A recent explosion in the amount of cardiovascular risk has swept across the globe. Primary prevention is the preferred method to lower cardiovascular risk. Lowering the prevalence of obesity is the most urgent matter...A recent explosion in the amount of cardiovascular risk has swept across the globe. Primary prevention is the preferred method to lower cardiovascular risk. Lowering the prevalence of obesity is the most urgent matter, and is pleiotropic since it affects blood pressure, lipid profiles, glucose metabolism, inflammation, and atherothrombotic disease progression. Given the current obstacles, success of primary prevention remains uncertain. At the same time, the consequences of delay and inaction will inevitably be disastrous, and the sense of urgency mounts. Pathological and epidemiological data confirm that atherosclerosis begins in early childhood, and advances seamlessly and inexorably throughout life. Risk factors in childhood are similar to those in adults, and track between stages of life. When indicated, aggressive treatment should begin at the earliest indication, and be continued for many years. For those patients at intermediate risk according to global risk scores, C-reactive protein, coronary artery calcium, and carotid intima-media thickness are available for further stratification. Using statins for primary prevention is recommended by guidelines, is prevalent, but remains under prescribed. Statin drugs are unrivaled, evidence-based, major weapons to lower cardiovascular risk. Even when low density lipoprotein cholesterol targets are attained, over half of patients continue to have disease progression and clinical events. Though clinical evidence is incomplete, altering or raising the blood high density lipoprotein cholesterol level continues to be pursued. The aim of this review is to point out the attention of key aspects of vulnerable plaques regarding their pathogenesis and treatment.展开更多
1 Introduction Although older adults are generally among the highest users of cardiovascular medications, they are typically underrepresented or excluded from most efficacy and safety trials. Drug developers are usual...1 Introduction Although older adults are generally among the highest users of cardiovascular medications, they are typically underrepresented or excluded from most efficacy and safety trials. Drug developers are usually reluctant to include many senior adults in randomized controlled clinical trials in part due to their high prevalence of multiple comorbidities, frailty, and polypharmacy; and to age-related pharmacokinetic and pharmacodynamic complexities. Consequently, there is often insufficient high quality evidence-based data to inform pharmacologic management of common cardiovascular conditions on older adults. In the absence of data, clinicians often rely on conceptual principles regarding metabolism and drug-drug interactions to minimize adverse drug events, but this is often not well-substantiated or standardized. A related challenge is poor cardiovascular medication adherence among older adults, and its detrimental impact on their health outcomes. In this brief review we highlight some aspects of these topics.展开更多
Depression is a common medical problem and is more prevalent among patients with coronary artery disease. Whether early detection and treatment of depression will enhance cardiovascular outcome is uncertain. Obviously...Depression is a common medical problem and is more prevalent among patients with coronary artery disease. Whether early detection and treatment of depression will enhance cardiovascular outcome is uncertain. Obviously, the safety and efficacy of the anti-depression drugs is an important link. This article reviews the patho-physiologic and behavioural links between depression and cardiovascular disease progression, the treatment of depression, and the potential benefits of anti-depressants in patients with coronary disease.展开更多
The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortali...The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older 〉 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for theft primary cardiovascular disease, with the associated risks and benefits of treatment.展开更多
Objective:To assess whether people who ever use any form of chewing substance in Asia are at increased risk of cardiovascular disease(CVD).Methods:PubMed and ISI Web of Science were searched for relevant studies,with ...Objective:To assess whether people who ever use any form of chewing substance in Asia are at increased risk of cardiovascular disease(CVD).Methods:PubMed and ISI Web of Science were searched for relevant studies,with no limitation on language or study year.Studies were included if they provided quantitative estimate of the association between ever use of chewing substance and the occurrence of CVD.Two authors independently implemented inclusion criteria,abstracted study characteristics,and performed meta-analysis.Summary relative risks were estimated on the basis of a random effect model.We used Q statistic and Egger's test to examine heterogeneity across studies and potential publication bias,respectively.Results:Eight eligible studies were included.The relative risk of CVD for ever using chewing substances with or without tobacco was 1.26(95% confidence interval(CI) 1.12-1.40),which was unchanged when restricted to cohort studies [1.25(1.08-1.42)] or cohort studies in Taiwan [1.31(1.12-1.51)].The summary relative risk for ischemic heart disease was 1.27(1.02-1.52),and was lowered to 1.26(0.85-1.67) after exclusion of a cross-sectional study.The overall relative risk for cerebrovascular disease was 1.32(1.08-1.56).On the basis of the Taiwan data,the summary relative risk of CVD for betel(Areca catechu) chewing was 1.30(1.17-1.44).Data on dose-response were limited to betel chewing in Taiwan,suggesting a relationship between risk of CVD and cumulative exposure.Two large cohorts in Taiwan reported a greater risk of CVD with betel chewing than with smoking.Conclusions:An association was detected between betel chewing with or without tobacco and the risk of CVD.Betel chewing may impose a greater CVD risk than smoking.More effort is needed in developing betel chewing cessation programmes.The relationship between betel chewing and subgroups of CVD requires further investigation.展开更多
