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1
World Health Organization. Cardiovascular Disease Programme., red. WHO CVD-risk management package for low- and medium-resource settings. Geneva: World Health Organization, 2002.
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2
Banerjee, Amitava, i Kaleab Asrress. Risk factors for cardiovascular disease. Redaktorzy Patrick Davey i David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0086.
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The most prevalent cardiovascular diseases (CVDs) are atherosclerotic, affecting all arterial territories. Epidemiologic studies such as the Framingham and INTERHEART studies have firmly established the commonest or ‘traditional’ risk factors for CVD; namely, smoking, hypertension, diabetes mellitus, hypercholesterolaemia, and a family history of CVD. The ‘risk-factors approach’ to CVD looks at these factors, individually and in combination, in the causation of disease. The complex causation pathways involve interplay of individual factors, whether genetic or environmental. More recently, there has been increasing interest in ‘epigenetics’ or the way in which the environment interacts with genes in the process underlying CVD. This chapter presents an analysis of the traditional and novel risk factors for CVD.
3
Almedawar, Mohamad M., Richard C. Siow i Henning Morawietz. MicroRNAs as novel biomarkers in depression, diabetes, and cardiovascular diseases. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198789284.003.0003.
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Diabetic, depressive, and cardiovascular disorders are leading causes of morbidity. In diabetics, symptoms of depression are associated with increased clinical complications. Diabetes mellitus is a major risk factor of cardiovascular diseases (CVDs). The vascular depression hypothesis suggests that CVD can increase the risk of depression or exacerbate depression-related conditions. Several studies found a strong correlation between depression and pre-existing vascular disease and vice versa. Recent studies implicate microvascular dysfunction in the pathophysiology of depression and CVD. In addition, microRNAs are potent regulators of gene expression in physiological and pathophysiological processes affecting the microcirculation. We propose an interaction between diabetes mellitus, depression, and CVD involving changes in microcirculation and microRNA expression. Hence, studies are warranted to develop novel microRNA therapeutics and biomarkers to identify diabetic patients at increased risk of developing clinical complications of depression.
4
Bhopal, Raj S. Epidemic of Cardiovascular Disease and Diabetes. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198833246.001.0001.
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Coronary heart disease (CHD) and stroke, collectively cardiovascular disease (CVD), are caused by narrowing and blockage of the arteries supplying the heart and brain, respectively. In type 2 diabetes (DM2) insulin is insufficient to maintain normal blood glucose. South Asians have high susceptibility to these diseases. Drawing upon the scientific literature and discussions with 22 internationally recognized scholars, this book focuses on causal explanations and their implications for prevention and research. Genetically based hypotheses are considered together with the developmental origins of health and disease (DOHAD) family of hypotheses. The book then considers how CHD, stroke, and DM2 are closely linked to rising affluence and the accompanying changes in life-expectancy and lifestyles. The established causal factors are shown to be insufficient, though necessary, parts of a convincing explanation for the excess of DM2 and CVD in South Asians. In identifying new explanations, this book emphasizes glycation of tissues, possibly leading to arterial stiffness and microcirculatory damage. In addition to endothelial pathways to atherosclerosis an external (adventitial) one is proposed, i.e. microcirculatory damage to the network of arterioles that nourish the coronary arteries. In addition to the ectopic fat in their liver and pancreas as the cause of beta cell dysfunction leading to DM2, additional ideas are proposed, i.e. microcirculatory damage. The high risk of CVD and DM2 in urbanizing South Asians is not inevitable, innate or genetic, or acquired in early life and programmed in a fixed way. Rather, exposure to risk factors in childhood, adolescence, and most particularly in adulthood is the key. The challenge to produce focused, low cost, effective actions, underpinned by clear, simple, and accurate explanations of the causes of the phenomenon is addressed.
5
Uddandrao, V. V. Sathibabu, i Parim Brahma Naidu, red. Advancements in Cardiovascular Research and Therapeutics: Molecular and Nutraceutical Perspectives. BENTHAM SCIENCE PUBLISHERS, 2022. http://dx.doi.org/10.2174/97898150508371220101.
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This reference summarizes recent advancements in knowledge about cardiovascular disease and pharmacology. The goal of the book is to inform readers about recent findings on cardiovascular therapeutics and how to conduct experiments to evaluate natural products. It presents 10 chapters that cover basic clinical research on cardiovascular diseases and therapeutic agents derived from natural sources. The book concludes with a series of experiments that demonstrate the methods to test the ameliorative effects of 3 phytochemicals: Biochanin A (red clover), Zingiberene (ginger oil) and Betaine (sugar beet). Key Features - 10 chapters that highlight recent research cardiovascular medicine and pharmacology - Covers knowledge about basic cardiovascular physiology, congestive heart failure treatment and the treatment of heart inflammation. - Covers uses, benefits, and drawbacks of numerous rodent and non-rodent animal models for studying CVD - Updates readers about 21st-century CRISPR-cas9 technology and its uses in CVD. - Covers the significance of Indian Ayurvedic techniques on the cardiovascular system, - Covers information about nutraceuticals for CVD therapy - Includes experiments to evaluate 3 phytochemicals for the treatment of different heart diseases such as hypertension, obesity-cardiomyopathy and the mitigation of inflammatory cytokines in myocardial infarction. This book is an informative resource for cardiologists, and researchers working in the field of cardiovascular pharmacology. It also helps readers to understand the benefits of herbal medications that are commonly available for consumption in homes.
6
Tubaro, Marco, Pascal Vranckx, Susanna Price, Christiaan Vrints i Eric Bonnefoy, red. The ESC Textbook of Intensive and Acute Cardiovascular Care. Wyd. 3. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198849346.001.0001.
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Cardiovascular diseases (CVDs) are a major cause of premature death worldwide and a cause of loss of disability-adjusted life years. For most types of CVD early diagnosis and intervention are independent drivers of patient outcome. Clinicians must be properly trained and centres appropriately equipped in order to deal with these critically ill cardiac patients. This new updated edition of the textbook continues to comprehensively approach all the different issues relating to intensive and acute cardiovascular care and addresses all those involved in intensive and acute cardiac care, not only cardiologists but also critical care specialists, emergency physicians and healthcare professionals. The chapters cover the various acute cardiovascular diseases that need high quality intensive treatment as well as organisational issues, cooperation among professionals, and interaction with other specialities in medicine.
7
Goldsmith, David J. Cardiovascular disease and chronic kidney disease. Redaktor David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0098.
