Current Vascular Pharmacology - Volume 10, Issue 6, 2012

Dysglycemia as a pre-stage of diabetes mellitus and abdominal obesity are closely interrelated at multiple levels and by a whole array of complex mechanisms, many of which seem to have the potential of causing harm to large blood vessels, in particular to coronary and peripheral vascular segments. Both conditions are associated with elevated circulating concentrations of free fatty acids in conjunction with insulin resistanc Read More

The present paper examines major evidences on the correlation between pre-diabetes, diabetes and cardiovascular risk, especially focusing on early and multifactorial treatment strategies holding the potential to delay the occurrence of micro- and macro-vascular complications causing impaired quality of life and reduced survival.

Diabetic dyslipidemia is due to a multiple array of metabolic abnormalities determining a typical phenotype characterized by increased plasma triglycerides, reduced HDL and a preponderance of small, dense LDL. This dyslipidemia, defined as atherogenic dyslipidemia, is thought to be highly responsible for the increased cardiovascular risk in diabetes mellitus. Several lines of evidence indicate that the increased liver producti Read More

In almost every epidemiological analysis so far performed a strong correlation always emerges between degree of hyperglycemia and risk of both micro- and macrovascular complications. However, whereas lowering plasma glucose levels by intensive treatment has proven to reduce the risk of development of retinopathy, nephropathy and neuropathy, the effect on macrovascular complications has remained quite doubtful. Mult Read More

Patients with diabetes and prediabetes are at high risk for micro- and macrovascular complications. A multifactorial management strategy improves their prognosis considerably. Of concern is that these patients often fall between two specialties: cardiovascular medicine and diabetology. Practice guidelines for this patient category have been issued in collaboration between the European Society of Cardiology Read More

Atherosclerosis is a chronic inflammatory disease that is based on the interaction between inflammatory cell subsets and specific cells in the arterial wall. SIRT1 deacetylates histone and non-histone proteins and has been implicated in protective effects of caloric restriction on lifespan and metabolic pathways in yeast, nematodes, and mice. In the vasculature of rodents, SIRT1 mediates vasodilatation through the release of Read More

The present work is addressing the latest advances made in understanding the molecular mechanisms of vascular aging. Increased production of reactive oxygen species (ROS) is the common denominator of vascular aging, endothelial dysfunction and atherosclerosis. ROS are generated by different intracellular molecular pathways. In view of its role in determining the redox state of the cells and their responses to free radic Read More

Cardiovascular disease is multidimensional and new ideas are needed to develop the conventional risk factor paradigm that has been based on the Framingham Heart Study since more than 30 years. Traditional risk factors such as hypertension, smoking, hyperlipidemia and diabetes can only explain about 50% of the distribution of coronary heart disease whereas the inclusion of new risk markers or protective markers may inc Read More

Arterial aging, characterized by arterial stiffening that is clinically evaluable as aortic pulse wave velocity, is risky for CV events, disability, and loss of cognitive function. Today the only adopted strategy to decrease arterial aging/ arterial stiffness is represented by decreasing BP. Selective antihypertensive drug classes (calcium channel blockers, converting enzyme inhibitors, angiotensin type 1 receptor antagonists) showed Read More

Loss of normal endothelial function and bioactivity of nitric oxide (NO), associated with increased production of reactive oxygen species (ROS), are characteristics of cardiovascular disease states. There is good experimental evidence that these abnormalities are causally related to cardiovascular disease pathogeneses, and are amenable to therapeutic intervention. However, simple attempts to increase NO levels or Read More

Although the impressive progression of modern diagnostic opportunities and therapeutic options, cardiovascular diseases still represent the leading causes of morbidity and mortality, worldwide. Beyond the effective pharmacological treatment of major cardiovascular disease or sequelae, however, cardiovascular diseases developing in adult individuals are largely preventable. The substantial failure to prevent cardiovascul Read More

The need of early, preclinical detection of disease is given by the fact that in 50% of patients dying due to coronary death, mortality is neither heralded by cardiac symptoms nor diagnosis make .The risk during life of suffering of consequences of atherosclerosis can be efficiently assessed through the Framingham risk score (among several other global risk scores). Global risk scores although originally formulated to give a Read More

All coronary patients should be advised and have the opportunity to access a comprehensive cardiovascular prevention and rehabilitation programme, addressing all aspects of lifestyle - smoking cessation, healthy eating and being physically active - together with more effective management of blood pressure, lipids and glucose. To achieve the clinical benefits of a multidisciplinary and multifactorial prevention pr Read More

Low high-density lipoprotein (HDL) cholesterol levels are associated with an increased risk of coronary artery disease and myocardial infarction. Experimental studies have identified several potential anti-atherogenic properties of HDL, including promotion of macrophage cholesterol efflux, endothelial nitric oxide stimulation, anti-inflammatory and anti-thrombotic effects. These observations have lead to the important questi Read More

