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Archive for the ‘HTN in Youth’ Category

Cardiovascular Diseases and Pharmacological Therapy: Curations by Aviva Lev-Ari, PhD, RN


Cardiovascular Diseases and Pharmacological Therapy: Curations by Aviva Lev-Ari, PhD, RN, 2006 – 4/2018

 

+120 articles listed below cover the following topics:

  • National Trends: Cardiovascular-related Hospital stay, Cost of Treatment & Societal Burden
  • Introduction to Drug Types: De Novo Brand, Generic, Biologics, Biosimsilars
  • Anti-Inflammatory & Systemic Inflammatory
  • Anti-thrombotic Drug Class & Novel Oral Anticoagulants (NOACs)
  • Pharmaco-Genetics response to Congenital and Spontaneous Mutations: new drugs and new biomarkers for Atherosclerosis, Genetic-related Novel Anti-Cholesterol, Lipids, LDL, HDL, Hypertriglyceridemia Hyperlipidemia
  • Epigenetics, Gender differences and Life Style: DM, Obesity, Hormonal Markers, Diets, Chrono-therapeutics
  • BP Management: Genetics & Human Adaptive Immunity
  • Anti-arrhythmic Drugs – Atrial Fibrillation (AF) & Silent Cerebral Infarctions
  • MI, Acute Coronary Syndrome (ACS) and Heart Failure (HF)
  • Calcium &Cardiovascular Diseases: Contractile Dysfunction, Calcium as Neurotransmitter Sensor
  • Regeneration: Cardiac System (cardiomyogenesis) and Vasculature (angiogenesis)
  • Vascular Biology, Atherosclerosis and Molecular Cardiology

 

A new mechanism of action to attack in the treatment of coronary artery disease (CAD), Novartis developed Ilaris (canakinumab), a human monoclonal antibody targeting the interleukin-1beta innate immunity pathway

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/04/06/a-new-mechanism-of-action-to-attack-in-the-treatment-of-coronary-artery-disease-cad-novartis-developed-ilaris-canakinumab-a-human-monoclonal-antibody-targeting-the-interleukin-1beta-innate-i/

 

Advantages and Disadvantages of Novel Oral Anticoagulants (NOACs)

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/03/20/advantages-and-disadvantages-of-novel-oral-anticoagulants-noacs/

 

Acute Coronary Syndrome (ACS): Strategies in Anticoagulant Selection: Diagnostics Approaches – Genetic Testing Aids vs. Biomarkers (Troponin types and BNP)

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/03/13/acute-coronary-syndrome-acs-strategies-in-anticoagulant-selection-diagnostics-approaches-genetic-testing-aids-vs-biomarkers-troponin-types-and-bnp/

 

Cholesterol Lowering Novel PCSK9 drugs: Praluent [Sanofi and Regeneron] vs Repatha [Amgen] – which drug cuts CV risks enough to make it cost-effective?

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/03/12/cholesterol-lowering-novel-pcsk9-drugs-praluent-sanofi-and-regeneron-vs-repatha-amgen-which-drug-cuts-cv-risks-enough-to-make-it-cost-effective/

 

Higher BMI (Obesity Marker): Earlier onset of incident CVD followed by Shorter overall Survival – Men and women of all ages

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/03/05/higher-bmi-obesity-marker-earlier-onset-of-incident-cvd-followed-by-shorter-overall-survival-men-and-women-of-all-ages/

 

ODYSSEY Outcomes trial evaluating the effects of a PCSK9 inhibitor, alirocumab, on major cardiovascular events in patients with an acute coronary syndrome to be presented at the American College of Cardiology meeting on March 10.

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/02/28/odyssey-outcomes-trial-evaluating-the-effects-of-a-pcsk9-inhibitor-alirocumab-on-major-cardiovascular-events-in-patients-with-an-acute-coronary-syndrome-to-be-presented-at-the-america/

 

Sex and Gender Connections: Heart and Brain Disease in Women

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/02/28/sex-and-gender-connections-heart-and-brain-disease-in-women/

 

In 2018 Cardiovascular PharmacoTherapy Market: Anti-thrombotic Drug Class Segment will continue to bring in the biggest profit and dominate production

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/02/27/in-2018-cardiovascular-pharmacotherapy-market-anti-thrombotic-drug-class-segment-will-continue-to-bring-in-the-biggest-profit-and-dominate-production/

 

Cost per Inpatient Hospital Stay: Five cardiovascular issues ranked in the top 10 – #1 Heart valve disorders, #2 Acute myocardial infarction (heart attack), #4 Coronary atherosclerosis, #7 Septicemia, #10 Acute cerebrovascular disease

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/02/27/cost-per-inpatient-hospital-stay-five-cardiovascular-issues-ranked-in-the-top-10-1-heart-valve-disorders-2-acute-myocardial-infarction-heart-attack-4-coronary-atherosclerosis/

 

There may be a genetic basis to CAD and that CXCL5 may be of therapeutic interest

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/02/09/there-may-be-a-genetic-basis-to-cad-and-that-cxcl5-may-be-of-therapeutic-interest/

 

FDA Approval marks first presentation of bivalirudin in frozen, premixed, ready-to-use formulation

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/01/24/fda-approval-marks-first-presentation-of-bivalirudin-in-frozen-premixed-ready-to-use-formulation/

 

What Level of Blood Pressure (BP) should be Treated? Comments on the New Guidelines

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2018/01/24/what-level-of-blood-pressure-bp-should-be-treated-comments-on-the-new-guidelines/

 

FDA approval on 12/1/2017 of Amgen’s evolocumb (Repatha) a PCSK9 inhibitor for the prevention of heart attacks, strokes, and coronary revascularizations in patients with established cardiovascular disease

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/12/01/fda-approval-on-12-1-2017-of-amgens-evolocumb-repatha-a-pcsk9-inhibitor-for-the-prevention-of-heart-attacks-strokes-and-coronary-revascularizations-in-patients-with-established-cardiovascular-di/

 

Long-term Canakinumab Treatment Lowering Inflammation Independent of Lipid Levels for Residual Inflammatory Risk Benefit – Personalized Medicine for Recurrent MI, Strokes and Cardiovascular Death

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/11/21/long-term-canakinumab-treatment-lowering-inflammation-independent-of-lipid-levels-for-residual-inflammatory-risk-benefit-personalized-medicine-for-recurrent-mi-strokes-and-cardiovascular-death/

 

Daily Highlights at 2017 American Heart Association Annual Meeting Scientific Sessions

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/11/14/daily-highlights-at-2017-american-heart-association-annual-meeting-scientific-sessions/

 

2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults – A REPORT OF THE American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/11/14/2017-guideline-for-the-prevention-detection-evaluation-and-management-of-high-blood-pressure-in-adults-a-report-of-the-american-college-of-cardiology-american-heart-association-task-force-on-clin/

 

2017 American Heart Association Annual Meeting: Sunday’s Science at #AHA17 – Presidential Address

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/11/13/2017-american-heart-association-annual-meeting-sundays-science-at-aha17-presidential-address/

 

Systemic Inflammatory Diseases as Crohn’s disease, Rheumatoid Arthritis and Longer Psoriasis Duration May Mean Higher CVD Risk

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/10/09/systemic-inflammatory-diseases-as-crohns-disease-rheumatoid-arthritis-and-longer-psoriasis-duration-may-mean-higher-cvd-risk/

 

Shaun Coughlin from UCSF Cardiovascular Research Center to cardio group for the Novartis Institute for Biomedical Research in Cambridge, MA

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/08/17/shaun-coughlin-from-ucsf-cardiovascular-research-center-to-cardio-group-for-the-novartis-institute-for-biomedical-research-in-cambridge-ma/

 

In Europe, BigData@Heart aim to improve patient outcomes and reduce societal burden of atrial fibrillation (AF), heart failure (HF) and acute coronary syndrome (ACS).

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/07/10/in-europe-bigdataheart-aim-to-improve-patient-outcomes-and-reduce-societal-burden-of-atrial-fibrillation-af-heart-failure-hf-and-acute-coronary-syndrome-acs/

 

SNP-based Study on high BMI exposure confirms CVD and DM Risks – no associations with Stroke

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/07/10/snp-based-study-on-high-bmi-exposure-confirms-cvd-and-dm-risks-no-associations-with-stroke/

 

Tweets by @pharma_BI and @AVIVA1950 at World Medical Innovation Forum – CARDIOVASCULAR • MAY 1-3, 2017, BOSTON, MA

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/05/05/tweets-by-pharma_bi-and-aviva1950-at-world-medical-innovation-forum-cardiovascular-%E2%80%A2-may-1-3-2017-boston-ma/

 

e-Proceedings for Day 1,2,3: World Medical Innovation Forum – CARDIOVASCULAR • MAY 1-3, 2017, BOSTON, MA

Curator and Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/05/05/e-proceedings-for-day-123-world-medical-innovation-forum-cardiovascular-%E2%80%A2-may-1-3-2017-boston-ma/

REAL TIME Highlights and Tweets: Day 1,2,3: World Medical Innovation Forum – CARDIOVASCULAR • MAY 1-3, 2017, BOSTON, MA

Author and Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/05/03/deliverables-day-123-world-medical-innovation-forum-cardiovascular-%E2%80%A2-may-1-3-2017-boston-ma-httpsworldmedicalinnovation-orgagenda-highlights-of-live-day-1-world-medical/

 

Expedite Use of Agents in Clinical Trials: New Drug Formulary Created – The NCI Formulary is a public-private partnership between NCI, part of the National Institutes of Health, and pharmaceutical and biotechnology companies

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2017/01/12/expedite-use-of-agents-in-clinical-trials-new-drug-formulary-created-the-nci-formulary-is-a-public-private-partnership-between-nci-part-of-the-national-institutes-of-health-and-pharmaceutical-and/

 

Reversing Heart Disease: Combination of PCSK9 Inhibitors and Statins – Opinion by Steven Nissen, MD, Chairman of Cardiovascular Medicine at Cleveland Clinic

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2016/12/29/reversing-heart-disease-combination-of-pcsk9-inhibitors-and-statins-opinion-by-steven-nissen-md-chairman-of-cardiovascular-medicine-at-cleveland-clinicopinion-on-reversing-heart-disease-combinat/

 

Coronary Heart Disease Research: Sugar Industry influenced national conversation on heart disease – Adoption of Low Fat Diet vs Low Carbohydrates Diet

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2016/09/17/coronary-heart-disease-research-sugar-industry-influenced-national-conversation-on-heart-disease-adoption-of-low-fat-diet-vs-low-carbohydrates-diet/

 

Pathophysiology in Hypertension: Opposing Roles of Human Adaptive Immunity

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2016/08/19/pathophysiology-in-hypertension-opposing-roles-of-human-adaptive-immunity/

 

PCSK9 inhibitors: Reducing annual drug prices from more than $14 000 to $4536 would be necessary to meet a $100 000 per QALY threshold per JAMA

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2016/08/17/pcsk9-inhibitors-reducing-annual-drug-prices-from-more-than-14%E2%80%AF000-to-4536-would-be-necessary-to-meet-a-100%E2%80%AF000-per-qaly-threshold-per-jama/

 

The presence of any Valvular Heart Disease (VHD) did not influence the comparison of Dabigatran [Pradaxa, Boehringer Ingelheim] with Warfarin

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2016/08/16/the-presence-of-any-valvular-heart-disease-vhd-did-not-influence-the-comparison-of-dabigatran-pradaxa-boehringer-ingelheim-with-warfarin/

 

Resveratrol, an antioxidant found in red wine presented since 2003 presented for its potential to lower risk for cardiovascular disease and neurodegeneration by increasing cell survival and slowing aging: 2014 Study – Diet rich in resveratrol offers no health boost

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2016/07/25/resveratrol-an-antioxidant-found-in-red-wine-2014-study-resveratrol-offers-no-health-boost/

 

Amgen’s Corlanor® can help Reduce the Risk of Hospitalization for Patients with worsening Heart Failure

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2016/05/04/amgens-corlanor-can-help-reduce-the-risk-of-hospitalization-for-patients-with-worsening-heart-failure/

 

Effectiveness of Anti-arrhythmic Drugs: Amiodarone and Lidocaine, for treating sudden cardiac arrest, increasing likelihood of Patients Surviving Emergency Transport to Hospital

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2016/04/04/effectiveness-of-anti-arrhythmic-drugs-amiodarone-and-lidocaine-for-treating-sudden-cardiac-arrest-increasing-likelihood-of-patients-surviving-emergency-transport-to-hospital/

 

Efficacy and Tolerability of PCSK9 Inhibitors by Patients with Muscle-related Statin Intolerance – New Cleveland Clinic study published in JAMA 4/2016

Curators: Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2016/04/03/efficacy-and-tolerability-of-pcsk9-inhibitors-by-patients-with-muscle-related-statin-intolerance-new-cleveland-clinic-study-published-in-jama-42016/

 

Triglycerides: Is it a Risk Factor or a Risk Marker for Atherosclerosis and Cardiovascular Disease ? The Impact of Genetic Mutations on (ANGPTL4) Gene, encoder of (angiopoietin-like 4) Protein, inhibitor of Lipoprotein Lipase

Reporters, Curators and Authors: Aviva Lev-Ari, PhD, RN and Larry H. Bernstein, MD, FCAP

https://pharmaceuticalintelligence.com/2016/03/13/triglycerides-is-it-a-risk-factor-or-a-risk-marker-for-atherosclerosis-and-cardiovascular-disease-the-impact-of-genetic-mutations-on-angptl4-gene-encoder-of-angiopoietin-like-4-protein-that-in/

 

In One-Hour: A Diagnosis of Heart Attack made possible by one Blood Test

Reporter: Larry H Bernstein, MD, FCAP

https://pharmaceuticalintelligence.com/2016/01/14/in-one-hour-a-diagnosis-of-heart-attack-made-possible-by-one-blood-test/

 

Heart-Failure–Related Mortality Rate: CDC Reports comparison of 2000, 2012, 2014  – the decease is steadily reversed

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2016/01/05/heart-failure-related-mortality-rate-cdc-reports-comparison-of-2000-2012-2014-the-decease-is-steadily-reversed/

 

PCSK9: A Recent Discovery in Understanding Cholesterol Regulation @ AMGEN Cardiovascular

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2015/08/04/pcsk9-a-recent-discovery-in-understanding-cholesterol-regulation-amgen-cardiovascular/

 

Praluent – FDA approved as Cholesterol-lowering Medicine for Patient non responsive to Statin due to Genetic origin of Hypercholesterolemia

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2015/07/27/praluent-fda-approved-as-cholesterol-lowering-medicine-for-patient-non-responsive-to-statin-due-to-genetic-origin-of-hypercholesterolemia/

 

Atherosclerosis: What is New in Biomarker Discovery

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2015/07/01/atherosclerosis-what-is-new-in-biomarker-discovery/

 

Cangrelor wins Clopidogrel (Plavix): reduction of Risk of a composite of all-cause mortality, myocardial infarction, ischemia driven revascularization, and stent thrombosis

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2015/04/16/cangrelor-wins-clopidogrel-plavix-reduction-of-risk-of-a-composite-of-all-cause-mortality-myocardial-infarction-ischemia-driven-revascularization-and-stent-thrombosis/

 

Sets of co-expressed Genes influence Blood Pressure Regulation: Genome-wide Association and mRNA expression @US National Heart, Lung, and Blood Institute

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2015/04/16/sets-of-co-expressed-genes-influence-blood-pressure-regulation-genome-wide-association-and-mrna-expression-us-national-heart-lung-and-blood-institute/

 

HDL-C: Target of Therapy – Steven E. Nissen, MD, MACC, Cleveland Clinic vs Peter Libby, MD, BWH

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/11/07/hdl-c-target-of-therapy-steven-e-nissen-md-macc-cleveland-clinic-vs-peter-libby-md-bwh/

 

Atrial Fibrillation and Silent Cerebral Infarctions: A Meta Analysis Study and Literature Review

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/11/04/atrial-fibrillation-and-silent-cerebral-infarctions-a-meta-analysis-study-and-literature-review/

 

Intracranial Vascular Stenosis: Comparison of Clinical Trials: Percutaneous Transluminal Angioplasty and Stenting (PTAS) vs. Clot-inhibiting Drugs: Aspirin and Clopidogrel (dual antiplatelet therapy) – more Strokes if Stenting

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/10/15/intracranial-vascular-stenosis-comparison-of-clinical-trials-percutaneous-transluminal-angioplasty-and-stenting-ptas-vs-clot-inhibiting-drugs-aspirin-and-clopidogrel-dual-antiplatelet-therapy/

 

Hypertension: It is Autoimmunity that Underlies its Development in Humans

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/10/08/hypertension-it-is-autoimmunity-that-underlies-its-development-in-humans/

 

OPINION LEADERSHIP on Cardiovascular Diseases

Cardiovascular Original Research: Cases in Methodology Design for Content Co-Curation

  • Cardiovascular Diseases, Volume Two: Cardiovascular Original Research: Cases in Methodology Design for Content Co-Curation. On Amazon.com since 11/30/2015

http://www.amazon.com/dp/B018Q5MCN8

 Epilogue to Volume Two

Author and Curator: Aviva Lev-Ari, PhD, RN, Editor-in-Chief, BioMed e-Series of e-Books

https://pharmaceuticalintelligence.com/2014/07/31/opinion-leadership-on-cardiovascular-diseases/

 

Risk of Major Cardiovascular Events by LDL-Cholesterol Level (mg/dL): Among those treated with high-dose statin therapy, more than 40% of patients failed to achieve an LDL-cholesterol target of less than 70 mg/dL.