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Even after as full a statistical adjustment as can be made for traditional cardiovascular risk factors has been undertaken, impaired kidney function and raised concentrations of albumin in urine each increase the risk of cardiovascular disease (CVD) by two- to fourfold, the degree increasing with severity. If the patient is also suffering from diabetes (as either the cause of CKD or a complication of it), the risks of CVD increase two- to fourfold again. CKD patients should, therefore, be acknowledged as having perhaps the highest cardiovascular risk of any patient cohort. CVD is underdiagnosed and undertreated in these patients. In early CKD the manifestations of CVD are similar to those of other patients. In late CKD and particularly in patients on dialysis the epidemiology is different. Left ventricular hypertrophy is very common and sudden cardiac death is greatly increased in incidence. Heart failure is a common complication. Calcification of valves and vessels becomes increasingly common and bad CVD outcomes are associated with hyperphosphataemia and other manifestations. The mechanisms by which risks are increased are not fully understood. The evidence base for the effectiveness of established therapies for CVD is relatively light in patients with CKD, but there is evidence for benefit of lipid-lowering therapies and most nephrologists believe that blood pressure and volume control are important for good long-term outcomes. Evidence of impact on CVD of interventions to alter mineral bone disease is disappointingly weak.
8
Price, Susanna, Marco Tubaro, Pascal Vranckx i Christiaan Vrints. Intensive and acute cardiac care: an introduction. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0001.
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Cardiovascular diseases (CVDs) are a major cause of premature death worldwide and an important cause of loss of disability-adjusted life years. For most types of CVD, early diagnosis and intervention are independent drivers of patient outcome. Clinicians must be properly trained and centers appropriately equipped in order to deal with these critically ill cardiac patients. The textbook explores the intricate nature of Intensive and Acute Cardiovascular Care and provides assistance for diagnosis and preventive care across the multitude of cardiovascular diseases.
9
Thomas, Gregory S., L. Samuel Wann i Myrvin H. Ellestad, red. Ellestad's Stress Testing. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190225483.001.0001.
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The 6th edition of the textbook Ellestad’s Stress Testing: Principles and Practice was written for the new and veteran clinician alike performing stress testing. Thoroughly updated, referenced and interspersed with case examples, the book reviews how to get the most out exercise testing, without and with ancillary imaging. In addition to evaluation of ST segment depression, other powerful tools to detect ischemia and forecast the future are reviewed to increase the diagnostic accuracy and prognostic ability of exercise testing. The recognition and significance of exercise induced arrhythmias and conduction defects are examined. When to convert to pharmacologic stress or add ancillary imaging, including myocardial perfusion imaging, echocardiography, coronary calcium scoring, and magnetic reference imaging are reviewed. The use of stress testing in the management of obstructive and non-obstructive coronary artery disease (CAD), heart failure, cardiac rehabilitation, peripheral vascular disease, congenital heart and other cardiovascular diseases (CVD) is examined. Options to optimize the diagnostic capabilities of exercise and other diagnostic testing for women are highlighted. Strategic use of exercise testing in the face of a decreasing burden of CAD in the developed world, as well as the opportunity to rely on exercise testing as the first test to evaluate CVD in the developing world, are reviewed. The fundamentals of exercise physiology and myocardial ischemia that serve as the foundation for exercise testing in health and disease are explained.
10
Wohl, David A., i Jeffrey T. Kirchner. Cardiovascular Disease. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190493097.003.0041.
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There is a growing body of evidence that HIV-infected persons are at increased risk for cardiovascular disease (CVD) and associated complications, including myocardial infarction and stroke. Autopsy studies have noted premature atherosclerosis in HIV-infected adults, and epidemiological studies demonstrate higher rates of CVD among HIV-infected compared to HIV-uninfected patients. These findings are in part due to chronic inflammation and immune activation associated with HIV infection. Traditional CVD risk factors, including hypertension, hyperlipidemia, and cigarette smoking, also play keys roles. There is additional evidence from observational cohort studies that some antiretroviral drugs, including protease inhibitors and nucleoside reverse transcriptase inhibitors, may increase the risk of myocardial infarction. Treatment interventions to reduce the risk of CVD include diet, exercise, smoking cessation, lipid-lowering agents, and antihypertensive medications. For select patients, changing antiretroviral therapy to improve lipid profiles may be appropriate but should not compromise virologic or immunologic control.
11
Jarnert, Christina, Linda Mellbin, Lars Rydén i Jaakko Tuomilehto. Glucose intolerance and diabetes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0016.
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Diabetes dramatically increases the risk of cardiovascular diseases (CVD). Diabetes is defined by elevated glucose in blood circulation. The level of glycaemia has a graded relation with CVD risk and diabetes is very frequent in people with CVD. In the general population half of the people with type 2 diabetes are undiagnosed, yet efficient methods for population screening exist. Despite considerable improvements in the management of CVD, patients with disturbed glucose metabolism have not benefited to the same extent as those without diabetes. Primary and secondary prevention of CVD in people with diabetes and other disturbances in glucose metabolism must be multifactorial and treatment targets stricter than for patients without glucose aberrations. Increased collaboration between different therapeutic disciplines including diabetologists, cardiologists, general practitioners, and dieticians is key to improved management for this large and high-risk population. Some important aspects of these issues are presented in this chapter.
12
Jarnert, Christina, Linda Mellbin, Lars Rydén i Jaakko Tuomilehto. Glucose intolerance and diabetes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199656653.003.0016_update_001.
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Diabetes dramatically increases the risk of cardiovascular diseases (CVD). Diabetes is defined by elevated glucose in blood circulation. The level of glycaemia has a graded relation with CVD risk and diabetes is very frequent in people with CVD. In the general population half of the people with type 2 diabetes are undiagnosed, yet efficient methods for population screening exist. Despite considerable improvements in the management of CVD, patients with disturbed glucose metabolism have not benefited to the same extent as those without diabetes. Primary and secondary prevention of CVD in people with diabetes and other disturbances in glucose metabolism must be multifactorial and treatment targets stricter than for patients without glucose aberrations. Increased collaboration between different therapeutic disciplines including diabetologists, cardiologists, general practitioners, and dieticians is key to improved management for this large and high-risk population. Some important aspects of these issues are presented in this chapter.
13
Riccardi, Gabriele, i Maria Masulli. Overweight, obesity, and abdominal adiposity. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0013.
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Obesity is a serious chronic disease of epidemic and global proportions. The incidence of cardiovascular diseases (CVD) is increased in obese people. Since overweight and obesity are associated with decreased lifespan, weight loss might be expected to improve long-term survival and to have beneficial effects on CVD risk. The therapeutic approaches for obesity are lifestyle changes, drugs, and bariatric surgery. Lifestyle modifications include modest weight loss and moderate-intensity physical activity. A low-fat (low saturated fat), low-sugar diet rich in fruit and vegetables, as well as legumes and whole grains, should be advised for its beneficial impact on weight and cardiovascular risk. Bariatric surgery represents an effective treatment in cases of severe obesity. Prevention of overweight and obesity at the population level will probably play a major role in combating the present obesity epidemic. Combining different intervention strategies is probably the best choice for maximizing the effects and minimizing the costs.
