Timely topics in medicine. Cardiovascular diseases最新文献

Recent research demonstrates the complexity and variety of pathophysiologic processes underlying cerebral ischemia. This review will focus on the multimodal effects of the various drugs currently used for stroke prevention. The most recent clinical studies of each will also be reviewed, and the implications for clinical use and future research discussed. An evolving approach for stroke prevention will include a combination of antiplatelets, increased use of statins, ACE inhibitors and possibly vitamin therapy.

The sequelae of cardiovascular disease contribute significantly to morbidity and mortality in developed nations. As a class, the statins have been shown to measurably reduce the burden of atherosclerotic illness. However, muscle- and, more recently, nerve-related toxicity have emerged as potential complications leading to treatment withdrawal. Generally, the myopathic signs and symptoms of tenderness, myalgias, cramping and elevated serum creatine kinase (CK) activity are fully reversible after drug discontinuation. Growing evidence suggests that latent or previously minimal symptomatic muscle disease may predispose to the development of myopathy. Less information is available regarding the natural history of the sensorimotor neuropathy, but it appears to be less reversible if large fiber function is clinically manifest. Pathophysiologic clues regarding the potential causes of statin myopathy with or without neuropathy are discussed with particular attention paid to the implications of disrupted mevalonate metabolism. For example, secondary defects in isoprenoid biosynthesis are expected to impair the production of a variety of intermediaries such as dolichols, which are crucial for N-linked glycosylation; geranylgeranyl pyrophosphate, which is necessary for coenzyme Q10 and G-protein synthesis; farnesyl-pyrophosphate, which facilitates the endoproteolytic cleavage and maturation of prelamin A and modifies B-type lamins and G-proteins; and isopentenylpyrophosphate, which is involved in a nucleoside modification of selenocysteinyl-tRNA and thus indirectly related to the synthesis of all selenoproteins (estimated at 35). The nature of statin neuromyotoxicity remains unresolved; however, investigating the cellular corollaries of deranged isoprenoid metabolism may uncover clues that lead to a more complete understanding of the elusive pathophysiology.

April 20-22, 2005, Diabetes UK held its annual conference in Glasgow, United Kingdom. The meeting brought together investigators, clinicians, professionals and policy makers interested in the field of diabetes. This report will examine the advances in understanding the risk factors, epidemiology, risk reduction and management of cardiovascular disease and lipid abnormalities in diabetic patients.

Adrenomedullin was originally discovered as a vasodilative peptide, but recent studies have revealed its pleiotropic effects. Among these studies, the antioxidative properties of adrenomedullin were observed in adrenomedullin knockout mice. Through its antioxidative effect, adrenomedullin can protect organs from damage induced by high blood pressure, ischemia and aging. This indicates that antioxidants that can inhibit reactive oxygen species production but do not have a scavenging effect could be a new effective therapeutic target for organ protection in hypertension as well as metabolic syndrome, in which higher oxidative stress plays a pivotal role.

The concept of atherosclerosis as an inflammatory disorder has led to the exploration of new pathogeneses of this disease. In this regard, the levels of several inflammatory molecules are frequently increased in subjects at high risk of developing an acute coronary event. With a simple analysis we can characterize the circulating levels of a marker and its therapeutic modulation with various drugs. In this review we have analyzed different inflammatory markers currently used, such as C-reactive protein (CRP), CD40 ligand, adhesion molecules and chemokines, and their possible modulation by therapeutic intervention with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors. Moreover, in the future, new technologies will allow us to discover new markers, or sets of them, that could indicate the direction to be taken in the prevention and treatment of cardiovascular diseases.