RECORD STATUS: None CITATION: Svensson M, Stenberg B, Asztely M, Jernberger A, Jonsson E, Marke L A, Magnusson S. Vascular surgery for arteriosclerosis in the legs. Stockholm: Swedish Council on Technology Assessment in Health Care (SBU) 1989: 100

BACKGROUND: Pioglitazone is an insulin-sensitizing agent that has been reported to have anti-arteriosclerotic effects. OBJECTIVE: To investigate the anti-arteriosclerotic effects of pioglitazone in patients with diabetes mellitus using pulse wave velocity (PWV) as an index of efficacy. METHODS: Twenty-seven patients with type 2 diabetes mellitus were randomly assigned to two groups, and pioglitazone (n=13) or glibenclamide (n=14) was administered for 6 months. The TG, TC, LDL-C, and HDL-C, FPG, HbA1c, IRI levels, HOMA-IR, and ba-PWV data were examined before and after administration of each agent. RESULTS: FPG and HbA1c were significantly improved in both the groups after treatment, but IRI, HOMA-IR and were improved only in the PIO group. The percent change of ba-PWV from the baseline after treatment in the PIO group improved significantly than that in the GC group (-6.3 +/- 5.6% versus 0.8 +/- 5.7%). CONCLUSIONS: The findings in this study suggested that pioglitazone has anti-arteriosclerotic effects. We concluded that drugs for the treatment of diabetes mellitus should be selected taking into consideration such endpoints as blood sugar control, and also the risk of complications such as cardiovascular events in the future.

PURPOSE: We previously reported that hypertension is related to colonic diverticular bleeding, suggesting the involvement of arteriosclerosis. The recurrence of diverticular bleeding has been little investigated. We aimed to elucidate additional risk factors for diverticular bleeding and also to investigate the incidence rates and risk factors for re-bleeding. METHODS: Between January 2006 and September 2010, 62 patients with diverticular bleeding were admitted to our hospital. We then selected 124 control subjects with non-bleeding diverticula from the colonoscopy database of our department. Additionally, a retrospective cohort study was conducted using these case patients to estimate the re-bleeding rate after initial diverticular bleeding and the risk factors for re-bleeding. Odds ratios for diverticular bleeding were calculated by multivariate logistic regression in a case-control study. Cumulative re-bleeding rates since initial bleeding and hazard ratios of risk factors were estimated by Kaplan-Meier method and Cox proportional hazard model. RESULTS: Sixty-two patients presented 99 bleeding episodes including the initial ones. Diabetes mellitus (OR 2.5, 95 % CI 1.2-5.2, P = 0.03), cardio- or cerebrovascular diseases (OR 4.2, 95 % CI 1.7-11.3, P = 0.003), and NSAID use (OR 3.7, 95 % CI 1.3-11.6, P = 0.02) were shown to be independent risk factors. The cumulative re-bleeding rates were 21 %, 34 %, and 40 % at 1, 2, and 3 years, respectively, in which NSAID use (HR 6.3, 95 % CI 1.7-20.7, P = 0.007) was a risk factor for re-bleeding. CONCLUSIONS: Diabetes mellitus and vascular diseases were risk factors for diverticular bleeding, suggesting systemic metabolic disorders and arteriosclerosis might play an important role.

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In a randomized, double-blind, controlled study, 153 patients with claudication were each given either 20 infusions of Na2EDTA or 20 infusions of saline. Walking distances and ankle/brachial indices were measured before, during, and after treatment. In 30 patients, angiograms and transcutaneous oxygen tensions were obtained before, during, and after treatment. The patients' subjective evaluations of the effect of treatment were also recorded. It is concluded that EDTA chelation therapy has no effect in patients with intermittent claudication in the legs caused by arteriosclerosis.

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We document racial trends in chronic conditions among older men between 1910 and 2004. The 1910 black arteriosclerosis rate was six times higher than the white 2004 rate and more than two times higher than the 2004 black rate. We argue that blacks' greater lifelong burden of infection led to high arteriosclerosis rates in 1910. Infectious disease, especially respiratory infections at older ages and rheumatic fever and syphilis at younger ages, predicted arteriosclerosis in 1910, suggesting that arteriosclerosis has an infectious cause. Additional risk factors for arteriosclerosis were being born in the second relative to the fourth quarter, consistent with studies implying that atherogenesis begins in utero, and a low body mass index, consistent with an infectious disease origin of arteriosclerosis.

BACKGROUND: Cardiac transplantation is associated with oxidant stress, which may contribute to the development of accelerated coronary arteriosclerosis. We postulated that treatment with antioxidant vitamins C and E would retard the progression of transplant-associated arteriosclerosis. METHODS: In a double-blind prospective study, 40 patients (0-2 years after cardiac transplantation) were randomly assigned vitamin C 500 mg plus vitamin E 400 IU, each twice daily (n=19), or placebo (n=21) for 1 year. The primary endpoint was the change in average intimal index (plaque area divided by vessel area) measured by intravascular ultrasonography (IVUS). Coronary endothelium-dependent vasoreactivity was assessed with intracoronary acetylcholine infusions. IVUS, coronary vasoreactivity, and vitamin C and E plasma concentrations were assessed at baseline and at 1 year follow-up. All patients received pravastatin. Analyses were by intention to treat. FINDINGS: Vitamin C and E concentrations increased in the vitamin group (vitamin C 43 [SD 21] to 103 [43] mmol/L; vitamin E 24 [14] to 65 [27] mmol/L) but did not change in the placebo group (vitamin C 45 [15] vs 43 [16] mmol/L; vitamin E 27 [14] vs 27 [9] mmol/L; p<0.0001 for difference between groups). During 1 year of treatment, the intimal index increased in the placebo group by 8% (SE 2) but did not change significantly in the treatment group (0.8% [1]; p=0.008). Coronary endothelial function remained stable in both groups. INTERPRETATION: Supplementation with antioxidant vitamins C and E retards the early progression of transplant-associated coronary arteriosclerosis.

This study compared the effects of long-term administration of nicorandil and isosorbide dinitrate (ISDN) on vascular endothelial function and the progression of arteriosclerosis. Forty-two patients with ischemic heart disease were randomly allocated to receive nicorandil (N group; 15 mg/d) or ISDN (I group, 40 mg/d). Twelve normal subjects served as controls. Vascular endothelial function and the progression of arteriosclerosis (intima-media thickness, IMT), as determined by carotid vascular ultrasound, were assessed 1 week before and 3 months after drug administration. Reactive hyperemia was induced in the forearm for 5 minutes, and the percentage change in the diameter of the brachial artery (% change in flow-mediated dilation, %FMD) was calculated. FMD was significantly lower in CAD groups than in controls. The %FMD significantly decreased (7.2 +/- 1.9 to 4.2 +/- 2.8) in the I group, while rising from 6.8 +/- 1.6 to 8.0 +/- 2.0 in the N group. IMT increased by 0.036 +/- 0.015 mm in the I group but showed no significant change in the N group (-0.01 +/- 0.012 mm). Thus, ISDN deteriorates IMT and FMD, whereas a beneficial effect of nicorandil is seen on FMD with no effect on IMT. Long-term treatment with nicorandil may be desirable for prevention of cardiovascular events.