Disease Knowledge Centres

• Angiology - Disease Topic Overview

  Angiology is the medical specialty that involves pathology and treatment of vessels whatever their nature; blood (veins, arteries, capillaries) or lymphatic vessels.

  Cardiovascular diseases remain the major cause of death across Europe, and are a major cause of morbidity and loss of quality of life.¹ Each year, more than 4 million Europeans die of cardiovascular disease.¹ The large majority of these cardiovascular events are due to atherosclerosis.¹

  Atherosclerosis is characterised by the deposit of a lipid plaque (atheroma) on the artery walls, causing damage (sclerosis).² The progressive obstruction of vessels primarily affects the coronary arteries; atherosclerosis accounts for the vast majority of cases of myocardial infarction and angina pectoris, but is also the cause of stroke.²

  Several risk factors are involved in atherosclerosis; hypercholesterolemia, hypertension, smoking, stress, physical inactivity, obesity and diabetes.¹ Diabetes is a major risk factor, with 80% of all deaths in diabetic patients being attributed to atherosclerosis.³

  Varicose veins and chronic venous insufficiency are also very common in developed countries with an incidence of between 25% and 33%, depending on the country, and more often affecting women than men.⁴ Chronic venous insufficiency can cause serious diseases such as ulcer, phlebitis (thrombophlebitis) or pulmonary embolism, if the clot reaches the pulmonary artery.⁵

  Angiosarcoma is a rare cancer that develops from cells of the inner lining of the walls of blood and lymph vessels (endothelium).⁶ This is high-grade malignant tumor, accounting for less than 2% of the soft tissue sarcomas, and is due to exposure to toxic metals.⁶

  Efforts have been made in the prevention of risk factors, and the therapeutic management of stroke, by many European states. These must be pursued further in order to reduce morbidity and mortality.¹

  1. Scholte op Reimer W. et al. Euro Cardiovascular diseases in Europe 2006. Heart Survey. European Society of Cardiology. 2006 : available online.
  2. Mizuno Y. et al. Inflammation and the development of atherosclerosis. Journal of Atherosclerosis and Thrombosis. May 2011 ; 18 (5) : 351-8.
  3. Bansilal S. et al. Optimal treatment of the diabetic patient with multivessel disease. Current Cardiology Reports. 2008 ; 10 (4) : 272-284.
  4. Meissner M.H et al. Pathophysiology of Varicose Veins and Chronic Venous Insufficiency. Comprehensive Vascular and Endovascular Surgery. Second Edition. 2009 : 729-748.
  5. Beers M.H. et al. The Merck manual of medical information. Merck research laboratories. Second home edition. 2003 : 231-239.
  6. Papadimitriou V.D. et al. Angiosarcoma of kidney: a case report and review of literature. Urology Journal. Summer 2009 ; 6 (3) : 223-5.

• Cholesterol

  

  Diagnosing and managing coronary heart disease (CHD) can be challenging. In most patients, it takes years or even decades before the underlying coronary pathology leads to clinical manifestations. Major emphasis is needed in controlling overall cardiovascular risk factors in CHD as risk factor control remains poor in these patients and increases the risk of an event.¹

  The Cholesterol Knowledge Centre offers you a range of tools that will help you identify, diagnose and decide upon an appropriate treatment strategy for your patients at risk of CHD. The Centre's educational aids will allow you to keep up to date with the latest research, recommendations and guidelines. It also offers you tools to help you keep your patients engaged in their therapy, thereby significantly reducing their risk of future cardiovascular events.

  ENTER the Cholesterol Knowledge Centre

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  References

  1. Graham I et al. Eur J Cardiovasc Prev Rehab 2007; 14: E1-E40

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  An elevated level of low-density lipoprotein cholesterol (LDL-C) is a form of dyslipidaemia that has been shown to be strongly associated with an increased risk of developing atherosclerosis and cardiovascular disease (CVD), leading to cardiovascular events.

