Multiple Risk Factors in Cardiovascular Disease: Strategies of Prevention of Coronary Heart Disease, Cardiac Failure, and Stroke

369 Pages·1998·18.89 MB·English

by  H. Bryan Brewer Jr. (auth.)

MULTIPLE RISK FACfORS IN CARDIOVASCULAR DISEASE
STRATEGIES OF PREVENTION OF CORONARY HEART DISEASE,
CARDIAC FAILURE, AND STROKE
Medical Science Symposia Series
Volume 12
The titles published in this series are listed at the end of this volume.
Multiple Risk Factors
in Cardiovascular Disease
Strategies of Prevention of Coronary Heart
Disease, Cardiac Failure, and Stroke
Edited by
A. M. Gotto, Jr.
Cornell University Medical College,
New York, NY, U.sA.
C. Lenfant
National Heart, Lung, and Blood Institute,
NIH, Bethesda, MD, U.SA.
R. Paoletti
Institute ofP harmacological Sciences,
University ofM ilan, Italy
A. L. Catapano
Institute ofPharmacological Sciences,
University ofM ilan, Italy
and
A. S. Jackson
Giovanni Lorenzini Medical Foundation,
Houston, TX, U.S.A.
Springer-Science+Business Media, B.V.
A C.I.P. Catalogue record for this book is available from the Library of Congress.
ISBN 978-94-010-6108-7 ISBN 978-94-011-5022-4 (eBook)
DOI 10.1007/978-94-011-5022-4
Printed an acid1'tu paper
AII Rights Reserved
@1998 Springer Science+Business Media Dordrecht
Originally published by Kluwer Acadcmic Publishers in 1998
Softcon'r reprint ofthr hardco\'rr Ist rdition 1998
No part of the material protected by this copyright notice may be reproduced or
utilized in any fonn or by any means, electronic or mechanical,
including photocopying, recording Of by any infonnation storage and
retrieval system, without wrilten pennission rrom Ihe copyright owner
CONTENTS
Preface ix
List of Contributors xi
I. PLAsMA LIPIDS AND LIPOPROTEINS
New Insights into the Role of HDL in the Development of Cardiovascular
Disease 1
H.B. Brewer, Jr.
Mechanisms of the Hypolipidemic Action of Fibrates 9
J. Auwerx, J. Dallongeville, J.-C. Fruchart, and B. Staels
Lipid Lowering Drugs and the Arterial Wall 19
R. Paoletti, F. Bernini, A. Corsini, and M. Soma
Perspectives on Lipid-Lowering Therapy: Past and Present 25
A.M. Gotto, Jr.
ll. COAGULATION, FIBRINOLYSIS, AND PLATELET INHIBITION
Role of the Fibrinolytic and the Coagulation System in the Formation and 35
Disorders of Blood Vessels
P. Carmeliet and D. Collen
Evolving Understanding of Coronary Thrombosis and New Insights into 45
Therapeutic Strategies
V. Fuster
Platelet Activation and Carotid Arterial Atherothrombosis 61
K.K.Wu
ill. EMERGING RISK FACTORS FOR CARDIOVASCULAR DISEASE
Tissue Factor and the Regulation of Arterial Thrombosis 67
M.B. Taubman
Fibrinogen: Risk Factor or Risk Marker? 75
E. Ernst and W. Koenig
vi CONTENTS
PAI-l and the Risk of Cardiovascular Disease 85
I. Juhan-Vague and M.C. Alessi
Plasma Homocyst(e)ine [H(e)] and Arterial Occlusive Diseases: Gene
Nutrient Interactions
M.R. Malinow
IV. RISK FACTORS AND INTERVENTION: NATIONAL INITIATIVES
The Role of Social and Psychoemotional Factors in the Development of 105
Cardiovascular Disease: The Experience in Eastern European Countries
E./. Chazov
European Action on Secondary Prevention 109
D.A. Wood on behalf of the EUROASPIRE Study Group
Cardiovascular Risk Factors in Normotensive and Hypertensive Egyptians: 119
Preliminary Results, Egyptian National Hypertension Project (NHP)
M.M. Ibrahim, for the NHP Investigative Team
v.
