There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness

American Journal of Preventive Cardiology, Год журнала: 2022, Номер 12, С. 100371 - 100371

Опубликована: Авг. 6, 2022

Atherosclerotic cardiovascular disease (ASCVD) is epidemic throughout the world and etiologic for such acute events as myocardial infarction, ischemic stroke, unstable angina, death. ASCVD also impacts risk dementia, chronic kidney peripheral arterial mobility, impaired sexual response, a host of other visceral impairments that adversely impact quality rate progression aging. The relationship between low-density lipoprotein cholesterol (LDL-C) one most highly established investigated issues in entirety modern medicine. Elevated LDL-C necessary condition atherogenesis induction. Basic scientific investigation, prospective longitudinal cohorts, randomized clinical trials have all validated this association. Yet despite enormous number which support need reducing burden atherogenic blood, percentage high very high-risk patients who achieve stratified target reductions low has remained last thirty years. Atherosclerosis preventable disease. As clinicians, time come us to take primordial primary prevention more serously. Despite plethora therapeutic approaches, large majority at are poorly or inadequately treated, leaving them vulnerable progression, events, poor aging due loss function multiple organs. Herein we discuss greatly intensify efforts reduce risk, decrease burden, provide comprehensive earlier assessment optimally prevent its complications. Evidence presented treatment should aim far lower goals management, into account many factors than commonly employed today begin significantly life.

Язык: Английский

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Endothelial dysfunction as a factor leading to arterial hypertension

Pediatric Nephrology, Год журнала: 2022, Номер 38(9), С. 2973 - 2985

Опубликована: Ноя. 21, 2022

Hypertension remains the main cause of cardiovascular complications leading to increased mortality. The discoveries recent years underline important role endothelial dysfunction (ED) in initiating development arterial hypertension. endothelium lines interior entire vascular system body and acts as a physical barrier between blood tissues. Substances mediators produced by exhibit antithrombotic anti-inflammatory properties. Oxidative stress inflammation are conditions that damage shift function from vasoprotective vasoconstrictive, prothrombotic, pro-apoptotic functions. A dysfunctional contributes hypertension further complications. Reduced nitric oxide (NO) bioavailability plays an essential pathophysiology ED-associated New technologies provide tools identify pathological changes structure endothelium. Endothelial should be considered therapeutic strategies for children with

Язык: Английский

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Cardiovascular risk factors and molecular routes underlying endothelial dysfunction: Novel opportunities for primary prevention

Biochemical Pharmacology, Год журнала: 2022, Номер 202, С. 115108 - 115108

Опубликована: Май 26, 2022

Язык: Английский

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The Vascular Endothelium and Coagulation: Homeostasis, Disease, and Treatment, with a Focus on the Von Willebrand Factor and Factors VIII and V

International Journal of Molecular Sciences, Год журнала: 2022, Номер 23(15), С. 8283 - 8283

Опубликована: Июль 27, 2022

The vascular endothelium has several important functions, including hemostasis. homeostasis of hemostasis is based on a fine balance between procoagulant and anticoagulant proteins fibrinolytic antifibrinolytic ones. Coagulopathies are characterized by mutation-induced alteration the function certain coagulation factors or disturbed mechanisms responsible for regulating coagulation. Homeostatic therapies consist in replacement nonreplacement treatments administration agents. Rebalancing products reestablish inhibiting natural pathways. These agents include monoclonal antibodies, such as concizumab marstacimab, which target tissue factor pathway inhibitor; interfering RNA therapies, fitusiran, targets antithrombin III; protease inhibitors, serpinPC, active protein C. In cases thrombophilia (deficiency C, S, V Leiden), treatment may direct oral anticoagulants, therapy (plasma recombinant ADAMTS13) congenital deficiency ADAMTS13, immunomodulators (prednisone) if autoimmune. Monoclonal-antibody-based anti-vWF immunotherapy (caplacizumab) used context severe thrombophilia, regardless cause disorder. disseminated intravascular coagulation, choice consists antifibrinolytics, all-trans-retinoic acid, soluble human thrombomodulin.

Язык: Английский

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Insulin resistance in ischemic stroke: Mechanisms and therapeutic approaches

Frontiers in Endocrinology, Год журнала: 2022, Номер 13

Опубликована: Дек. 15, 2022

The pathological condition of insulin resistance prevents the neuroprotective effects insulin. Numerous studies have demonstrated that resistance, as an independent risk factor for ischemic stroke, accelerates formation thrombosis and promotes development atherosclerosis, both which are major mechanisms stroke. Additionally, negatively affects prognosis patients with stroke regardless whether patient has diabetes, but not well studied. We explored association between primary brain injury in (inflammation, oxidative stress, neuronal damage), looking potential causes poor due to resistance. Furthermore, we summarize therapeutic approaches propose new directions clinically improving

Язык: Английский

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Endothelial dysfunction and its relation in different disorders: Recent update

Health Sciences Review, Год журнала: 2023, Номер 7, С. 100084 - 100084

Опубликована: Март 12, 2023

Endothelial dysfunction is characterized by a reduction in nitric oxide generation or an unbalanced distribution of the relaxing and contracting pressures produced endothelial cells. Endothelium was once assumed to be nothing more than mechanical barrier. now recognized as tissue that regulates tone, cell formation, leukocyte, thrombocyte, artery wall contact. The pathophysiologic pathways behind are great interest, researchers working hard figure out what they how affect diabetes, psoriasis, Inflammatory Bowel Disease, hypertension, heart failure, renal inflammation, stroke, atherosclerosis, oxidative stress. activation important processes progression pathogenesis atherosclerosis. psoriasis patients with arterial hypertension thought caused disturbance action L-oxidative arginine's metabolism, revealed decrease NO bioavailability high degree inactivation, stress, antioxidant state. failing characterised irregular cardiac vascular characteristics abnormalities In such conditions can increased various approaches like using generating compounds which done either through inhalation NO, use hybrid drugs oral NO-NSAIDs combination inorganic nitrites. On other hand endogenous levels direct delivery l‑arginine, l‑citrullineor Arginase inhibition. eNOS also activated statins, Corticosteroids, Second β-adrenoceptor antagonists increase level. This review will assist understanding dysfunction, its pathogenesis, connection variety disorders.