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/07/29/risk-of-major-cardiovascular-events-by-ldl-cholesterol-level-mgdl-among-those-treated-with-high-dose-statin-therapy-more-than-40-of-patients-failed-to-achieve-an-ldl-cholesterol-target-of-less-th/

 

Commentary on Biomarkers for Genetics and Genomics of Cardiovascular Disease: Views by Larry H Bernstein, MD, FCAP

Commissioned article, Author: Larry H Bernstein, MD, FCAP

https://pharmaceuticalintelligence.com/2014/07/16/commentary-on-biomarkers-for-genetics-and-genomics-of-cardiovascular-disease-views-by-larry-h-bernstein-md-fcap/

 

Coagulation Therapy: Leading New Drugs – Efficacy Comparison

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/05/10/coagulation-therapy-leading-new-drugs-efficacy-comparison/

 

Apixaban (Eliquis): Mechanism of Action, Drug Comparison and Additional Indications

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/05/10/apixaban-eliquis-mechanism-of-action-drug-comparison-and-additional-indications/

 

Boston Heart Diagnostics (BHD) offers Statin Induced Myopathy (SLCO1B1) Genotype test and genetic tests targeting ApoE, Factor V Leiden, prothrombin (Factor II), and CYP2C19

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/04/17/boston-heart-diagnostics-bhd-offers-statin-induced-myopathy-slco1b1-genotype-test-and-genetic-tests-targeting-apoe-factor-v-leiden-prothrombin-factor-ii-and-cyp2c19/

 

@@@ Cardiovascular Diseases and Pharmacological Therapy: Curations by Aviva Lev-Ari, PhD, RN

Curator: Aviva Leve-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/04/17/cardiovascular-diseases-and-pharmacological-therapy-curations-by-aviva-lev-ari-phd-rn/

 

Richard Lifton, MD, PhD of Yale University & Howard Hughes Medical Institute: Recipient of 2014 Breakthrough Prizes Awarded in Life Sciences for the Discovery of Genes and Biochemical Mechanisms that cause Hypertension

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/03/03/richard-lifton-md-phd-of-yale-university-and-howard-hughes-medical-institute-recipient-of-2014-breakthrough-prizes-awarded-in-life-sciences-for-the-discovery-of-genes-and-biochemical-mechanisms-tha/

 

Differences in Health Services Utilization and Costs between Antihypertensive Medication Users Versus Nonusers in Adults with Diabetes and Concomitant Hypertension from Medical Expenditure Panel Su…

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/02/28/differences-in-health-services-utilization-and-costs-between-antihypertensive-medication-users-versus-nonusers-in-adults-with-diabetes-and-concomitant-hypertension-from-medical-expenditure-panel-su-2/

 

2014 Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism Conference: San Francisco, Ca. Conference Dates: San Francisco, CA 3/18-21, 2014

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/02/26/2014-epidemiology-and-prevention-nutrition-physical-activity-and-metabolism-conference-san-francisco-ca-conference-dates-san-francisco-ca-318-21-2014/

 

2014 High Blood Pressure Research Conference, 9/9 – 9/12, 2014 — Hilton SF Union Square, San Francisco, CA

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/02/24/2014-high-blood-pressure-research-conference-99-912-2014-hilton-sf-union-square-san-francisco-ca/

 

Females and Non-Atherosclerotic Plaque: Spontaneous Coronary Artery Dissection – New Insights from Research and DNA Ongoing Study

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/02/12/female-and-non-atherosclerotic-plaque-spontaneous-coronary-artery-dissection-new-insights-from-research-and-dna-ongoing-study/

 

Hypertension – JNC 8 Guideline: Henry R. Black, MD, Michael A. Weber, MD and Raymond R. Townsend, MD

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/02/12/hypertension-jnc-8-guideline-henry-r-black-md-michael-a-weber-md-and-raymond-r-townsend-md/

 

Why Don’t You Trust Generic Drugs as Much as Brand Name …

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/02/10/why-dont-you-trust-generic-drugs-as-much-as-brand-name/

 

National Trends, 2005 – 2011: Adverse-event Rates Declined among Patients Hospitalized for Acute Myocardial Infarction or Congestive Heart Failure

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/02/04/national-trends-2005-2011-adverse-event-rates-declined-among-patients-hospitalized-for-acute-myocardial-infarction-or-congestive-heart-failure/

 

Is Pharmacogenetic-based Dosing of Warfarin Superior for Anticoagulation Control?

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/02/04/is-pharmacogenetic-based-dosing-of-warfarin-superior-for-anticoagulation-control/

 

Prolonged Wakefulness: Lack of Sufficient Duration of Sleep as a Risk Factor for Cardiovascular Diseases – Indications for Cardiovascular Chrono-therapeutics

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/02/02/prolonged-wakefulness-lack-of-sufficient-duration-of-sleep-as-a-risk-factor-for-cardiovascular-diseases-indications-for-cardiovascular-chrono-therapeutics/

 

Testosterone Therapy for Idiopathic Hypogonadotrophic Hypogonadism has Beneficial and Deleterious Effects on Cardiovascular Risk Factors

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/01/30/testosterone-therapy-for-idiopathic-hypogonadotrophic-hypogonadism-has-beneficial-and-deleterious-effects-on-cardiovascular-risk-factors/

 

Calcium and Cardiovascular Diseases: A Series of Twelve Articles in Advanced Cardiology

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/01/28/calcium-and-cardiovascular-diseases-a-series-of-twelve-articles-in-advanced-cardiology/

 

Acute Myocardial Infarction: Curations of Cardiovascular Original Research – A Bibliography

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/01/22/acute-myocardial-infarction-curations-of-cardiovascular-original-research-a-bibliography/

 

On-Hours vs Off-Hours: Presentation to ER with Acute Myocardial Infarction – Lower Survival Rate if Off-Hours

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/01/22/on-hours-vs-off-hours-presentation-to-er-with-acute-myocardial-infarction-lower-survival-rate-if-off-hours/

 

2014 Winter in New England: The Effect of Record Cold Temperatures on Cardiovascular Diseases

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/01/21/2014-winter-in-new-england-the-effect-of-record-cold-temperatures-on-cardiovascular-diseases/

 

Voices from the Cleveland Clinic: On the New Lipid Guidelines and On the ACC/AHA Risk Calculator

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/01/21/voices-from-the-cleveland-clinic-on-the-new-lipid-guidelines-and-on-the-accaha-risk-calculator/

 

Is it Hypertension or Physical Inactivity: Cardiovascular Risk and Mortality – New results in 3/2013

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/01/19/is-it-hypertension-or-physical-inactivity-cardiovascular-risk-and-mortality-new-results-in-32013/

 

Regeneration: Cardiac System (cardiomyogenesis) and Vasculature (angiogenesis)

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/01/15/regeneration-cardiac-system-and-vasculature

 

Conceived: NEW Definition for Co-Curation in Medical Research

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/01/04/conceived-new-definition-for-co-curation-in-medical-research/

 

The Young Surgeon and The Retired Pathologist: On Science, Medicine and HealthCare Policy – The Best Writers Among the WRITERS

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/12/10/the-young-surgeon-and-the-retired-pathologist-on-science-medicine-and-healthcare-policy-best-writers-among-the-writers/

 

Diabetes-risk Forecasts: Serum Calcium in Upper-Normal Range (>2.5 mmol/L) as a New Biomarker

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/09/25/diabetes-risk-forecasts-serum-calcium-in-upper-normal-range-2-5-mmoll-as-a-new-biomarker/

 

Do Novel Anticoagulants Affect the PT/INR? The Cases of XARELTO (rivaroxaban) or PRADAXA (dabigatran)

Curators: Lal, V., Justin D. Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/09/23/do-novel-anticoagulants-affect-the-ptinr-the-cases-of-xarelto-rivaroxaban-and-pradaxa-dabigatran/

 

Calcium-Channel Blocker, Calcium Release-related Contractile Dysfunction (Ryanopathy) and Calcium as Neurotransmitter Sensor

Curators: Justin D. Pearlman, MD, PhD, FACC, Larry H. Bernstein, MD FCAP and Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/09/16/calcium-channel-blocker-calcium-as-neurotransmitter-sensor-and-calcium-release-related-contractile-dysfunction-ryanopathy/

 

Disruption of Calcium HomeostasisCardiomyocytes and Vascular Smooth Muscle Cells: The Cardiac and Cardiovascular Calcium Signaling Mechanism

Curators: Larry H. Bernstein, MD FCAP, Justin D. Pearlman, MD, PhD, FACC, and Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/09/12/disruption-of-calcium-homeostasis-cardiomyocytes-and-vascular-smooth-muscle-cells-the-cardiac-and-cardiovascular-calcium-signaling-mechanism/

 

Synaptotagmin functions as a Calcium Sensor: How Calcium Ions Regulate the fusion of vesicles with cell membranes during Neurotransmission

Curators:  Larry H. Bernstein, MD FCAP and Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/09/10/synaptotagmin-functions-as-a-calcium-sensor-how-calcium-ions-regulate-the-fusion-of-vesicles-with-cell-membranes-during-neurotransmission/

 

Cardiac Contractility & Myocardium Performance: Ventricular Arrhythmias and Non-ischemic Heart Failure – Therapeutic Implications for Cardiomyocyte Ryanopathy (Calcium Release-related Contractile Dysfunction) and Catecholamine Responses

Curators: Justin D. Pearlman, MD, PhD, FACC, Larry H. Bernstein, MD FCAP and Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/08/28/cardiac-contractility-myocardium-performance-ventricular-arrhythmias-and-non-ischemic-heart-failure-therapeutic-implications-for-cardiomyocyte-ryanopathy-calcium-release-related-contractile/

 

Cardiovascular Original Research: Cases in Methodology Design for Content Curation and Co-Curation

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/07/29/cardiovascular-original-research-cases-in-methodology-design-for-content-curation-and-co-curation/

 

Heart Transplant (HT) Indication for Heart Failure (HF): Procedure Outcomes and Research on HF, HT @ Two Nation’s Leading HF & HT Centers

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/07/09/research-programs-george-m-linda-h-kaufman-center-for-heart-failure-cleveland-clinic/

 

Congenital Heart Disease (CHD) at Birth and into Adulthood: The Role of Spontaneous Mutations

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/06/09/congenital-heart-disease-at-birth-and-into-adulthood-the-role-of-spontaneous-mutations-the-genes-and-the-pathways/

 

Clinical Indications for Use of Inhaled Nitric Oxide (iNO) in the Adult Patient Market: Clinical Outcomes after Use, Therapy Demand and Cost of Care

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/06/03/clinical-indications-for-use-of-inhaled-nitric-oxide-ino-in-the-adult-patient-market-clinical-outcomes-after-use-therapy-demand-and-cost-of-care/

 

Inhaled Nitric Oxide in Adults: Clinical Trials and Meta Analysis Studies – Recent Findings

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/06/02/inhaled-nitric-oxide-in-adults-with-acute-respiratory-distress-syndrome/

 

Imaging Biomarker for Arterial Stiffness: Pathways in Pharmacotherapy for Hypertension and Hypercholesterolemia Management

Curators: Justin D. Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/05/24/imaging-biomarker-for-arterial-stiffness-pathways-in-pharmacotherapy-for-hypertension-and-hypercholesterolemia-management/

 

Synthetic Biology: On Advanced Genome Interpretation for Gene Variants and Pathways: What is the Genetic Base of Atherosclerosis and Loss of Arterial Elasticity with Aging

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/05/17/synthetic-biology-on-advanced-genome-interpretation-for-gene-variants-and-pathways-what-is-the-genetic-base-of-atherosclerosis-and-loss-of-arterial-elasticity-with-aging/

 

Diagnosis of Cardiovascular Disease, Treatment and Prevention: Current & Predicted Cost of Care and the Promise of Individualized Medicine Using Clinical Decision Support Systems

Curators: Justin D. Pearlman, MD, PhD, FACC, Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/05/15/diagnosis-of-cardiovascular-disease-treatment-and-prevention-current-predicted-cost-of-care-and-the-promise-of-individualized-medicine-using-clinical-decision-support-systems-2/

 

Gene, Meis1, Regulates the Heart’s Ability to Regenerate after Injuries.

