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Coronary Risk Factors Update, An Issue of Medical Clinics - E-Book

Coronary Risk Factors Update, An Issue of Medical Clinics - E-Book

Valentin Fuster | Jagat Narula

(2012)

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Book Details

Abstract

This issue of Medical Clinics of North America provides the latest essential updates on coronary risk factors.  The following key questions are answered.  Are new biomarkers informative? LDL: the lower the better?  How important is HDL?  How much credit does triglyceride deserve?  How important is family history of coronary disease?  How important is age in determining coronary risk factors?  Endothelial progenitor cells, menopause, and coronary risk factors?  What is the role of imaging in prevention of coronary artery disease?  Is genomics ready for primetime?  Pediatric statinization?  Individualized statinization?  Polypill for some, polypill for all?

Table of Contents

Section Title Page Action Price
Front Cover Cover
Medical Clinics of North America i
Copyright Page ii
Table of Contents ix
Contributors v
Preface: Risk Factor Update: Old Wine in a New Bottle? xiii
Chpater 1. Are Novel Serum Biomarkers Informative? 1
CALIBRATION 2
DISCRIMINATION 2
NET RECLASSIFICATION IMPROVEMENT 3
CURRENT TECHNIQUES FOR RISK STRATIFICATION 5
INDIVIDUAL BIOMARKERS 6
REFERENCES 9
Chpater 2. LDL Cholesterol: The Lower the Better 13
BIOLOGY, PATHOPHYSIOLOGY, AND EVOLUTION 13
CLINICAL TRIALS OF LDL-C LOWERING 15
SAFETY DATA ON REDUCING LDL-C TO VERY LOW LEVELS WITH STATINS 21
SUMMARY 24
REFERENCES 24
Chpater 3. HDL–Cholesterol: Perfection is the Enemy of Good? 27
WHAT IS HDL? 30
CLASSIFICATION OF HDLs 30
MECHANISMS OF ANTIATHEROGENIC PROPERTIES OF HDL 30
AGENTS THAT INCREASE HDL-C 32
SUMMARY 34
REFERENCES 34
Chpater 4. Triglycerides: How Much Credit Do They Deserve? 39
PREVALENCE AND DEFINITION 39
TG PHYSIOLOGY AND CAUSES OF ELEVATED TGS 40
GENETIC STUDIES IN HYPERTRIGLYCERIDEMIA 40
MEASURING TGS 41
BIOLOGIC ROLE OF TGS IN CAD 42
EVIDENCE FOR TGS AS AN INDEPENDENT RISK FACTOR FOR CAD 42
NONPHARMACOLOGIC AND PHARMACOLOGIC TREATMENT OF HYPERTRIGLYCERIDEMIA 44
POSTPRANDIAL VERSUS FASTING TGS 49
HYPERTRIGLYCERIDEMIA IN SPECIAL POPULATIONS: WOMEN 49
TGS: HOW MUCH CREDIT DO THEY DESERVE? 50
REFERENCES 50
Chpater 5. Atherosclerosis in Chronic Kidney Disease: Lessons Learned from Glycation in Diabetes 57
GLYCATION AND ATHEROSCLEROSIS IN DIABETES 57
CARBAMYLATION OF VASCULAR PROTEINS AS A CONTRIBUTOR TO ATHEROSCLEROSIS 60
SUMMARY 62
REFERENCES 62
Chpater 6. \"My Parents Died of Myocardial Infarction: Is that My Destiny? 67
MI AND ATS RISK FACTORS PARTLY OVERLAP 68
POSITIVE FAMILY HISTORY 69
FAMILIAL ENVIRONMENTAL FACTORS 71
MI: LOW-DOSE INPUT OF MANY GENES 72
NOVEL CANDIDATE GENES, UNRELATED TO KNOWN RISK FACTORS, ADD TO CLASSIC RISK FACTORS 72
MONOGENIC FACTORS 80
NEXT-GENERATION SEQUENCING 80