Язык: Английский

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Sex differences in vascular endothelial cells

Atherosclerosis, Год журнала: 2023, Номер 384, С. 117278 - 117278

Опубликована: Сен. 26, 2023

Endothelial cells are important constituents of blood vessels and play a critical role in vascular homeostasis. They do not only control the exchanges between surrounding tissues, but also essential regulating flow, modulating immune-cell trafficking controlling growth repair. dysfunction leads to cardiovascular diseases is characterized by deficiency secretion vasodilator molecules, elevated reactive oxygen species (ROS), expression adhesion molecules excretion proinflammatory cytokines. The sex hormones, estrogens, androgens progestogens, regulate endothelial functions. Because disease risk increases after menopause, it believed that female estrogens progestogens promote cell health function whereas androgens, male might be detrimental. However, as illustrated present review, picture simple. In addition, influences physiology independently hormones at genetic level.

Язык: Английский

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Accelerated Vascular Aging in Chronic Kidney Disease: The Potential for Novel Therapies

Circulation Research, Год журнала: 2023, Номер 132(8), С. 950 - 969

Опубликована: Апрель 13, 2023

The pathophysiology of vascular disease is linked to accelerated biological aging and a combination genetic, lifestyle, biological, environmental risk factors. Within the scenario uncontrolled artery wall processes, CKD (chronic kidney disease) stands out as valid model for detailed structural, functional, molecular studies this process. cardiorenal syndrome relates detrimental bidirectional interplay between cardiovascular system. In addition established factors, group patients subjected plethora other emerging such inflammation, oxidative stress, mitochondrial dysfunction, vitamin K deficiency, cellular senescence, somatic mutations, epigenetic modifications, increased apoptosis. A better understanding mechanisms through which uremic milieu triggers maintains early has provided important new clues on inflammatory pathways factors alike, altered behavior cells in arterial wall. Advances biology opens avenues novel pharmacological nutritional therapeutic interventions. Such strategies hold promise improve future prevention treatment not only but also elderly general population.

Язык: Английский

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Persistent endothelial dysfunction in post-COVID-19 syndrome and its associations with symptom severity and chronic inflammation

Angiogenesis, Год журнала: 2023, Номер 26(4), С. 547 - 563

Опубликована: Июль 28, 2023

Post-COVID-19 syndrome (PCS) is a lingering disease with ongoing symptoms such as fatigue and cognitive impairment resulting in high impact on the daily life of patients. Understanding pathophysiology PCS public health priority, it still poses diagnostic treatment challenge for physicians.In this prospective observational cohort study, we analyzed retinal microcirculation using Retinal Vessel Analysis (RVA) patients compared to an age- gender-matched healthy (n = 41, matched out n 204).PCS exhibit persistent endothelial dysfunction (ED), indicated by significantly lower venular flicker-induced dilation (vFID; 3.42% ± 1.77% vs. 4.64% 2.59%; p 0.02), narrower central artery equivalent (CRAE; 178.1 [167.5-190.2] 189.1 [179.4-197.2], 0.01) arteriolar-venular ratio (AVR; (0.84 [0.8-0.9] 0.88 [0.8-0.9], 0.007). When combining AVR vFID, predicted scores reached good ability discriminate groups (area under curve: 0.75). Higher severity correlated (R - 0.37 0.017). The association microvascular changes were amplified exhibiting higher levels inflammatory parameters.Our results demonstrate that prolonged hallmark PCS, impairments seem explain As potential therapies emerge, RVA parameters may become relevant clinical biomarkers diagnosis therapy management.This study was previously registered at ClinicalTrials ("All Eyes PCS-Analysis Microvasculature Patients Syndrome". NCT05635552. https://clinicaltrials.gov/ct2/show/NCT05635552 ). Persistent post-COVID-19 syndrome. Acute SARS-CoV-2 infection indirectly or directly causes endotheliitis N 41 recruited vessel analysis performed assess function. Images SVA DVA are illustrative data analysis. For each patient cohort, diameter three measurement cycles calculated plotted diameter-time curve. exhibited reduced veins (vFID) measured dynamic (DVA) arteriolar (CRAE) (AVR) tendency towards (CRVE) when naïve participants. Created BioRender.com.

Язык: Английский

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Endothelial cell dysfunction in cardiac disease: driver or consequence?

Frontiers in Cell and Developmental Biology, Год журнала: 2023, Номер 11

Опубликована: Окт. 25, 2023

The vascular endothelium is a multifunctional cellular system which directly influences blood components and cells within the vessel wall in given tissue. Importantly, this interface undergoes critical phenotypic changes response to various biochemical hemodynamic stimuli, driving several developmental pathophysiological processes. Multiple studies have indicated central role of initiation, progression, clinical outcomes cardiac disease. In review we synthesize current understanding endothelial function dysfunction as mediators cardiomyocyte phenotype setting distinct pathologies; outline existing

Язык: Английский

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