Clinical Evidence of Cross Talk between Dyslipidemia and RAS Activation

O'Callaghan et al. 38 examined the effects of pravastatin in the setting of background antihypertensive therapy with ACE inhibitors and calcium antagonists. They treated 25 hypertensive hypercholesterolemic patients with 12 weeks of either pravastatin or placebo in this double-blind, placebo-controlled parallel group study. Placebo treatment did not alter plasma lipids, whereas 12 weeks of treatment with pravastatin reduced total cholesterol by 27 and LDL cholesterol by 35 . There was no change...

Calcifications Arterial Stiffness and Atherosclerosis

Mackey Lakshmi Venkitachalam Kim Sutton-Tyrrell Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa., USA Vascular calcification can occur in either the intimal or medial layers of the arterial wall. Intimal calcification is associated with atherosclerosis, which is characterized by lipid accumulation, inflammation, fibrosis and development of focal plaques. Medial calcification is associated with arteriosclerosis, i.e. age- and...

Glucose Insulin and Potential Mechanisms of Vascular Stiffening

Among patients with diabetes 15 or the metabolic syndrome, arterial stiffening is observed across all age groups. In children with severe obesity, arterial wall stiffness and endothelial dysfunction are accompanied by low plasma apolipoprotein A-I levels, insulin resistance, and android fat distribution, changes that may be the main risk factors for the early events leading to atheroma formation 16 . The positive correlation between insulin resistance and central arterial stiffness and the...

Mechanical Stress and Arterial Remodeling

An arterial wall is a complex tissue composed of different cell populations capable of structural and functional changes, in response to direct injury and atherogenic factors, or to modifications of long-term hemodynamic conditions. The principal geometric modifications induced by hemodynamic alterations are changes of arterial lumen and or arterial wall thickness due to activation, proliferation and migration of VSM cells, and rearrangements of cellular elements and ECM 12-18 . The mechanical...

Effects of Statins on Vascular Elasticity

Determinant of Vascular Elasticity and Compliance Vascular elasticity or compliance or stiffness is a major determinant of vascular resistance. The elasticity is determined by all components of the vessel wall, including the endothelium, SMCs, and the interstitium composed primarily of fibroblasts. Table 2. Evidence for blood pressure-lowering effect of statins Table 2. Evidence for blood pressure-lowering effect of statins 23 patients with hypertension and hyperlipidemia Fluvastatin lowered...

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Predictive value for fatal stroke of pulse wave velocity (PWV) in essential hypertensive patients from 36 . Fig. 1. Predictive value for fatal stroke of pulse wave velocity (PWV) in essential hypertensive patients from 36 . Brachial pulse pressure (instead of carotid pulse pressure) is used for the calculation of all these parameters and this may reduce their precision. Despite this limitation, all these parameters are well accepted as indices of arterial stiffness 35 . Cross-sectional...

Subjects with Atherosclerosis

Nowadays, the standard treatment of hypertension in middle age aims to decrease SBP, DBP and MBP and therefore to shift the age-BP curve towards lower values of SBP, DBP and MBP. The findings discussed in this chapter clearly indicate that, over 60 years of age, a novel objective of treatment should be not only a shift of the BP curve but also a reduction of the normal increase of SBP and decrease of DBP with aging, thereby reducing the slope of the age-PP curve (fig. 6) 82 . This goal may be...

Arterial Stiffness and Extracoronary Calcification

In the studies which have evaluated the association between arterial stiffness and extracoronary calcification, it is not completely clear whether the calcification measures represent intimal or medial calcification or a combination of the two. In an early paper, Witteman et al. 15 evaluated the 9-year progression of aortic calcification (by x-ray) among women aged 45-64 at baseline. Progression of aortic calcification was associated with a decrease in diastolic BP of 10 mm Hg or more. On...

Treatment Strategies to Reduce Arterial Stiffening in DM2 table

Arterial stiffness increases the risk for cardiovascular events, dementia, renal failure, and death. These adverse outcomes result from decreased compliance of the central vasculature which leads to widened pulse pressure, impaired cardiac performance, and reduced coronary perfusion. In contrast to vascular areas that are protected by vasoconstriction, renal and cerebral vessels are exposed to higher pulsatile circumferential and shear stress, increasing the risk of microvascular disease 18 ....

Atherosclerosis Arterial Stiffness and Antihypertensive Therapy

As shown earlier in this book, the links between atherosclerosis, arterial stiffness, age and high BP are often difficult to establish, particularly according to age. Many atherosclerotic alterations (AA) are subclinical and difficult to define in routine clinical investigations. On the other hand, many markers have been proposed, such as defects in vascular relaxation, alterations in endotheli-um-dependent flow dilatation and or presence of atherosclerotic plaques (see chapter by Baldewsing et...