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Coronary Artery Disease: Risk Promoters, Pathophysiology and Prevention
Gundu HR Rao, S Thanikachalam
1:
Epidemic of Coronary Heart Disease in the Migrant South-African Indian Population
SUMMARY
INTRODUCTION
Historical Background
Cardiovascular Mortality Rates
Risk Factors for CHD in the Community
Association between Hypercholesterolemia and Other Risk Factors
Association of Risk Factors with Presence of CHD (Table 1.2)
Insulin Resistance
Dietary Pattern of Durban Indians
Other Dietary Studies in South Africa
Other Clinical Studies in South Africa
Comparison of CHD Data in India and in Indians in the UK
CONCLUSION
2:
Clustering of Cardiovascular Risk Factors in Asian Indians
3:
Coronary Artery Disease in Asian Indians: An Update and Review
ABSTRACT
INTRODUCTION
OVERVIEW OF CAD AMONG OVERSEAS ASIAN INDIANS
Overview of CAD in India
CAD Rates in Rural India
CAD Rates in Urban India
Contrasting CAD Trends in India and US
Cardinal Features of CAD among Asian Indians
Prematurity of CAD
Severity of CAD
Conventional Risk Factors
Tobacco Abuse
Hypertension
Generalized Obesity
Apple-type and Pear-type Obesity
Waist Circumference
Socioeconomic Status (SES)
Psychosocial Factors
Diabetes Mellitus
Metabolic Syndrome (Insulin Resistance Syndrome)
Low HDL and High TG
Total Cholesterol
Asian Indian Ethnicity
Risk Factors and Paradox Galore
Japanese Paradox
Chinese Paradox
Asian Indian Paradox
Lipoprotein (a) – A Genetic Risk Factorfor Premature CAD among Asian Indians
Lipoprotein(a), the “Deadly Cholesterol”
Multiplicative Effects of Lp(a) with Conventional and Emerging Risk Factors
Homocysteine
Other Emerging Risk Factors
Double Jeopardy from Nature and Nurture: Lessons from Singapore.
Preventive and Therapeutic Implications
Early Modification of Lifestyle
Physical Activity
Dietary Modification
Saturated Fat (SAFA)
Trans-unsaturated Fatty Acids (TRUFA)
Monounsaturated Fatty Acids (MUFA) and Polyunsaturated Fatty Acids (PUFA)
Reuse of Oil Used for Deep Frying
Contaminated Vegetarianism
Should Asian Indians be Tested Differently?
Should Asian Indians be Treated Differently?
The Triglyceride Issue
Non-HDL Cholesterol
Relevance of NCEP III to Asian Indians
Expanding Use of Statins in the Prevention and Treatment of CAD
Management of Subjects with Elevated Lp(a) Levels
CONCLUSION
4:
Coronary Artery Disease Risk Factors in the Urban Population of Chennai
PRECLINICAL ATHEROSCLEROSIS
Comparison of Intimal Medial Thickness inSubjects with and without Diabetes—CUPS
Comparison of Functional Changes in the Arteries inSubjects with and without Diabetes—CUPS
Why are Diabetics more Prone to CAD?
Hypercalcemia and CAD
Hypertension
Dyslipidemia
Newer Risk Factors For CAD
Lipoprotein(a)
Homocysteine
Fibrinolytic Factors
CONCLUSION
5:
Metabolic Syndrome X, Type 2 Diabetes Mellitus and Cardiovascular Disorders are Common in Asian Indians: But, Why and How?
SUMMARY
INTRODUCTION
CONVENTIONAL RISK FACTORS IN ASIAN INDIANS
ABDOMINAL OBESITY IS COMMON IN ASIAN INDIANS: BUT, WHY AND HOW?
METABOLIC SYNDROME X: AN INFLAMMATORY CONDITION
Metabolic Syndrome X in Asian Indians has its Origins in the Perinatal Period
Is there a Role for ω-3 and ω-6 Fatty Acids in Metabolic Syndrome X in Asian Indians?
