Medical Management of Vascular Disease

2013 ◽  
Author(s):  
Deepak G. Nair ◽  
Russell H. Samson
Keyword(s):  
Vascular Disease ◽  
Medical Management ◽  
Lifestyle Modification ◽  
Disease Process ◽  
Antiplatelet Agents ◽  
Aortic Aneurysms ◽  
Lipid Lowering ◽  
Pharmacological Intervention ◽  
Bile Acid Sequestrants ◽  
Artery Disease

Although surgeons may be able to bypass or open blocked arteries and replace aneurysms with minimally invasive surgery, patients continue to die from the other cardiovascular consequences of vascular disease. Surgeons must become more involved in the nonsurgical treatments of peripheral artery disease (PAD). A good understanding of the role of lipids in atherosclerosis is critical but surgeons must also recognize the threats of diabetes; smoking; hypertension; and hyperlipidemia on PAD. Treatments, including lifestyle modification, diet, exercise, and the influence of lipid-lowering agents is described. Medications that can alter PAD are described in detail and include statins; fibrates; niacin; bile acid sequestrants; ezetimibe; and antiplatelet agents. Side effects and monitoring is also described. Although much of the review covers the general principles of medical management of patients with PAD, components of this overall disease process are also provided and include pharmacological intervention for claudication; stroke; aortic aneurysms; and nonatherosclerotic vascular disease. This review contains 2 figures, 2 tables, and 181 references.

Sex Differences in the Inflammatory Response: Pharmacological Opportunities for Therapeutics for Coronary Artery Disease

2021 ◽  
Vol 61 (1) ◽  
pp. 333-359 ◽  
Author(s):  
Asad Shabbir ◽  
Krishnaraj Sinhji Rathod ◽  
Rayomand Syrus Khambata ◽  
Amrita Ahluwalia
Keyword(s):  
Sex Difference ◽  
Inflammatory Responses ◽  
Vascular Inflammation ◽  
Management Strategies ◽  
Disease Process ◽  
Pharmacological Intervention ◽  
Men And Women ◽  
Fibrous Cap ◽  
Vessel Closure ◽  
Artery Disease

Coordinated molecular responses are key to effective initiation and resolution of both acute and chronic inflammation. Vascular inflammation plays an important role in initiating and perpetuating atherosclerotic disease, specifically at the site of plaque and subsequent fibrous cap rupture. Both men and women succumb to this disease process, and although management strategies have focused on revascularization and pharmacological therapies in the acute situation to reverse vessel closure and prevent thrombogenesis, data now suggest that regulation of host inflammation may improve both morbidity and mortality, thus supporting the notion that prevention is better than cure. There is a clear sex difference in the incidence of vascular disease, and data confirm biological differences in inflammatory initiation and resolution between men and women. This article reviews contemporary opinions describing the sex difference in the initiation and resolution of inflammatory responses, with a view to explore potential targets for pharmacological intervention.

scholarly journals Plasma Lipoprotein(a) Indicates Risk for 4 Distinct Forms of Vascular Disease

2007 ◽  
Vol 53 (4) ◽  
pp. 679-685 ◽  
Author(s):  
Gregory T Jones ◽  
Andre M van Rij ◽  
Jennifer Cole ◽  
Michael JA Williams ◽  
Emma H Bateman ◽  
...  
Keyword(s):  
Risk Factor ◽  
Vascular Disease ◽  
Plasma Lipids ◽  
Association Studies ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Odds Ratios ◽  
Lipoprotein A ◽  
History Of ◽  
Artery Disease