OBJECTIVE: To review the pharmacological effects and mechanisms of action of Astragaloside IV in Huangqi (Radix Astragali Mongolici). METHODS: Aticles focusing on Astragaloside IV in English and Chinese in databases w...OBJECTIVE: To review the pharmacological effects and mechanisms of action of Astragaloside IV in Huangqi (Radix Astragali Mongolici). METHODS: Aticles focusing on Astragaloside IV in English and Chinese in databases were collected and reviewed in order to summarize the latest extraction separation, pharmacokinetics, and the pharmacological effects of astrageloside IV. RESULTS: Protective effects of Astrageloside IV on the cardiovascular system, immune, digestive, nervous system were identified, and the action mechanisms were associated with regulation of the calcium balance, anti-oxydant, antiapoptosis, antivirus, and so on. CONCLUSION: Astrageloside IV has broad application prospects, especially in cardiovascular diseases, digestive diseases, cancer and other modern high incidence, high-risk diseases, and could be developed as a medicine.展开更多
文摘A recent explosion in the amount of cardiovascular risk has swept across the globe. Primary prevention is the preferred method to lower cardiovascular risk. Lowering the prevalence of obesity is the most urgent matter, and is pleiotropic since it affects blood pressure, lipid profiles, glucose metabolism, inflammation, and atherothrombotic disease progression. Given the current obstacles, success of primary prevention remains uncertain. At the same time, the consequences of delay and inaction will inevitably be disastrous, and the sense of urgency mounts. Pathological and epidemiological data confirm that atherosclerosis begins in early childhood, and advances seamlessly and inexorably throughout life. Risk factors in childhood are similar to those in adults, and track between stages of life. When indicated, aggressive treatment should begin at the earliest indication, and be continued for many years. For those patients at intermediate risk according to global risk scores, C-reactive protein, coronary artery calcium, and carotid intima-media thickness are available for further stratification. Using statins for primary prevention is recommended by guidelines, is prevalent, but remains under prescribed. Statin drugs are unrivaled, evidence-based, major weapons to lower cardiovascular risk. Even when low density lipoprotein cholesterol targets are attained, over half of patients continue to have disease progression and clinical events. Though clinical evidence is incomplete, altering or raising the blood high density lipoprotein cholesterol level continues to be pursued. The aim of this review is to point out the attention of key aspects of vulnerable plaques regarding their pathogenesis and treatment.
文摘1 Introduction Although older adults are generally among the highest users of cardiovascular medications, they are typically underrepresented or excluded from most efficacy and safety trials. Drug developers are usually reluctant to include many senior adults in randomized controlled clinical trials in part due to their high prevalence of multiple comorbidities, frailty, and polypharmacy; and to age-related pharmacokinetic and pharmacodynamic complexities. Consequently, there is often insufficient high quality evidence-based data to inform pharmacologic management of common cardiovascular conditions on older adults. In the absence of data, clinicians often rely on conceptual principles regarding metabolism and drug-drug interactions to minimize adverse drug events, but this is often not well-substantiated or standardized. A related challenge is poor cardiovascular medication adherence among older adults, and its detrimental impact on their health outcomes. In this brief review we highlight some aspects of these topics.
文摘Depression is a common medical problem and is more prevalent among patients with coronary artery disease. Whether early detection and treatment of depression will enhance cardiovascular outcome is uncertain. Obviously, the safety and efficacy of the anti-depression drugs is an important link. This article reviews the patho-physiologic and behavioural links between depression and cardiovascular disease progression, the treatment of depression, and the potential benefits of anti-depressants in patients with coronary disease.
文摘The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older 〉 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for theft primary cardiovascular disease, with the associated risks and benefits of treatment.
基金(No. 2004C30067) supported by the Zhejiang Provincial Science and Technology Plan Project,China
文摘Objective:To assess whether people who ever use any form of chewing substance in Asia are at increased risk of cardiovascular disease(CVD).Methods:PubMed and ISI Web of Science were searched for relevant studies,with no limitation on language or study year.Studies were included if they provided quantitative estimate of the association between ever use of chewing substance and the occurrence of CVD.Two authors independently implemented inclusion criteria,abstracted study characteristics,and performed meta-analysis.Summary relative risks were estimated on the basis of a random effect model.We used Q statistic and Egger's test to examine heterogeneity across studies and potential publication bias,respectively.Results:Eight eligible studies were included.The relative risk of CVD for ever using chewing substances with or without tobacco was 1.26(95% confidence interval(CI) 1.12-1.40),which was unchanged when restricted to cohort studies [1.25(1.08-1.42)] or cohort studies in Taiwan [1.31(1.12-1.51)].The summary relative risk for ischemic heart disease was 1.27(1.02-1.52),and was lowered to 1.26(0.85-1.67) after exclusion of a cross-sectional study.The overall relative risk for cerebrovascular disease was 1.32(1.08-1.56).On the basis of the Taiwan data,the summary relative risk of CVD for betel(Areca catechu) chewing was 1.30(1.17-1.44).Data on dose-response were limited to betel chewing in Taiwan,suggesting a relationship between risk of CVD and cumulative exposure.Two large cohorts in Taiwan reported a greater risk of CVD with betel chewing than with smoking.Conclusions:An association was detected between betel chewing with or without tobacco and the risk of CVD.Betel chewing may impose a greater CVD risk than smoking.More effort is needed in developing betel chewing cessation programmes.The relationship between betel chewing and subgroups of CVD requires further investigation.
文摘OBJECTIVE: To review the pharmacological effects and mechanisms of action of Astragaloside IV in Huangqi (Radix Astragali Mongolici). METHODS: Aticles focusing on Astragaloside IV in English and Chinese in databases were collected and reviewed in order to summarize the latest extraction separation, pharmacokinetics, and the pharmacological effects of astrageloside IV. RESULTS: Protective effects of Astrageloside IV on the cardiovascular system, immune, digestive, nervous system were identified, and the action mechanisms were associated with regulation of the calcium balance, anti-oxydant, antiapoptosis, antivirus, and so on. CONCLUSION: Astrageloside IV has broad application prospects, especially in cardiovascular diseases, digestive diseases, cancer and other modern high incidence, high-risk diseases, and could be developed as a medicine.