14
Betteridge, D. John, red. Epidemiology of cardiovascular disease: the scale of the problem. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199543502.003.0001.
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• The epidemic of cardiovascular disease (CVD) has been and still is very dynamic and heterogeneous when comparing time trends and mortality rates in different places of the world.• Age-standardized CVD mortality rates have declined in some countries, mainly due to a better management of the essential risk factors.• Unfavourable trends in CVD incidence are found and foreseen in developing countries due to demographic and to adverse lifestyle changes.• Comprehensive CVD prevention strategies are needed to promote primary prevention and better implementation of effective preventive actions in patients with established CVD.
15
Mavrides, Nicole, i Charles Nemeroff. Biological Effects of Depression in Cardiac Illness. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190603342.003.0004.
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Both depression and cardiac disease are extremely common medical conditions, both separately and together. Depression in patients with cardiovascular disease (CVD) and coronary artery disease (CAD) has long been associated with poor functional and cardiovascular outcomes. Studies for the past 20 years have demonstrated that not only can depression affect the risk of CAD, but so can anxiety, panic, personality types, trauma, and stress. More recently, the studies have focused more on the pathophysiological processes that can characterize depression in cardiac disease; such as inflammation, heart rate variability, and platelet clotting abnormalities in addition to many others. This chapter focuses on the pathophysiological and biological mechanisms that can potentially explain the bidirectional association between depression and cardiac disease.
16
Jardine, Alan G., i Rajan K. Patel. Lipid disorders of patients with chronic kidney disease. Redaktor David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0102.
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The risk of developing cardiovascular (CV) disease is increased in patients with chronic kidney disease (CKD) and although dyslipidaemia is a major contributory factor to the development of premature CV disease, the relationship is complex. Changes in lipid fractions are related to glomerular filtration rate and the presence and severity of proteinuria, diabetes, and other confounding factors. The spectrum of CV disease changes from lipid-dependent, atheromatous coronary disease in early CKD to lipid-independent, non-coronary disease, manifesting as heart failure, and sudden cardiac death in advanced and end-stage renal disease. Statin-based lipid-lowering therapy is proven to reduce coronary events across the spectrum of CKD. The relative reduction in overall CV events, however, diminishes as CKD progresses and the proportion of lipid-dependent coronary events declines. There is nevertheless a strong argument for the use of statin-based therapy across the spectrum of CKD. The argument is particularly strong for those patients with progressive renal disease who will eventually require transplantation, in whom preventive therapy should start as early as possible. The SHARP study established the benefits and endorses the use of lipid-lowering therapy in CKD 3-4 but uncertainty about the value of initiation of statin therapy in CKD 5 remains. There is, however, no rationale for stopping agents started earlier in the course of the illness for compelling indications, particularly in those who will ultimately be transplanted. The place of high-density lipoprotein-cholesterol raising and triglyceride lowering therapy needs to be assessed in trials. Modifying dyslipidaemia in CKD has demonstrated that lipid-dependent atheromatous cardiovascular disease is only one component of the burden of CV disease in CKD patients, that this is proportionately less in advanced CKD, and that modification of lipid profiles is only one part of CV risk management.
17
O’Flaherty, Martin, Susanna Sans-Menendez, Simon Capewell i Torben Jørgensen. Epidemiology of atherosclerotic cardiovascular disease: scope of the problem and its determinants. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0001.
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The epidemic of cardiovascular disease (CVD) in the twentieth century prompted many population-based surveys. Now, a huge number of epidemiological studies provide a clear picture of the risk for CVD. Approximately 80% of CVD can be explained by smoking, high blood pressure, and deterioration of lipid and glucose metabolism, the two latter mediated through an unhealthy diet (high intake of salt, saturated fat, and refined sugar) and physical inactivity. A causal web for CVD shows that the influence is seen throughout the life course, and that ‘upstream‘ factors like socioeconomic status, health policies, and industrial influences all have a powerful impact on the more downstream parameters like lifestyle and biomarkers. This emphasizes that population-level interventions represent the most effective options for future strategies for the prevention of CVD.
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Fox, Grenville, Nicholas Hoque i Timothy Watts. Cardiovascular problems. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198703952.003.0009.
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This chapter describes the aetiology, presentation, investigation, and management of congenital heart disease (CHD) and acquired cardiovascular problems. It begins by describing the fetal circulation, transition to the neonatal circulation at birth, and the epidemiology of congenital heart disease. There is a guide to the diagnosis of congenital heart disease using a problem-based approach (heart failure, cyanosis, collapse and shock, heart murmurs), together with general principles of management including the use of inotropes, prostaglandin, and surgery. Types of structural heart disease are detailed and grouped according to functional consequences: left to right shunts, right to left shunts/cyanotic CHD, common mixing, and well and sick babies with an obstruction. Myocardial disease, hypertension, interpreting the ECG in neonates, and arrhythmias are also covered.
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Ather, Sameer, Ayman Farag, Vikas Bhatia i Fadi G. Hage. Role of Imaging in Chronic Kidney Disease. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0017.
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Cardiovascular disease is highly prevalent in patients with chronic kidney disease (CKD) and is the biggest contributor of death in these patients. Myocardial perfusion imaging (MPI) is a validated tool for diagnosing coronary artery disease (CAD) and for predicting short and long term prognosis in this patient population. Non-invasive stress imaging, with MPI or other imaging modalities, is widely used for risk stratification in patients with end-stage renal disease (ESRD) being evaluated for kidney transplantation due to the paucity of donor organs and the high cardiovascular risk of patients on the transplant waiting list. In this Chapter we will review the data on diagnostic accuracy and risk stratification using MPI in patients with CKD and ESRD highlighting the special challenges that are unique to this population. We will also discuss novel indicators that have been used in these patients to improve risk stratification.
20
Theorell, Töres, Chantal Brisson, Michel Vézina, Alain Milot i Mahée Gilbert-Ouimet. Psychosocial factors in the prevention of cardiovascular disease. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0018.
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The chapter starts with a theoretical sociological, psychological, and physiological framework for the relationships between psychosocial factors and coronary heart disease (CHD). This is followed by a review of the scientific evidence supporting such an association. Individual behaviours and coping mechanisms as well as environmental conditions of relevance for CHD are described. In particular, type A and D behaviour, depressive states, covert coping, social support and social network, socioeconomic conditions, as well as theoretical work environment models of relevance for CHD (job strain, effort-reward imbalance, organizational justice and leadership) are discussed. The remaining part of the chapter surveys the results from controlled studies of the effects of psychosocial interventions. There is accumulating evidence from such controlled studies that risk factors for CHD can be favourably influenced.
