoxine; Ergot Alkaloids; Peripheral Vascular Diseases; Vascular Diseases