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The distribution of fat within the body, particularly visceral fat is an important determinant in the development of various cardiovascular and metabolic disorders, and is influenced by angiotensin II and the renin–angiotensin system. Given these issues, this Article examines he relationship of obesity to cardiovascular disease and metabolic syndrome and the effectiveness of obesity management.
Proteinuria is a useful early marker for progressive renal dysfunction. Angiotensin II is centrally involved in all stages of renal pathophysiology, and angiotensin-II-receptor blockers can be useful therapeutic agents in preventing the development of overt kidney disease. This Article discusses the role of angiotensin II in cardiovascular and renovascular disease, and the effectiveness of angiotensin-II-receptor blocker therapy.
Cardiovascular mortality and morbidity remain high despite a variety of therapies being available. New avenues for therapy are, therefore, continually sought. Here, whether the relationship that exists between cardiovascular and renal disease could provide such an opportunity is discussed, in the context of treatment strategies directed at the renin–angiotensin–aldosterone system.
The definition of this syndrome, its utility as a predictor of cardiovascular risk, and the treatment implications of diagnosis remain unsettled. In this Article, de Zeeuw and Bakker argue that, while the most commonly used definitions of the metabolic syndrome perform poorly in estimatation of cardiovascular risk, the concept is nonetheless useful.
Proliferator-activated receptor-γ has a key role in glucose and lipid metabolism and activation lead to benefits in patients with diabetes. Telmisartan can robustly activate this nuclear receptor as well as blocking the angiotensin II type 1 receptor. This Article assesses whether this dual effect affords telmisartan additional benefits over other angiotensin-II-receptor blockers.
Endothelial dysfunction is an early manifestation of atherosclerotic disease. Circulating cells that express CD34, including endothelial and hematopoietic progenitor cells, might play a part in the development and progression of atherosclerosis. In this paper the authors evaluate the association between coronary endothelial dysfunction and concentrations of circulating CD34+cell subsets.
Cardiac rehabilitation, in most developed countries, is a proven means of reducing mortality but it is grossly underutilized owing to factors involving both the health system and patients. These issues have not been investigated concurrently. In this paper the authors describe a prospective study with a multilevel design to show that the most relevant physician perceptions of such programs are program quality and perceived benefit. For patients, they are barriers to cardiac rehabilitation, which might be conveyed during pre-referral discussions. Work to improve physicians' perceptions and patients' understanding of rehabilitation services might improve use.
Many coronary heart disease patients fail to reach recommended LDL levels, either due to intolerance or inadequate response to available lipid-lowering therapy. Microsomal triglyceride transfer protein (MTP) inhibitors may provide a novel alternative pathway for LDL lowering. In this paper the authors tested the safety and LDL lowering efficacy of the MTP inhibitor, AEGR-733, alone and in combination with ezetimibe.
Leptin may be a key regulator of C-reactive protein (CRP) levels, which in turn, is a marker of systemic inflammation. Both leptin and CRP are predictors of cardiovascular disease (CVD). High leptin levels are independently associated with CVD even after adjustment for CRP; elevated CRP levels are not associated with CVD after adjustment for leptin. However, subjects with increased leptin and CRP are at the highest risk for CVD.
The custom microenvironment “vascular niche” is a potential therapeutic target for several pathophysiological conditions. Osteoblasts act as regulators of the hematopoietic stem cell niche, and activation of the parathyroid hormone (PTH) receptor may increase the number of cells mobilized into the bloodstream. The authors demonstrate that PTH may enhance the efficiency of hematopoietic stem cell-based therapy in a recognized model of peripheral ischemia.
Rheumatic heart disease is an important problem in developing countries but many cases are detected only when the disease has progressed to cardiac failure. Screening can detect cases earlier, but there are no screening guidelines. In this paper the authors describe a novel screening protocol and report a high echocardiographically confirmed prevalence of rheumatic heart disease among Tongan schoolchildren.