C-Reactive Protein Screening for Cardiovascular Disease

Wiesbauer, Franz; Miles, J. Shawn

doi:10.1001/archinte.163.2.242-a

Cited by 2 publications

(1 citation statement)

References 5 publications

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“…26 C-reactive protein (CRP) is another marker of systemic vascular inflammation that correlates with the progression of atherosclerosis. 28 Elevated CRP is a stronger predictor than low-density lipoprotein (LDL) cholesterol of cardiovascular events and is associated with blunted endothelium-dependent vasodilation of peripheral arteries. 29,30 In patients with diabetes, elevated CRP is an independent risk factor for cardiovascular disease, making it another clinically useful monitoring tool.…”

Section: Markers Of Endothelial Dysfunctionmentioning

confidence: 99%

Cardiovascular Risk Factors in Childhood Diabetes

Miller¹,

Silverstein²

2003

The Endocrinologist

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The concern for early cardiovascular morbidity and mortality is becoming increasingly more common in the pediatric arena due to the continually increasing incidence of type 1 and type 2 diabetes mellitus, as well as the rise in obesity in this population. Currently the only treatment recommendations are derived from adult guidelines, due to a lack of evidence-based data in children. Independent risk factors for cardiovascular disease are similar in children and adults: obesity, presence of diabetes, hyperglycemia, insulin resistance, hypertension, and hyperlipidemia. Postmortem studies in children have shown that atherosclerotic plaques begin in childhood, and coronary artery lesions can be seen as early as 10 years of age. The development of atherosclerotic plaques appears to be due to endothelial dysfunction as a result of inflammatory changes from the above listed cardiovascular risk factors. Currently there are several serum markers of inflammation that are predictive of cardiovascular disease in adults, but the significance of changes in the levels of these markers in children is currently unknown. Additionally, there are several noninvasive techniques to measure endothelial dysfunction, including brachial artery reactivity and ECHO Doppler carotid intima-medial thickness, which may ultimately prove to be predictive for cardiovascular disease in children. The management of hypertension in adult patients has been a critical aspect of prevention of cardiovascular disease, but treatment of hypertension in pediatric patients is difficult due to the lack of trials of safety and efficacy in children, as well as lack of universally accepted standards for the appropriate age and blood pressure level for starting treatment. However, data from adult studies of cardiovascular risk suggest that there would be benefit to early, aggressive control of elevated blood pressure in children. Future studies will be needed to determine which antihypertensive medications will be safe and effective in children, as well as to determine starting points for treatment of hypertension in this population. The treatment of dyslipidemia in adults has resulted in significant risk reduction for cardiovascular morbidity and mortality, but there is a paucity of information available about the long-term safety of using lipidlowering medications in growing children. Currently, bile acid sequestrants are the only lipid-lowering medication approved for children of all ages, while other lipid-lowering medications are only approved for use in children age 10 and above, and for use in familial hypercholesterolemia. Short-term studies of the statin medications in small groups of male children have shown excellent compliance with no adverse effects on growth, sexual maturation, or hormone levels, but longer-term, more comprehensive studies are needed in the pediatric population. Both the statins and the thiazolidinediones have been shown to have pleotropic effects on the endithelium, which may confer a cardioprotective environment. Treatment of cardio...

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Section: Markers Of Endothelial Dysfunctionmentioning

confidence: 99%

Cardiovascular Risk Factors in Childhood Diabetes

Miller¹,

Silverstein²

2003

The Endocrinologist

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Pharmacotherapy for dyslipidaemia – current therapies and future agents

Bays

Stein

2003

Expert Opinion on Pharmacotherapy

157

109

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Current lipid-altering agents that lower low density lipoprotein cholesterol (LDL-C) primarily through increased hepatic LDL receptor activity include statins, bile acid sequestrants/resins and cholesterol absorption inhibitors such as ezetimibe, plant stanols/sterols, polyphenols, as well as nutraceuticals such as oat bran, psyllium and soy proteins; those currently in development include newer statins, phytostanol analogues, squalene synthase inhibitors, bile acid transport inhibitors and SREBP cleavage-activating protein (SCAP) activating ligands. Other current agents that affect lipid metabolism include nicotinic acid (niacin), acipimox, high-dose fish oils, antioxidants and policosanol, whilst those in development include microsomal triglyceride transfer protein (MTP) inhibitors, acylcoenzyme A: cholesterol acyltransferase (ACAT) inhibitors, gemcabene, lifibrol, pantothenic acid analogues, nicotinic acid-receptor agonists, anti-inflammatory agents (such as Lp-PLA(2) antagonists and AGI1067) and functional oils. Current agents that affect nuclear receptors include PPAR-alpha and -gamma agonists, while in development are newer PPAR-alpha, -gamma and -delta agonists, as well as dual PPAR-alpha/gamma and 'pan' PPAR-alpha/gamma/delta agonists. Liver X receptor (LXR), farnesoid X receptor (FXR) and sterol-regulatory element binding protein (SREBP) are also nuclear receptor targets of investigational agents. Agents in development also may affect high density lipoprotein cholesterol (HDL-C) blood levels or flux and include cholesteryl ester transfer protein (CETP) inhibitors (such as torcetrapib), CETP vaccines, various HDL 'therapies' and upregulators of ATP-binding cassette transporter (ABC) A1, lecithin cholesterol acyltransferase (LCAT) and scavenger receptor class B Type 1 (SRB1), as well as synthetic apolipoprotein (Apo)E-related peptides. Fixed-dose combination lipid-altering drugs are currently available such as extended-release niacin/lovastatin, whilst atorvastatin/amlodipine, ezetimibe/simvastatin, atorvastatin/CETP inhibitor, statin/PPAR agonist, extended-release niacin/simvastatin and pravastatin/aspirin are under development. Finally, current and future lipid-altering drugs may include anti-obesity agents which could favourably affect lipid levels.

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C-Reactive Protein Screening for Cardiovascular Disease

Cited by 2 publications

References 5 publications

Cardiovascular Risk Factors in Childhood Diabetes

Cardiovascular Risk Factors in Childhood Diabetes

Pharmacotherapy for dyslipidaemia – current therapies and future agents

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