Vascular health and risk management
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Vasc Health Risk Manag · Jan 2008
ReviewSystematic review of implementation strategies for risk tables in the prevention of cardiovascular diseases.
Cardiovascular disease prevention is guided by so-called risk tables for calculating individual's risk numbers. However, they are not widely used in routine practice and it is important to understand the conditions for their use. ⋯ Implementation strategies for cardiovascular risk tables have been sparsely studied. Future research on implementation of cardiovascular risk tables needs better embedding in the systematic and problem-based approaches developed in implementation science.
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Vasc Health Risk Manag · Jan 2008
ReviewSystematic review of implementation strategies for risk tables in the prevention of cardiovascular diseases.
Cardiovascular disease prevention is guided by so-called risk tables for calculating individual's risk numbers. However, they are not widely used in routine practice and it is important to understand the conditions for their use. ⋯ Implementation strategies for cardiovascular risk tables have been sparsely studied. Future research on implementation of cardiovascular risk tables needs better embedding in the systematic and problem-based approaches developed in implementation science.
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Vasc Health Risk Manag · Jan 2008
ReviewMechanisms of endothelial dysfunction in obstructive sleep apnea.
Endothelial activation and inflammation are important mediators of accelerated atherogenesis and consequent increased cardiovascular morbidity in obstructive sleep apnea (OSA). Repetitive episodes of hypoxia/reoxygenation associated with transient cessation of breathing during sleep in OSA resemble ischemia/reperfusion injury and may be the main culprit underlying endothelial dysfunction in OSA. Additional factors such as repetitive arousals resulting in sleep fragmentation and deprivation and individual genetic susceptibility to vascular manifestations of OSA contribute to impaired endothelial function in OSA. The present review focuses on possible mechanisms that underlie endothelial activation and inflammation in OSA.
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Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) can significantly decrease cardiovascular mortality and morbidity, irrespective of the patients' cholesterol status. This paper reviews the effects of perioperative statin therapy in patients undergoing noncardiac surgery. ⋯ Ideally a large scale multi-centre randomized controlled trial of perioperative statin therapy should be performed but this may be difficult to conduct since there is already overwhelming evidence in the literature to suggest perioperative cardiovascular protective properties. Statins may still be under-prescribed in surgical patients.
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Vasc Health Risk Manag · Jan 2008
ReviewCurrent concepts in the management of hepatopulmonary syndrome.
The hepatopulmonary syndrome is characterized as the triad of liver disease, pulmonary gas exchange abnormalities leading to arterial deoxygenation and evidence of intrapulmonary vascular dilatations. This review summarizes the pathological mechanisms leading to pulmonary vascular changes in hepatopulmonary syndrome. ⋯ Liver transplantation is considered to be the definitive treatment of hepatopulmonary syndrome with often successful reversal of hypoxemia, however other treatments have been trialed. This review further appraises the evidence for the use of pharmacological agents and the role of radiological interventions in hepatopulmonary syndrome.