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/05/03/gene-meis1-regulates-the-hearts-ability-to-regenerate-after-injuries/

 

Prostacyclin and Nitric Oxide: Adventures in Vascular Biology – A Tale of Two Mediators

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/04/30/prostacyclin-and-nitric-oxide-adventures-in-vascular-biology-a-tale-of-two-mediators/

 

Genetics of Conduction Disease: Atrioventricular (AV) Conduction Disease (block): Gene Mutations – Transcription, Excitability, and Energy Homeostasis

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/04/28/genetics-of-conduction-disease-atrioventricular-av-conduction-disease-block-gene-mutations-transcription-excitability-and-energy-homeostasis/

 

Economic Toll of Heart Failure in the US: Forecasting the Impact of Heart Failure in the United States – A Policy Statement From the American Heart Association

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/04/25/economic-toll-of-heart-failure-in-the-us-forecasting-the-impact-of-heart-failure-in-the-united-states-a-policy-statement-from-the-american-heart-association/

 

Harnessing New Players in Atherosclerosis to Treat Heart Disease

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/04/25/harnessing-new-players-in-atherosclerosis-to-treat-heart-disease/

 

Cholesteryl Ester Transfer Protein (CETP) Inhibitor: Potential of Anacetrapib to treat Atherosclerosis and CAD

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/04/07/cholesteryl-ester-transfer-protein-cetp-inhibitor-potential-of-anacetrapib-to-treat-atherosclerosis-and-cad/

 

Hypertriglyceridemia concurrent Hyperlipidemia: Vertical Density Gradient Ultracentrifugation a Better Test to Prevent Undertreatment of High-Risk Cardiac Patients

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/04/04/hypertriglyceridemia-concurrent-hyperlipidemia-vertical-density-gradient-ultracentrifugation-a-better-test-to-prevent-undertreatment-of-high-risk-cardiac-patients/

 

Fight against Atherosclerotic Cardiovascular Disease: A Biologics not a Small Molecule – Recombinant Human lecithin-cholesterol acyltransferase (rhLCAT) attracted AstraZeneca to acquire AlphaCore

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/04/03/fight-against-atherosclerotic-cardiovascular-disease-a-biologics-not-a-small-molecule-recombinant-human-lecithin-cholesterol-acyltransferase-rhlcat-attracted-astrazeneca-to-acquire-alphacore/

 

High-Density Lipoprotein (HDL): An Independent Predictor of Endothelial Function & Atherosclerosis, A Modulator, An Agonist, A Biomarker for Cardiovascular Risk

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/03/31/high-density-lipoprotein-hdl-an-independent-predictor-of-endothelial-function-artherosclerosis-a-modulator-an-agonist-a-biomarker-for-cardiovascular-risk/ 

 

Genomics & Genetics of Cardiovascular Disease Diagnoses: A Literature Survey of AHA’s Circulation Cardiovascular Genetics, 3/2010 – 3/2013

Curators: Aviva Lev-Ari, PhD, RN and Larry H. Bernstein, MD, FCAP

https://pharmaceuticalintelligence.com/2013/03/07/genomics-genetics-of-cardiovascular-disease-diagnoses-a-literature-survey-of-ahas-circulation-cardiovascular-genetics-32010-32013/

 

The Heart: Vasculature Protection – A Concept-based Pharmacological Therapy including THYMOSIN

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/02/28/the-heart-vasculature-protection-a-concept-based-pharmacological-therapy-including-thymosin/

 

Thymosin References

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/02/27/thymosin-references/

 

Arteriogenesis and Cardiac Repair: Two Biomaterials – Injectable Thymosin beta4 and Myocardial Matrix Hydrogel

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2013/02/27/arteriogenesis-and-cardiac-repair-two-biomaterials-injectable-thymosin-beta4-and-myocardial-matrix-hydrogel/

 

PCI Outcomes, Increased Ischemic Risk associated with Elevated Plasma Fibrinogen not Platelet Reactivity

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/01/10/pci-outcomes-increased-ischemic-risk-associated-with-elevated-plasma-fibrinogen-not-platelet-reactivity/

 

Heart Renewal by pre-existing Cardiomyocytes: Source of New Heart Cell Growth Discovered

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2012/12/23/heart-renewal-by-pre-existing-cardiomyocytes-source-of-new-heart-cell-growth-discovered/

 

Special Considerations in Blood Lipoproteins, Viscosity, Assessment and Treatment

Curators: Larry H. Bernstein and Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2012/11/28/special-considerations-in-blood-lipoproteins-viscosity-assessment-and-treatment/

 

Peroxisome proliferator-activated receptor (PPAR-gamma) Receptors Activation: PPARγ transrepression for Angiogenesis in Cardiovascular Disease and PPARγ transactivation for Treatment of Diabetes

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/11/13/peroxisome-proliferator-activated-receptor-ppar-gamma-receptors-activation-pparγ-transrepression-for-angiogenesis-in-cardiovascular-disease-and-pparγ-transactivation-for-treatment-of-dia/

 

Cardiovascular Risk Inflammatory Marker: Risk Assessment for Coronary Heart Disease and Ischemic Stroke – Atherosclerosis.

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2012/10/30/cardiovascular-risk-inflammatory-marker-risk-assessment-for-coronary-heart-disease-and-ischemic-stroke-atherosclerosis/

 

Clinical Trials Results for Endothelin System: Pathophysiological role in Chronic Heart Failure, Acute Coronary Syndromes and MI – Marker of Disease Severity or Genetic Determination?

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/10/19/clinical-trials-results-for-endothelin-system-pathophysiological-role-in-chronic-heart-failure-acute-coronary-syndromes-and-mi-marker-of-disease-severity-or-genetic-determination/

 

Sustained Cardiac Atrial Fibrillation: Management Strategies by Director of the Arrhythmia Service and Electrophysiology Lab at The Johns Hopkins Hospital

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2012/10/16/sustained-cardiac-atrial-fibrillation-management-strategies-by-director-of-the-arrhythmia-service-and-electrophysiology-lab-at-the-johns-hopkins-hospital/

 

Endothelin Receptors in Cardiovascular Diseases: The Role of eNOS Stimulation

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/10/04/endothelin-receptors-in-cardiovascular-diseases-the-role-of-enos-stimulation/

 

Inhibition of ET-1, ETA and ETA-ETB, Induction of NO production, stimulation of eNOS and Treatment Regime with PPAR-gamma agonists (TZD): cEPCs Endogenous Augmentation for Cardiovascular Risk Reduction – A Bibliography

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/10/04/inhibition-of-et-1-eta-and-eta-etb-induction-of-no-production-and-stimulation-of-enos-and-treatment-regime-with-ppar-gamma-agonists-tzd-cepcs-endogenous-augmentation-for-cardiovascular-risk-reduc/

Positioning a Therapeutic Concept for Endogenous Augmentation of cEPCs — Therapeutic Indications for Macrovascular Disease: Coronary, Cerebrovascular and Peripheral

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2012/08/29/positioning-a-therapeutic-concept-for-endogenous-augmentation-of-cepcs-therapeutic-indications-for-macrovascular-disease-coronary-cerebrovascular-and-peripheral/ 

 

Cardiovascular Outcomes: Function of circulating Endothelial Progenitor Cells (cEPCs): Exploring Pharmaco-therapy targeted at Endogenous Augmentation of cEPCs

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/08/28/cardiovascular-outcomes-function-of-circulating-endothelial-progenitor-cells-cepcs-exploring-pharmaco-therapy-targeted-at-endogenous-augmentation-of-cepcs/

 

Endothelial Dysfunction, Diminished Availability of cEPCs, Increasing CVD Risk for Macrovascular Disease – Therapeutic Potential of cEPCs

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/08/27/endothelial-dysfunction-diminished-availability-of-cepcs-increasing-cvd-risk-for-macrovascular-disease-therapeutic-potential-of-cepcs/

 

Vascular Medicine and Biology: Classification of Fast Acting Therapy for Patients at High Risk for Macrovascular Events – Macrovascular Disease – Therapeutic Potential of cEPCs

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2012/08/24/vascular-medicine-and-biology-classification-of-fast-acting-therapy-for-patients-at-high-risk-for-macrovascular-events-macrovascular-disease-therapeutic-potential-of-cepcs/

 

 

Ethical Considerations in Studying Drug Safety — The Institute of Medicine Report

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2012/08/23/ethical-considerations-in-studying-drug-safety-the-institute-of-medicine-report/

 

Cardiac Arrhythmias: A Risk for Extreme Performance Athletes

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2012/08/08/cardiac-arrhythmias-a-risk-for-extreme-performance-athletes/

 

Biosimilars: Intellectual Property Creation and Protection by Pioneer and by Biosimilar Manufacturers

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/07/30/biosimilars-intellectual-property-creation-and-protection-by-pioneer-and-by-biosimilar-manufacturers/

 

Biosimilars: Financials 2012 vs. 2008

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/07/30/biosimilars-financials-2012-vs-2008/

 

Biosimilars: CMC Issues and Regulatory Requirements

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/07/29/biosimilars-cmc-issues-and-regulatory-requirements/

 

Cardiovascular Disease (CVD) and the Role of agent alternatives in endothelial Nitric Oxide Synthase (eNOS) Activation and Nitric Oxide Production

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/07/19/cardiovascular-disease-cvd-and-the-role-of-agent-alternatives-in-endothelial-nitric-oxide-synthase-enos-activation-and-nitric-oxide-production/

 

Resident-cell-based Therapy in Human Ischaemic Heart Disease: Evolution in the PROMISE of Thymosin beta4 for Cardiac Repair

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/04/30/93/

 

Triple Antihypertensive Combination Therapy Significantly Lowers Blood Pressure in Hard-to-Treat Patients with Hypertension and Diabetes

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/05/29/445/

 

Macrovascular Disease – Therapeutic Potential of cEPCs: Reduction Methods for CV Risk

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/07/02/macrovascular-disease-therapeutic-potential-of-cepcs-reduction-methods-for-cv-risk/

 

Mitochondria Dysfunction and Cardiovascular Disease – Mitochondria: More than just the “powerhouse of the cell”

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/07/09/mitochondria-more-than-just-the-powerhouse-of-the-cell/

 

Bystolic’s generic Nebivolol – positive effect on circulating Endothelial Progenitor Cells endogenous augmentation

Curator: Aviva Lev-Ari, PhD, RN 

https://pharmaceuticalintelligence.com/2012/07/16/bystolics-generic-nebivolol-positive-effect-on-circulating-endothilial-progrnetor-cells-endogenous-augmentation/

Lev-Ari, A. Heart Vasculature (2007) Regeneration and Protection of Coronary Artery Endothelium and Smooth Muscle: A Concept-based Pharmacological Therapy of a Combined Three Drug Regimen.

Bouve College of Health Sciences, Northeastern University, Boston, MA 02115

 

Lev-Ari, A. & Abourjaily, P. (2006a) “An Investigation of the Potential of circulating Endothelial Progenitor Cells (cEPC) as a Therapeutic Target for Pharmacologic Therapy Design for Cardiovascular Risk Reduction.”

  • Part IMacrovascular Disease – Therapeutic Potential of cEPCs – Reduction methods for CV risk.
  • Part II:(2006b) Therapeutic Strategy for cEPCs Endogenous Augmentation: A Concept-based Treatment Protocol for a Combined Three Drug Regimen.
  • Part III: (2006c)Biomarker for Therapeutic Targets of Cardiovascular Risk Reduction by cEPCs Endogenous Augmentation using New Combination Drug Therapy of Three Drug Classes and Several Drug Indications.

Northeastern University, Boston, MA 02115

 

Curator: Medical Research – 557 articles in Books

Editorial & Publication of Articles in e-Books by Leaders in Pharmaceutical Business Intelligence: Contributions of Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/10/16/editorial-publication-of-articles-in-e-books-by-leaders-in-pharmaceutical-business-intelligence-contributions-of-aviva-lev-ari-phd-rn/

 

 

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The Cost to Value Conundrum in Cardiovascular Healthcare Provision


The Cost to Value Conundrum in Cardiovascular Healthcare Provision

Author: Larry H. Bernstein, MD, FCAP

I write this introduction to Volume 2 of the e-series on Cardiovascular Diseases, which curates the basic structure and physiology of the heart, the vasculature, and related structures, e.g., the kidney, with respect to:

1. Pathogenesis
2. Diagnosis
3. Treatment

Curation is an introductory portion to Volume Two, which is necessary to introduce the methodological design used to create the following articles. More needs not to be discussed about the methodology, which will become clear, if only that the content curated is changing based on success or failure of both diagnostic and treatment technology availability, as well as the systems needed to support the ongoing advances.  Curation requires:

  • meaningful selection,
  • enrichment, and
  • sharing combining sources and
  • creation of new synnthesis

Curators have to create a new perspective or idea on top of the existing media which supports the content in the original. The curator has to select from the myriad upon myriad options available, to re-share and critically view the work. A search can be overwhelming in size of the output, but the curator has to successfully pluck the best material straight out of that noise.

Part 1 is a highly important treatment that is not technological, but about the system now outdated to support our healthcare system, the most technolog-ically advanced in the world, with major problems in the availability of care related to economic disparities.  It is not about technology, per se, but about how we allocate healthcare resources, about individuals’ roles in a not full list of lifestyle maintenance options for self-care, and about the important advances emerging out of the Affordable Care Act (ACA), impacting enormously on Medicaid, which depends on state-level acceptance, on community hospital, ambulatory, and home-care or hospice restructuring, which includes the reduction of management overhead by the formation of regional healthcare alliances, the incorporation of physicians into hospital-based practices (with the hospital collecting and distributing the Part B reimbursement to the physician, with “performance-based” targets for privileges and payment – essential to the success of an Accountable Care Organization (AC)).  One problem that ACA has definitively address is the elimination of the exclusion of patients based on preconditions.  One problem that has been left unresolved is the continuing existence of private policies that meet financial capabilities of the contract to provide, but which provide little value to the “purchaser” of care.  This is a holdout that persists in for-profit managed care as an option.  A physician response to the new system of care, largely fostered by a refusal to accept Medicaid, is the formation of direct physician-patient contracted care without an intermediary.

In this respect, the problem is not simple, but is resolvable.  A proposal for improved economic stability has been prepared by Edward Ingram. A concern for American families and businesses is substantially addressed in a macroeconomic design concept, so that financial services like housing, government, and business finance, savings and pensions, boosting confidence at every level giving everyone a better chance of success in planning their personal savings and lifetime and business finances.

http://macro-economic-design.blogspot.com/p/book.html

Part 2 is a collection of scientific articles on the current advances in cardiac care by the best trained physicians the world has known, with mastery of the most advanced vascular instrumentation for medical or surgical interventions, the latest diagnostic ultrasound and imaging tools that are becoming outdated before the useful lifetime of the capital investment has been completed.  If we tie together Part 1 and Part 2, there is ample room for considering  clinical outcomes based on individual and organizational factors for best performance. This can really only be realized with considerable improvement in information infrastructure, which has miles to go.  Why should this be?  Because for generations of IT support systems, they are historically focused on billing and have made insignificant inroads into the front-end needs of the clinical staff.

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Cardiology, Genomics and Individualized Heart Care: Framingham Heart Study (65 y-o study) & Jackson Heart Study (15 y-o study)


Cardiology, Genomics and Individualized Heart Care

Curator: Aviva Lev-Ari, PhD, RN

The topic of Cardiology, Genomics and Individualized Heart Care is been developed in the following forthcoming e-Book on a related subject matter:

Curators: Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN

This e-Book has the following Parts:

PART 1
Genomics and Medicine

Introduction to Volume Three
1.1: Genomics and Medicine: The Physician’s View
1.2: Ribozymes and RNA Machines – Work of Jennifer A. Doudn
1.3: Genomics and Medicine: The Geneticist’s View
1.4: Genomics in Medicine – Establishing a Patient-Centric View of Genomic Data

PART 2
Epigenetics- Modifiable Factors Causing Cardiovascular Diseases

2.1 Diseases Etiology

2.1.1 Environmental Contributors Implicated as Causing Cardiovascular Diseases
2.1.2 Diet: Solids and Fluid Intake
2.1.3 Physical Activity and Prevention of Cardiovascular Diseases
2.1.4 Psychological Stress and Mental Health: Risk for Cardiovascular Diseases
2.1.5 Correlation between Cancer and Cardiovascular Diseases
2.1.6 Medical Etiologies for Cardiovascular Diseases: Evidence-based Medicine – Leading DIAGNOSES of Cardiovascular Diseases, Risk Biomarkers and Therapies
2.1.7 Signaling Pathways
2.1.8 Proteomics and Metabolomics

2.2 Assessing Cardiovascular Disease with Biomarkers

2.2.1 Issues in Genomics of Cardiovascular Diseases
2.2.2 Endothelium, Angiogenesis, and Disordered Coagulation
2.2.3 Hypertension BioMarkers
2.2.4 Inflammatory, Atherosclerotic and Heart Failure Markers
2.2.5 Myocardial Markers

2.3  Therapeutic Implications: Focus on Ca(2+) signaling, platelets, endothelium

2.3.1 The Centrality of Ca(2+) Signaling and Cytoskeleton Involving Calmodulin Kinases and Ryanodine Receptors

2.3.2 Platelets in Translational Research ­ 2

2.3.3 The Final Considerations of the Role of Platelets and Platelet Endothelial Reactions in Atherosclerosis

2.3.4 Nitric Oxide Synthase Inhibitors (NOS-I)

2.3.5 Resistance to Receptor of Tyrosine Kinase

2.3.6 Oxidized Calcium Calmodulin Kinase and Atrial Fibrillation

2.3.7 Advanced Topics in Sepsis and the Cardiovascular System at its End Stage

2.4 Comorbidity of Diabetes and Aging

PART 3
Determinants of Cardiovascular Diseases
Genetics, Heredity and Genomics Discoveries

Introduction
3.1 Why cancer cells contain abnormal numbers of chromosomes (Aneuploidy)
3.2 Functional Characterization of Cardiovascular Genomics: Disease Case Studies @ 2013 ASHG
3.3 Leading DIAGNOSES of Cardiovascular Diseases covered in Circulation: Cardiovascular Genetics, 3/2010 – 3/2013
3.4  Commentary on Biomarkers for Genetics and Genomics of Cardiovascular Disease

PART 4
Individualized Medicine Guided by Genetics and Genomics Discoveries

4.1 Preventive Medicine: Cardiovascular Diseases
4.2 Gene-Therapy for Cardiovascular Diseases
4.3 Congenital Heart Disease/Defects
4.4 Pharmacogenomics for Cardiovascular Diseases

SOURCE

https://pharmaceuticalintelligence.com/biomed-e-books/series-a-e-books-on-cardiovascular-diseases/volume-three-etiologies-of-cardiovascular-diseases-epigenetics-genetics-genomics/

The Next Frontier in Heart Care

Research Aims to Personalize Treatment With Genetics

Nov. 25, 2013 7:18 p.m. ET

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http://online.wsj.com/news/articles/SB10001424052702304281004579220373600912930#!