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Theorell, Töres, Chantal Brisson, Michel Vézina, Alain Milot i Mahée Gilbert-Ouimet. Psychosocial factors in the prevention of cardiovascular disease. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199656653.003.0018_update_001.
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The chapter starts with a theoretical sociological, psychological, and physiological framework for the relationships between psychosocial factors and coronary heart disease (CHD). This is followed by a review of the scientific evidence supporting such an association. Individual behaviours and coping mechanisms as well as environmental conditions of relevance for CHD are described. In particular, type A and D behaviour, depressive states, covert coping, social support and social network, socioeconomic conditions, as well as theoretical work environment models of relevance for CHD (job strain, effort-reward imbalance, organizational justice and leadership) are discussed. The remaining part of the chapter surveys the results from controlled studies of the effects of psychosocial interventions. There is accumulating evidence from such controlled studies that risk factors for CHD can be favourably influenced.
22
Kotseva, Kornelia, Neil Oldridge i Massimo F. Piepoli. Evaluation of preventive cardiology. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0026.
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The Joint European Societies guidelines on cardiovascular disease (CVD) prevention define lifestyle and risk factor targets for patients with coronary or other atherosclerotic disease and people at high risk of developing CVD. However, several surveys in Europe and the United States showed inadequate lifestyle and risk factor management and under-use of prophylactic drug therapies in primary and secondary CVD prevention. Various professional associations have developed core components, standards, and outcome measures to evaluate quality of care and provide guidelines for identifying opportunities for improvements. Optimal control of cardiovascular risk factors is one of the most effective methods for reducing vascular events in patients with atherosclerotic disease or high cardiovascular risk. Improving treatment adherence is also very important. Health-related quality of life (HRQL) is considered as an outcome measure in research studies and in clinical practice. HRQL measures can help in improving patient-clinician communication, screening, monitoring, and continuous assessment of quality of care.
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Kotseva, Kornelia, Neil Oldridge i Massimo F. Piepoli. Evaluation of preventive cardiology. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199656653.003.0026_update_001.
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The Joint European Societies guidelines on cardiovascular disease (CVD) prevention define lifestyle and risk factor targets for patients with coronary or other atherosclerotic disease and people at high risk of developing CVD. However, several surveys in Europe and the United States showed inadequate lifestyle and risk factor management and under-use of prophylactic drug therapies in primary and secondary CVD prevention. Various professional associations have developed core components, standards, and outcome measures to evaluate quality of care and provide guidelines for identifying opportunities for improvements. Optimal control of cardiovascular risk factors is one of the most effective methods for reducing vascular events in patients with atherosclerotic disease or high cardiovascular risk. Improving treatment adherence is also very important. Health-related quality of life (HRQL) is considered as an outcome measure in research studies and in clinical practice. HRQL measures can help in improving patient-clinician communication, screening, monitoring, and continuous assessment of quality of care.
24
Ferreira, Isabel, i Jos WR Twisk. Physical activity, cardiorespiratory fitness, and cardiovascular health. Redaktorzy Neil Armstrong i Willem van Mechelen. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198757672.003.0017.
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It is now recognized that cardiovascular disease (CVD) is partly a paediatric problem, i.e. the onset begins in childhood, although clinical symptoms may not become apparent until later in life. Therefore, from a primary prevention point of view, the extent to which physical activity or physical fitness in childhood may deter this process is of utmost importance. Although physical activity and CRF at a young age have not been directly linked to the incidence of CVD, evidence thus far supports cardiovascular health benefits of early higher physical activity and CRF levels on cardiometabolic risk factors like obesity, blood pressure, insulin resistance, and their maintenance throughout the course of life. By affecting these intermediary pathways, lifelong (high-intensity) physical activity may also deter the age-related decreases in CRF and related signs of premature arterial ageing.
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Shelley, Emer, i Margaret E. Cupples. Health promotion to improve cardiovascular health in the general population. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0024.
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Prevention of cardiovascular disease (CVD) requires consideration of the extent to which the social, physical, and fiscal environment facilitates heart-healthy lifestyles. The high-risk strategy for prevention offers major benefits for those with diagnosed CVD and those known to be at increased risk compared with their peers. From a population health perspective strategies to reduce risk in the majority not known to be at high risk have the potential for much greater benefits. Prevention programmes to improve CVD risk in communities should tailor objectives and programme design, including evaluation, to the resources available. Baseline information is required on knowledge, attitudes, and behaviours, as well as risk factors and morbidity, in order to raise awareness of needs, support programmes appropriately, and help reduce inequalities. Responsibility for changing behaviour rests with the individual, but preventive services can provide support, involving partners and family members.
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Sprague, Stuart M., i Menaka Sarav. Chronic kidney disease-mineral and bone disorder. Redaktor David J. Goldsmith. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0115_update_001.
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The kidneys play a critical role in maintaining normal serum calcium and phosphorus concentrations, under the regulation of three main hormones: parathyroid hormone, calcitriol, and fibroblast growth factor 23. With the progression of chronic kidney disease (CKD), most patients develop CKD–mineral and bone disorder (CKD-MBD), which is a systemic disorder involving derangement in mineral metabolism, renal osteodystrophy, and extraskeletal calcification. Disturbances in mineral metabolism develop early in CKD and include phosphate retention, hypocalcaemia, vitamin D deficiency, and hyperparathyroidism. Renal osteodystrophy involves pathologic changes of bone morphology related to progressive CKD and is quantifiable by histomorphometry, based on bone biopsy. CKD-MBD is associated with significant morbidity, including bone loss, fractures, cardiovascular disease, immune suppression, as well as increased mortality. As the disorder begins early in the course of CKD, a proactive approach with intervention is important. Therapeutic strategies could then be employed to prevent and correct these disturbances, aiming to improve cardiovascular outcomes and survival. Current practice guidelines for CKD-MBD are based on insufficient data and high-quality studies are required before specific treatment can be advocated strongly.
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Dhaun, Neeraj, i David J. Webb. Endothelins and their antagonists in chronic kidney disease. Redaktor David J. Goldsmith. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0114_update_001.
