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CARDIOVASCULAR
RISK FACTORS
Edited by Armen Yuri Gasparyan
Cardiovascular Risk Factors
Edited by Armen Yuri Gasparyan
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2012 InTech
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First published March, 2012
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from orders@intechopen.com
Cardiovascular Risk Factors, Edited by Armen Yuri Gasparyan
p. cm.
ISBN 978-953-51-0240-3
Contents
Preface IX
Chapter 1 Cardiovascular Risk Investigation: When Should It Start? 1
Anabel Nunes Rodrigues, Gláucia Rodrigues de Abreu
and Sônia Alves Gouvêa
Chapter 2 Early Identification of Cardiovascular
Risk Factors in Adolescents and
Follow-Up Intervention Strategies 17
Heather Lee Kilty and Dawn Prentice
Chapter 3 Novel and Traditional Cardiovascular
Risk Factors in Adolescents 61
Alice P.S. Kong and Kai Chow Choi
Chapter 4 Cardiovascular Risk Factors in the Elderly 81
Melek Z. Ulucam
Chapter 5 Vascular Inflammation: A New Horizon
in Cardiovascular Risk Assessment 103
Vinayak Hegde and Ishmael Ching
Chapter 6 Alterations in the Brainstem Preautonomic
Circuitry May Contribute to Hypertension
Associated with Metabolic Syndrome 141
Bradley J. Buck, Lauren K. Nolen, Lauren G. Koch,
Steven L. Britton and Ilan A. Kerman
Chapter 7 Cardiometabolic Syndrome 161
Alkerwi Ala’a, Albert Adelin
and Guillaume Michèle
Chapter 8 Relationship Between Cardiovascular Risk Factors
and Periodontal Disease: Current Knowledge 193
Sergio Granados-Principal, Nuri El-Azem,
Jose L. Quiles, Patricia Perez-Lopez,
Adrian Gonzalez and MCarmen Ramirez-Tortosa
VI Contents
Chapter 9 Cardiovascular Risk Assessment
in Diabetes and Chronic Kidney Diseases:
A New Insight and Emerging Strategies 217
Ali Reza Khoshdel
Chapter 10 Non Invasive Assessment of Cardiovascular
Risk Profile: The Role of the Ultrasound Markers 251
Marco Matteo Ciccone, Michele Gesualdo,
Annapaola Zito, Cosimo Mandurino,
Manuela Locorotondo and Pietro Scicchitano
Chapter 11 Endothelial Progenitor Cell Number:
A Convergence of Cardiovascular Risk Factors 265
Michel R. Hoenig
and Frank W. Sellke
Chapter 12 Nitric Oxide Signalling in
Vascular Control and Cardiovascular Risk 279
Annette Schmidt
Chapter 13 An Anti-Inflammatory Approach in
the Therapeutic Choices for
the Prevention of Atherosclerotic Events 301
Aldo Pende and Andrea Denegri
Chapter 14 Gender-Specific Aspects in the Clinical
Presentation of Cardiovascular Disease 327
Chiara Leuzzi, Raffaella Marzullo, Emma Tarabini Castellani
and Maria Grazia Modena
Chapter 15 The Role of Stress in a Pathogenesis of CHD 337
Taina Hintsa, Mirka Hintsanen,
Tom Rosenström and Liisa Keltikangas-Järvinen
Chapter 16 Pulse Pressure and Target Organ Damage 365
Adel Berbari and Abdo Jurjus
Chapter 17 Low-Level Exposure to
Lead as a Cardiovascular Risk Factor 387
Anna Skoczynska and Marta Skoczynska
Chapter 18 Obstructive Sleep Apnoea Syndrome
as a Systemic Low-Grade Inflammatory Disorder 411
Carlos Zamarrón, Emilio Morete and Felix del Campo Matias
Chapter 19 New Cardiovascular Risk
Factors and Physical Activity 433
Nicolás Terrados
and Eduardo Iglesias-Gutiérrez
Contents VII
Chapter 20 Dietary Supplements and Cardiovascular Disease: What
is the Evidence and What Should We Recommend? 449
Satoshi Kashiwagi and Paul L. Huang
Chapter 21 Mediterranean Diet and Cardiovascular Risk 465
Javier Delgado-Lista, Ana I. Perez-Caballero,
Pablo Perez-Martinez, Antonio Garcia-Rios,
Jose Lopez-Miranda and Francisco Perez-Jimenez
Preface
An Insight on Cardiovascular Risk Factors: Challenges and
Opportunities
Our understanding of the implications of cardiovascular risk factors has greatly
improved over the past two decades. It has been postulated that numerous risk factors
and markers of inflammation and immune response trigger pathologic changes in the
vascular wall from early life, leading to atherosclerotic cardiovascular disease in later
life [1]. It has also been widely recognized that no single risk factor causes
atherosclerotic disease, and that the likelihood of the disease depends on a
multifactorial genetic and environmental background. The complex nature of risk
factors and their interdependence implies the need of multidirectional preventive
measures, which should be monitored and assessed with the use of multiple
demographic, clinical, genetic and laboratory parameters.