Two influential heart studies are joining forces to bring the power of genetics and other 21st century tools to battle against heart disease and stroke. Ron Winslow and study co-director Dr. Vasan Ramachandran explain. Photo: Shubhangi Ganeshrao Kene/Corbis.

Scientists from two landmark heart-disease studies are joining forces to wield the power of genetics in battling the leading cause of death in the U.S.

Cardiologists have struggled in recent years to score major advances against heart disease and stroke. Although death rates have been dropping steadily since the 1960s, progress combating the twin diseases has plateaued by other measures.

Genetics has had a profound impact on cancer treatment in recent years. Now, heart-disease specialists hope genetics will reveal fresh insight into the interaction between a

  • person’s biology,
  • living habits and
  • medications

that can better predict who is at risk of a heart attack or stroke.

“There’s a promise of new treatments with this research,” said Daniel Jones, chancellor of the University of Mississippi and former principal investigator of the 15-year-old Jackson Heart Study, a co-collaborator in the new genetics initiative.

Scienc e Source /Photo Researchers Inc. (hearts); below, l-r: Boston University; Robert Jordan/Univ. of Miss.; Jay Ferchaud/Univ. of Miss Medical Center

Prevention efforts also could improve with the help of genetics research, Dr. Jones said. For example, an estimated 75 million Americans currently have high blood pressure, or hypertension, but only about half of those are able to control it with medication. It can take months of trial-and-error for a doctor to get the right dose or combination of pills for a patient. Researchers hope genetic and other information might enable doctors to identify subgroups of hypertension that respond to specific treatments and target patients with an appropriate therapy.

Also collaborating on the genetics project is the 65-year-old Framingham Heart Study. Its breakthrough findings decades ago linked heart disease to such factors as smoking, high blood pressure and high cholesterol. Framingham findings have been a foundation of cardiovascular disease prevention policy for a half-century.

More than 15,000 people have participated in the Framingham study. The Jackson study, with more than 5,000 participants, was launched in 1998 to better understand risk factors in African-Americans, who were underrepresented in Framingham and who bear a higher burden of cardiovascular disease than the rest of the population. Both studies are funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

Exactly how the collaboration, announced last week, will proceed hasn’t been determined. One promising area is the “biobank,” the collection of more than one million blood and other biological samples gathered during biennial checkups of Framingham study participants going back more than a half century.

The samples are stored in freezers in an underground earthquake-proof facility in Massachusetts, said Vasan Ramachandran, a Boston University scientist who takes over at the beginning of next year as principal investigator of the Framingham Heart Study. Another 40,000 samples from the Jackson study are kept in freezers in Vermont. By subjecting samples to DNA sequencing and other tests, researchers say they may be able to identify variations linked to progression of cardiovascular disease—or protection from it.

Each study is likely to enroll new participants as part of the collaboration to allow tracking of risk factors and diet and exercise habits, for instance, in real time instead of only during infrequent checkups.

Heart disease is linked to about 800,000 deaths a year in the U.S. In 2010, some 200,000 of those deaths could have been avoided, including more than 112,300 deaths among people younger than 65, according to a recent analysis by the Centers for Disease Control and Prevention. But those avoidable deaths reflected a 3.8% per year decline in mortality rates during the previous 10 years.

Now, widespread prevalence of obesity and diabetes threatens to undermine such gains. And a large gap remains between how white patients and minorities—especially African-Americans—benefit from effective strategies.

There have been few new transformative cardiovascular treatments since the mid-1980s to early 1990s, when a stream of large-scale trials of new agents ranging from clot-busters to treat heart attacks to the mega class of statins electrified the cardiology field with evidence of significant improvements in survival from the disease. One reason: Some of those remedies have proven tough to beat with new treatments.

What’s more, use of the current menu of medicines for reducing heart risk remains an imprecise art. Besides

  • blood pressure drugs,
  • cholesterol-lowering statins

also are widely prescribed. Drug-trial statistics show that to prevent a single first heart attack in otherwise healthy patients can require prescribing a statin to scores of patients, but no one knows for sure who actually benefits and who doesn’t.

“It would be great if we could make some more paradigm-shifting discoveries,” said Michael Lauer, director of cardiovascular sciences at the NHLBI, which is a part of the National Institutes of Health.

Finding new treatments isn’t the only aim of the new project. “You could use existing therapies smarter,” said Joseph Loscalzo, chairman of medicine at Brigham and Women’s Hospital in Boston.

The American Heart Association launched the initiative and has committed $30 million to it over the next five years. The AHA sees the project as critical to its goal to achieve a 20% improvement in cardiovascular health in the U.S. while also reducing deaths from heart disease and stroke by 20% for the decade ending in 2020, said Nancy Brown, the nonprofit organization’s chief executive.

The Jackson study has already identified characteristics of cardiovascular risk among African-American patients “that may have promise for new insights” in a collaborative effort, said Adolfo Correa, professor of medicine and pediatrics at University of Mississippi Medical Center and interim director of the Jackson study.

For instance, there is a higher prevalence of obesity among Jackson participants than seen in the Framingham cohorts. Obesity is associated with high blood pressure, diabetes and cardiovascular risk. Diabetes is also more prevalent among blacks than whites.

But African-Americans of normal weight appear to have higher rates of hypertension and diabetes than whites of normal weight. “The question is, should [measures] for defining diabetes be different or the same for the [different] populations and are they associated with the same risk of cardiovascular disease?” said Dr. Correa. The collaboration, he said, may provide better comparisons.

Researchers, who plan to use tools other than genetics, think more might be learned about blood pressure and heart and stroke risk by monitoring patients in real time using mobile devices rather than taking readings only in periodic office visits. For example, high blood pressure during sleep or spikes during exercise could indicate risks that don’t show up in a routine measurement in the doctors’ office.

A big challenge is making sense of the huge amounts of data involved in sequencing DNA and linking it to

  • medical records,
  • diet and
  • exercise habits and other variables that influence risk.

“The analytical methods for sorting out these complex relationships are still in evolution,” said Dr. Loscalzo, of Brigham and Women’s Hospital. “The cost of sequencing is getting cheaper and cheaper. The hard part is analyzing the data.”

Write to Ron Winslow at ron.winslow@wsj.com

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CVD Core


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See in red my comments, below

Cardiovascular Diseases: Causes, Risks and Management

Justin D. Pearlman MD PhD MA FACC, Editor

Cardiovascular diseases comprise problems of the heart and blood vessels, including rhythm, blood supply, blood pressure, birth defects, or damage from cholesterol, tobacco, street drugs, radiation, viruses, bacteria, or fungi.

Thus the category includes heart failure (inadequate pump function), heart or vessel infection (endocarditis, vasculitis), birth defects (congenital heart disease)

Cardiovascular Diseases: Causes, Risks and Management

Justin D. Pearlman MD ME PhD MA FACC, Editor

 

Leaders in Pharmaceutical Business Intelligence

Aviva Lev-Ari, PhD, RN

Director and Founder

Editor-in-Chief

Other e-Books  in the  BioMedicine Series

Perspectives on Nitric Oxide in Disease Mechanisms

Human Immune System in Health and in Disease

Metabolic Genomics & Pharmaceutics

Infectious Disease & New Antibiotic Targets

Cancer Biology and Genomics for Disease Diagnosis

Nanotechnology in Drug Delivery

Genomics Orientations for Personalized Medicine 

This book is a comprehensive review of Innovations in Cardiovascular Medicine, including the latest discoveries in

  • Cardiac Medical Imaging,
  • Regenerative Medicine,
  • Pharmacotherapy,
  • Medical Devices for Cardiac Repair,
  • Genomics, and opportunities for Targeted Therapy.

It is written by experts in their respective subspecialties. The e-Book’s articles have been published on the Open Access Online Scientific Journal, since April 2012.  All new articles on this subject will continue to be incorporated with periodical updates.

http://www.pharmaceuticalIntelligence.com

The Journal is a scientific, medical and business, multi-expert authoring environment for information syndication in domains of Life Sciences, Medicine, Pharmaceutical and Healthcare Industries, BioMedicine, Medical Technologies & Devices. Scientific critical interpretations and original articles are written by PhDs, MDs, MD/PhDs, PharmDs, Technical MBAs as Experts, Authors, Writers (EAWs) on an Equity Sharing basis.

The Editor, Justin D. Pearlman MD ME PhD MA FACC, has many different perspectives developed during the years, including:

  • Chief of Cardiology,
  • non-invasive imaging,
  • molecular biology,
  • mathematics,
  • imaging research

contributed a number of firsts:

  • non-endemic Chagas diagnosis,
  • intensity projection angiography,
  • magnetization tagging,
  • myocardial injury mapping by magnetic resonance contrast retention,
  • myocardial viability by MRI,
  • atheroma lipid liquid crystal characterization,
  • outpatient inotropic infusion therapy,
  • angiogenesis imaging,
  • multimodal in vivo stem cell imaging,
  • real-time velocity beam MRI,
  • in vivo microscopic MRI,
  • dobutamine stress echocardiography for low gradient valve disease,
  • alternative stress tests,
  • diagnostic electrocardiography in magnetic environments,
  • statistical methods to solve error propagation of large array genomics,
  • discovery of monocyte role in native coronary collateral development,
  • image tracked stem cell treatment of  heart attacks,
  • singularity editing in differential topology.

 

Preface to the Three Volume Series

Cardiovascular disease has been a leading cause of death and disability and so it has also been a major focus for intense research, development, and progress. Knowledge of the causes, risks, and best practices for management continually change. That is why a dynamic electronic living textbook presents an exciting opportunity to help you keep current with the ephemeral leading edge. This book is an outgrowth of the commitment of Leaders in Pharmaceutical Business Intelligence to present the most exciting timely and pertinent advances of our day, in a continual medium to stay fresh and up to date. We hope diverse multispecialty perspectives will help you in your quest to understand, adapt and advance the leading edge of cardiovascular disease causes, risks and best practices management.

On the Diagnosis of Cardiovascular Disease: causes, manifestations, consequences and priorities

Doctors aim to spend their time on prevention, diagnosis, and disease management. More and more the time is diverted to expanding demands for documentation and bureaucratic navigation. This article focuses on the art of diagnosis, with examples based on cardiovascular diseases. Diagnosis cannot be achieved without a knowledge of the causes (etiology) of ailments, a necessary but not sufficient component of diagnosis. The causes broadly relate to nature and nurture, how our biological system develops and functions (nature), and its interactions with the outside world driven in part by behavior, diet, exposures, and activities (nurture). The nature of our individuality has been traced to the human genome, a map of code for protein products that build our structures and mediate our body part functions. Numerous blood tests have been devised to check the expression and activity level of such genomic products to identify disease and characterize its stage. The role of diet, behavior, exposures, activities or lack thereof is well established as a complicit factor in disease development and progression.

The art of diagnosis is designed to find out what is wrong. Literally, it is a flow of knowing, based on knowledge of causes of ailments, probabilities (prevalence), consequences, manifestations, priorities (which would be most urgent) and tests: CPCMPT. Review of those elements generates a list of concerns, often expressed as a “differential diagnosis” which is  a prioritized list of plausible explanations for the observations, patient’s report of symptoms and findings from patient examination. The second stage of diagnosis, called the “work-up,” selects and applies tests to stratify the list of possibilities further as well as to characterize the manifestations and stage of disease. Technically, analysis of biological samples, imaging studies and intervention trials each represent tests; however, they are often viewed as distinct tools with just the former labeled as tests (biological samples include blood tests, urine tests, sputum or saliva samples, and biopsies). The primary goal of the work-up is to establish one or more specific diagnoses as the cause of ailment. The secondary goal of the work-up is to characterize the manifestations and stage of disease to define expectations and clarify options for the disease management. The third goal is to develop a management a plan to slow or stop the ailment, decrease risks of complications, slow or stop progression of disease manifestations or otherwise minimize functional impairment.

The manifestations of disease are categorized as signs and symptoms.

  • Signs are observable evidence of consequences,
  • Symptoms are subjective complaints.

A major component of diagnostic skill is the ability to identify and characterize correctly signs and symptoms of all relevant disease conditions. A second major component of diagnostic skill is the ability to select appropriate tests and interpret their significance in context, in keeping with the patient’s presentation.

When someone sees a doctor about chest pain, coronary artery disease is a prominent consideration. The most common causes of chest pain are mechanical (muscle and bone, e.g., muscle spasms, muscle and bone inflammation), but those conditions are not generally life-threatening. The consequences of blocked arteries – arrhythmia, permanent weakness of the heart, blood clots, pulmonary emboli, stroke, cardiogenic shock, death – raise the stakes and push coronary disease high in priority even when the probabilities are low. The prioritization of the differential diagnosis list has multiple considerations: urgency (how quickly it can worsen), severity of consequences, and the probabilities of a macrovascualar event (prevalence, risk factors). A ten percent risk of coronary disease typically takes precedence over a 70% likelihood of muscle spasm in terms of diagnostic testing.

The road map for the construction of our individuality as humans has been fully mapped: the human genome. Genetic variation means we are not fully determined by the mix of genes inherited from our parents. In addition to the genetic material on our 48 chromosomes, and the genetic material in mitochondria inherited from the mother, there are spontaneous changes in the genetic code, and there are modifications that affect gene expression (which codes produce gene products, quantities, rates, and post-production modifications).

The causes of cardiovascular disease are defined by Murphy’s law: what can go wrong will. However, on the nature side, most malfunctions are too severe to reach the light of day, so there is a limited list of disease mechanisms associated with sufficient viability to reach medical attention. Those mechanisms can be summarized by a mnemonic: diseases can develop new metals in-flame, a-fact externs generated (disease mechanisms: congenital, developmental, neoplastic, metabolic, inflammatory, infectious, extrinsic (e.g. stab wound), and degenerative). A taxonomy of cardiovascular diseases can be constructed in various ways: (1) itemize the major cardiovascular functions and subclassify the dysfunctions, (2) itemize by principle anatomic involvement and subclassify by pathology, (3) classify by mechanism of disease, etiology. Compendiums of cardiovascular disease may be found in: (1) French’s Differential Diagnosis, (2) Robbins and Angel Pathology, (3) Guyton’s Textbook of Physiology, as well as cardiovascular disease textbooks such as Hurst, Braunwald, Mayo Clinic, Cleveland Clinic…

Diagnosis takes many forms. The paranoid inclusive approach, manifested as “medical student syndrome”, considers any semblance of a sign or symptom vaguely similar to a disease manifestation as a frightening prospect worthy of detailed pursuit. The minimalist pragmatic approach commonly attributed to general practitioners focuses on reassurance, and pursuit of persisting complaints that match a common ailment. That approach has been summarized by the advice: when you hear hoof beats think of horses, not zebras. Specialists, on the other hand, are taught to consider all possibilities, with due consideration to urgency and treatability, so that zebras are not punished.