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The endothelins (ETs) are a family of related peptides of which ET-1 is the most powerful endogenous vasoconstrictor and the predominant isoform in the cardiovascular and renal systems. The ET system has been widely implicated in both cardiovascular disease and chronic kidney disease (CKD). ET-1 contributes to the pathogenesis and maintenance of hypertension and arterial stiffness, as well endothelial dysfunction and atherosclerosis. By reversal of these effects, ET antagonists, particularly those that block ETA receptors, may reduce cardiovascular risk. In CKD patients, antagonism of the ET system may be of benefit in improving renal haemodynamics and reducing proteinuria, effects seen both in animal models and in some human studies. Data suggest a synergistic role for ET receptor antagonists with angiotensin-converting enzyme inhibitors in lowering blood pressure, reducing proteinuria, and in animal models in slowing CKD progression. However, in clinical trials, fluid retention or cardiac failure has caused concern and these agents are not yet ready for general use for risk reduction in CKD.
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Pisinger, Charlotta, i Serena Tonstad. Smoking. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0010.
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Smoking causes all forms of cardiovascular disease (CVD): there is no safe level of smoking. The health benefits of quitting smoking are immediate. In patients with coronary heart disease smoking cessation results in a dramatic decline in future cardiovascular events and reduces cardiovascular death; it is the most effective and cheapest treatment for preventing new or recurrent CVD. Tobacco dependence should be regarded as a chronic disease with a lifelong risk of relapse. Making treatment readily available and reducing barriers to treatment increase the likelihood that smokers will accept treatment. Medication and follow-up should be arranged for all smokers upon hospital discharge and in outpatient settings. High priority should be given to identification and documentation of the smoking status of all patients, and systematic provision of cessation support. Clinicians should also ask about exposure to second-hand smoke and should play an active role in advocating for stronger tobacco controls.
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Pisinger, Charlotta, i Serena Tonstad. Smoking. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199656653.003.0010_update_001.
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Smoking causes all forms of cardiovascular disease (CVD): there is no safe level of smoking. The health benefits of quitting smoking are immediate. In patients with coronary heart disease smoking cessation results in a dramatic decline in future cardiovascular events and reduces cardiovascular death; it is the most effective and cheapest treatment for preventing new or recurrent CVD. Tobacco dependence should be regarded as a chronic disease with a lifelong risk of relapse. Making treatment readily available and reducing barriers to treatment increase the likelihood that smokers will accept treatment. Medication and follow-up should be arranged for all smokers upon hospital discharge and in outpatient settings. High priority should be given to identification and documentation of the smoking status of all patients, and systematic provision of cessation support. Clinicians should also ask about exposure to second-hand smoke and should play an active role in advocating for stronger tobacco controls.
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Gerhard, Leo. Cbd Oil for Cardiovascular Disease: The Complete Survival Manual to Regaining Your Cardiovascular Health Using CBD Oil. Independently Published, 2019.
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Schmid, Jean-Paul, i Hugo Saner. Ambulatory preventive care: outpatient clinics and primary care. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0023.
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Cardiac rehabilitation (CR) services aim to restore the physical, psychosocial, and vocational status of cardiac patients. The role of these services has evolved due to the progress of interventional cardiology with its prompt and effective treatment of acute coronary syndromes. The focus has moved from the restoration of a patient’s health following an acute event towards a more pronounced long-term targeted secondary prevention intervention. As a consequence, CR services have also expanded their indication in order to include not only patients after myocardial infarction or surgery but also a variety of ’non-acuteʼ cardiovascular disease (CVD) states like stable coronary heart disease and peripheral obstructive artery disease as well as asymptomatic patients with no history of CVD but with a constellation of cardiovascular risk factors, especially metabolic syndrome or diabetes mellitus. This chapter provides a wide-ranging summary of the issues concerning outpatients and primary care.
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Schmid, Jean-Paul, Hugo Saner, Paul Dendale i Ines Frederix. Ambulatory preventive care: outpatient clinics and primary care. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199656653.003.0023_update_001.
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Cardiac rehabilitation (CR) services aim to restore the physical, psychosocial, and vocational status of cardiac patients. The role of these services has evolved due to the progress of interventional cardiology with its prompt and effective treatment of acute coronary syndromes. The focus has moved from the restoration of a patient’s health following an acute event towards a more pronounced long-term targeted secondary prevention intervention. As a consequence, CR services have also expanded their indication in order to include not only patients after myocardial infarction or surgery but also a variety of ’non-acuteʼ cardiovascular disease (CVD) states like stable coronary heart disease and peripheral obstructive artery disease as well as asymptomatic patients with no history of CVD but with a constellation of cardiovascular risk factors, especially metabolic syndrome or diabetes mellitus. This chapter provides a wide-ranging summary of the issues concerning outpatients and primary care.
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Schwitter, Juerg. Coronary artery disease. Redaktor Dudley Pennell. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0105.
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In the work-up of suspected or known coronary artery disease (CAD), cardiovascular magnetic resonance (CMR) is an established technique and it is recommended by most recent guidelines. Stress dobutamine and stress perfusion CMR yield sensitivities and specificities to detect anatomically defined CAD (>50% coronary stenoses) ranging from 83% to 91% and from 83% to 86%, respectively, with areas under the receiver operating characteristic curve (AUCs) of 0.80–0.93. Multicentre trials report AUCs of 0.75–0.91 to detect CAD and showed superiority over scintigraphic techniques. Increasing evidence in thousands of patients demonstrates the highly predictive value of CMR. Exclusion of ischaemia by CMR goes along with excellent event-free survival rates of 0.5–0.9%/year. Cost analyses in large data sets (e.g. in the European CMR registry), suggest considerable cost savings for CMR over first-line invasive strategies in suspected CAD. Tissue characterization by CMR to detect scar, necrosis, oedema, microvascular obstruction, or haemorrhage is of particular importance in the setting of acute coronary syndromes and this application is emerging as the number of centres offering CMR increases.
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Haynes, Richard J., i James A. Gilbert. Chronic kidney disease and dialysis. Redaktor Rutger Ploeg. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0128.
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Chronic kidney disease (CKD) is a common disorder as currently defined. Patients with CKD face two major hazards: cardiovascular disease and—in a minority—progression to end-stage renal disease (ESRD). Advanced CKD also causes numerous metabolic and other complications. The management of CKD involves excluding acute kidney injury, diagnosing the cause of CKD, slowing progression, and detecting and treating complications. If patients do reach ESRD, then renal replacement therapy (RRT) options must be considered. These include haemodialysis, peritoneal dialysis, or transplantation. Haemodialysis requires creation of an arteriovenous fistula or insertion of a prosthetic graft while peritoneal dialysis necessitates the insertion of a catheter into the abdominal cavity. All forms of dialysis access are associated with complications both in the short and long term. However, they remain vital and central to the life and the well-being of the end-stage renal patient on dialysis.
