Atherosclerosis

Stroke patients with cerebral microbleeds on MRI scans have arteriolosclerosis as well as systemic atherosclerosis.

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Cerebral microbleeds (CMBs) are recognized as a manifestation of arteriolosclerosis in cerebral small vessels. However, little is known regarding whether stroke patients with CMBs often have systemic atherosclerosis. The aim of the present study was to elucidate this issue using the cardio–ankle vascular index (CAVI), a new index of systemic atherosclerosis, in acute ischemic stroke patients. We prospectively studied 105 patients (71 males, median age=70.0 years) with acute ischemic stroke. All of the patients were examined using T2*-weighted gradient echo magnetic resonance imaging (MRI) to look for and assess the CMBs and using fluid-attenuated inversion recovery to evaluate white matter hyperintensity (WMH). We assigned the patients into CMB and non-CMB groups and compared the clinical characteristics of these groups. The factors associated with CMBs were investigated using multivariate logistic regression analysis. T2*-weighted gradient echo MRI revealed CMBs in 47 patients (44.8%) and no CMBs in 58 patients (55.2%). The CAVI was significantly higher in the CMBs group (10.5 vs. 8.6, P<0.001). In the multivariate logistic regression analysis, CAVI per one point increase (odds ratio (OR), 1.50; 95% confidence interval (CI), 1.12–2.00; P=0.006), advanced WMH (OR, 4.78; 95% CI, 1.55–14.74; P=0.006) and impaired kidney function (OR, 3.31; 95% CI, 1.16–9.81; P=0.031) were independent factors associated with the presence of CMBs. A high CAVI was independently associated with CMBs in patients with acute ischemic stroke. Our results indicated that ischemic stroke patients with CMBs may have cerebral arteriolosclerosis as well as systemic atherosclerosis.

Source: Hypertension Research/nature.

Erectile dysfunction: A sign of heart disease?

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The same process that creates heart disease may also cause erectile dysfunction, only earlier.

Erectile dysfunction — difficulty maintaining an erection sufficient for sex — can be an early warning sign of heart problems. Understanding the connections between the two may help you get treatment before heart problems become serious. Likewise, if you have heart disease, getting the right treatment may help with erectile dysfunction.

Clogged arteries: Where erectile dysfunction and heart disease meet

Atherosclerosis (ath-ur-o-skluh-ROE-sis) — sometimes called hardening of the arteries — is the buildup of plaques in the arteries of your body. The smaller arteries in the body, such as in the penis, are the first to get plugged up. The plaque reduces blood flow in the penis, making an erection difficult. Erectile dysfunction is an alert to look for atherosclerosis in larger arteries supplying your heart and other organs and to take steps to treat it. Atherosclerosis also increases your risk of other problems, including aneurysm, stroke and peripheral artery disease.

Certain men are at increased risk

Besides sharing a common disease process, erectile dysfunction and heart disease also share many risk factors. These risk factors increase the likelihood that your erectile dysfunction could be a sign of underlying atherosclerosis and heart disease:

  • Having diabetes. Men who have diabetes are at especially high risk of erectile dysfunction, heart disease and other problems caused by restricted blood flow.
  • Having high cholesterol. A high level of low-density lipoprotein (LDL, or “bad”) cholesterol can lead to atherosclerosis.
  • Being a smoker. Smoking cigarettes raises your risk of developing atherosclerosis. It also directly affects your ability to get an erection.
  • Having high blood pressure. Over time, high blood pressure damages the lining of your arteries and accelerates the process of atherosclerosis.
  • Having a family member with heart disease. It’s more likely your erectile dysfunction could be linked to heart disease if you have a first-degree relative such as a sibling or parent who had heart disease at a young age.
  • Your age. The younger you are, the more likely that erectile dysfunction signals a risk of heart disease. Men younger than 50 are at especially high risk. In men older than 70, erectile dysfunction is much less likely to be a sign of heart disease.
  • Being overweight. Being overweight or obese increases your risk of both heart disease and erectile dysfunction due to atherosclerosis and other reasons.
  • Being depressed. There’s some evidence that depression is associated with an increased chance of having heart problems — and erectile dysfunction.

Treatment for erectile dysfunction caused by heart disease

If your doctor thinks you may be at risk of heart disease, making lifestyle changes such as exercising, changing your diet or losing weight may be enough to help keep your heart healthy — and improve your ability to have an erection. If you have more-serious signs and symptoms of heart disease, you may need further tests or treatment. If you have both erectile dysfunction and heart disease, talk to your doctor about treatment options for erectile dysfunction. If you take certain heart medications, especially nitrates, it is not safe to use many of the medications used to treat erectile dysfunction.

Source: Mayo Clinic.

 

Revised Guidelines: Secondary Prevention and Risk Reduction in Patients with Atherosclerotic Disease.

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New recommendations for cardiac rehabilitation and risk reduction are welcome, but updated guidance is lacking on lipid and blood pressure management.

Sponsoring Organizations: American Heart Association, American College of Cardiology

Background and Purpose: This revision updates the 2006 secondary prevention guidelines (JW Cardiol Jun 8 2006) and incorporates risk reduction into their title and purview. The guidelines continue to focus on important patient behaviors, including 30 minutes of physical activity daily, smoking cessation and avoidance of secondhand smoke, and weight management. However, the writing committee has deferred making major changes to the 2006 recommendations on blood pressure control and lipid management pending the revised versions of the National Heart, Lung, and Blood Institute‘s Joint National Committee guidelines (JNC) and Adult Treatment Panel report (ATP), respectively (both expected in 2012).

Key Points:
1. A new section of Class I and Class IIa recommendations highlights the importance of referring patients for cardiac rehabilitation.

2. The guideline authors have reorganized the section on lipid management to emphasize evidence-based use of statins rather than the achievement of target lipid levels. Although no new specific recommendations have been added, the lack of evidence supporting non-statin lipid-lowering agents has demoted the use of combined drug therapies from Class I to either Class IIa or IIb, depending on the agent.

3. The authors have updated recommendations regarding antiplatelet therapy, incorporating new data on prasugrel from TRITON TIMI 38 and ticagrelor from PLATO (Class I).

4. The recommendations for beta-blocker therapy have been expanded and clarified, reflecting evidence that the drugs are most efficacious in patients with recent myocardial infarction, left ventricular systolic dysfunction, or both.

5. The guidelines now identify and direct specific recommendations to populations at very high risk for poor outcomes.

6. A new section of Class IIa and Class IIb recommendations addresses screening for and management of depression.

Comment: The shift in focus toward risk reduction will help clinicians improve care for many patients, including older adults and those with depression. Although the guidelines are extensive and well written, the lack of new recommendations regarding the management of hyperlipidemia and hypertension decreases their immediate value. Virtually all patients with atherosclerotic disease have one or both of these conditions, and it is unfortunate that we must await the eighth edition of JNC and the fourth edition of ATP to inform current, evidence-based management decisions.

Source:Journal Watch Cardiology