The healthcare system promotes the idea of generalists serving as the front line, identifying who can be managed simply, with specialists serving as finishers for more complex cases or cases requiring special skills. A flaw in that model is the need for detailed knowledge of zebras and subtle findings that may represent an urgent issue at the front line for triage. If the generalist does not know that mild symptoms from mitral valve disease or aortic valve disease may require urgent detailed assessment, patients may be referred to a specialist too late to prevent consequences that requires an earlier intervention.

Parsimony in diagnosis refers to identifying the fewest number of diagnoses that explain all the findings. The concept has been attributed to Osler, and it builds on a guiding procedure voiced in the middle ages by Occum, known as Occum’s razor: when deciding between two explanations, favor the one that requires the fewest assumptions. Parsimony is a useful guide for diagnosis of a previously healthy patient who develops a number of findings that are temporally coherent. After age 65 (official geriatrics age), physicians are taught to abandon parsimony and expect more diagnoses than findings.

A study of difficult diagnoses lead to the concept of a pivotal finding as one that has a narrow differential list. The diagnostic process is prone to errors, including cognitive biases, which may benefit from computer assistance. Intuition and analytics can be applied to reduce cognitive bias. The author developed a just-in-time social networking system within a software package called Missive(c) that enables rapid access to such tools, combining efficiency in documentation with improved quality of analysis and reports (faster and better).

Among older Americans, more are hospitalized for heart failure than for any other medical condition (diastolic failure=stiff heart, systolic failure= inadequate pumping).

Genomics – the study of the genetic basis for disease – is rapidly expanding knowledge about etiology (cause of disease), and it helps identify opportunities for accurate diagnosis and treatment. The American Heart Association journal CIRCULATION has published 348 relevant articles related to cardiovascular genomics from 2010-2013.  For example, just on the subtopic of atherosclerosis (hardening of arteries), genomics offers major progress. The genetic factors that affect arterial stiffness are strongly related to a very common underlying health concern, hypertension (high blood pressure). The counterpart to genetics is environment (nature versus nurture), but genetics carries the trump cards because it determines the sensitivities to environment.

anatomy

physiology

laboratory tests

interventional trials

Boundaries of the Domain: Cardiovascular Diseases: Causes, Risks and Management – Volume 1,2,3

 

The scope of cardiovascular disease scholarly contributions will grow to include: anatomy, surgery, molecular biology, ethics, imaging (echo, nuclear, PET, MRI, OCT, CT), congenital, stress tests, ECG, electrophysiology/rhythm/channelopathies, pacing, resynchronizing, AICD, cardiomyopathies, syncope, valve disease, aorta, renal artery, thrombosis, venous diseases, vasculitis, endothelium, metabolic syndrome, dyslipidemia, risk factors, biomarkers, hypertension, embolism, pulmonary hypertension, cardiac tumors, women’s health, CAD, Angina,  Stem cells, complications of MI, thrombolysis, rehabilitation, reflexes, hormones, diastology, pharmaceuticals, myocarditis, hypertrophy, failure, shock, hemodynamics, interventions, contrast nephropathy, and contrast systemic fibrosis, as well as other relevant topics you may suggest.

An overview of the Core Research on Cardiovascular Diseases is based on the following NINE articles: 

Have only the article title as a live link of the following 9 [originally were on CVD Zero, title and links, now only links]

  1. https://pharmaceuticalintelligence.com/2013/05/15/diagnosis-of-cardiovascular-disease-treatment-and-prevention-current-predicted-cost-of-care-and-the-promise-of-individualized-medicine-using-clinical-decision-support-systems-2/ 
  2. https://pharmaceuticalintelligence.com/2013/05/04/cardiovascular-diseases-decision-support-systems-for-disease-management-decision-making/ 
  3. https://pharmaceuticalintelligence.com/2013/03/07/genomics-genetics-of-cardiovascular-disease-diagnoses-a-literature-survey-of-ahas-circulation-cardiovascular-genetics-32010-32013/
  4. https://pharmaceuticalintelligence.com/2013/05/17/synthetic-biology-on-advanced-genome-interpretation-for-gene-variants-and-pathways-what-is-the-genetic-base-of-atherosclerosis-and-loss-of-arterial-elasticity-with-aging/ 
  5. https://pharmaceuticalintelligence.com/2013/05/11/arterial-elasticity-in-quest-for-a-drug-stabilizer-isolated-systolic-hypertension-caused-by-arterial-stiffening-ineffectively-treated-by-vasodilatation-antihypertensives/ 
  6. https://pharmaceuticalintelligence.com/2013/05/24/imaging-biomarker-for-arterial-stiffness-pathways-in-pharmacotherapy-for-hypertension-and-hypercholesterolemia-management/ 
  7. https://pharmaceuticalintelligence.com/2013/04/28/genetics-of-conduction-disease-atrioventricular-av-conduction-disease-block-gene-mutations-transcription-excitability-and-energy-homeostasis/
  8. https://pharmaceuticalintelligence.com/2013/05/07/on-devices-and-on-algorithms-arrhythmia-after-cardiac-surgery-prediction-and-ecg-prediction-of-paroxysmal-atrial-fibrillation-onset/ 
  9. https://pharmaceuticalintelligence.com/2013/05/22/acute-and-chronic-myocardial-infarction-quantification-of-myocardial-viability-fdg-petmri-vs-mri-or-pet-alone

The main points are

[bring here ONLY the INTRODUCTION and the Summary of each, THEN The EDITOR will provide perspective on the Research and the current STate of Cardiology in the US in 2013/2014]

A. Now you provide ONLY links to 

Volume #

Contributors to Volume #

eTOCS in Volume #

REPEAT A. for each Volume

Volume One: Causes of Cardiovascular Diseases

Table of Contents

Hardening of the arteries is described as atherosclerosis, or porridge-like wall changes with scarring, which leads to heart attacks, high blood pressure, stroke, and organ injury mediated by ischemia (insufficient nutrient blood supply). The causes are both nature (genetic) and nurture (behavior, diet). Specifics of the causes guide diagnosis and management.

Chapter 1.2: Genomics

The completion of the human genome map was a major accomplishment, as gene products make signals, receptors and building blocks that establish health and disease. However, it is just a stepping stone, not explaining why, where, or how the gene products are regulated and  interact.

Chapter 1.3: Cardiovascular Imaging

Imaging applies a principle of physics (light transmission, sound transmission, xray transmission, magnetic resonance, radioactivity) to provide a map of interior structures and/or activities. Image processing (computing) derives further information than simple display of an observed tissue-sensitive parameter. In the case of computed tomography (CT), magnetic resonance (MRI), positron-emission tomography (PET), and single-photon emission tomography (SPECT),  computer reformatting of image data is essential.

Volume Two: Risk Assessment of Cardiovascular Diseases

Contributors

Table of Contents

Cardiovascular disease is the leading cause of death and disability, affecting more than four times as many people as all forms of cancer combined.

Chapter  2.2: Testing for cardiovascular risk

The volunteer population of Framingham Massachusetts provided decades of data clarifying determinants of risk for cardiovascular diseases. That data helped establish the usefulness of cholesterol screening, and lead to the search for additional tests to identify risk and guide management.

Chapter 2.3: Biomarkers

Biomarkers are chemistry levels (concentrations in the blood) that identify injury or risk for injury.

Volume Three: Management of Cardiovascular Diseases

Contributors

Chapter  3.1: Therapeutic Genomics

As the mysteries of the human genome products are unraveled, we get closer to identifying key components. One of them is Thymosin beta 4 (Tβ4) , which plays an essential role in cardiac and blood vessel development and regeneration. It may lead to breakthroughs in angiogenesis and vasculogenesis, or new vessel development, mimicking the behavior of the lucky few who develop new vessels, or collaterals, as a natural bypass system, without requiring a surgeon to provide a blood supply to avoid or limit heart attacks.

Chapter 3.2: Image guidance of Therapy

The US government is helping to sponsor new imaging methods, while they also inhibit it by adding new taxes.

Chapter 3.3: Drug therapy

Emerging new therapies are presented, along with the biological basis.

Chapter 3.4: Cardiovascular Interventions

Technological advances enable minimally invasive solutions to problems previously addressed by surgery or autopsy.

Introduction 

 

Contributors above, need a LINK to the appropriate contributors in each volume. Table of Contents of each volume above need a LINK to the eTOCS of each volume.  

Please UPDATE all links ABOVE to the appropriate locations in the respective volumes, after implementing the carry over, remove links below EXCEPT CVD1,2,3 and remove this comment of mine in RED, here

REFERENCES for CVD CORE

A.  Diagnosis of Cardiovascular Disease and Cost of Care

Bernstein, HL and A. Lev-Ari 5/15/2013 Diagnosis of Cardiovascular Disease, Treatment and Prevention: Current & Predicted Cost of Care and the Promise of Individualized Medicine Using Clinical Decision Support Systems

https://pharmaceuticalintelligence.com/2013/05/15/diagnosis-of-cardiovascular-disease-treatment-and-prevention-current-predicted-cost-of-care-and-the-promise-of-individualized-medicine-using-clinical-decision-support-systems-2/ 

B. Cardiovascular DiseasesDisease Management Decision Making – use of CDSS

Pearlman, JD and A. Lev-Ari 5/4/2013 Cardiovascular Diseases: Decision Support Systems for Disease Management Decision Making

https://pharmaceuticalintelligence.com/2013/05/04/cardiovascular-diseases-decision-support-systems-for-disease-management-decision-making/ 

C. Genomics & Genetics of Cardiovascular Disease Diagnoses

Lev-Ari, A. and L H Bernstein 3/7/2013 Genomics & Genetics of Cardiovascular Disease Diagnoses: A Literature Survey of AHA’s Circulation Cardiovascular Genetics, 3/2010 – 3/2013

https://pharmaceuticalintelligence.com/2013/03/07/genomics-genetics-of-cardiovascular-disease-diagnoses-a-literature-survey-of-ahas-circulation-cardiovascular-genetics-32010-32013/

D.  Genetic Base of Atherosclerosis and Loss of Arterial Elasticity with Aging

Lev-Ari, A. 5/17/2013 Synthetic Biology: On Advanced Genome Interpretation for Gene Variants and Pathways: What is the Genetic Base of Atherosclerosis and Loss of Arterial Elasticity with Aging

https://pharmaceuticalintelligence.com/2013/05/17/synthetic-biology-on-advanced-genome-interpretation-for-gene-variants-and-pathways-what-is-the-genetic-base-of-atherosclerosis-and-loss-of-arterial-elasticity-with-aging/ 

E.  Hypertension and Vascular Compliance: 2013 Thought Frontier – An Arterial Elasticity Focus

Pearlman, JD and A. Lev-Ari 5/11/2013 Hypertension and Vascular Compliance: 2013 Thought Frontier – An Arterial Elasticity Focus

https://pharmaceuticalintelligence.com/2013/05/11/arterial-elasticity-in-quest-for-a-drug-stabilizer-isolated-systolic-hypertension-caused-by-arterial-stiffening-ineffectively-treated-by-vasodilatation-antihypertensives/ 

F.  Arterial Stiffness: Pharmacotherapy for Hypertension and Hypercholesterolemia Management

Pearlman, JD and A. Lev-Ari 5/24/2013 Imaging Biomarker for Arterial Stiffness: Pathways in Pharmacotherapy for Hypertension and Hypercholesterolemia Management

https://pharmaceuticalintelligence.com/2013/05/24/imaging-biomarker-for-arterial-stiffness-pathways-in-pharmacotherapy-for-hypertension-and-hypercholesterolemia-management/ 

G. Genetics of Conduction Disease

Lev-Ari, A. 4/28/2013 Genetics of Conduction Disease: Atrioventricular (AV) Conduction Disease (block): Gene Mutations – Transcription, Excitability, and Energy Homeostasis

https://pharmaceuticalintelligence.com/2013/04/28/genetics-of-conduction-disease-atrioventricular-av-conduction-disease-block-gene-mutations-transcription-excitability-and-energy-homeostasis/

H.  Arrhythmia after Cardiac Surgery Prediction and ECG Prediction of Paroxysmal Atrial Fibrillation Onset

Pearlman, JD and A. Lev-Ari 5/7/2013 On Devices and On Algorithms: Arrhythmia after Cardiac Surgery Prediction and ECG Prediction of Paroxysmal Atrial Fibrillation Onset

https://pharmaceuticalintelligence.com/2013/05/07/on-devices-and-on-algorithms-arrhythmia-after-cardiac-surgery-prediction-and-ecg-prediction-of-paroxysmal-atrial-fibrillation-onset/ 

I.  Myocardial Infarction: Quantification of Myocardial Perfusion Viability

Pearlman, JD and A. Lev-Ari 5/22/2013 Acute and Chronic Myocardial Infarction: Quantification of Myocardial Perfusion Viability – FDG-PET/MRI vs. MRI or PET alone

https://pharmaceuticalintelligence.com/2013/05/22/acute-and-chronic-myocardial-infarction-quantification-of-myocardial-viability-fdg-petmri-vs-mri-or-pet-alone/

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Curator: Aviva Lev-Ari, PhD, RN

We covered the Elevated Blood Pressure and High Adult Arterial Stiffness in the following articles on this Open Access Online Scientific Journal:

Pearlman, JD and A. Lev-Ari 5/24/2013 Imaging Biomarker for Arterial Stiffness: Pathways in Pharmacotherapy for Hypertension and Hypercholesterolemia Management

https://pharmaceuticalintelligence.com/2013/05/24/imaging-biomarker-for-arterial-stiffness-pathways-in-pharmacotherapy-for-hypertension-and-hypercholesterolemia-management/

Lev-Ari, A. 5/17/2013 Synthetic Biology: On Advanced Genome Interpretation for Gene Variants and Pathways: What is the Genetic Base of Atherosclerosis and Loss of Arterial Elasticity with Aging

https://pharmaceuticalintelligence.com/2013/05/17/synthetic-biology-on-advanced-genome-interpretation-for-gene-variants-and-pathways-what-is-the-genetic-base-of-atherosclerosis-and-loss-of-arterial-elasticity-with-aging/

Bernstein, HL and A. Lev-Ari 5/15/2013 Diagnosis of Cardiovascular Disease, Treatment and Prevention: Current & Predicted Cost of Care and the Promise of Individualized Medicine Using Clinical Decision Support Systems

https://pharmaceuticalintelligence.com/2013/05/15/diagnosis-of-cardiovascular-disease-treatment-and-prevention-current-predicted-cost-of-care-and-the-promise-of-individualized-medicine-using-clinical-decision-support-systems-2/

Pearlman, JD and A. Lev-Ari 5/11/2013 Hypertension and Vascular Compliance: 2013 Thought Frontier – An Arterial Elasticity Focus

https://pharmaceuticalintelligence.com/2013/05/11/arterial-elasticity-in-quest-for-a-drug-stabilizer-isolated-systolic-hypertension-caused-by-arterial-stiffening-ineffectively-treated-by-vasodilatation-antihypertensives/

Pearlman, JD and A. Lev-Ari 5/7/2013 On Devices and On Algorithms: Arrhythmia after Cardiac Surgery Prediction and ECG Prediction of Paroxysmal Atrial Fibrillation Onset

https://pharmaceuticalintelligence.com/2013/05/07/on-devices-and-on-algorithms-arrhythmia-after-cardiac-surgery-prediction-and-ecg-prediction-of-paroxysmal-atrial-fibrillation-onset/

Pearlman, JD and A. Lev-Ari 5/4/2013 Cardiovascular Diseases: Decision Support Systems for Disease Management Decision Making

https://pharmaceuticalintelligence.com/2013/05/04/cardiovascular-diseases-decision-support-systems-for-disease-management-decision-making/

Lev-Ari, A. 5/29/2012 Triple Antihypertensive Combination Therapy Significantly Lowers Blood Pressure in Hard-to-Treat Patients with Hypertension and Diabetes

https://pharmaceuticalintelligence.com/2012/05/29/445/

Lev-Ari, A. 12/31/2012 Renal Sympathetic Denervation: Updates on the State of Medicine

https://pharmaceuticalintelligence.com/2012/12/31/renal-sympathetic-denervation-updates-on-the-state-of-medicine/

Manuela Stoicescu, MD, PhD, 2/9/2013 An Important Marker of Hypertension in Young Adults

https://pharmaceuticalintelligence.com/2013/02/09/an-important-marker-of-hypertension-in-young-adults/

Manuela Stoicescu, MD, PhD, 2/9/2013 Arterial Hypertension in Young Adults: An Ignored Chronic Problem

https://pharmaceuticalintelligence.com/2013/02/09/arterial-hypertension-in-young-adults-an-ignored-chronic-problem/

We present below, a new study on whether elevated pediatric BP could predict high PWV in adulthood and if there is a difference in the predictive ability between the standard BP definition endorsed by the National High Blood Pressure Education Program and the recently proposed 2 simplified definitions.

