Ann S. Jackson – författare

The issue of interaction of risk factors in cardiovascular disease is discussed in this text which is a collection of the scientific contributions to the 4th International Symposium on Multiple Risk Factors and Cardiovascular Disease: Strategies of Prevention of Coronary Heart Disease, Cardiac Failure, and Stroke. The book addresses the role of simultaneous risk factors in patients. Because patients with two or more risk factors are at very high risk for developing cardiovascular diseases, special care should be taken in the choice of appropriate therapeutic intervention. Risk factors are also discussed from the point of view of the biochemist and the pharmacologist by addressing the mechanisms underlying the onset of hypertension, hyperlipoproteinemia, hypercoagulability, and the possibility of therapeutic intervention. This book should therefore be of value to the biochemist, pharmacologist, and clinical pharmacologist, as well as to specialists in the field of cardiovascular medicine.

List of Contributors xviii An Aging Humankind: New Realities E. Dicgalusy Does Menopause Increase the Risk of Coronary Heart Disease? M.V. Huisrnan Chronic Low-Grade Metabolic Acidosis in Normal Adult Humans: Pathophysiology and Consequences L. Frassetto, R.C. Morris, Jr., K. Todd, and A. Sebastian The Menopause, Sex Hormones, and Rheumatic Disease G. Hall Novel Mechanisms of Estrogen Action J.-A. Gustafsson The Action of Ovarian Steroid Hormones on Tissues and Organs M.J. Legato Nongenomic Mechanisms of Sex Hormones J.H.H. Thijssen Action of Specific Estrogens on Vascular Cells C.S. Wingrove and J.C. Stevenson Direct Actions of Estrogen on Vascular Cells Ameliorates Response to hjury D. W. Losordo ix Newer Progestogens G. Samsioe IV. 11. Cardiovascular Disease: Risk Factors Related to Thrombosis G. de Gaetano, M.B. Donati, and L. Iacoviello Estrogen Effect upon Coronary Vasculature G.M.C. Rosano, F. Leonardo, and G. Panina Estrogen and Endothelial Function A. Virdis, L. Ghiadoni, I. Sudano, S. Pinto, S. Taddei, and A. Salvetti Action of Specific Estrogens on the Coronary Artery: Effects on Lipoproteins, Coagulation, and Fibrinolysis J.M.Sullivan Coronary Heart Disease in Women: Status 1998 N. K. Wenger Introduction to Osteoporosis C. Christiansen Genetics of Osteoporosis L. Masi, L. Gennari, A. Falchetti, and M.L. Brandi The Clinical Management of Osteoporosis S.E. Papapou los VI.

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.

Despite its universality in human female aging, the menopause and its biology are not completely understood. New biologic mechanisms by which sex hormones may be detrimental or confer protection are continually being discovered. We are now starting to understand that the role of the estrogen receptor is not identical in all tissues. Important nongenomic effects for sex hormones have also been described. Hormone replacement therapy (HRT) has produced effects on health risks: some are reduced, some are increased, and the rest remain uncertain. HRT is being used by an increasing number of women to alleviate climacteric symptoms in the perimenopausal period and to prevent osteoporosis and cardiovascular disease later. Positive effects on Alzheimer's disease and dementia on the one hand, and an increase in venous thrombosis on the other, are currently being reported by several groups. Both the preventive benefits and the risk of breast cancer seem to be linked to long-term and current use. HRT requires further testing through specific clinical trials, currently underway in the United States, before confident recommendations may be made about the full range of benefits and risks.

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.

Despite its universality in human female aging, the menopause and its biology are not completely understood. New biologic mechanisms by which sex hormones may be detrimental or confer protection are continually being discovered. We are now starting to understand that the role of the estrogen receptor is not identical in all tissues. Important nongenomic effects for sex hormones have also been described. Hormone replacement therapy (HRT) has produced effects on health risks: some are reduced, some are increased, and the rest remain uncertain. HRT is being used by an increasing number of women to alleviate climacteric symptoms in the perimenopausal period and to prevent osteoporosis and cardiovascular disease later. Positive effects on Alzheimer''s disease and dementia on the one hand, and an increase in venous thrombosis on the other, are currently being reported by several groups. Both the preventive benefits and the risk of breast cancer seem to be linked to long-term and current use. HRT requires further testing through specific clinical trials, currently underway in the United States, before confident recommendations may be made about the full range of benefits and risks.