TESTING THE HYPOTHESIS AND ITS THERAPEUTIC IMPLICATIONS
6:
Homocysteine, Fibrinogen, Insulin Resistance and Lipid Profiles of Children of Young Patients with Coronary Artery Disease
INTRODUCTION
CAD Risk Factors: Conventional and Emerging Trends
Emerging Risk Factors
Risk Factors and Indian Paradox
CAD, Children and Family History
Inherited Biochemical Markers Common in CAD
Studies
Lipid Profile Norms
Platelet Aggregation and Lipid Profile
Insulin and Lipid Profile
Lp (a), Apoprotein B (Apo-B) and Lipid Profile
Homocysteine, Fibrinogen and Lipid Profile
CONCLUSIONS
7:
The Indian Paradox: From Perception to Prevention
THE EPIDEMIOLOGICAL TRANSITION
IMMIGRANT ASIAN INDIANS—DISPARATE RISK
Does Discordance Really Exist Between Disease Prevalence and Risk Factors?
RESPONSIBLE MECHANISMS
Insulin Resistance/Diabetes
Central Obesity
Low HDL
High Triglycerides
High Lp[a]
Homocysteine
CRP
Coenzyme Q10 and Total Q10
Dietary Influences and the Role of the Indo-Mediterranean Diet
Endothelial Dysfunction
UNIFYING THEORY AND RECOMMENDATIONS
ACKNOWLEDGMENT
8:
Intrauterine Risk Factors in Atherosclerosis “From Womb to Tomb”
INTRAUTERINE RISK FACTORS AND DYSLIPIDEMIA IN ADULT
Clinical Evidence
Experimental
INTRAUTERINE FACTORS AND INSULIN RESISTANCE
Against
INTRAUTERINE FACTORS AND HYPERTENSION IN ADULT
Clinical
Experimental
Comment
INTRAUTERINE RISK FACTORS AND OBESITY
For
Against
INTRAUTERINE RISK FACTORS IN ATHEROSCLEROSIS SUMMARY
CONCLUDING REMARKS
9:
Early Detection of Vascular Disease as a Strategy to Prevent Morbid Events
10:
Tissue Plasminogen Activator, Plasminogen Activator Inhibitor and Coronary Artery Disease in Indians
THE FIBRINOLYTIC SYSTEM
tPA, PAI-1 and CAD
tPA, PAI-1 and Diabetes
tPA and PAI-1—Indian Scenario
CONCLUSION
11:
Homocysteine and Cardiovascular Diseases
INTRODUCTION
HOMOCYSTEINE METABOLISM
HOMOCYSTEINE IN BLOOD
CAUSES OF HYPERHOMOCYST(E)INEMIA
Genetic: Enzyme Deficiency
Nutritional: Vitamin Deficiency
Drugs
Disease
HOMOCYSTEINE AND CORONARY ARTERY DISEASE
HOMOCYSTEINE AND NON-CORONARY VASCULAR DISEASE
Mechanism of Homocysteine-induced Vascular Disease
TREATMENT OF HYPERHOMOCYSTEINEMIA
ONGOING STUDIES
CONCLUSION
12:
Oxidative Damage: A Possible Causal Link between Diabetes and Coronary Heart Disease in the Asian Population
INTRODUCTION
Risk Factors for CHD and Oxidative Damage in the Indian Population
OXIDATIVE STRESS AND DAMAGE IN DIABETES
Sources and Mechanisms of Action
OXIDATIVE DAMAGE IN DIABETIC ANIMAL MODEL AND HUMAN SUBJECTS
Overview
Diabetes and Oxidative Damage in Animal Models
Oxidative Stress in Diabetes and Components of the Antioxidant Defense System
Human Studies and Oxidative Damage
PATHOGENESIS OF CORONARY HEART DISEASE AND OXIDATIVE DAMAGE
The Development of Coronary Heart Disease
The Role of Oxidation in Coronary Heart Disease
SUMMARY
13:
Novel Risk Factors hs-CRP: Its Role in Cardiovascular Risk Assessment in Healthy Individuals
INTRODUCTION
CRP and hs-CRP
Standard CRP
High Sensitive CRP (hs-CRP)
Pro-Inflammatory Risk Factors as Triggers of Inflammation in Atherogenesis
Sources and Sites of Inflammatory Markers and Proinflamatory Cytokines
CRP: MARKER AND MEDIATOR OF INFLAMMATION
CRP AS A PROGNOSTIC MARKER OF CVD IN NORMALS
CRP-CHD Risk in Indian Asians
Recommendations for Use of Inflammatory Markers in Clinicaland Public Health Practice as per the Centers for Disease Controland Prevention and the American Heart Association23
14:
Global Risk Assessment for Diabetes and Vascular Diseases: Need for New Guidelines for South Asians
ABSTRACT
15:
Platelet Hyperfunction as a Risk Promoter for Acute Coronary Events
ABSTRACT
INTRODUCTION
PLATELET PHYSIOLOGY
Activation of Circulating Blood Cells and Inflammation
Vascular Dysfunction
Hormones, Stress and Acute Coronary Events
Therapeutic Implications
16:
Cardiac Allograft Vasculopathy
CONCLUSION
17:
Serum Lipids and Apolipoprotein-B: Need to Modify the Guidelines to Identify Indians at Risk for CHD
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION
ACKNOWLEDGMENT
18:
The Oxidation Paradox in Atherosclerosis
SUMMARY
Exercise is an Oxidative Stress
Consumption of PUFA Increases Oxidative Susceptibility
Estrogens: Pro-oxidants?
