Open Access Minireview Article

Age Related Hemodynamic Blood Pressure Changes for Cardiovascular Disease and Stroke: A Mini-review

Steven G. Chrysant, George S. Chrysant

Cardiology and Angiology: An International Journal, Page 23-33
DOI: 10.9734/CA/2013/4723

The blood pressure (BP) changes with the advancement of age from the predominant diastolic BP (DBP) in the young to the predominant systolic BP (SBP) in the older person. This shift is due to the stiffening of the large arteries as a result of the ageing process and the replacement of the elastic fibers with collagen fibers resulting in the loss of compliance and the elastic recoil of these vessels. The end result is augmentation in pulse wave velocity (PWV) and widening of pulse pressure (PP). The SBP rises linearly with the advancement of age whereas, the DBP rises up to the age 50 years and begins to decline after the age of 60 years leading to a progressive increase in PP. These hemodynamic changes of BP are frequently associated with an increased incidence in cardiovascular disease (CVD) and strokes. Several studies have shown an inverse relationship between DBP and CVD, whereas no such a relationship has been demonstrated for stroke. However, recently, an inverse relationship has been reported between DBP and stroke for subjects 50 years of age or older. The implications of BP changes with age as they are related to CVD and strokes will be discussed in this mini review. It appears from these recent findings that in treating the hypertension in the elderly to reduce CVD and stroke, care should be taken not to allow the DBP to drop below 55-80 mmHg, since below this DBP level the incidence of CVD and strokes increase.

 

Open Access Review Article

Endothelial Progenitor Cells in Coronary Artery Disease: The 5-Year Experience at a Single Center

Francesco Pelliccia, Cesare Greco, Ferdinando Franzoni, Carlo Gaudio

Cardiology and Angiology: An International Journal, Page 1-8
DOI: 10.9734/CA/2013/3372

Endothelial progenitor cells (EPCs) are a heterologous population of bone marrow-derived cells that play a key role in maintaining homeostasis of the endothelium, as they home to areas of endothelial injury, replace damaged endothelium, and participate in neovascularisation. The relationship between EPCs number and the severity of atherosclerosis is still a matter of debate. Abnormalities in EPCs have been associated with coronary artery disease, as experimental investigations have shown that a decrease in the endogenous pool of EPCs may accelerate the course of atherosclerosis, and the number of EPCs has been reported to be reduced in patients with atherosclerosis and in apparently healthy subjects without overt disease. On the opposite, other studies have found that the number of EPCs in the blood is increased in patients with angiographically significant coronary artery disease. The potential exists that EPCs constitute a therapeutic target, because persistent stimulation of EPCs by pharmacological intervention may, at least theoretically, repair endothelial injury and prevent the progression of atherosclerosis in patients at risk. Indeed, experimental and clinical studies have revealed that the number of EPCs can be increased by several pharmacological interventions such as hormones, statins, recombinant human EPO, and blockage of the angiotensin converting enzyme system. This review addresses the clinical correlates and prognostic significance of EPCs in a large cohort of patients with coronary artery disease that has been evaluated at a single Academic center in Italy.

 

Open Access Review Article

The Adverse Effects of Wealth on Cardiovascular Health: A Scientific Statement of the International College of Cardiology

R. B. Singh, K. Hristova, V. V. Muthusamy, S. S. Rastogi, T. K. Basu, E. Toda, T. Takahashi, J. Fedacko, D. Pella, F. De Meester, D. W. Wilson, R. N. Mondal, M. Ishaq, M. R. Mohideen

Cardiology and Angiology: An International Journal, Page 9-22
DOI: 10.9734/CA/2013/3375

Background and Aims: Increase in economic status may be associated with increased consumption of Western type of foods and sedentary behaviour. In the present review, we discuss that increase in wealth may be associated with adverse effects on health behaviour.

Study Design and Methods: Internet search and discussion with colleagues.

Results: Review of studies indicate that with increase in wealth, there is increased consumption of high fat, ready prepared foods and decrease in physical activity in most of  the  countries resulting in obesity and metabolic syndrome, leading to cardiovascular diseases (CVDs) and other chronic conditions. Many experts during the United Nations High Level Meeting in Sept 2011, misinterpreted the WHO estimates and proposed that, of total deaths, 22·4 million arise in the poorest countries, and 13.7 million in high-income and upper-middle-income countries and therefore poverty may be the major cause of  deaths due to non-communicable diseases (NCDs). A recent study shows that 57.0 % of deaths in adults (aged 25-64 years) were due to CVDs and other chronic diseases, 25.5% due to communicable diseases and 15.9% due to injury and accidents. The deaths due to NCDs were highly prevalent among higher social classes compared to lower social classes who had greater deaths due to communicable diseases. It is interesting to know from new data from United States, that there is ‘Wealth’ without cardiovascular health in America. The whole world is likely to have the same scenario in the near future.

Conclusions: Increase in wealth may be associated with altered health behaviour; greater consumption of unhealthy foods, tobacco consumption, mental load and sedentary behaviour resulting in increased risk of deaths due to CVDs and other chronic diseases which may change with knowledge about health education. Wealth may cause extension in life by buying of expensive drug therapy, intervention and surgery which are known to add income and employment in the west.