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Ferro, Charles J., i Khai Ping Ng. Recommendations for management of high renal risk chronic kidney disease. Redaktor David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0099.
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Poorer renal function is associated with increasing morbidity and mortality. In the wider population this is mainly as a consequence of cardiovascular disease. Renal patients are more likely to progress to end-stage renal disease, but also have high cardiovascular risk. Aiming to reduce both progression of renal impairment and cardiovascular disease are not contradictory. Focusing on the management of high-risk patients with proteinuria and reduced glomerular filtration rates, it is recommended that blood pressure should be kept below 140/90, or 130/80 if proteinuria is > 1 g/24 h (protein:creatinine ratio (PCR) >100 mg/mmol or 0.9 g/g). These targets may be modified according to age and other factors. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor antagonists should form part of the therapy for patients with proteinuria > 0.5 g/24 h (PCR > 50 mg/mmol or 0.45 g/g). Use of ACEIs or angiotensin receptor blockers in patients with lower levels of proteinuria may be indicated in some patient groups even in the absence of hypertension, notably in diabetic nephropathy. Evidence that other agents that reduce proteinuria bring additional benefits is weak at present. The best studies of ‘dual-blockade’ with various combinations of ACEIs, ARBs, and renin inhibitors have shown additional hazard with little evidence of additional benefit. Hyperlipidaemia—regardless of lipid levels, statin therapy is indicated in secondary cardiovascular prevention, and in primary prevention where cardiovascular risk is high, noting that current risk estimation tools do not adequately account for the increased risk of patients with CKD. There is not substantial evidence that lipid lowering therapy impacts on average rates of loss of GFR in progressive CKD. Non-drug lifestyle interventions to reduce cardiovascular risk, including stopping smoking, are important for all. Acidosis—in more advanced CKD it is justified to treat acidosis with oral sodium bicarbonate. Diet—sodium restriction to < 100 mmol/day (6 g/day) and avoidance of excessive dietary protein are justified in early to moderate CKD. Recommendations to limit levels of protein to 0.8 g/kg body weight are suggested by some, but additional protective effects of this are likely to be slight in patients who are otherwise well managed. Low-protein diets may carry some risk. Lower-protein diets may however be used to prevent symptoms in advanced CKD not treated by dialysis.
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Hajhosseiny, Reza, Kaivan Khavandi i David J. Goldsmith. Sudden cardiac death in chronic kidney disease. Redaktor David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0108.
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Epidemiological data demonstrate the unique vulnerability of chronic kidney disease (CKD) subjects to cardiovascular disease, the most catastrophic being sudden cardiac death (SCD). In patients with declining kidney function there is a continuum of cardiovascular risk. In those individuals who survive to reach end-stage renal disease (ESRD), the risk of suffering a cardiac event is extremely high. Some of this risk is explained by the common risk factors and traditional cardiovascular events, namely atherosclerotic plaque fissure and rupture, but there is now evidence of a distinct ‘later CKD’ mechanism, notably arrhythmias. This appears particularly true in later stages of CKD and corresponds with the multifaceted range of myocardial and vascular insults operating. The physiological milieu of disordered vessel autoregulation, sequestered vasoprotective agents, loss of conduit and small artery elasticity/compliance, a stiffened and fibrotic myocardium, with calcified and diseased coronary arteries, all within an inflammatory environment, all contribute to arrhythmia generation. The final insult is changes in volume and electrolyte status. Risk stratification tools would be helpful in guiding clinicians to recognize those subjects likely to benefit from specific interventional strategies. These might include the novel, or emerging serum, haemodynamic, or electrocardiographic biomarkers in CKD. Current tools—such as those used for stratifying risk for SCD and determining the need for ICD implantation—are not valid in ESRD patients. Beta blockers appear likely to be generally advisable, blood pressure permitting, for patients with significant cardiomyopathy. Evidence for implantable cardiac defibrillators (ICD) is lacking. There is good reason to think that young dialysis patients at high risk of sudden death may benefit, but the risk/benefit ratio for older patients is less likely to be advantageous. These hypotheses need further investigation.
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Raggi, Paolo, i Luis D’Marco. Imaging for detection of vascular disease in chronic kidney disease patients. Redaktor David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0116.
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The well-known severity of cardiovascular disease in patients suffering from chronic kidney disease (CKD) requires an accurate risk stratification of these patients in several clinical situations. Imaging has been used successfully for such purpose in the general population and it has demonstrated excellent potential among CKD patients as well. Two main forms of arterial pathology develop in patients with CKD: atherosclerosis, with accumulation of inflammatory cells, lipids, fibrous tissue and calcium in the subintimal space, and arteriosclerosis. The latter is characterized by accumulation of deposits of hydroxyapatite and amorphous calcium crystals in the muscular media of the vessel wall, and is believed to be more closely associated with alterations of mineral metabolism than with traditional atherosclerosis risk factors. The result is the development of what appears to be premature arterial ageing, with loss of elastic properties, increased stiffness, and increased overall fragility of the arterial system. Despite intensifying research and increasing awareness of these issues, the underlying pathophysiology of the aggressive vasculopathy of CKD remains largely unknown. As a consequence, there are currently very limited pathways to prevent progression of vascular damage in CKD. The indications, strengths and weaknesses of several imaging modalities employed to evaluate vascular disease in CKD are described, focusing on coronary arterial circulation and the peripheral arteries, with the exclusion of the intracranial arteries.
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Reiner, Željko, Olov Wiklund i John Betteridge. Lipids. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0015.
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Dyslipidaemia, particularly elevated low-density lipoprotein (LDL) cholesterol, is one of the most important risk factors for cardiovascular disease (CVD). Low concentrations of high-density lipoprotein (HDL) cholesterol are independently associated with high CVD risk, while moderately elevated triglycerides are considered to be a marker of increased CVD risk. The presence of dyslipidaemias secondary to other conditions must be excluded before beginning treatment. All patients with familial hypercholesterolaemia are at high risk and should be treated by lipid-lowering therapy. Lifestyle changes are the backbone of treatment for dyslipidaemia. Statins are recommended as the first-line drugs for hypercholesterolaemia while fibrates are used primarily to decrease elevated triglycerides. If the treatment targets cannot be reached by monotherapy with lipid-lowering drugs, combination treatment may be needed.
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Beaulieu, Monica, Catherine Weber, Nadia Zalunardo i Adeera Levin. Chronic kidney disease long-term outcomes. Redaktor David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0097.