Antiatherogenic Effects of Oxidized Lipids and Oxidized LDL
Oxidation of LDL in Plasma
Solution to the Oxidation Paradox
CONCLUSION
ACKNOWLEDGMENTS
19:
Signaling Events in Atherosclerosis: Pro- and Antiatherogenic Properties of Sphingosine-1-Phosphate
ABSTRACT
INTRODUCTION
GENERATION OF SPHINGOSINE-1-PHOSPHATE IN BLOOD
SIGNAL TRANSDUCTION BY SPHINGOSINE-1-PHOSPHATE
PROATHEROGENIC ACTIONS OF SPHINGOSINE-1- PHOSPHATE
Secretion of IL-6 and IL-8
Expression of Adhesion Molecules
Proliferation of Vascular Smooth Muscle Cells
Antiapoptotic Action on T-Cells
ANTIATHEROGENIC ACTIONS OF SPHINGOSINE-1-PHOSPHATE
Migration of Endothelial Cells
Angiogenesis
Preservation of Vascular Integrity
MECHANISM(S) OF SPHINGOSINE-1-PHOSPHATE MEDIATED BARRIER PROTECTION
SUMMARY
ACKNOWLEDGMENTS
20:
Normal Endothelium—Anatomy and Functions
INTRODUCTION
STRUCTURE
FUNCTION
FUNCTIONAL ASPECTS
CONCLUSION
21:
Role of Endothelial Dysfunction in Coronary Artery Disease
INTRODUCTION
Nitric Oxide—the Most Critical Endothelial Factor
Endothelial Dysfunction (EnD) and Atherosclerosis
Hypercholesterolemia (HCL)
Systemic Hypertension (SHT)
Diabetes Mellitus
Smoking
Diagnosis of Endothelial Dysfunction
Positron Emission Tomography (PET)
THERAPEUTIC IMPLICATIONS
L-Arginine
Gene Transfer
CONCLUSION
ACKNOWLEDGMENT
22:
Endothelial Function: Intervention—Experimental and Clinical
NORMAL ENDOTHELIUM
Regulation of Vascular Tone
INTERVENTION—EXPERIMENTAL AND CLINICAL
Beneficial Effects of Cholesterol—Lowering Therapy on the Coronary Endothelium in Patients with Coronary Artery Disease (N Engl J Med 1995;332:481–7)
Methods
Results
Conclusions
The Effects of Cholesterol—Lowering and Antioxidant Therapy on Endothelium-Dependent Coronary Vasomotion (N Engl J Med 1995;332:481 93)
Methods
Results
Conclusions
Simvastatin, an HMG—Coenzyme α Reductase Inhibitor, Improves Endothelial Function within 1 Month (Circulation 1997;95:1126–31)
Methods and Results
Conclusions
Antiotensin-Converting Enzyme Inhibition with Quinapril Improves Endothelial Vasomotor Dysfunction in Patients with Coronary Artery Disease
Methods and Results
Conclusions
Role of Oxidant Stress in Endothelial Dysfunction Produced by Experimental Hyperhomocyst(e)inemia in Humans (Circulation 1999;100:1161–68)
Methods: Subjects
Measurements
23:
Pathophysiology of Plaque Rupture and the Concept of Plaque Stabilization
PLAQUE COMPOSITION AND TYPES
Stable and Unstable Atherosclerotic Plaques
Stable Atherosclerotic Plaques
Unstable Atherosclerotic Plaques
Pathogenesis of Plaque Destabilization and Thrombosis
Mechanism of Thrombosis in the Atherosclerotic Plaque
Endothelial Erosion
Plaque Disruption
Plaque Rupture: Clinical Manifestations
Why do Acute Coronary Syndromes Evolve from Mild to Moderate Stenosis?