Over the past decades, the dominating concept of cardiovascular prevention has been
based on the initial results of the landmark Framingham Heart Study, which linked
the burden of cardiovascular disease with a combination of traditional risk factors,
such as age, sex, arterial hypertension, hyperlipidemia, smoking, obesity, diabetes, and
sedentary lifestyle. The study led to the validation and wide-spread use of the
Framingham Risk Score, which is an indispensable tool for stratifying cardiovascular
risk and treatment by clinicians and deploying strategies for community-based
primary preventive measures by health administrators [2, 3].
The decades-long application of the Framingham Risk Score in different populations
worldwide has also revealed its inherent limitations and led to the development of
several alternative tools (e.g., SCORE [Systematic Coronary Risk Evaluation],
Reynolds Risk Score, QRISK [QRESEARCH Cardiovascular Risk Algorithm]) [4].
Though the new tools have addressed some problems, none of these has been
universally accepted, raising concerns over ethnicity, psychosocial background,
comorbidities, drug therapies, and validity of biomarkers incorporated in the risk
scores. For example, a recent large study showed that currently available risk scores
do not provide precise estimates of cardiovascular risk in patients with rheumatoid
arthritis [5], leaving the issue of risk-score-based cardiovascular prevention in this
particular population uncertain. The guidance based on cardiovascular risk scores in
patients with inflammatory disorders may either underestimate, which is more likely,
X Preface
or overestimate the real risk. Given the results of statistical analyses in large cohorts,
an attempt was made to correct values of risk scores in patients with rheumatoid
arthritis by using a 1.5 multiplier [6]. In practice, however, the latter approach was not
regarded as realistic [7], necessitating more research into cardiovascular
pathophysiology and therapies in inflammatory disorders.
There are still many uncertainties over the interaction between traditional and novel
risk factors leading to premature cardiovascular morbidity and mortality in the
general population and in patients with diseases predisposing to vascular damage and
accelerated atherothrombosis. Systemic inflammation has long been regarded as a
crucial factor of premature cardiovascular disease. Initial evidence for this stems from
the Physicians’ Health Study [8], which highlighted the significance of subclinical
inflammation and slight elevation of C-reactive protein (CRP) level undetectable by
conventional laboratory tests. A more recent large trial, the Justification for Use of statins
in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), reaffirmed that
the suppression of low-grade inflammation (CRP just above 2 mg/l) can bring benefits in
terms of primary cardiovascular prevention in the general population [9]. The JUPITER
study also proved that the greatest cardiovascular risk reduction as a result of
antiinflammatory therapy with rosuvastatin is expected in subjects with the highest
levels of CRP. Whether the same or even greater risk reduction can be derived in high-
and low-grade inflammatory disorders and whether statins can occupy their niche in the
combined treatment of the patients are still a matter of debate, which may be resolved
once the results of specifically designed and powered trials become available [10-12].
Several lines of evidence, mainly derived from retrospective cohort studies, suggest
that systemic inflammation drives atherogenesis in cohorts of patients with systemic
lupus erythematosus (SLE) and rheumatoid arthritis (RA). The exposure to high-grade
inflammation is a crucial pathogenic factor in these patients, justifying aggressive
antiinflammatory treatment, which, in turn, proved to reduce atherosclerotic burden
among other disease-modifying effects [13-15]. The link between inflammation and
atherosclerotic cardiovascular disease, however, is not universally evident across
cohorts of patients with inflammatory disorders [16]. A recent systematic review on
vascular function in RA revealed discrepancies across numerous cross-sectional and
longitudinal studies, and questioned the direct link between rheumatoid inflammation
and vasculopathy [17]. Moreover, numerous studies of varying levels of evidence
suggested the lack of association between persistent low-grade inflammation and
atherosclerotic vascular disease in patients with systemic vasculitides, including those
with Wegener granulomatosis [18] and Behçet disease (BD) [19], the latter viewed as a
model of venous thrombosis [20]. Obviously, the reported discrepancies indicate the
complexity of atherogenic pathways and warrant further research into novel
cardiovascular risk markers.