Simplified Definitions of ElevatedPediatric Blood Pressure and High Adult Arterial Stiffness

  1. Heikki Aatola, MDa,
  2. Costan G. Magnussen, PhDb,c,
  3. Teemu Koivistoinen, MD, MSca,
  4. Nina Hutri-Kähönen, MD, PhDd,
  5. Markus Juonala, MD, PhDb,e,
  6. Jorma S.A. Viikari, MD, PhDe,
  7. Terho Lehtimäki, MD, PhDf,
  8. Olli T. Raitakari, MD, PhDb,g, and
  9. Mika Kähönen, MD, PhDa

+Author Affiliations


  1. aDepartments of Clinical Physiology,

  2. dPediatrics, and

  3. fClinical Chemistry, Fimlab Laboratories, University of Tampere and Tampere University Hospital, Tampere, Finland;

  4. eDepartments of Medicine, and

  5. gClinical Physiology and Nuclear Medicine, and

  6. bthe Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Turku University Hospital, Turku, Finland; and

  7. cMenzies Research Institute Tasmania, University of Tasmania, Tasmania, Australia

ABSTRACT

OBJECTIVE: The ability of childhood elevated blood pressure (BP) to predict high pulse wave velocity (PWV), a surrogate marker for cardiovascular disease, in adulthood has not been reported. We studied whether elevated pediatric BP could predict high PWV in adulthood and if there is a difference in the predictive ability between the standard BP definition endorsed by the National High Blood Pressure Education Program and the recently proposed 2 simplified definitions.

METHODS: The sample comprised 1241 subjects from the Cardiovascular Risk in Young Finns Study followed-up 27 years since baseline (1980, aged 6–15 years). Arterial PWV was measured in 2007 by whole-body impedance cardiography.

RESULTS: The relative risk for high PWV was 1.5 using the simple 1 (age-specific) definition, 1.6 using the simple 2 (age- and gender-specific) definition, and 1.7 using the complex (age-, gender-, and height-specific) definition (95% confidence interval: 1.1–2.0, P = .007; 1.2–2.2, P = .001; and 1.2–2.2, P = .001, respectively). Predictions of high PWV were equivalent for the simple 1 or simple 2 versus complex definition (P = .25 and P = .68 for area under the curve comparisons, P = .13 and P = .35 for net reclassification indexes, respectively).

CONCLUSIONS: Our results support the previous finding that elevated BP tracks from childhood to adulthood and accelerates the atherosclerotic process. The simplified BP tables could be used to identify pediatric patients at increased risk of high arterial stiffness in adulthood and hence to improve the primary prevention of cardiovascular diseases.

Key Words:

  • blood pressure
  • pediatrics
  • prehypertension
  • screening
  • stiffness
  • Abbreviations:
    AUC —
    area under receiver-operating characteristic curve
    BP —
    blood pressure
    CVD —
    cardiovascular diseases
    NHBPEP —
    National High Blood Pressure Education Program
    NPV —
    negative predictive value
    NRI —
    net reclassification improvement
    PPV —
    positive predictive value
    PWV —
    pulse wave velocity
  • Accepted March 12, 2013.

http://pediatrics.aappublications.org/content/early/2013/06/05/peds.2012-3426.abstract?sid=1755f2a0-4e03-4bc8-a563-23458d9dc988

Kids’ High BP Tied to Arterial Stiffness as Adults

By Todd Neale, Senior Staff Writer, MedPage Today

Published: June 10, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

High blood pressure in childhood defined in three different ways was associated with high pulse wave velocity — a surrogate marker for cardiovascular disease — 27 years later, researchers found.

The relationship remained significant whether high blood pressure was identified using a complex definition that incorporated age, sex, and height or one of two simplified definitions (relative risk 1.5 to 1.7), according to Mika Kähönen, MD, PhD, of Tampere University Hospital in Finland, and colleagues.

The predictive ability of the two simplified definitions was comparable to that of the more complex definition, the researchers reported online in Pediatrics.

In guidelines published in 2004, the National High Blood Pressure Education Program recommended screening blood pressure at all pediatric visits starting at age 3. The document provides definitions for normal, prehypertensive, and hypertensive blood pressure levels according to age, sex, and height. But including all three of those factors results in hundreds of blood pressure thresholds for patients up to age 17.

Recently, two simplified definitions have been proposed — one that relies only on age and sex and reduces the number of blood pressure thresholds to 64 and another that relies on age alone and reduces the number of thresholds to 10.

“Our results support the previous finding that elevated blood pressure tracks from childhood to adulthood and accelerates the atherosclerotic process,” they wrote. “The simplified blood pressure tables could be used to identify pediatric patients at increased risk of high arterial stiffness in adulthood and hence to improve the primary prevention of cardiovascular diseases.”

“This complex definition could at least partly explain the poor diagnosis of prehypertension and hypertension in children and adolescents reported previously,” Kähönen and colleagues wrote.

The researchers explored the relationship between high blood pressure in childhood and high pulse wave velocity, which is a measure of arterial stiffness, in adulthood, as well as whether the definition of high blood pressure mattered, using 1,241 participants from the Cardiovascular Risk in Young Finns Study.

The participants were 6- to 15-years-old (mean age 10.7) at baseline in 1980. The researchers followed them for 27 years, at which point arterial pulse wave velocity was measured using whole-body impedance cardiography.

At baseline, the percentage of participants who had high blood pressure was 53.9% according to the definition based on age, 57.8% according to the definition based on age and sex, and 43.2% according to the more complex definition recommended in the guidelines.

At the 27-year follow-up assessment, 20% of the participants had a high pulse wave velocity. Compared with those with a low pulse wave velocity, these individuals had significantly higher blood pressure values and higher rates of elevated blood pressure at baseline. The differences widened at the adult follow-up.

Elevated pediatric blood pressure was associated with a greater risk of having a high pulse wave velocity for all three definitions used in the study:

  • Age-based: RR 1.5, 95% CI 1.1-2.0
  • Age- and sex-based: RR 1.6, 95% CI 1.2-2.2
  • Age-, sex-, and height-based: RR 1.7, 95% CI 1.2-2.2

The predictive ability of the definitions were not different from one another, as illustrated by a lack of significant differences when comparing area under the receiving-operating characteristic curves and net reclassification indexes (P>0.1 for all comparisons).

“This finding is clinically meaningful because both these simplified tables could be more easily implemented as a screening tool in pediatric healthcare settings and outside of a physician’s office when the height percentile required for the complex definition may not be obtainable,” the authors wrote.

They acknowledged that their study was potentially limited in that the method for measuring pulse wave velocity is not commonly used in epidemiologic settings. In addition, there could have been bias stemming from participants dropping out during follow-up and generalizability of the findings may be limited to white European individuals.

The study was supported by the Academy of Finland, the Social Insurance Institution of Finland, the Turku University Foundation, the Medical Research Fund of Kuopio University Hospital, the Medical Research Fund of Tampere University Hospital, the Turku University Hospital Medical Fund, the Emil Aaltonen Foundation, the Juha Vainio Foundation, the Finnish Foundation of Cardiovascular Research, the Finnish Cultural Foundation, and The Tampere Tuberculosis Foundation.

The authors reported no conflicts of interest.

From the American Heart Association:

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FUNDING: Supported by the Academy of Finland (grants 77841, 117832, 201888, 121584, and 126925); the Social Insurance Institution of Finland; the Turku University Foundation; the Medical Research Fund of Kuopio University Hospital; the Medical Research Fund of Tampere University Hospital; the Turku University Hospital Medical Fund; the Emil Aaltonen Foundation (T. Lehtimäki); the Juha Vainio Foundation; the Finnish Foundation of Cardiovascular Research; the Finnish Cultural Foundation; and The Tampere Tuberculosis Foundation.

Aatola H, et al “Simplified definitions of elevated pediatric blood pressure and high adult arterial stiffness” Pediatrics2013; DOI: 10.1542/peds.2012-3426.

 

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An Important Marker of Hypertension in Young Adults: Plasma Renin

Author: Manuela  Stoicescu, MD, PhD

Original research

Manuela  Stoicescu, MD, PhD

Consultant Internal Medicine, Assistant Professor

 Faculty of Medicine and Pharmacy, Medical Disciplines Department

University of Oradea,  Romania

ABSTRACT

Introduction:  Plasma renin level is an important marker of hypertension in the young adults. The purpose of this study was to determine the role of increased levels of plasmatic renin in the pathogenesis of hypertension in the young adults and to highlight the main conditions underlying the pathogenesis of hypertension in the young people in these circumstances.

Material and methods: The group of patients taking part in the study was of 121 young hypertensive adults (selected from a group of 321 young hypertensive adults), with the age between 18-35 years, with elevated blood pressure exceeding 140/90mmHg in at least three repeated measurements at intervals of one week to exclude white coat phenomenon, or had a blood pressure value greater than 170/100mmHg at the first measurement and increased plasma renin levels above the 4,3ng/ml.

Results and discussion: Of the 121 young hypertensive patients with increased plasma renin levels, 49 were cases of renal artery stenosis representing 40.50% (p<0.001), 8 cases were represented by small unilateral kidneys representing 6.61% (p<0.001), renal cell carcinoma (previously known as “hypernephron” – Grawitz tumor) was responsible for the younger group of patients studied of 4 cases representing 3.30% (p <0.001) of the cases of hypertension in the young adults, and 60 cases representing 49.59% were represented by pheochromocytoma.

Conclusions: The results show the role of plasma renin dosing as being particularly important in the pathogenesis of secondary hypertension in the young adults

Keywords: Renin, arterial hypertension (HBP), young adults

INTRODUCTION

Renin is an enzyme secreted by the juxtaglomerular apparatus to maintain electrolyte balance and blood pressure in the appropriate limits. Plasma renin level is an important marker of hypertension in the young adults. The purpose of this study was to determine the role of increased levels of plasma renin in the pathogenesis of hypertension in the young adults and highlight the main conditions underlying the pathogenesis of hypertension in the young adults with increased plasmatic renin. The principal diseases which had increased plasma renin levels were: renal artery stenosis, pheochromocytoma, congenital unilateral small kidney, primary reninoma (renal cell carcinoma or Grawitz tumor), situations in which renin is secreted in excess, the highest values being in cases of renal cell carcinoma, of 320ng/ml.

MATERIAL AND METHODS

The group of patients taking parts in the study was of 121 hypertensive young adults, with the ages between 18-35 years with elevated blood pressure over 140/90mmHg in at least three repeated measurements at intervals of one week to exclude white coat phenomenon frequently encountered in the young, or had a severely increased blood pressure of  >170/100mmHg on the first measurement and plasma renin levels greater than 4,3 ng/ml.

Parameters for assessment of the diseases which had increased plasma rennin levels were clinical, radiological, biological and histopathological. The study was done after the diagnosis of hypertension and staging according OMS. All patients were investigated clinically and fully analyzed paraclinically. They agreed to participate in the trial after they were explained the criteria of professional ethics, scientific and terms of confidentiality. All patients participating in the study had plasmatic renin levels above 4.3ng /ml. The statistical analysis was done with the help of EPIINFO application, version 6.0, program of the Center for Disease Control and Prevention-CDC in Atlanta, suitable for processing of medical statistics. Averages were calculated for the parameters, frequency ranges, standard deviations, tests of statistical significance by Student method (t test) and χ ².

RESULTS

The group of young hypertensive patients with ages 18-35 years, with elevated blood pressure >140/90mmHg, with increased plasma renin levels over 4.3ng/ml we found 49 cases of renal artery stenosis representing    40.50%, 8 cases of congenital small kidney representing 6.61%, 4 cases of Grawitz tumors (renal cell carcinoma) representing 3.30% and 60 cases of pheochromocytoma representing 49.59%. Table No.1

Table 1. The main conditions that were present in the group of young hypertensive patients with increased plasma renin level.

Diseases

No. of cases

Percentage of cases [%]

Vascular pathology

Renal artery stenosis

49

40.50%

Renal parenchymatous pathology

Congenital small kidney

8

6.61%

Renal carcinoma

(Gravitz tumor)

4

3.30%

Pheochromocytoma

60

49.59%

The positive criteria’s of diagnostic for the diseases were included in the study was:

I. Renal artery stenosis

  1. The increased value of diastolic blood pressure over 110mmHg.
  2. Paraombilical systolic murmur.
  3. Imaging of arteriography.
  4. Increased plasmatic renin level > 4.3 ng / ml.

II. Congenital small kidney

  1. Values of  blood pressure over 140/90mmHg.
  2. Arteriography – put in evidence the small kidney
  3. The abdominal MRI
  4. Increased plasmatic renin level > 4.3 ng / ml.

III. Renal carcinoma (Gravitz tumor)

  1. Unilateral lumbar pain
  2. Loss of appetite
  3. Weight loss
  4. Macroscopic hematuria (blood in the urine)
  5. The value of plasma rennin level increased > 4.3ng /ml, mentioning that in this situation the plasma renin values reached the highest values up to 320ng/ml
  6. The abdominal MRI
  7. The renal biopsy

IV. Pheochromocytoma

  1. The paroxysmal outbursts of severe blood pressure over 220/120mmHg
  2. Headache
  3. Tremor of extremities
  4. Nervousness
  5. Increased serum catecholamine levels above 260pg/ml
  6. Increased urinary catecholamine values above the 7.4 mg/24 hrs
  7. Increased plasmatic renin level > 4.3 ng/ml.
  8. The abdominal MRI used in the detection of adrenal tumors .

Table 2. Diagnostic criteria’s met by patients

Diseases

No. of cases

Diagnostic criteria’s met by patients

Vascular pathology

Renal artery stenosis

49

24 cases      4 of 4

25 cases      3 of 4

Renal parenchymatous pathology

Congenital small kidney

8

 

8 cases      4 of 4

 

Renal carcinoma

(Gravitz tumor)

4

2 cases       7 of 7

2 cases       6 of 7

Pheochromocytoma

60

38 cases      8 of 8

12 cases      7 of 8

10 cases      6 of 8

Of the group of young hypertensive patients studied with increased plasma renin activity, 49 of the cases were renal artery stenosis representing 40.50% (p <0.001). The parameters of the clinical assessment were the increased value of diastolic blood pressure over 110mmHg, paraombilical systolic murmur and an imaging of arteriography. Figure 1.