Detection of the Vulnerable Plaque
Coronary Angiography (CAG)
Angioscopy
Intravascular Ultrasound (IVUS)
Intravascular Elastography
Intravascular Theromography
Near Infrared (NIR) Spectroscopy
Optical Coherence Tomography
Raman Spectroscopy
Vascular MRI
Electron Beam CT or Ultra fast CT (EBCT)
Plaque Stabilization
Integrated Approach to Plaque Stabilization
Plaque Specific Consideration
Process Specific Consideration
Time Specific Consideration
Strategies for Stabilization of the Destabilized Plaque
Percutaneous Interventions (PCI)
High-Dose Lipid-Lowering Therapy
Long-term Antithrombotic and/or Anticoagulant Therapy
Short-term Antithrombotic Therapy with GpIIb/IIIa Receptor Blockers in Medical Management of Destabilized Plaques
Strategies for Stabilization of the Vulnerable PLAQUE
Lipid-Lowering Agents
Angiotensin-Converting Enzyne Inhibitors (ACEI)
Inhibition of Inflammation
Acceleration of Reverse Cholesterol Transport
Antioxidant Therapy
Trigger Reduction in Plaque Stabilization
Promoters of Extracellular Matrix Synthesis
Inhibitors of Matrix Degradation
Gene Therapy
CONCLUSIONS
24:
Are ACE Inhibitors Anti-Ischemic Agents?
CONCLUSION
25:
Pathophysiology of Unstable Angina
NORMAL ENDOTHELIAL FUNCTION
Regulation of Vascular Tone
26:
Role of Aspirin and Low Molecular Weight Heparins in Unstable Angina
27:
Lipid-Lowering Drugs and Coronary Artery Disease in Indians
INTRODUCTION
Epidemiology
Risk Factors
Lipoprotein(a)
Relationship between Lipid Abnormalities and Coronary Artery Disease in the Indian Population
Relationship between Lp(a) and CAD
Lp(a)
Management of Dyslipidemia: Indian Perspective
Prevention
28:
Prevention of Noncommunicable Diseases in India—ICMR's Initiatives
GLOBAL BURDEN OF NONCOMMUNICABLE DISEASES
NONCOMMUNICABLE DISEASE PROFILE IN SOUTH EAST ASIA REGION
NONCOMMUNICABLE DISEASES IN INDIA
CARDIOVASCULAR DISEASES IN INDIA
CARDIOVASCULAR DISEASE RESEARCH AT ICMR
ISCHEMIC HEART DISEASE
Risk Factor Analysis for IHD
Epidemiology of Coronary Heart Disease
Dietary Factors in CHD
Diabetes as a Risk Factor for CHD
Tobacco Use and CHD
Radio Date
Disease Surveillance and Lifestyle Modification
Behavior Factors and Lifestyle
Hypertension
Stroke in the Young
Rheumatic Heart Disease
Evaluation of Jones Criteria in the Diagnosis of RHD
Evaluation of Secondary Prophylaxis for RHD
Regional Distribution of RHD in Children
Bacterial and Immunological Parameters amongst High-Risk Schoolchildren
Center for Advanced Research on RF and RHD
Operational Research and Strategies for Control of RF and RHD
Community Control of RF and RHD
Jai Vigyan Mission Mode Project on Community Control of RF/RHD In India
Epidemiology of Gp. A Beta Hemolytic Streptococci (GABHS)
Control of RF/RHD
Vaccine Development and Trial
Advanced Studies on RF/RHD
29:
Controlling the Cardiovascular Disease Epidemic in Developing Countries: Urgent Need for Evidence-Based Action
30:
The Challenge and Opportunity of Blood Pressure Chronomics in India
CONCLUSION
31:
Management of Thrombotic and Cardiovascular Disordersin the 21st Century
ABSTRACT
INTRODUCTION
32:
An Update on Thrombolytic Agents
INTRODUCTION
SELECTION CRITERIA FOR LYTIC THERAPY
PHARMACOLOGICAL AND CLINICAL USE
STREPTOKINASE
CHOICE OF NEW THROMBOLYTIC AGENT
PREHOSPITAL THROMBOLYSIS
Modulation of Endogenous Fibrinolytic Activity
Factor XIIIa Inhibitors
PAI-1 Inhibitors
Glycoprotein IIb/IIIa Inhibitors
The Integrelin and Low-Dose Thrombolysis in Acute Myocardial Infarction (INTRO AMI) Trial
CONCLUSION
INDEX
TOC
Index
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