LDL OXIDATION, ANTIOXIDANTS, AND ATHEROSCLEROSIS
Lipid Deposition and Oxidation in the Evolution of the Atherosclerotic Lesion: 131
Lessons Learned from Hypercholesterolemic Animal Models
M.E. Rosenfeld
Oxidative Modification of LDL and Atherogenesis 141
D. Steinberg
Dietary Antioxidants and Cardiovascular Disease 149
A.R. Folsom
Is "Antioxidant Status" a Risk Factor? 157
D. Steinberg
VI. DIABETES
Diabetes and Atherosclerosis: Risk Factors and Clinical Trials 165
G. Steiner
Insulin Resistance: What, Why, and How 171
G.M. Reaven
CONTENTS vii
Diabetes 181
D. Tschoepe
Dyslipidemia, Diabetes, and Cell Adhesion Molecules 191
Y. Abe, B. El-Masri, K.T. Kimball, H. Pownall, K. Osmundsen, C. W. Smith, and
C.M. Ballantyne
Novel Therapeutic Approaches to Insulin ResistancelDiabetic Dyslipidemia 199
C.R. Sirtori and F. Pazzucconi
VII. GENETIC DETERMINANTS OF CARDIOVASCULAR DISEASE
Hypertension and Thrombosis, Genetic Determinants of Cardiovascular Disease 209
R.R. Williams, S.C. Hunt, P.N. Hopkins, L. Wu, and J.-M. Lalouel
Lipoproteins and Cardiovascular Risk: From Genetics to Prevention of Coronary 217
Heart Disease
P. Cullen, H. Funke, H. Schulte, and G. Assmann
Obesity and Diabetes 229
J. Hirsch
Clustering of Cardiovascular Risk Factors 233
S.M. Haffner
VIII. INFLAMMATION AND CARDIOVASCULAR DISEASE
Neutrophil-Endothelial Cells Cooperation in the Handling of Leukotrienes: 239
Role in Coronary Inflammation
C. Buccellati, G. Rossoni, A. Bonazzi, S. Zarini, M. Bolla, J. Maclouf, G.C. Folco,
andA. Sala
Integrin Expression and Macrophage Resistance 'to ApoptPsis in Atherosclerosis 247
R. Judware, J.K. Yun, T.S. McCormick, and E.G. Lapetina
IX. FROM CHOLESTEROL TO CARDIOVASCULAR EVENTS, WHERE Is THE BRIDGE?
Effect of Statins Beyond Lowering Cholesterol: Where Do We Stand? 253
P. Quarato, N. Ferri, L. Arnaboldi, R. Fumagalli, R. Paoletti, and A. Corsini
Lessons from Clinical Trials: LCAS and Other Studies 267
JAo Herd
viii CONTENTS
Improving the Cost Effectiveness of Lipid Lowering 'Therapy in Coronary Heart 275
Disease Prevention
T A. Jacobson and K.L. Marchman
x.
LIFESTYLE AND CARDIOVASCULAR DISEASE
Diet and Cardiovascular Disease 285
J.C. LaRosa
Alcohol and Coronary Heart Disease: A Comparison of Ecologic and Non- 297
Ecologic Studies
M.H. Criqui
Preventing Cardiovascular Disease: Effective Smoking Cessation Strategies for 303
the Busy Clinician
J.K. Ockene and l.S. Ockene
XI. MULTIPLE RISK FACTORS AND CARDIOVASCULAR DISEASE
Risk Factors for Cardiovascular Disease and the Endothelium 313
H. Haller
Epidemiology of Risk Factor Clustering in Elevated Blood Pressure 325
W.B. Kannel, P. W.F. Wilson, H. Silbershatz, and R.B. D'Agostino
Hypertension and Coronary Heart Disease Risk Factor Management 335
M.C. Houston
Global Risk Management: New Strategies for Implementation 349
S.C. Smith, Jr.