AN1-1

Figure 1. Arteriography of the right renal artery stenosis (M.I. aged 21 years with HBP = 170/120mmHg)

Of the group of young patients participating in the study, we found 8 cases of unilateral small kidney representing 6.61% (p<0.001). The pathogenic mechanism of hypertension was ischemic, in that all cases arterial high blood pressure evolved along with hyperreninemia in congenital unilateral small kidney. The early diagnosis of renal disease is very important, in the best cases before the hypertension causes severe nephroangiosclerosis on the contralateral kidney, leading to nephrectomy which then can then lead to the disappearance of hypertension. The parameters of assessment in this case were the clinical blood pressure values above 140/90mmHg, imaging methods to put in evidence the small kidney: arteriography Figure2 abdominal MRI Figura3 and biological-increased plasmatic renin activity> 4.3 ng / ml.

AN2-1

Figure2. Arteriography evidence the congenital small left kidney (D.R. of 19 years old with HBP = 165/110mmHg)

AN3-1

Figure 3. MRI – scan with contrast substance putting in evidence the left renal hypoplasia (D.R. of 19 years old with HBP = 165/110mmHg)

Renal cell carcinoma (renal carcinoma, previously “hypernephroma” – Grawitz tumor) was responsible for the younger group of patients studied, 4 cases representing 3,30% (p<0.001) of the HBP young cases. All had severely elevated blood pressure values over 200/100mmHg. The diagnostic was based on clinical parameters: unilateral lumbar pain, loss of appetite, weight loss, but only two cases had macroscopic hematuria (blood in the urine), biological – the value of increased plasma rennin level > 4.3ng /ml, mentioning that in this situation the plasma renin values reached the highest values up to 320ng/ml. Imaging parameters are represented in the abdominal MRI by Figure 4.

AN4-1

Figure 4. MRI-scan with bilateral renal tumor (F.R.of 34 years with malignant HBP=220/130mmHg — worked with pesticides)

Histopathological parameters were put into evidence in all four cases in which renal biopsy was performed and the histopathological results of which are outlined below:

Two cases were clear cell renal carcinoma based on the histopathology results after renal biopsy – histological preparation with H&E staining with the objective of 10X is shown in (Figure 5a) and (Figure 5b)

AN5a

Figure 5a. Clear cell renal carcinoma (objective 10x) – H&E stain (M.I. 21 years with paroxysmal HBP=200/110mmHg)

AN5b

Figure 5b. Clear cell renal carcinoma (objective 10x) – H&E stain (P.R. 28 years with severe form HBP=210/110mmhHg)

The other two cases of renal carcinoma are represented in the following H&E stained images, after the renal biopsy (Figure 6) and (Figure 7).

AN6

Figure 6. Renal carcinoma (objective 10x). H & E stain (I.G. 31 years with paroxysmal HBP=210/115 mmHg)

AN7

Figure 7. Renal carcinoma (objective 10x). H & E stain (F.R. 34 years with malignant HBP=220/130mmHg — worked with pesticides)

Hypertension in the young patients with renal cell carcinoma took the form of severe paroxysmal HBP=200/110mmHg or above in all four cases, due to excessive secretion of renin produced in large quantities by the tumor and it was the one form which attracted most the clinical attention when it was not manifested by macroscopic hematuria.

Of the group of hypertensive young adults studied, 60 of the cases were of pheochromocytoma representing 49.59%.

The diagnostic criteria used in this clinical situation were: paroxysmal outbursts of severe blood pressure values over 220/120mmHg accompanied by headache, tremor of extremities, nervousness, biological parameters represented by increased serum catecholamine levels above 260pg/ml, increased urinary catecholamine values above the 7.4 mg/24 hrs, imaging parameters which were used in the detection of adrenal tumors by performing an abdominal MRI. Figure 8.

AN8-1

Figure 8. Abdominal MRI-scan with pheochromocytoma of the right adrenal gland (G.R. 24 years with paroxysmal HBP=220/130mmHg)

DISCUSSIONS

The importance of this study was to measure the level of plasma renin of hypertensive young patients with ages between 18-35 years to determine its role in the pathogenesis of secondary hypertension in the young adults. Also the conditions in which plasma renin level is increased in the context of secondary hypertension in the young patients.

Renovascular hypertension was one of the important causes of secondary hypertension in the young, its frequency in the group of patients studied was of 49 cases with renal artery stenosis representing 40.50% (p <0.001), in all these cases the renin plasma level was increased above 4,3ng/ml.
Safian R.D. and Textor S.C. [1] found the frequency of renal artery stenosis in a group of young hypertensive patients with increased plasma renin activity, as being 42.36%, which is slightly higher than in our study, this difference could be explained by a better paraclinical investigation of the young patients with hypertension.

Of the group of young hypertensive patients participating in the study we found 8 cases of unilateral congenital small kidney, representing 6.61% (p<0.001).
Goddard C, et al. [2] found that the incidence of hypertension in young people with kidney hypoplasia was 25%. They suggested that the renin-angiotensin-aldosterone system plays an important role in the pathogenesis of hypertension in the situation of renal hypoplasia. This difference could be explained by the fact that young patients in other countries had an increased teratogenic risk compared with the young in our country.
Renal cell carcinoma (Grawitz tumor) was responsible for the younger group of patients studied, 4 cases representing 3.30% (p<0.001) of all the young hypertensive patients. Two cases were clear cell renal cell carcinoma histopathology analyzed after a renal biopsy. The data obtained are slightly lower than those in the literature (5%) Sukarochana [3] and (4%) Gangurly [4]. This difference could be explained by the fact that our country carcinogenic risk factors are lower.

Rose HJ, Pruitt AW [5] reported the case of a young patient with severe hypertension of 190/110mmHg, which after further investigations had found increased plasma renin levels and after paraclinical investigations a solitary simple kidney cyst was found.

DW Robertson et al. [6] reported the case of a young man who had elevated blood pressure (HBP=180/120mmHg) and after investigations increased plasma renin level was found and a left renal tumor (primary reninoma) was found, whose blood pressure values were normalized after tumor resection.

Pheochromocytoma was found in 60 of the cases representing 49.59% of cases of the young hypertensive adults.

Abrams HL [7] found that the incidence of pheochromocytoma in the young hypertensive cases was 21.03%, Bravo EL [8] found 42.38% cases of pheochromocytoma, and Bravo EL, Gifford RWJr [9] 46.03 % of young hypertensive patients with pheochromocytoma. These results are lower than those obtained in our study. This could be explained by the risk factors in this geographical area and dominant genetic factor has an important role in the etiology of pheochromocytoma.

CONCLUSIONS

  1. Plasmatic renin level is an important marker of hypertension in the young adults.
  2. The highest plasmatic renin levels up to 320ng/ml were found in the cases of renal cell carcinoma, because the kidney tumor cells secrete increased amounts of renin.
  3. This situation suggests that hypertension in the young adults is hyperreninemia hypertension in the most cases dominated by a vasoconstriction and increased peripheral vascular resistance due hyperactivity of the sympathetic nervous system, being a rapidly evolving form of hypertension with vascular complications.
  4. The results of plasma renin dosing shows its important role in the pathogenesis in secondary hypertension of  the young adults, these conditions are not quite as rare as one might think but not enough investigated.
  5. This marker should be routinely performed in young patients with hypertension, especially those with medium and severe forms of blood pressure > 170/100mmHg, having a role in establishing the etiology of hypertension in the young, however presently it is still not made often enough, but situation must to be change in the future.

REFERENCES:

[1]   Safian R.D, Textor S.C, Renal-artery stenosis, N Engl J Med 2001,  344(6):431-42.

[2]   Goddard C , Vallothon MB, Broyer M, Plasma rennin activity in segmental hypoplasia of kidneys with hypertension, Nephron 2003, 11:308-17.

[3]   Sukarochana K, Nephroblastoma and hypertension J Surg 2005, 7- 573.

[4]  Gangurly, Gribble J, Tune B, Kempson RL, Luetscher JA , Renin  secreting nephroblastom with severe hypertension, Ann Intern Med 2003, 79(8) 35-7.  

[5]   Rose HJ, Pruitt AW, Hypertension, hyperreninemia and a solitary renal cyst in an adolescent, Am J Med 2004, 61; 579-82.

[6]   Robertson DW, Klidjiana A, Harding KK, Walters G, Lee MR, Robb-Smith AHT, Hypertension due to a renin-secreting renal tumor, Am Med 2005, 43 (9) 63-76.

[7]   Abrams HL, Siegelman S, Adams DF,- Computed tomography versus ultrasound of the adrenal gland, A prospective study, Radiology 1982, 143-121.

[8]   Bravo EL, Pheochromocytoma: New concepts and future trends, Kidney Int 1991, 40:544-556.

[9]   Bravo EL, Gifford RWJr, Pheochromocytoma: Diagnosis, localization and management, N Engl J. Med 1984, 311-1298.

Corresponding author

Manuela Stoicescu, Internal Medicine Department, University of Oradea, Faculty of Medicine and Pharmacy, Oradea, Romania: County Hospital of Oradea, Phone 0723019951, e-mail: manuela_stoicescu@yahoo.com

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Arterial Hypertension in Young Adults: An Ignored Chronic Problem

Author: Manuela   Stoicescu, MD, PhD

Original research

Manuela   Stoicescu, MD, PhD

Consultant Internal Medicine, Assistant Professor

Faculty of Medicine and Pharmacy, Medical Disciplines Department

University of Oradea,  Romania

 

ABSTRACT

Introduction:

Don’t ignore the young patients: being young does not necessary mean being healthy.

Objectives:

The objectives in this study was to analyzed the principal clinical aspects and conduct laboratory investigations with young people in group of age 18-35 years. Attracting attention to the diagnosis of hypertension in the young in the early stages of life. I choice this topic because high blood pressure in the young, in particularly, in this group age was insufficiently studied while a high frequency of cases presented every day was continuously  increasing.

Material and method:

The study was performed in the Ambulatory Specialty of the Internal Diseases Department in the County Hospital in Oradea, Romania. Study period was  1 October 2006 to 31 July 2009. Included in the study were 321 patients with hypertension exceeding 140/90 mmHg which was maintained higher after three consecutive determinations in intervals of one week to exclude the “white coat phenomenon”, an effect noted very frequent in young people, especially in young women, because a young persons have hyperactivity of simpatico nervous systemic, or the value of blood pressure was higher more than 170/110 mmHg from first determination.

Results

1. Importance of the genetic factors in the etiologies of disease was suggests that family prevalence of hypertension in the young people and another family diseases like hyperaldosteronism, polycystic kidney and multiple endocrine neoplasias MEN2a.

2. Importance of personal pathologic antecedents demonstrated in my study that repetitive Streptococcus angina with Streptococcus β hemolytic group A originated in the first place as a cause in hypertension in the young people in context of acute streptococcal renal parenchymatous diseases.

3. Renin plasmatic level is a very important marker of high blood pressure in the young. It was high in 121 cases (37.69%). This situation suggests that hypertension in the young is hyperreninemic hypertension in many cases because a young person has a systemic hyperactivity of simpatico nervous.

4. Left ventricular hypertrophy is been detected in X-ray, ECG and echocardiography. In my studied I detected left ventricular hypertrophy in 35 patients representing 10.49%.

5. Proteinuria was represented in 96 cases (29.90%) has two meanings:

  • nephropathy complication of hypertension  or
  • acute glomerulonephritis or
  • nephritis syndrome accompaniment with hematuria 38 cases (11.83%).

6. The eye ground findings of young people with hypertension are frequently normal. In the absence of prior readings, one needs to look for evidence of target organ damage that may suggest chronicity. In my study this changes appeared for 86 cases 23.3 %, hemorrhages and exudates I rarely found in 9 cases represent 2.8% and papilla edema was presented in 2 cases even when hypertension was very severe more than 200/120 mmHg and complicate with hypertensive encephalopathy.

Conclusions: Guidelines for hypertension treatment with young patients group of ages 18-35 was developed, which I hope will help the activity of physicians in general specialties in their practice, to use for diagnosis and easy work. This is new and hypertension in the young in this group of ages was insufficiently studied.

Key words: hypertension diagnosis, young adults.


INTRODUCTION

Prior to the last twenty years it was impossible to accept the idea that hypertension and atherosclerosis begin in adolescence and even earlier in childhood. Current concepts concerning the nature of hypertension in the young are changing. Earlier clinical impressions indicated that hypertension in the young was secondary and the essential hypertension occurred only rarely.

In my recent study, involving young people, of the age group of age 18-35 year old, indicated that young with high levels of blood pressure often the cause is known and often is unknown. When high BP (HBP) is found in the young the young compared with their peers, it is  likely that the HBP will continue to Adulthood. My study has indicated that the level of blood pressure in young is closely related to the occurrence of hypertension in adulthood. Thus, changing concepts suggest that essential hypertension begins in early life. Considerable information is now known about the clinical and pathologic features of hypertension in adults.

We understand clinical diagnoses, the pathophysiology and humoral background, and the consequences of end stage renal disease (ESRD). We are even beginning to consider that essential hypertension may represent more than one disease. By contrast, little is known about the early natural development of essential hypertension. For example, how can hypertension in young be defined? We cannot equate level of blood pressure with cardiovascular damage as in adults (cardiovascular, cerebral, and renal disease). Furthermore, there is little specific information that can be used to predict development of adult hypertension. As a beginning, descriptive studies of the early natural development of essential hypertension are needed. It is logical to assume that prevention would be most successful if the disease process could be understood and treated in its earliest phase.

OBJECTIVES

      Don’t ignore the young adult patient. Being young does not necessary means being healthy. Key objectives in my study was to analyze the principal clinical aspects and laboratory tests performed on  young adults in the group age 18-35 year old, to advocate for the attention needed for diagnosis of hypertension in the young adults in the early stages of the disease.                                                                                                         

MATERIAL AND METHOD

     The study was performed in the Ambulatory Specialty of the Internal Diseases Department at the County Hospital in Oradea, Romana. Study period was  1 October 2006 to 31 July 2009. Study participants:

  • 321 young patients,
  • group of ages 18-35, patients with high blood pressure more than 140/90 mmHg
  • after three consecutive determinations in interval one week maintain higher than 140/90 mmHg to exclude the “white coat phenomenon”, effect very frequently encountered with young adults especially with young women, because young person have a hyperactivity of sympathetic nervous system, or
  • the value of blood pressure was high more than 170/110mmHg from first determination.

The patients had a comprehensive physical examination (clinical and par clinical) and diagnosed with hypertension in different stages.

The study consideration was done after having confirmed the diagnosis of hypertension and the standardization according to the phenomenon of high blood pressure and the classification of OMS.

The patients agreed to participate after being introduced in the study after they have been explained the deontological and preserving of the confidentiality criteria.

For statistics data I has been used the EPIINFO application, 6.0 version, a program of The Center of Disease Control and Prevention- Atlanta, with the Student method (test t) and χ²

RESULTS AND DISCUSSIONS

We observed that a 1/5 of the patients studied have in family antecedents of young adults hypertensive member of the family:hypertension in 70 cases (21.80%), stroke in 46 cases  (14.33%), myocardial infarction in 55 cases (17.13%), peripheral vascular disease in 23 cases ( 7.16%)  obesity 38 (11.83%), pre-eclamptic toxemia in 31 cases(9.65% ), hyperaldosteronism in 18 cases (5.60%),  polycystic kidney in 26 cases (8.09%), multiple endocrine neoplasias MEN2a in 14 cases (4.36%) Distribution of cases according to family history.  See, Table 1.