Abstract Background: Increased lipoprotein(a) [Lp(a)] concentrations are predictive for coronary artery disease (CAD). The risk conferred by Lp(a) for other types of vascular disease compared with CAD has not been investigated within a single population. This study aimed to investigate Lp(a) risk association for 4 different types of vascular disease (including CAD) within a predominantly white population. Methods: We used an Lp(a) ELISA that measures Lp(a) independently of apolipoprotein(a) size to measure plasma Lp(a) in patients [384 CAD, 262 peripheral vascular disease, 184 ischemic stroke (stroke), 425 abdominal aortic aneurysm] and 230 disease-free controls. We then conducted association studies with logistic regression, integrating the potential confounding effects of age, sex, diabetes, plasma lipids, and a history of previous hypertension, hypercholesterolemia, and smoking. Results: Multivariate analyses with Lp(a) concentrations of >45 nmol/L (the 75th percentile value for controls) as the clinical cutoff showed increased Lp(a) concentrations to be a risk factor for all disease groups, with adjusted odds ratios ranging from 1.96 [95% confidence interval (CI) 1.24–3.08] for CAD to 2.33 (95% CI 1.39–3.89) for PVD. The risk conferred by Lp(a) appeared to be independent of other confounders, including exposure to statin/fibrate therapies. Similar odds ratios and CIs between disease groups indicated that increased Lp(a) conferred a similar risk for all groups studied. Conclusions: Lp(a) constitutes a stable risk factor of similar magnitude for 4 major forms of vascular disease. This association was not altered by exposure to standard lipid-lowering therapy.

The American Vascular Association Screening Program: Rationale, Method, Guidelines, and Progress

2005 ◽  
Vol 29 (2) ◽  
pp. 85-89 ◽  
Author(s):  
George S. Lavenson
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Screening Program ◽  
Carotid Artery Disease ◽  
Aortic Aneurysms ◽  
Peripheral Vascular ◽  
Early Management ◽  
Abdominal Aortic ◽  
Accredited Laboratories ◽  
Artery Disease

Introduction The Society of Vascular Surgery, in partnership with the Society for Vascular Ultrasound (SVU), established a National Vascular Screening Program thru the American Vascular Association (AVA). The program screens for the immediate causes of stroke, abdominal aortic aneurysms (AAA), and peripheral vascular disease. Detection of these conditions while the patient still is asymptomatic allows for early management and avoidance of the devastating events they can cause. Methods A quick carotid scan is used for detection of carotid artery disease, an EKG rhythm strip for atrial fibrillation, blood pressure determination for hypertension, a quick abdominal scan for AAA, and ankle/brachial indices for peripheral vascular disease. The SVU position on screening, recommending credentialed technologists and accredited laboratories, is used in the AVA screening program, and reporting only the presence or absence of disease has been recommended. Results The AVA program, and three other programs reported, screened 6,073 seniors. It is estimated that the carotid screenings alone prevented 30 strokes and saved $12,061,400,000 in stroke costs. Conclusion The AVA screening program, with quality ensured by the SVU guidelines, has the potential to prevent a major number of strokes and deaths. Recommendation is for extension of the screening program and for efforts to obtain Medicare funding for the screening.

Medical management of symptomatic peripheral vascular disease

1990 ◽  
Vol 80 (5) ◽  
pp. 243-247 ◽  
Author(s):  
NK Skelton ◽  
WP Skelton
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Medical Management ◽  
Treatment Options ◽  
Disease Process ◽  
Peripheral Vascular ◽  
Primary Health Care Provider ◽  
Primary Health ◽  
Treatment Alternatives

As our society becomes older, peripheral vascular disease assumes greater significance. Many patients are not surgical candidates and, therefore, must opt for medical management. The podiatrist often assumes the role of primary health care provider, and a knowledge of the disease process, its consequences, and treatment alternatives becomes paramount. The authors detail the events leading to and the treatment options for symptomatic peripheral vascular disease.

scholarly journals Marine Natural Products and Coronary Artery Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Bo Liang ◽  
Xin-Yi Cai ◽  
Ning Gu
Keyword(s):  
Coronary Artery Disease ◽  
Natural Products ◽  
Coronary Artery ◽  
Marine Natural Products ◽  
Antioxidant Activities ◽  
Biological Activities ◽  
Chemical Diversity ◽  
Lipid Lowering ◽  
Pharmacological Intervention ◽  
Artery Disease

Coronary artery disease is the major cause of mortality worldwide, especially in low- and middle-income earners. To not only reduce angina symptoms and exercise-induced ischemia but also prevent cardiovascular events, pharmacological intervention strategies, including antiplatelet drugs, anticoagulant drugs, statins, and other lipid-lowering drugs, and renin–angiotensin–aldosterone system blockers, are conducted. However, the existing drugs for coronary artery disease are incomprehensive and have some adverse reactions. Thus, it is necessary to look for new drug research and development. Marine natural products have been considered a valuable source for drug discovery because of their chemical diversity and biological activities. The experiments and investigations indicated that several marine natural products, such as organic small molecules, polysaccharides, proteins, and bioactive peptides, and lipids were effective for treating coronary artery disease. Here, we particularly discussed the functions and mechanisms of active substances in coronary artery disease, including antiplatelet, anticoagulant, lipid-lowering, anti-inflammatory, and antioxidant activities.