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• Hypertension

  

  Hypertension, an increasingly common and chronic disease, and its consequences like stroke, coronary heart disease, heart failure and renal damage mean an enormous financial burden for the community.

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  Hypertension, an increasingly common and chronic disease, and its consequences like stroke, coronary heart disease, heart failure and renal damage mean an enormous financial burden for the community. The risk of cardiovascular morbidity and mortality is proportional to the degree of systolic or diastolic blood pressure elevation at any age and in either sex, and is markedly influenced by risk factors commonly associated with BP elevation.

  The term “isolated systolic hypertension” (ISH) describes raised systolic blood pressure with normal or low diastolic blood pressure. Some guidelines recognise two grades of isolated systolic hypertension:^1,3

  Increasingly, attention is becoming focused on systolic, rather than diastolic, blood pressure as the major factor to control in patients older than 50 years with essential hypertension.^1,2 Elevated systolic blood pressure (SBP) is a powerful predictor of all-cause mortality, coronary artery disease, stroke and renal disease.⁴

  Diagnostic procedures are aimed at: establishing blood pressure levels; identifying secondary causes of hypertension; evaluating the overall cardiovascular risk.

  It is now widely recognised that elevated blood pressure is frequently associated with obesity, insulin resistance and dyslipidaemia. The clustering of these symptoms has given rise to the concept of the ‘metabolic syndrome’, which carries a high risk of diabetes and cardiovascular disease.

  Guidelines on modern management of hypertension reflect a more preventive approach with reduced target BP and risk factor evaluation.  Initiation of antihypertensive treatment is based on two criteria; total level of cardiovascular risk and level of systolic and diastolic BP.

  Lifestyle inverventions should be instituted whenever appropriate in all patients. Pharmacological therapy should be started gradually, and target BP achieved progressively. To reach target BP, a large proportion of patients will require combination therapy.

  Enter the Hypertension Knowledge Centre

  What’s in the Hypertension Knowledge Centre?

  • Home
  • Definition/Classification hypertension
  • Diagnostic Evalua Hypertension
    
  • Cardiovascular Disease Risk Factors
  • The importance of Systolic Hypertension
    
  • Hypertension and the Metabolic Syndrome
  • Initiating Treatment
  • Lifestyle Interventions
  • Pharmacological Interventions
    
  • Role played by angiotensin II and the sympathetic nervous system in determining systolic blood pressure
  • Role played by angiotensin II
  • Primary intervention studies using AIIAs
    
  • A Dual Mechanism of Action
  • Overview of efficacy with eprosartan in essential hypertension
  • Eprosartan - effect on systolic blood pressure and pulse pressure
  • Other Efficacy Trials
  • Eprosartan in the secondary prevention of stroke: the MOSES study
    
  • Effect of eprosartan on blood platelets and fibrinolytic function
    
  • Renoprotection: the role of eprosartan
  • Tolerability and safety of eprosartan
    
  • Chemistry and pharmacokinetics of eprosartan
  • Dosage and administration of eprosartan
  • Summary: Benefits of eprosartan for patients with high blood pressure
  • References for Eprosartan
  • References for Moxonidine
  • Overview of moxonidine
    
  • Monotherapy - Efficacy of moxonidine versus active comparators
  • Dose-response of moxonidine
  • Long-term efficacy
  • Role of moxonidine in combination with other antihypertensives
    
  • Moxonidine in postmenopausal hypertensive women
    
  • Moxonidine in hypertensive patients with left ventricular hypertrophy
    
  • Renal protection: the role of moxonidine
  • Tolerability and safety of moxonidine
    
  • Chemistry and mode of action of moxonidine
  • The Effects of Moxonidine
    
  • Pharmacokinetics of moxonidine
  • Dosage and administration of moxonidine
    
  • Therapeutic Approach in Special Conditions
  • Resources

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  References

  1. Williams B, Poulter NR, Brown MJ, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004 - BHS IV. J Hum Hypertens 2004;18:139-185
  2. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003;289:2560-2572
  3. ESH Guidelines Committee. 2003 European Society of Hypertension – European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003;21(6):1011-1053
  4. Brooks DP, Ruffolo RR. Pharmacological mechanism of angiotensin II receptor antagonists: implications for the treatment of elevated systolic blood pressure. J Hypertens 1999;17(Suppl 2):S27-S32

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• Post-Myocardial Infarction

  

  Acute coronary syndrome (ACS) is a broad term that includes the diagnoses of unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). UA and NSTEMI are sometimes referred to collectively as non-ST-segment elevation ACS (NSTE-ACS).