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Chronic kidney disease (CKD) is associated with a variety of outcomes, some of which are directly and indirectly related to kidney disease, but which ultimately impact on patients’ quality of life and long-term outcomes. The events to which people with CKD are exposed ultimately determine their risk and prognosis of both progression to needing renal replacement therapy, or other morbidities and mortalities. The notion of competing risk is important. The five major outcomes of CKD are: progression of CKD, progression to ESRD (either dialysis or transplantation); death; cardiovascular events; infections; and hospitalizations. Where data is available, not only the risk of the specific outcome, but the factors which may predict those outcomes are described. Each section describes what is currently known about the frequency of the outcome, the limitations of that knowledge, the risk factors associated with outcome, and implications for care and future research. Available published literature often describes outcomes in CKD populations as if it is a homogenous group of patients. But it is well documented that outcomes in those with CKD differ depending on stage or severity, and whether they are or are not known to specialists. Where possible, each section ensures that the specific CKD cohort(s) from which the information is derived is clearly described.
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Zhang, Luxia, i Haiyan Wang. Chronic kidney disease in developing countries. Redaktor David J. Goldsmith. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0096_update_001.
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The spread of non-communicable diseases (NCDs) is a barrier to the development of goals including reduction of poverty, health equity, economic stability, and human security. NCDs accounted for 61% of the estimated 58 million deaths and 46% of the global burden of diseases worldwide in 2005. Among NCDs, chronic kidney disease (CKD) is of particular significance. It is recognized that the burden of CKD is not only limited to its impact on demands for renal replacement therapy but has equally major impacts on the health of the overall population. For example, it is now well established that among the general population as well as in the diabetic or hypertensive population, the prognosis, especially the mortality and acceleration of cardiovascular events, depends on kidney involvement. Also, CKD is associated with other major serious consequences including increased risk of acute kidney injury, increased risk of mineral and bone disease, adverse metabolic and nutritional consequences, infections, and reduced cognitive function. As a consequence of these amplifying effects, the financial expenditure and medical resources consumed for the management of CKD patients is much higher than expected. The burden of CKD is likely to have profound socioeconomic and public health consequences in developing countries.
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Garbarino, Sergio. Morbidity, mortality, societal impact, and accident in sleep disorders. Redaktorzy Sudhansu Chokroverty, Luigi Ferini-Strambi i Christopher Kennard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199682003.003.0053.
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Sleep disorders are associated with several morbidities, most strongly with psychiatric disorders, cognitive impairment, and impaired quality of life, as well as with increased mortality. Sleep problems are common across the lifespan from childhood to adolescence and adulthood. Physiological sleep continuity with respect to circadian rhythms is considered to be important for the maintenance of cardiovascular, metabolic, and immune function, physiological homeostasis, and psychological balance. Nowadays, it is reasonable to include sleep disturbances among the top 10 potentially modifiable cardiovascular disease (CVD) risk factors. The links between sleep disorders and morbidity as CVD show bidirectional associations. Because these disorders are chronic, they may also have a deleterious societal impact on a patient’s employment status, ability to work, risk of accident, and health. The relationship between work performance and sleep quality is reciprocal and potentially complex. This chapter illustrates the principal sleep disorders and their relevance as indicators of health status.
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Graham, Ian, Therese Cooney i Dirk De Bacquer. Risk stratification and risk assessment. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0005.
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Cardiovascular disease (CVD) is the biggest cause of death worldwide. The underlying atherosclerosis starts in childhood and is often advanced when it becomes clinically apparent many years later. CVD is manageable: in countries where it has reduced this is due to changes in lifestyle and risk factors and to therapy. Risk factor management reduces mortality and morbidity. In apparently healthy people CVD risk is most frequently the result of multiple interacting risk factors and a risk estimation system such as SCORE can assist in making logical management decisions. In younger people a low absolute risk may conceal a very high relative risk, and use of the relative risk chart or calculation of their ‘risk age’ may help in advising them of the need for intensive life style efforts. All risk estimation systems are relatively crude and require attention to qualifying statements.
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Connolly, Susan, i Margaret E. Cupples. Community-based prevention centres. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0025.
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The need for a new approach to cardiovascular disease prevention, both secondary and primary, that is different from traditional health service provision through hospital cardiac rehabilitation services and general practice is evident. The targets set in the cardiovascular prevention guidelines for modifiable cardiovascular risk factors-smoking, diet and physical activity, weight and its distribution, blood pressure, lipids, and diabetes-are not being adequately achieved for either coronary or other vascular patients or for those at high multifactorial risk of developing CVD. There is also evidence of an increasing disparity in levels of risk between different community groups, largely attributable to social determinants of health. Community-based prevention centres provide a novel approach to reducing cardiovascular risk, in which there is shared working between professionals and the public and a shared understanding of the barriers that individuals experience in their attempts to engage in effective measures for both secondary and primary prevention.
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Devlin, Hugh, i Rebecca Craven. Heart and blood supply. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198759782.003.0009.
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The heart in relation to dentistry is the topic of this chapter. Heart physiology is described with respect to the cardiac cycle, control of contraction, ECG, and arrhythmias. Control of the cardiovascular system is next considered and the clinical application of this in fainting, shock, and blood loss. Atherosclerosis, angina, and myocardial infarction are described. This leads to a discussion of heart failure and drugs commonly used in cardiovascular disease. Infective endocarditis and rheumatic fever are discussed and the associations between oral bacteria and cardiovascular disease. The concluding section deals with stroke (cerebrovascular accident or CVA), transient ischaemic attacks (TIA) and vascular dementia.
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Elder, Grahame J. Metabolic bone disease after renal transplantation. Redaktor Jeremy R. Chapman. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0288.
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Patients who undergo kidney transplantation have laboratory, bone, and soft tissue abnormalities that characterize chronic kidney disease mineral and bone disorder (CKD-MBD). After successful transplantation, abnormal values of parathyroid hormone, fibroblast growth factor 23, calcium, phosphate, vitamin D sterols, and sex hormones generally improve, but abnormalities often persist. Cardiovascular risk remains high and is influenced by prevalent vascular calcification, and fracture risk increases due to a combination of abnormal bone ‘quality’, compounded by immunosuppressive drugs and reductions in bone mineral density. Patients with well managed CKD-MBD before transplantation generally have a smoother post-transplant course, and it is useful to assess patients soon after transplantation for risk factors relevant to the general population and to patients with CKD. Targeted laboratory assessment, bone densitometry, and X-ray of the spine are useful for guiding therapy to minimize post-transplant effects of CKD-MBD. To reduce fracture risk, general measures include glucocorticoid dose minimization, attaining adequate 25(OH)D levels, and maintaining calcium and phosphate values in the normal range. Calcitriol or its analogues and antiresorptive agents such as bisphosphonates may protect bone from glucocorticoid effects and ongoing hyperparathyroidism, but the efficacy of these therapies to reduce fractures is unproven. Alternate therapies with fewer data include denosumab, strontium ranelate, teriparatide, oestrogen or testosterone hormone replacement therapy, tibolone, selective oestrogen receptor modulators, and cinacalcet. Parathyroidectomy may be necessary, but is generally avoided within the first post-transplant year. A schema is presented in this chapter that aims to minimize harm when allocating therapy.
