Improving cardiovascular risk reduction for primary prevention-utility of lifetime risk assessment.
Postgrad Med. 2010 Jul;122(4):192-9
Authors: Elward KS, Simpson RJ, Mendys P
The objective of this article is to review the evidence basis for short-term risk assessments of overall coronary heart disease (CHD) burden as compared with lifetime risk estimates of CHD, based on the current medical literature. We reviewed literature published in the last 6 years using the terms “cardiovascular prevention,” “Framingham risk scoring,” “lifetime risk,” and “cardiovascular risk assessment,” and subsequently evaluated 98 publications to determine the variation in these approaches to estimate cardiovascular risk factors and impact on clinical decision making. The current evidence base suggests that lifetime risk estimates offset the significant impact of age on traditional, short-term risk estimates of cardiovascular risk. We conclude that the use of lifetime risk estimates may be more clinically meaningful than traditional, short-term risk estimates to assess an individual’s overall risk burden, and may prevent the potential delay of therapeutic interventions to reduce cardiovascular events. For primary care, this difference may be of relevance to patients and should be communicated to them.
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Clinical Inquiries: Does red wine reduce cardiovascular risks?
J Fam Pract. 2010 Jul;59(7):406-7
Authors: Lin JK, Kelsberg G, Safranek S
yes. Moderate daily red wine consumption decreases cardiovascular risk compared with either abstinence or heavy and binge drinking (strength of recommendation [SOR]: B, meta-analysis of prospective cohort and case-control studies); however, not enough evidence exists to determine whether wine reduces cardiovascular risk more than other alcoholic beverages. A high dietary intake of fl avonoids, contained in red wine and other food products, correlates with decreased mortality from coronary heart disease (CHD) (SOR: B, meta-analysis of prospective cohort studies). Heavy alcohol drinking is associated with an increased risk of stroke, but data are lacking for low and moderate levels of wine consumption. (SOR: B, meta-analysis of prospective cohort and case-control studies).
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MG53 constitutes a primary determinant of cardiac ischemic preconditioning.
Circulation. 2010 Jun 15;121(23):2565-74
Authors: Cao CM, Zhang Y, Weisleder N, Ferrante C, Wang X, Lv F, Zhang Y, Song R, Hwang M, Jin L, Guo J, Peng W, Li G, Nishi M, Takeshima H, Ma J, Xiao RP
BACKGROUND: Ischemic heart disease is the greatest cause of death in Western countries. The deleterious effects of cardiac ischemia are ameliorated by ischemic preconditioning (IPC), in which transient ischemia protects against subsequent severe ischemia/reperfusion injury. IPC activates multiple signaling pathways, including the reperfusion injury salvage kinase pathway (mainly PI3K-Akt-glycogen synthase kinase-3beta [GSK3beta] and ERK1/2) and the survivor activating factor enhancement pathway involving activation of the JAK-STAT3 axis. Nevertheless, the fundamental mechanism underlying IPC is poorly understood. METHODS AND RESULTS: In the present study, we define MG53, a muscle-specific TRIM-family protein, as a crucial component of cardiac IPC machinery. Ischemia/reperfusion or hypoxia/oxidative stress applied to perfused mouse hearts or neonatal rat cardiomyocytes, respectively, causes downregulation of MG53, and IPC can prevent ischemia/reperfusion-induced decrease in MG53 expression. MG53 deficiency increases myocardial vulnerability to ischemia/reperfusion injury and abolishes IPC protection. Overexpression of MG53 attenuates whereas knockdown of MG53 enhances hypoxia- and H(2)O(2)-induced cardiomyocyte death. The cardiac protective effects of MG53 are attributable to MG53-dependent interaction of caveolin-3 with phosphatidylinositol 3 kinase and subsequent activation of the reperfusion injury salvage kinase pathway without altering the survivor activating factor enhancement pathway. CONCLUSIONS: These results establish MG53 as a primary component of the cardiac IPC response, thus identifying a potentially important novel therapeutic target for the treatment of ischemic heart disease.
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