The plasma levels of high-density lipoprotein (HDL) cholesterol are inversely related to cardiovascular risk. Traditional HDL-raising therapies, like fibrates, PPAR-γ agonists, and nicacin, among others, are associated with undesirable side effects, limited efficacy, or have not yet been shown to improve morbidity and mortality on top of statins in clinical outcome trials. A novel pharmacological target for raising circulating HDL-C l Read More

Among patients with atherothrombosis, including coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral arterial disease (PAD), patients with PAD generally have the worse prognosis. The Reduction of Atherothrombosis for Continued Health (REACH) Registry characterized the atherothrombotic risk factor profile, and evaluated treatment intensity and cardiovascular events among different ath Read More

Multisite artery or polyvascular disease is common. In the REACH registry, 15.9% of patients with either established atherosclerotic arterial disease or at least 3 risk factors for atherothrombosis had symptomatic polyvascular disease. History of risk factors and known co-morbidities, as well as a thorough physical examination, are mandatory in the initial screening and diagnostic work-up. Various non-invasive imaging techniques ( Read More

Multisite artery disease (MSAD) affects 15% to 30% of patients with clinically manifest atherosclerosis, and has a relevant negative impact on prognosis. However, studies specifically focused on MSAD are very few, and available evidence is scarce. Importantly, patients with MSAD require an integrated management, possibly by a “Vascular Team” composed of the different specialists involved in the treatment of atheroscler Read More

Carotid stenosis is frequent in the general population, especially in elderly people and is associated with a high risk of stroke and vascular events. In patients with asymptomatic carotid stenosis the overall annual risk of ipsilateral stroke has dramatically decreased over the past decades, due to improvement in medical management. Asymptomatic carotid stenosis is probably a better indicator of generalized atherosclerotic disea Read More

High blood pressure (BP) along with smoking habit and lipid disorders are the most important and modifiable risk factors for cardiovascular diseases. However, the prevalence of high BP has grown progressively over time with a progressive increase not only in the absolute number of patients but in the proportion of those showing BP values out of control. The increasing world-wide prevalence of hypertension and the r Read More

The lecture covered the role of lipids in the pathogenesis and treatment of non-cardiac vascular disease. The following conditions were considered: abdominal aortic aneurysms (AAAs), peripheral arterial disease (PAD), carotid artery disease and atherosclerotic renal artery stenosis (ARAS).

In this issue of Curr Vasc Pharmacol, Pfeiffer et al. [1] and Glorioso et al. [2] report the efficacy and tolerability of aliskiren/amlodipine single-pill combinations (SPCs) in patients with inadequate blood pressure (BP) response to amlodipine or aliskiren monotherapy, respectively.

Many patients with hypertension will require multiple antihypertensive drugs to achieve blood pressure (BP) control. This double-blind study evaluated the efficacy and safety of aliskiren/amlodipine single-pill combinations (SPCs) in patients with mild-to-moderate hypertension who were non-responsive to aliskiren monotherapy. After a 4-week run-in with aliskiren 300 mg, patients with mean sitting diastolic BP (msDBP) ≥ Read More

Intravascular hemolysis is a major component of anemia in sickle cell disease (SCD). Plasma extracellular hemoglobin (ECHb) liberated by intravascular hemolysis has deleterious effects on the vasculature. ECHb scavenges nitric oxide (NO) and promotes the pathogenesis of several clinical events including pulmonary hypertension, priapism and non-hemorrhagic strokes. ECHb reduces the bioavailability of NO which d Read More

Resting endothelial cells lining the inner surface of blood vessels have anti-thrombotic and anti-inflammatory actions, critical for maintaining normal vascular homeostasis. Upon localized or systemic stimulation, endothelial cells are activated to secrete bioactive molecules; among them is von Willebrand factor (VWF). Freshly secreted VWF is enriched in ultra-large (UL) forms that are anchored to endothelial cells to form long st Read More

Portal hypertension is a hemodynamic abnormality that involves a high risk of disability as well as a reduced life expectancy in patients with cirrhosis. Progress in the knowledge of pathophysiology of portal hypertension has opened a new perspective for different pharmacological approaches. In this context, the pleiotropic actions of statins on endothelial cell function have emerged as new options to reduce portal Read More

Most patients with hypertension will require treatment with at least two antihypertensive agents to achieve blood pressure (BP) control. This double-blind study evaluated the efficacy and safety of aliskiren/amlodipine single-pill combination (SPC) therapy in patients with mild-to-moderate hypertension who are inadequately responsive to amlodipine monotherapy. Patients with mean sitting diastolic BP (msDBP) ≥ 90 and < Read More

Energy homeostasis in mammalians is a teleological process regulated by the interplay between caloric intake and energy expenditure. Incretins are a significant component of the complex homeostatic network regulating the metabolic state in humans. This narrative review will focus on the basic concepts regarding incretins physiology and their regulatory feedback mechanisms affecting energy homeostasis. In this context, Read More