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  Acute coronary syndrome (ACS) is a broad term that includes the diagnoses of unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).¹ UA and NSTEMI are sometimes referred to collectively as non-ST-segment elevation ACS (NSTE-ACS).²

  Regardless of the specific clinical presentation, all cases of ACS result from myocardial ischaemia, usually due to the formation of an occlusive thrombus in a coronary artery following the rupture or erosion of an atherosclerotic lesion.²

  Prolonged, severe interruption of the blood flow to the myocardium (15-30 minutes) leads to necrosis, which is the pathological definition of myocardial infarction.^3,4 Complications include heart failure, conduction disturbances, arrhythmias and mitral valve regurgitation.¹

  The classic symptom of ACS is chest pain, which is frequently described as retrosternal pressure or heaviness, and may radiate to the jaw, neck or arms.² Other symptoms include diaphoresis, nausea, dyspnoea, abdominal pain and syncope.²

  Diagnosis and differential diagnosis is based on a combination of clinical examination, electrocardiography (ECG) and tests for cardiac enzymes (troponins) in the blood.²

  Although in-hospital mortality among patients presenting with ACS has declined considerably in recent decades, the risk of dying before reaching hospital has remained relatively unchanged.⁴ Recurrent MI, heart failure and cardiogenic shock are important causes of morbidity and mortality in the ACS population, both during hospitalisation and after discharge.⁵

  Following MI, a range of pharmacological and non-pharmacological interventions have been shown to reduce morbidity and mortality from cardiovascular causes.⁴ Antiplatelet agents, beta-blockers, ACE inhibitors and HMG-CoA reductase inhibitors (statins) all have a central role in post-MI care.

  Non-pharmacological interventions include implantation of a defibrillator (or cardiac synchronisation device) but also diet and lifestyle modifications, such as smoking cessation and regular exercise.⁴

  Enter the Post-MI Heart Failure Knowledge Centre

  What’s in the Post-MI Heart Failure Knowledge Centre?

  • Definitions and Epidemiology
  • Aetiology and Pathophysiology
  • Diagnosis
  • Management
  • Complications and Prognosis
  • Risk Factors
  • Definitions and Types of Heart Failure
  • Epidemiology
  • Pathophysiology
  • Signs and Symptoms
  • Ipmacy
  • Diuretics
  • Antiplatelet Agent and Anticoagulants
  • Beta Blockers
  • ACE Inhibitors and Angiotensin II Receptor Blockers
  • Aldosterone Receptor Antagonists
  • Oral Nitrates and Hydralazine
  • Statins
  • Digoxin
  • Counselling and Education
  • Lifestyle Modification
  • Invasive Procedures
  • Implantable Cardioverter-Defibrillators
  • Monitoring
  • Guidelines
  • Useful Links
  • Conferences and Congresses
  • Multimedia

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  References

  1. Kumar P, Clark M. Clinical medicine. 7th ed. Edinburgh: Saunders Elsevier, 2009.
  2. Bassand J-P, Hamm CW, Ardissino D, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology. Eur Heart J 2007;28:1598-660.
  3. Thygesen K, Alpert JS, White HD, et al. Universal definition of myocardial infarction. Eur Heart J 2007;28:2525-38.
  4. van de Werf F, Bax J, Betriu A, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 2008;29:2909-45.
  5. Fox KAA, Steg PG, Eagle KA, et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006. JAMA 2007;297:1892-900.

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