Table 1: Distribution of Cases according to Family History

Consideration

No. of cases

Percent

Hypertension for parents, grandparents, aunts, uncles and cousins

70

21.80%

Family antecedents of stroke

46

14.33 %

Family antecedents of myocardial infarction

55

17.13%

Family antecedents of peripheral vascular disease

23

7.16%

Family antecedents of obesity

38

11.83%

Pre-eclamptic toxemia

31

9.65%

Hyperaldosteronism

18

5.60%

Polycystic kidney

26

8.09%

Multiple endocrine neoplasias MEN2a

14

4.36%

A significant numbers of patients in my studies did not have any  antecedents of hypertension in their family history. That fact demonstrates that not only genetic factors have an important role in the etiology of the disease.ENvironmental factors count.

Significant number of  hypertensive young  patients had diseases in their personal history: Scarlatti in 27 (8.41%), repetitive angina with Streptococcus β hemolytic group A in 88 (27.41%), chronic ORAL infection focus in 35 (10.90%) chronic stomathological focus infections in 19 (5.91%), nephritis in 34(10.59%), endocrine disorders in 16 (4.98% ), physical and psychological in 22 (6.85%), head trauma in 11 (3.42%), therapy with corticosteroids secondary to another disease (for example erythematous systemic lupus) in 5 (1.55%),  therapy with AINS  drugs in 21 (6.54%), use decongestion nasal in 4 (1.24%) repetitive urinary tract infection in 28 (8.72%), syphilis in 11 (3.42%). See, Table II.

Table II: Distribution of Cases by Illnesses in  Personal History

Consideration

No. of cases

Percent

Scarlatti

27

8.41%

Repetitive Streptococcus angina with Streptococcus β hemolytic group A

88

27.41%

Chronic ORAL infection focus

35

10.90%

Chronic stomathological infection focus

19

5.91%

Nephritis

34

10.59%

Endocrine disorders

16

4.98%

Physical and psychical suprademanding

22

6,85%

Head  trauma

11

3,42%

Therapy with corticosteroids

5

1.55%

Therapy with AINS

21

6.54%

Use decongestion at nasal

4

1.24%

Repetitive urinary tract infections

28

8.72%

Syphilis

11

3.42%

Fig.1: Principal Diseases Etiology for Young Hypertensive Patients

HY1

Table III: Laboratory Results

Hemoglobin value ↑

18

5.60%

Hematocrit ↑

18

5.60%

Value of glucose ↑

68

21.18%

Cholesterol  ↑

78

24.29%

HDL cholesterol  ↑

86

26.79%

LDL cholesterol  ↑

77

23.67%

Triglycerides ↑

105

32.71%

Uric acid  ↑

57

17.75%

Creatinina ↑

38

11.83%

Urea ↑

36

11.21%

Serum sodium ↑

42

13.08%

Serum potassium↓

42

13.08%

Urinalysis -albuminuria+

-hematuria+

96

29.90%

38

11.83%

Urine culture with female +

104

32.29%

Table IV: Laboratory Special Tests

Rennin plasmatic↑

121

37.69%

Vanillyl Mandelic Acid testing (VMA): in urine↑

18

5.60%

Catecholamine urine↑

18

5.60%

Cortisol urine ↑

9

2.80%

Cortisolemia  ↑

9

2.80%

TSH ↑

16

4.98%

T3    ↑

16

4.98%

T4   ↑

16

4.98%

CT abdominal

114

35.51%

RMN abdominal

158

49.92%

Intravenous urogrography

102

31.77%

Observations on Eye Exam and Retinopathy [The eye ground (eye ground findings)]

Clearly, the most helpful information to have when one is attempting to establish the chronicity of hypertension is past blood pressure readings. Unfortunately, these are by no means always available since routine blood pressure measurement in young adults is not yet uniformly obtained. In the absence of prior readings, one needs to look for evidence of target organ damage that may suggest chronicity. In adolescent with even severe chronic hypertension or hypertensive encephalopathy. In my study this changes appear for the optic fund may show no more than retinal arteriolar narrowing in 103 cases represent 32.09% and arterio-venous nicking in 98 cases represent 30.53%, hemorrhages and exudates I rarely found in 9 cases represent 2.8%, papilla edema may be absent except in 2 cases even when hypertension was very severe more than 200/120 mmHg with complications of encephalopathy and in 109 cases represent 33.96 was normal result of eye ground examination. See Table V and Fig. 2

Just as there may be minimal eye ground findings, there are infrequently cardiac findings that suggest chronicity.

Table V  Distribution of Cases by Eye Exam Findings

Normal

109

33.96%

Arteriolar narrowing

103

32.09%

Arterio-venous nicking

98

30.53%

Exudates and hemorrhages

9

2.80%

Papilla edema

2

0.62%

HY2

Fig. 2: Distribution of Cases by Changes of Eye Ground Findings

The heart morphology was not clinically enlarged in many cases and the ECG and chest X-ray were usually unhelpful in detecting left ventricular hypertrophy unless hypertension has been prolonged and severe. In my studies left ventricular hypertrophy was present in 35 cases (10.49%), they are helpful in determining chronicity of hypertension and in 206 cases (64.18%) left ventricular hypertrophy was absent.  If negative suggesting nothing about the duration of hypertension. See Table VI and Fig 3

Table VI: Distribution of Cases by Changes in Chest X-Ray

Normal

206

64.18%

Elongation and elevated of left inferior arcos

99

30.85%

Cardiomegaly

12

3.73%

Aneurism of thoracic aorta

4

1.24%

HY3

Fig. 3: Distribution of Cases by Changes of chest X-Ray

The echocardiography seems to be more sensitive for evaluating chamber size and wall thickness than the ECG and can be helpful. Left atria hypertrophy and left ventricular hypertrophy (Sokolow -Lyon index) and left axial deviation was possible to detect. In my studies I found 35 cases (10.49%) with LVH, 36 cases (11.21%) with LAH and 35 cases (10.49%) with left axial deviation. Secondary changes of depolarization like ST segment sub elevated and negative T wave I found in 35 cases represent 10.49%. See Table VII and Fig. 4

Table 7: Distribution of Cases by Changes in ECG

Normal

180

56.07%

Left axial deviation> -30

35

10.90%

Left atria hypertrophy

36

11.21%

Left  ventricular hypertrophy

Sokolov -Lyon index(SV1+RV5/V6>35mm)

35

10.90%

Secondary  changes of depolarization – ST segment sub elevated  and T wave negative

35

10.90%

HY4

Fig. 4: Distribution of Cases by Changes in ECG

Table VIII:  Distribution of cases by Echocardiography of Hearth Examination

Normal

226

70.40%

Left ventricular hypertrophy

40

12.46%

Ejection fraction(FE) of left ventricular<55%

27

8.41%

Aortic coarctation

28

8.72%

HY5

Fig. 5: Distribution of cases by Changes in Echocardiography

Table IX: Distribution of Cases by Urine Analysis Results

Normal

187

58.27%

Proteinuria

96

29.90%

Hematuria

38

11.83 %

Proteinuria I detect in 96 cases (29.90%) and hematuria in 38 cases (11.83%). See Fig. 6

HY6

Fig.6: Distribution of cases by Urine Analysis Results

OMS stadialization classification high blood pressure in three stages. In my study about hypertension in the young adults,  the results are as follows:

  • Stages I:  270 cases represents 84.11%,
  • Stages II:  40 cases represents 12.46%,
  • Stages III:  9 cases (2.80%) and
  • Stage IV: malign hypertension 2 cases represents 0.62%.

See, Table IX  and Fig.7

Table IX: Distribution of Cases by Stadialization

Stages I

270

84.11%

Stages II

40

12.46%

Stages III

9

2.81%

Stages IV

2

0.62%

                                                              

HY7

Fig. 7: Distribution of Cases by Stadialization

DISCUSSION

1.   A 1/5 of group of patients studied have in family antecedents of young hypertensive family member with the following diseases:

  • stroke 46 cases  (14.33%),
  • myocardial infarction 55 cases (17.13%),
  • peripheral vascular disease 23 cases (7.16%),
  • obesity 38 (11.83%),
  • pre-eclamptic toxemia 31 cases (9.65%),
  • hiperaldosteronism in 18 cases (5.60%),
  • polycystic kidney 26cases (8.09%),
  • multiple endocrine diseases II 14 cases (4.36%).

These results  are in concordance with observations of Kotchen JM [1] which in a studies about young hypertensive patients concluded that family aggregation of hypertension was very frequent 20.2% (p<0,001) suggesting the importance of a genetic factor in the etiology of hypertension in the young adults.

    2.   An important number of  hypertensive young  patients were present in personal pathological antecedents: Scarlatti 27 (8.41%), repetitive angina with Streptococcus β hemolytic group A 88 (27.41%),chronic ORL infection focus 35 (10.90%) chronic stomathological focus infections 19 (5.91%), nephritis 34 (10.59%), endocrine disorders 16 (4.98% ), physical and psychical supra solicitation 22 (6.85%), head trauma 11 ( 3.42% ), therapy with corticosteroizi  from another disease (for example erithematous systemic lupus) 5 (1.55%) therapy with AINS  drugs 21 (6.54%), use decongestion nasal 4 (1.24%) repetitive urinary tract infection 28 (8.72%), syphilis 11 (3.42%)(p<0,001). Loggie JMH [2] in a studies with  hypertension in the young reported the streptococcus infection with Streptococcus β hemolytic group A was 18.2% , chronic ORAL infection focus was 8.9%, chronic stomathological focus infections was 3.98%, glomerulonephritis was 6.2% and  physical and psychical supra solicitation was 12.43% in personal pathological antecedents.

3.   Changes of retinal vascular were insufficiently studied in young adults. In my study this changes appear for the optic fund may show no more than retinal arteriolar narrowing 103 cases represent 32.09% and arterio venous nicking 98 cases represent 30.53% , hemorrhages and exudates I rarely found from 9 cases represent 2.8%, papilla edema may be absent except 2 cases even with hypertension was very severe more than 200/120mmHg and complicate with encephalopathy and 109 cases represent 33.96% was normal result of funduoscopic examination (p<0.001).

Skalina MEL et al. [3] observations: 281 hypertensive young patients 140 have changes for the optic fund arterio venous nicking 93 cases, hemorrhages found from 7 cases and exudates appear from 40 patients. 141 patients have the optic fund examination normal.

4.   The heart is not often clinically enlarged and the ECG and chest X-ray are usually unhelpful in detecting left ventricular hypertrophy unless hypertension has been prolonged and severe. In my studies left ventricular hypertrophy was present in 35 cases (10.49%), they are helpful in determining chronicity of hypertension and from 206 cases (64.174%) left ventricular hypertrophy was absent, that suggest that if negative, they tell one nothing about the duration of hypertension. The results are in concordance with observation with Laird WP and Fixler DE [4] who reports after performing chest X-ray for 210 young hypertensive, 103 have normal results, 78 have elongation and elevated of left inferior arcos and 29 present’s cardiomegaly.

5.   The echocardiogram seems to be more sensitive for evaluating chamber size and wall thickness than the ECG and can be helpful. Left atria hypertrophy and left ventricular hypertrophy (Sokolow-Lyon index) and left axial deviation it’s possible to detect. In my studies I found 35 cases (10.49%) with LVH, 36 cases (11.21%) with LAH and 35 cases (10.49%) with left axial deviation. Secondary changes of depolarization like ST segment sub elevated and negative T wave I found from 35 cases represent 10.49% (p<0,001).The results are in concordance with observation with Laird WP and Fixler DE [4], who reports than 18% from young hypertensive subject, presents left ventricular hypertrophy detected after echocardiography examination, end in concordance with observation with Schieken RM et al. [5] in Muscatine studies who reports more than 14% from young hypertensive subjects have left ventricular hypertrophy after make echocardiography examination.

6.   Proteinuria I detect in 96 cases (29.90%) and hematuria in 38 cases (11.83%).This changes appear in context of acute  glomerulonephritis and hypertension was secondary renal.

Schmider et al. [6] sustained that glomerular hyperfiltration is a early marker for nefroangiosclerosis and a sign for subclinical organ affected.

7. OMS stadialization classification high blood pressure in three stages. In my study about hypertension in young adults the results are: in stages I found 270 cases represents 84.11%, in stages II 40 cases represents 12.46%, in stages III 9 cases (2.80%) and malign hypertension 2 cases represents 0.62%.

CONCLUSIONS

  • 1. Importance of genetic factors in etiologies of disease is suggested that family aggregation of hypertension in young adults and another familial diseases like hyperaldosteronism, polycystic kidney and multiple endocrine diseases II.
  • 2. Importance of personal pathologic antecedents demonstrated in my study that repetitive Streptococcus angina with Streptococcus β hemolytic group A was found in the first place as a cause of hypertension in the young people in context of acute streptococcal renal parenchymatous diseases.
  • 3. Except nonspecific symptoms of high blood pressure exist specifically symptoms who suggest etiology of hypertension with young people.
  • 4. The fundoscopic findings in the young adult with hypertension are frequently normal. In the absence of prior readings, one needs to look for evidence of target organ damage that may suggest chronicity. In my study this changes appear for 86 cases 23.3 %  and hemorrhages and exudates I rarely found from 9 cases represent 2.8% and papilla edema may be absent except 2 cases even with hypertension is very severe more than 200/120mmHg and complication of encephalopathy.
  • 5. Left ventricular hypertrophy is possible to detect X-ray, ECG and echocardiography. In my studied I detected left ventricular hypertrophy from 35 patients represent 10.49%.
  • 6. Proteinuria 96 cases (29.90%) have two significance:  nephropathy complication of high blood pressure, or etiology in context or glomerulonephritis alone or accompaniment with hematuria 38 cases (11.83%) in nephritis syndrome.
  • 7. Renin plasmatic level is very important marker of high blood pressure in the young. Was high in 121 cases (37.69%).This situation suggests that hypertension in the young is hiperreninemic hypertension in many cases because young adults have hyperactivity of sympatetic nervous system.
  • 8. OMS classification evaluated stages I 270 cases (84.11%), stages II 40 cases (12.46%) in stages III 9 cases (2.80%) and malign hypertension (stages IV) 2 cases (0.62%)
  • 9. Finally I make a small guideline about hypertension with young patients group of ages 18-35, which I hope to help activity of every physician indifferent specialties in your practice, to use for diagnosis and easy work.

REFERENCES

1. Kotchen JM “Effect of relative weight on familial blood pressure aggregations“ Am J Epidemiol.1987 105-214.

2. Loggie JMH. “The diagnostic evaluation of adolescents with hypertension.” In Hunt JC, Dreifus LS, Dustan HP et al, eds Dialogues in Hypertension Update II vol 1. Lyndhurst, NJ: Health Learning Systems 1984:43-56.

3. Skalina MEL et al.:  Annable WL, Kleigman RM, Fanaroff AA “ Hypertensive retinopathy in the adolescent“ J Adolesc. 1983:103:781-6.

4. Laird WP and Fixler DE. “Left ventricular hypertrophy in adolescents with elevated blood pressure: assessment by chest roentgenography, electrocardiography and echocardiography.” Adolescents 2001;67:255-9.

5.Schieken RM and coauthors: Clarke WR, Lauer RM, “Left ventricular hypertrophy in the young with blood pressures in the upper quin-tile of the distribution: the Muscatine study.” Hypertenesion 2004;3:669-75.

6. Schmider and coauthors: Messerli FH, Garavaglia GE, Nunez BD “Glomerular hyperfiltration indicates target organ disease in essential hypertension.” Circulation 2003; 76: III-273.

 

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