Drug-Induced Movement Disorders

2015 ◽  
Vol 25 (2) ◽  
pp. 70-77
Author(s):  
Amy Lustig ◽  
Cesar Ruiz
Keyword(s):  
Movement Disorders ◽  
Medical Management ◽  
Disease Process ◽  
Underlying Disease ◽  
Extrapyramidal Symptoms ◽  
Drug Induced ◽  
General Overview ◽  
Management Approaches ◽  
Broad Understanding ◽  
Underlying Disease Process

The purpose of this article is to present a general overview of the features of drug-induced movement disorders (DIMDs) comprised by Parkinsonism and extrapyramidal symptoms. Speech-language pathologists (SLPs) who work with patients presenting with these issues must have a broad understanding of the underlying disease process. This article will provide a brief introduction to the neuropathophysiology of DIMDs, a discussion of the associated symptomatology, the pharmacology implicated in causing DIMDs, and the medical management approaches currently in use.

Statins and Inflammation in Cardiovascular Disease

2018 ◽  
Vol 23 (46) ◽  
pp. 7027-7039 ◽  
Author(s):  
Georgia Vogiatzi ◽  
Evangelos Oikonomou ◽  
Gerasimos Siasos ◽  
Sotiris Tsalamandris ◽  
Alexandros Briasoulis ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Lipid Lowering ◽  
Hmg Coa Reductase ◽  
Ample Evidence ◽  
Reductase Inhibitors ◽  
Immune System Activation ◽  
Hmg Coa Reductase Inhibitors ◽  
Anti Inflammatory ◽  
Artery Disease ◽  
Coa Reductase

Background: Chronic inflammation and immune system activation underlie a variety of seemingly unrelated cardiac conditions including not only atherosclerosis and the subsequent coronary artery disease but also peripheral artery disease, hypertension with target organ damage and heart failure. The beneficial effects of HMG-CoA reductase inhibitors or statins are mainly attributed to their ability to inhibit hepatic cholesterol biosynthesis. Beyond their lipid lowering activity, ample evidence exists in support of their potent anti-inflammatory properties which initiate from the inhibition of GTPase isoprenylation, activating a cataract of secondary pathways and extend to the inhibition and blocking of immune cell activation and interaction. </P><P> Objective: To summarize the anti-inflammatory mechanisms of statins in clinical and experimental settings in cardiovascular disease. </P><P> Methods: A systematic search of PubMed and the Cochrane Database was conducted in order to identify the majority of trials, studies, current guidelines and novel articles related to the subject. </P><P> Results: In vitro, statins have immuno-modulatory and anti-inflammatory effects, and they can exert antiatherosclerotic effects independently of their hypolipidemic actions. In addition, positive results have emerged from mechanistic and experimental studies on the active role of HMG-CoA reductase inhibitors in HF. By extrapolating those data in clinical setting, we further understand how HMG-CoA reductase inhibitors can beneficially affect not only systolic but also diastolic HF. </P><P> Conclusion: In this review article, we present the basic pathophysiologic data supporting the anti-inflammatory actions of statins in clinical and experimental settings and we link these mechanisms with confirmatory clinical data on the potent non lipid lowering effects of HMG-CoA reductase inhibitors.

Surgical Therapy for Coronary Artery Disease Among Patients With Combined Coronary Artery and Peripheral Vascular Disease

Circulation ◽  
1995 ◽  
Vol 91 (1) ◽  
pp. 46-53 ◽  
Author(s):  
Charanjit S. Rihal ◽  
Kim A. Eagle ◽  
Mary C. Mickel ◽  
Eric D. Foster ◽  
George Sopko ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Surgical Therapy ◽  
Peripheral Vascular ◽  
Artery Disease
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