Non-communicable diseases
Liam J. Donaldson, Paul D. Rutter in Donaldsons' Essential Public Health, 2017
A risk factor for a disease is something that increases an individual’s chances of developing that disease. For example, the major risk factors for cardiovascular disease are older age, male gender, family history (genetics), diabetes, smoking, diet, hypertension and physical inactivity. The relationship between several of these and the risk of death from cardiovascular disease is shown in Figure 4.7. From a population health perspective, the more common these risk factors are, the more prevalent the disease will be. Age, gender and genetics are of less practical interest because they are not modifiable (although the scope of genetic intervention in the light of scientific developments is difficult to predict). Some risk factors are disease states in their own right. For example, obesity is a risk factor for diabetes, which in turn is a risk factor for cardiovascular disease.
Perioperative cardiovascular evaluation and treatment of elderly patients undergoing noncardiac surgery
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Symptoms of cardiovascular disease should be carefully determined, especially characteristics of chest pain, if present. In patients with symptomatic coronary artery disease (CAD), the preoperative evaluation may lead to recognition of an increase in the frequency or pattern of anginal symptoms. It is important to realize that certain populations of patients, such as the elderly, women, or those with diabetes mellitus (DM), may present with more atypical symptoms of angina pectoris. Advanced age is a special risk factor, not only because of the increased likelihood of coronary disease, but also because of the effects of aging on the myocardium. The mortality of acute myocardial infarction (MI) increases dramatically in the aged. Often comorbidities may cloud the detection of angina in older individuals, such as concomitant dyspnea from pulmonary disease or physical debilitation reducing physical activity. If unstable angina is present, there is associated high perioperative risk of MI (8). Even when angina symptoms are “stable,” there may be a sizeable risk of perioperative myocardial ischemia depending on the functional limitation so that additional preoperative cardiovascular testing or perioperative monitoring may be useful.
Type 2 Diabetes Mellitus
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
Nephropathy by urine protein screening and quantification of albuminuria plus an assessment of creatinine clearance when indicated. Cardiovascular disease by history in terms of complaints related to chest pain, shortness of breath, especially during exercise or at night, altered exercise tolerance, or general nonspecific complaints of episodic not feeling well. An important parallel evaluation is the lipid status for HDL, LDL, and triglycerides, the smoking history, and whether the patient is taking aspirin for cardioprotection as is generally recommended. Lower extremity vascular insufficiency by physical examination and noninvasive or arteriogram studies indicated for complaints of claudication or physical findings that suggest vascular insufficiency. Neurological examination for cranial nerve palsies, mononeuropathies, carpel tunnel compression, and polyneuropathies. Also included is a careful examination of the feet for hygiene, calluses, and the shoes that are commonly worn to construct a risk profile for foot ulcers. Gastroparesis as suggested by early satiety or postmeal nausea and vomiting.
Experimental therapies targeting apolipoprotein C-III for the treatment of hyperlipidemia – spotlight on volanesorsen
Published in Expert Opinion on Investigational Drugs, 2019
Dimitrios Milonas, Konstantinos Tziomalos
Despite the substantial reduction in cardiovascular morbidity and mortality after the management of dyslipidemia with statins, residual risk remains even after achieving LDL-C targets. Emerging data suggest that targeting APOC3 might reduce not only TG levels but also cardiovascular risk. Volanesorsen, an antisense oligonucleotide inhibiting APOC3 induces substantial reductions in TG levels and also appears to increase HDL-C levels and to improve insulin sensitivity. However, larger studies are needed to evaluate the safety of this novel therapeutic approach in patients with hypertriglyceridemia and to assess its effects on cardiovascular morbidity and mortality. More studies are also needed to evaluate the safety and efficacy of AM580, another emerging therapy for inhibiting APOC3, which also appears to reduce TG levels and might also improve hepatic steatosis.
The effects of testosterone on transgender males on carotid intima-media thickness and serum inflammatory markers compared within patients with polycystic ovary syndrome
Published in Gynecological Endocrinology, 2022
Ayşe Özlem Balık, Fisun Vural, Okşan Alpogan, Murat Özoğul, Emin Erhan Dönmez
This study had some limitations as hyperlipidemia and serum testosterone levels were not reanalyzed at the time of surgery. Many factors such as age, ethnicity, sex, family history, smoking, hypertension, hyperlipidemia, diet, exercise, and obesity are associated with cardiovascular disease risk. It is very unlikely that increased CIMT can be attributed to testosterone use among so many risk factors. However, increased CIMT in the group with TGM is an important finding and the cause-effect relationship should be investigated in further studies. This study only investigated hematologic inflammatory markers, studies about inflammation are needed in transgenders. Another limitation of the study is that the evaluations belong to the early period of hormone replacement therapy; it would be more appropriate to evaluate TGMs after longer exposure to testosterone.
Cardiac sarcoidosis – an expert review for the chest physician
Published in Expert Review of Respiratory Medicine, 2019
Jamie S. Y. Ho, Edwin R. Chilvers, Muhunthan Thillai
Patients with sarcoidosis have been shown to be at increased risk of cardiovascular events compared to age- and sex-matched controls with an overall hazard ratio of 1.65 after adjusting for risk factors such as smoking status, diabetes and hypertension [8]. One explanation for this may be common inflammatory pathways between atherosclerosis and sarcoidosis. The true risk of acute coronary syndrome is difficult to ascertain, partly due to the active exclusion of subjects with evidence of previous cardiovascular disease in many studies but also as true CS may present similarly to acute coronary syndrome with symptoms of angina-like chest pain and shortness of breath, further complicating disease presentation [9]. Sarcoidosis has been shown to cause myocardial infarction through direct infiltration of coronary arteries [10] and is also associated with increased risk of pulmonary embolism [11].
Related Knowledge Centers
- Angina
- Arrhythmia
- Cardiomyopathy
- Coronary Artery Disease
- Myocardial Infarction
- Heart
- Blood Vessel
- Heart Failure
- Hypertensive Heart Disease
- Valvular Heart Disease