Xll. CARDIAC FAILURE
Sudden Cardiac Death in Heart Failure 357
E. Marban and G.F. Tomaselli
Subject Index 369
PREFACE
This volume is a collection of the most significant contributions to the 4th International
Symposium on MULTIPLE RISK FACTORS IN CARDIOVASCULAR DISEASE: STRATEGIES OF
PREVENTION OF CORONARY HEART DISEASE, CARDIAC F AlLURE, AND STROKE held in
Washington, D.C. in April 1997. The meeting focused on the risk factors for cardiovascular
disease and their interactions. The need for this symposium is based on the epidemiological,
clinical, and biological evidence that individuals from industrialized countries often possess
two or more risk factors which synergistically increase the global risk profile. This has
become more evident in recent years with the increase in life expectancy of populations in
the industrialized countries. The evidence that a combination of risk factors confers a very
high risk of developing cardiovascular diseases, is of pivotal interest in the process of
detection of patients who will benefit the most from pharmacological treatment. Many
recent epidemiological data identifying the intrinsic and environmental factors contributing
to the development of atherosclerosis are discussed. These results, in parallel with basic and
clinical research, underline atherosclerosis as a complex and multifactorial process involving
the influences of lipids, including lipoprotein subfractions, blood pressure rheologic forces,
carbohydrate tolerance, and thrombogenic factors, including fibrinogen, tissue factor, PAl-I,
and homocysteine. Furthennore, the risk associated with anyone of these risk factors varies
widely depending on the level of the associated atherogenic risk factors. Hyper
cholesterolemia and hypertriglyceridemia, for instance, are more common than would be
expected by chance among hypertensive patients. Hypertension also is more prevalent in
those with abnormal lipid levels than in those with normal lipid levels. The association of
many of these risk factors (upper body obesity, glucose intolerance, hyperlipemia, and high
blood pressure) has been defined as the plurimetabolic syndrome or syndrome X, and is
discussed in depth in this volume.
It is essential to consider a reduction in all risk factors involved in the development
of atherosclerosis as the real end-point in any treatment. Special care should be used in
selecting the pharmacological or nonpharmacological therapy without affecting adversely
the cardiovascular profile. Hence, preventive management as well as risk estimation in
individuals should be multifactorial with the goal of improving the cardiovascular risk
profile, thus retarding or preventing the onset of heart or vascular disease. This is
accomplished ultimately by causing existing lesions to regress, become stable, or progress
more slowly, and also by preventing the formation of new lesions.
The information derived from this meeting should therefore be useful to specialists
and practicing physicians in detennining the diagnostic and therapeutic approach to patients
presenting with multiple risk factors for cardiovascular disease.
The Editors
ix
List of contributors
Yasunori Abe
speros P. Martel Section of Leukocyte Biology, Deparbnent of Pediatrics, Baylor Col
lege of Medicine, Texas Children's Clinical Care Center, Ste 1130, 6621 Fannin, MC
3-2372, Houston, Texas 77030-2399, USA
Marie Christine Alessi
Laboratoire d 'Hematologie, CHU Timone, 27, Bid Jean Moulin, 13385 Marseille Cedex
5,France
Lorenzo Arnaboldi
Institute of Pharmacological Sciences, University of Milan, Via Balzaretti 9, 20133
Milan, Italy
Gerd Assmann
Institute of Clinical Chemistry and Laboratory Medicine, University of Miinster, Albert
Schweitzer-Strasse 33, 48149 Miinster, Germany
Johan Auwerx
Unite 325 INSERM, Departement d' Atherosclerose, Institut Pasteur de Lille, 1 rue du
Professeur Calmette, 59019 Lille, France
Christie M. Ballantyne
Baylor College of Medicine, 6565 Fannin, M.S. A-601 , Houston, Texas 77030, USA
Franco Bernini
Institute of Pharmacology and Pharmacognosy, University of Parma, 43100 Parma, Italy
Mantio Bolla
Center for Cardiopulmonary Pharmacology, Institute of Pharmacological Sciences, School
of Pharmacy, University of Milan, 20133 Milan, Italy
Albino Bonazzi
Center for Cardiopulmonary Pharmacology, Institute ofP harmacological Sciences, School
of Pharmacy, University of Milan, 20133 Milan, Italy
H. Bryan Brewer, Jr.
Molecular Disease Branch, National Heart, Lung, and Blood Institute, National Institutes
of Health, Building 10, Room 7N115, 10 Center Drive MSC 1666, Bethesda; Maryland
20892-1666, USA
Carola Buccellati
Center for Cardiopulmonary Pharmacology, Institute of Pharmacological Sciences, School
of Pharmacy, University of Milan, 20133 Milan, Italy
xi