New risk factors for atherosclerosis in hypertension: focus on the prothrombotic state and lipoprotein(a)

Abstract

Although adequate control of blood pressure is of basic importance in cardiovascular prevention in hypertensive patients, correction of additional risk factors is an integral part of their management. In addition to classical risk factors, epidemiological research has identified a number of other conditions that might significantly contribute to cardiovascular risk in the general population and might achieve specific relevance in patients with high blood pressure. In fact, more than 20% of patients with premature cardiovascular events do not have any of the traditional risk factors and, although effective intervention on blood pressure and additional risk factors has significantly reduced cardiovascular morbidity and mortality, the contribution to stroke, coronary artery disease and renal failure is still unacceptably high. Evaluation of new risk factors may further expand our capacity to predict atherothrombotic events when these factors are included along with the traditional ones in the assessment of global cardiovascular risk in hypertensive patients. Because it could be anticipated that the role of these novel factors will become increasingly evident in the future, researchers with an interest in hypertension and physicians dealing with problems related to cardiovascular prevention should give them appropriate consideration. This review summarizes the basic biology and clinical evidence of two emerging risk factors that are reciprocally related and contribute to the development and progression of organ damage in hypertension: the prothrombotic state and lipoprotein(a).

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

“…Moreover, MPO itself and MPO-derived reactive oxygen species have been shown to increase the expression of tissue factor, leading to a thrombotic state 91) , and influence erythrocyte deformation and aggregation, leading to membrane generation, rouleau formation and higher blood viscosity [92][93][94][95][96][97] . In addition, other cardiovascular risk factors (cigarette smoking, hyperglycemia) [98][99][100][101][102][103][104][105] and immune-inflammatory/oxidative stress-related factors (C-reactive protein, CD40 ligand, fibrinogen and D-dimer, lipoprotein (a)) 81, [106][107][108][109][110][111][112][113][114][115][116][117][118] have been reported to influence the platelet-fibrin clot structure and blood viscosity/erythrocyte aggregation. These findings are of considerable interest, since they suggest that some factors influencing blood thrombogenicity/ viscosity and erythrocyte properties (deformability and/or aggregability) may play important roles in the evolution of erythrocyte-rich large thrombi.…”

The effects of angiotensin receptor blockers vs. calcium channel blockers on the acute exercise-induced inflammatory and thrombotic response

“…1 Arterial hypertension (AH) is an established cardiovascular (CV) risk factor, whereas inflammatory and prothrombotic biomarkers implicated in the pathophysiology of AH [2][3][4] have emerged as novel CV risk factors. [5][6][7][8][9][10][11] Of the many promising molecules, C-reactive protein (CRP), serum amyloid A (SAA), white blood cells (WBC) count, tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6), fibrinogen, von Willebrand factor (vWF) and plasminogen activator inhibitor-1 (PAI-1) have generated considerable attention as predictors of AH, atherosclerosis, plaque destabilization and major CV events. [2][3][4][5][6][7][8][9][10][11] The acute effects of exercise on circulating biomarkers have mainly been studied many hours after exercise in young athletes engaging in exhaustive exercise of long duration (for example, a marathon race).…”

“…[5][6][7][8][9][10][11] Of the many promising molecules, C-reactive protein (CRP), serum amyloid A (SAA), white blood cells (WBC) count, tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6), fibrinogen, von Willebrand factor (vWF) and plasminogen activator inhibitor-1 (PAI-1) have generated considerable attention as predictors of AH, atherosclerosis, plaque destabilization and major CV events. [2][3][4][5][6][7][8][9][10][11] The acute effects of exercise on circulating biomarkers have mainly been studied many hours after exercise in young athletes engaging in exhaustive exercise of long duration (for example, a marathon race). [12][13][14][15][16] The early acute phase response (APR) during short-term, vigorous aerobic exercise (work rate of at least 6 metabolic equivalents, for example, jogging) 1 in older, untrained adults has not been well studied.…”

Association of Elevated Serum Lipoprotein(a), Inflammation, Oxidative Stress and Chronic Kidney Disease with Hypertension in Non-diabetes Hypertensive Patients

“…The correlations of hypertension with elevated Lp(a) levels, hs-CRP, renal insufficiency and increased oxidative stress partly explains the increased susceptibility to vascular disease in HT patients with renal insufficiency. It can be hypothesized that the atherogenic effect of Lp(a) might adversely affect the renal vasculature and aggravate renal function in these patients [1]. Alternatively, higher levels of Lp(a) and CRP in hypertensive patients might be simply explained by worse renal function.…”

“…A prothrombotic state and elevated serum lipoprotein(a) [Lp(a)] are the two emerging risk factors that are reciprocally related and contribute to cardiovascular consequences in hypertensive patients with early renal failure [1,2]. Elevated Lp(a) has been demonstrated in patients with moderate impairment of renal function, suggesting that this lipoprotein contributes to the increased risk for atherosclerotic disease seen in hypertensive patients [3].…”