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Kashani, Kianoush B., i Amy W. Williams. Renal Failure. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0473.
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Renal failure is caused by acute kidney injury or chronic kidney disease. Acute kidney injury (AKI) is a common, devastating complication that increases mortality and morbidity among patients with various medical and surgical illnesses. Also known as acute renal failure, AKI is a rapid deterioration of kidney function that results in the accumulation of nitrogenous metabolites and medications and in electrolyte and acid-base imbalances. This chapter discusses the definition, epidemiology, pathophysiology, and etiology of AKI; the clinical approach to patients with AKI; and the management of AKI. Chronic kidney disease (CKD) has been categorized into 5 stages. When renal function decreases to stage 3, the complications of CKD become evident. These complications include hypertension, cardiovascular disease, lipid abnormalities, anemia, metabolic bone disease, and electrolyte disturbances. To prevent the progression of CKD, therapy must be directed toward preventing these complications and achieving adequate glucose control in diabetic patients with CKD.
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HEARTS in the Americas Regulatory Pathway to the Exclusive Use of Validated Blood Pressure Measuring Devices. Pan American Health Organization, 2021. http://dx.doi.org/10.37774/9789275124864.
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Cardiovascular disease (CVD) is the leading cause of disease burden globally. According to the 2017 Global Burden of Disease estimates, there were 14 million new cases of CVD, 80 million people living with this condition, and nearly 1 million deaths attributed to CVD in the Americas. Hypertension is the major risk factor for CVD, causing half of the cases, and is highly prevalent, affecting one in four adults, including 40% of those over age 25 years.To appropriately detect hypertension, accurate measurement of blood pressure is critical, and inaccurate measurement of BP has important consequences for policies to address hypertension, as well as for patient safety and quality of care. The Fourth World Health Organization (WHO) Global Forum on Medical Devices identified several critical issues related to medical devices. Among those issues were recommendations for increased regulation of medical devices in low- and middle-income countries and development of technical specifications to optimize procurement of priority medical devices. World Health Assembly Resolution 67.20 (Regulatory system strengthening for medical products) stresses the importance of regulation of medical devices for better public health outcomes and to increase access to safe, effective, and quality medical products. This publication seeks to contribute to meeting these recommendations by providing a practical tool for governments to improve their national regulatory frameworks to improve accuracy of blood pressure measuring devices (BPMDs), in turn contributing to the exclusive use of accuracy validated automated BPMDs in primary health care (PHC) facilities by 2025. This publication can also guide the development of procurement mechanisms that will ensure exclusive availability of BPMDs in PHC facilities. Specifically, this publication will provide a brief background on the importance of using validated BPMDs and highlight key elements of regulations related to pre-market approvals to promote accurate BPMDs.
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Biggar, Patrick, Hansjörg Rothe i Markus Ketteler. Epidemiology of calcium, phosphate, and parathyroid hormone disturbances in chronic kidney disease. Redaktor David J. Goldsmith. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0109_update_001.
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Chronic kidney disease-mineral and bone disorders (CKD-MBD), calcium, phosphate, and parathyroid hormone are biomarkers of mortality and cardiovascular risk. Hyperphosphataemia is a prominent and pathophysiologically most plausible risk indicator. Calcium balance and load appear to be more important than serum concentrations. Parathyroid hormone is a less reliable marker with a relatively wide range extending above that applicable for a normal population especially when used as a singular laboratory parameter without additional assessment of bone metabolism, for example, bone-specific alkaline phosphatase and bone biopsy. There is not a single prospective controlled hard-outcome study that provides us with unequivocal evidence that such an isolated laboratory parameter-based treatment approach will lead to significant clinical improvements. As CKD-MBD is complex, clinical decisions would be made easier by informative prospective trials.
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Kinsella, Sinead, i John Holian. The effect of chronic renal failure on critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0218.
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The incidence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) is increasing, reflecting an increase in the incidence and prevalence of hypertension and type 2 diabetes. Patients with CKD and ESKD frequently experience episodes of critical illness and require treatment in an intensive care unit (ICU)setting. Management requires specific consideration of their renal disease status together with their acute illness. Mortality in critically-ill patients with ESKD is frequently related to their co-morbid conditions, rather than their ESKD status. Illness severity scoring systems allocate high points for renal variables and tend to overestimate actual mortality. Patients with ESKD and CKD requiring ICU admission have better ICU and in-hospital survival than patients with denovo acute kidney injury requiring renal replacement therapy. Appropriately selected patients benefit from ICU admission and full consideration for ICU care should be given to these patients if required, despite their renal disease status. Cardiovascular disease and sepsis account for the majority of ICU admissions in this population and the aetiology of these conditions differs from that in patients without kidney disease. Optimal critical care management of patients with ESKD and CKD requires that these differences are recognized.
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Gutiérrez, Orlando M. Fibroblast growth factor 23, Klotho, and phosphorus metabolism in chronic kidney disease. Redaktor David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0119.
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Fibroblast growth factor 23 (FGF23) and Klotho have emerged as major hormonal regulators of phosphorus (P) and vitamin D metabolism. FGF23 is secreted by bone cells and acts in the kidneys to increase urinary P excretion and inhibit the synthesis of 1,25 dihydroxyvitamin D (1,25(OH)2D) and in the parathyroid glands to inhibit the synthesis and secretion of parathyroid hormone. Phosphorus excess stimulates FGF23 secretion, likely as an appropriate physiological adaptation to maintain normal P homeostasis by enhancing urinary P excretion and diminishing intestinal P absorption via lower 1,25(OH)2D. The FGF23 concentrations are elevated early in the course of chronic kidney disease (CKD) and may be a primary initiating factor for the development of secondary hyperparathyroidism in this setting. Klotho exists in two forms: a transmembrane form and a secreted form, each with distinct functions. The transmembrane form acts as the key co-factor needed for FGF23 to bind to and activate its cognate receptor in the kidneys and the parathyroid glands. The secreted form of Klotho has FGF23-independent effects on renal P and calcium handling, insulin sensitivity, and endothelial function. Disturbances in the expression of Klotho may play a role in the development of altered bone and mineral metabolism in early CKD. In addition, abnormal circulating concentrations of both FGF23 and Klotho have been linked to excess cardiovascular disease, suggesting that both play an important role in maintaining cardiovascular health.