Over the past decade, several promising markers of inflammation-mediated
atherosclerosis have emerged. Of these, markers of activated platelets, such as platelet-
bound P-selectin, CD40 ligand, beta-thromboglobulin, platelet factor 4, platelet-
[...]... risks Therefore the detection of the risk factors in asymptomatic children can contribute to a decrease in cardiovascular disease, preventing those diseases such as hypertension, obesity and dyslipidemia becomes the epidemic of this new century 2 Cardiovascular risk factors Atherosclerosis begins early in life Thus, it is critical to detect cardiovascular disease risk factors during childhood and adolescence... Research on the prevalence, incidence and concurrence of cardiovascular disease risk factors in adolescents Research on associations and connections between adolescent CV risk factors, adult risk factors and the development of CVD Research methods and instruments used to study, screen, measure and test for cardiovascular risk factors in adolescents at the population health level and at the individual program... incidence of cardiovascular disease is likely to occur when today’s adolescents enter adulthood Thus, it is important to either eliminate or reduce risk factors in young people and other age groups (Williams et al., 2002) Fig 1 Factors associated with cardiovascular risk in children and adolescents 2.1 Atherosclerosis Although AD becomes symptomatic at a later period of life, identifying risk factors early... atherosclerosis provides important links between underlying mechanisms of atherogenesis and risk factors Several 4 Cardiovascular Risk Factors studies have examined different circulating markers of inflammations, such as cytokines and adhesion molecules, as potential predictors of the present and the future risk of cardiovascular diseases Moreover,functional and structural changes are documented in arteries... detecting risk factors during childhood/adolescence is crucial for establishing a prognosis and preventing target organ damage in adults Thus, initiating disease detection and prevention at this stage of life and introducing changes in lifestyle can reduce the incidence and severity of cardiovascular diseases Risk factors are more meaningful when they are integrated Hence, studies of cardiovascular risk factors. .. rising cardiovascular risk factors, and thus to reduce cardiovascular disease in adulthood It is well established that atherosclerosis begins in childhood and adolescence and that cardiovascular risk in early years can be tracked into adulthood cardiovascular disease (CVD) (Berenson et al., 2010; McCrindle et al., 2010; McCusker, et al., 2004; Yoshinga et al., 2008) Research into adolescent cardiovascular. .. childhood risk factors for diseases cardiovascular that may emerge in adult life Thus, the studies involving analysis of cardiovascular risk factors should always register the prevalence and their correlations in childhood, as an essential to identify a population at risk Thus, beyond the direct benefits on children evaluated such studies could point out other family members carrying from such risks Therefore... considered cardiovascular risk factors Prospective studies have shown that obesity appears many years before the onset of insulin resistance (Taskinen, 2003), and insulin resistance is mainly responsible for the hemodynamic and metabolic disturbances of this syndrome (Morton et al., 2001) It is believed that MS is due to a combination of genetic and environmental factors wherein 6 Cardiovascular Risk Factors. .. receptor blockers only ramipril and telmisartan bring most benefits of cardiovascular protection in high -risk populations of patients [38] Undoubtedly, knowledge of cardiovascular risk factors has greatly advanced over the past decades Old dogmas over cholesterol as the only target of cardiovascular prevention have been replaced by theories supporting the diversity of atherosclerotic pathways and the... to most countries (Yusef et al., 2004) 20 Cardiovascular Risk Factors The Canadian Heart and Stroke Foundation’s Annual Report (2010) warns that young Canadian adults are increasingly at risk for heart disease: And that “a perfect storm of risk factors and demographic changes are converging to create an unprecedented burden on Canada’s fragmented system of cardiovascular care, and no Canadian young . CARDIOVASCULAR RISK FACTORS Edited by Armen Yuri Gasparyan Cardiovascular Risk Factors Edited by Armen Yuri Gasparyan Published by InTech Janeza. orders@intechopen.com Cardiovascular Risk Factors, Edited by Armen Yuri Gasparyan p. cm. ISBN 978-953-51-0240-3 Contents Preface IX Chapter 1 Cardiovascular Risk Investigation:. Identification of Cardiovascular Risk Factors in Adolescents and Follow-Up Intervention Strategies 17 Heather Lee Kilty and Dawn Prentice Chapter 3 Novel and Traditional Cardiovascular Risk Factors
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