Epidemiology Cardiovasculer Desease

The first studies on cardiovascular health were performed in 1949 by using occupational health data and were published in 1958. The causes, prevention, and/or treatment of all forms of cardiovascular disease remain active fields of, with hundreds of scientific studies being published on a weekly basis. A trend has emerged, particularly in the early 2000s, in which numerous studies have revealed a link between fast food and an increase in heart disease. These studies include those conducted by the Ryan Mackey Memorial Research Institute, Harvard University and the Sydney Center for Cardiovascular Health. Many major fast food chains, particularly McDonald's, have protested the methods used in these studies and have responded with healthier menu options.

A fairly recent emphasis is on the link between low-grade that hallmarks atherosclerosis and its possible interventions. (CRP) is an common inflammatory marker that has been found to be present in increased levels in patients at risk for cardiovascular disease. Also osteoprotegerin which involved with regulation of a key inflammatory transcription factor called NF-κB has been found to be a risk factor of cardiovascular disease and mortality.

Some areas currently being researched include possible links between infection with Chlamydophila pneumoniae and coronary artery disease. The Chlamydia link has become less plausible with the absence of improvement after antibiotic use.

Effect of Aspirin and Bradykinin

It is believed that aspirin counteracts some of the beneficial action of ACE inhibitors, although the mechanism involved are unknown. It has been speculated that bradykinin or substance P, both potenciated by ACE inhibitors, may be involved.

We have shown that exogenous bradykinin and substance P cause vasodilation in patients with heart failure, that there is no effect of intra arterial on its own, and thede is no effect or aspirin, intra arterial or oral, on the responses to bradykinin and substance P. Demonstrasion of these responsive to bradykinin and substance is novel in patients with heart failure, and is only partly consistent with previous wodk in vitro, in animals and in healty vollunterss.

Suboptimal Dosage of ACEI in Heart Failure

Previous mortality studies have indicated that the ideal target dosage of ACE inhibitors in patients with chronic heart failure is 50-100% of the maximum recomaded drug dosage.

The evidence available is consistent with the recommindation seen to recur in the medical literatur-that is, to titrate the dose of ACE inhibitor to the highest tolerated by each patient, aiming to at least meet the target doses of the major mortality studies. The problems is that the typical dose pescribed in current common practice falls weel short of this. critically, the findings of our study suggest that arround 25% of patients with chronic heart failure are receiving a suboptimal dose of ACE inhibitor without good reason. There also remains some room for improving the proportion of patients sterted on an ACE inhibitor.

Difficulties Associated with Treatment in Eldery Patients

Heart failure is common in eldery patients but may be very difficult to treat due to the presence of polypharmacy, multipple commorbid diagnose and agreater susceptibility to adverse events. However, few data are available to quantify the range and extent of these underlying problems as fail eldery patients are seldom included in major heart failure clinical trials.

This retrospective study highlights some of the diagnostic and management difficulties associated with heart failure in the frail older patients. Although the numbers studied are relatively smal and the data collected were from routine daily practice. The study ilustrates a number of important issues in the very old heart failur patients. Although the majority of the findings are not new, the study provides quantitative data on polypharmacy, incontinence, cognitive disfunction and depresion in the eldery heart failure patiens. Awareness of the extent and implication of these associated factors may facillitate optimum management.

Insufficient Treatment of Heart Failure in Eldery

The rate of mortality and morbidity are high in elderly patients with congestive heart failure.

Although age has been confirmed to be a powerful predictor of mortality (in elderly patients with hypertention), evidence based recomanded treatments are less often prescribed and laboratory test are less frequently performed. Thus, to improve quality of care and outcome of older patients, there is a need to develope targeted management strategies to better translate the advancing medical knowledge into clinical practice.

Blood Pressure and Angiotention Converting Enzyme Inhibitor Use in Hypertensive Patients with Cronic Renal Insufficiency

Control of hypertention in patients with cronic renal failure rduce the risk of progression to end stage renal disease and development of cardiovascular disease. In particular, use of ACE inhibitors has been associated with a delayed loss of renal funtion, although, it is curently unknown if this property is being utilised by prescribing physicians.

We conclude that achieved BP control among hypertensive CRI (chdonic renal insufficiency) subject, thoug no worse than that among those without CRI, remained suboptimal. Patient with a CrCI (creatinin clearence) 21 to 40 mL/min - a population that should be targeted for ACE inhibitor treatment-were actualy less likely to be prescribed ACE inhibitors0. Our data identify areas in which the care of patients with CRI can be improved. Education concerning the importance of agressive BP lowering and apropriate ACE inhibitors use, as well as earlier referal to njephrologist for-co management of CRI patients, may improve the care of the large number of ambulatory patients with reduce renal function.

Effect on Progression of Arterial Stiffness in Patients with Hypertention

Arterial stiffness, reflected by a hight pulse4 wave velocity (PWV), is suspected to be an independent risk factor for cardiovascular disease. patients with hypertention often have increased arterial stiffness, but it is unknown if a causal relationshipexist between the two.

The present longitudinal study shows that accelerated arterial aging in treated hypertensive subjects is in large measure explained by uncontroled blood pressure levels, high HR (heart rate), and altered renal function. controlling blood pressure and lowering HR could reduce age related progression of arterial stiffness.