KNOWN RISKY ALLELES AND PERSONAL RISK STRATIFICATION IN CURRENT CLINICAL PRACTICE 80
ROLE OF GENETIC COUNSELING 81
SUMMARY 83
REFERENCES 83
Chpater 7. Age As a Risk Factor 87
ASSESSMENT OF CVD RISK USING AGE AS PART OF RISK SCORES 87
AGE IS AN INDEPENDENT RISK FACTOR FOR CARDIOVASCULAR DISEASE 88
RELATIVE RISK VERSUS ABSOLUTE RISK ASSESSMENT 89
COMMUNICATING CVD RISK TO YOUNG AND OLD 89
INFLUENCE OF AGE ON OTHER INDIVIDUAL RISK FACTORS 89
INFLUENCE OF INDIVIDUAL RISK FACTORS ON AGE-ASSOCIATED CVD RISK 90
SUMMARY 90
REFERENCES 90
Chpater 8. Coronary Artery Disease in Aging Women: A Menopause of Endothelial Progenitor Cells? 93
THE EMERGING ROLE OF ENDOTHELIAL PROGENITOR CELLS IN ATHEROGENESIS 93
UNIQUE FEMALE CARDIOVASCULAR PROTECTION DURING THE REPRODUCTIVE AGE 94
EXAMINING THE OBVIOUS: WHAT IS UNIQUE ABOUT THE FEMALE ENDOTHELIAL PROGENITOR CELL BIOLOGY DURING THE REPRODUCTIVE AGE? 95
LESSONS TO BE LEARNED 98
REFERENCES 98
Chpater 9. Imaging for Prevention 103
CARDIOVASCULAR EPIDEMIOLOGY AND THE DETECTION GAP FOR IDENTIFYING HIGH-RISK INDIVIDUALS 103
WHAT IS IMAGING FOR PREVENTION? 103
GLOBAL RISK SCORES 104
SCREENING WITH CV IMAGING—CAN CT CAC SCORING IMPROVE DETECTION OF HIGH-RISK INDIVIDUALS? 104
CAC SCREENING—THE BENEFIT OUTWEIGHS THE PROJECTED RISK 108
SUMMARY 109
REFERENCES 109
Chpater 10. Genomics: Is It Ready for Primetime? 113
DNA SEQUENCE VARIATION AND THE HapMap PROJECT 114
MONOGENIC DISORDERS 114
GENETIC UNDERPINNINGS OF COMMON COMPLEX DISEASES AND THE GWAS 114
9p21: THE FIRST AND MOST ROBUST GENETIC RISK FACTOR TO EMERGE FROM GWAS 114
AN ABUNDANCE OF GENETIC RISK VARIANTS DISCOVERED BY GWAS 115
MECHANISMS UNDERLYING SNP ASSOCIATION DISCOVERED IN GWAS 117
PHARMACOGENOMICS 117
INFORMATION GLEANED FROM CAD GENETIC RISK VARIANTS 118
ADVANTAGES OF DNA RISK VARIANTS OVER CONVENTIONAL BIOMARKERS 118
ROLE OF GENETIC RISK VARIANTS IN PREDICTION AND TREATMENT OF CORONARY ARTERY DISEASE 118
SUMMARY 119
REFERENCES 119
Chpater 11. Statins Personalized 123
GENETIC CONTRIBUTORS TO BLOOD LIPID LEVELS 124
PHENOTYPE AND STATIN RESPONSE 127
GENETIC CONTRIBUTORS TO STATIN-INDUCED LDL-C REDUCTION 128
GENETIC CONTRIBUTORS TO STATIN-ASSOCIATED REDUCTION IN CLINICAL EVENTS 130
GENETIC CONTRIBUTORS TO STATIN-ASSOCIATED ADVERSE EFFECTS 131
SUMMARY 134
ACKNOWLEDGMENTS 134
REFERENCES 134
Chpater 12. Childhood Cholesterol Disorders: The Iceberg Base or Nondisease? 141
PEDIATRIC LIPID ABNORMALITIES: SCOPE OF THE PROBLEM 141
SIGNIFICANCE OF ATHEROSCLEROSIS DURING CHILDHOOD 141
CHILDHOOD CHOLESTEROL LEVELS AND ATHEROSCLEROSIS 142
TRACKING OF LIPID DISORDERS FROM CHILDHOOD TO ADULTHOOD 143
SCREENING FOR LIPID DISORDERS 143
LIPID TESTS IN CHILDREN 144
CLINICAL PRESENTATIONS OF LIPID DISORDERS IN CHILDHOOD 145
LIFESTYLE MODIFICATION OF PEDIATRIC LIPID DISORDERS 146
PHARMACOTHERAPY FOR PEDIATRIC LIPID DISORDERS 147
CONTROVERSY ABOUT PEDIATRIC LIPID SCREENING AND TREATMENT 148
LITERATURE GAPS 149
SUMMARY 150
REFERENCES 150
Index 155