Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the industrialized world and in the future is expected to be the number one killer worldwide. The main cause underlying CVD is atherosclerosis. A key event in atherosclerosis initiation and progression is oxidative stress through the production of reactive oxygen species as well as endothelial dysfunction. Several pro- inflammatory and anti-inflammatory cytokines and proteins are involved in this process, complemented by activation of adhesion molecules that promote leukocyte rolling, tethering and infiltration into the sub-endothelial space. Statins represent the agent of choice since numerous clinical trials have verified that their pharmacological action extends beyond lipid lowering. Statins demonstrate direct anti-oxidant effects by scavenging free radicals and stimulating anti-oxidant enzymes while acting as regulators for cytokine, protein and adhesion molecule expression, all of which are involved in the atherosclerotic process. Statin use is considered one of the most efficient currently used interventions in managing CVD with the likely hood of remaining so in the near future.
It is estimated that erectile dysfunction (ED) affects more than 150 million people worldwide and this number is expected to double by the year 2025. Vascular component represents the most important etiological cause of erectile dysfunction. ED shares almost all risk factors, such as hypertension, diabetes mellitus, hyperlipidaemia and smoking, with arteriosclerosis. Moderate to severe ED is associated with a considerably increased risk for coronary heart disease (CHD). This review was conducted in May 2016, when the PubMed database was searched using the combination of the terms “erectile dysfunction” and “cardiovascular diseases”, “coronary artery diseases” and “risk factors”. In this review, we analyzed the published literature, regarding the predictive role of ED in CVD and the association of ED risk factors with CVD risk factors, aiming to draw particular attention on the role of sexual inquiry of all men to prevent or decrease major cardiovascular events. In conclusion, the early detection of ED can prevent major cardiovascular events with early management of cardiovascular risk and permits to include patients in a risk stratification group. Erectile function should be evaluated using questionnaires in all male patients to prevent and decrease the rates of major cardiovascular events.
Introduction: Percutaneous coronary intervention is the first therapeutic choice in the treatment of symptomatic coronary artery disease and Multi-Slice Computed Tomography Coronary Angiography (MSCT-CA) is a new non-invasive diagnostic tool in the follow-up of these patients. The aim of our study was to evaluate the rate of in-stent restenosis (ISR), to identify the predictive factors for ISR at 1 year after PCI and to assess the progression of non-culprit lesions, using a MSCT-CA follow-up.
Material and methods: The study included 30 patients with acute coronary syndrome treated with one BMS implantation. The patients were divided into Group A (9 patients) presenting ISR and Group B (21 patients) without ISR at 1 year MSCT-CA follow-up.
Results: ISR lesions were mostly localized on the LAD (45%). No significant difference between the study groups was identified for risk factors, as male gender (77.7% vs. 85.71%, p = 0.62), hypertension (88.8% vs. 95.23%, p = 0.51), smoking status (33.3% vs. 72.22%, p = 0.23), history of CVD (55.5% vs. 47.61%, p >0.99), diabetes (11.11% vs. 19.04%, p >0.99), hyperlipidemia (22.22% vs. 52.38%, p = 0.22), CKD (44.44% vs. 14.28%, p = 0.15), age, triglycerides and SYNTAX Score. A significant difference was recorded in baseline cholesterol level (141.7 ± 8.788 vs. 182.8 ± 12; p = 0.029). Ca Score at 1 year was significantly higher in patients with ISR (603.1 ± 529.3 vs. 259.4 ± 354.6; p = 0.005). 66.67% of patients from Group A presented significant non-culprit lesions at baseline vs. 23.81% in Group B (p = 0.041).
Conclusions: MSCT-CA is a useful non-invasive diagnostic tool for ISR in the follow-up of patients who underwent primary PCI for an acute coronary syndrome. The presence of significant non-culprit lesions at the time of the primary PCI could be a predictive factor for ISR. A Ca Score >400 determined at 1-year follow-up is associated with a higher rate of ISR, and could be considered a significant cardiovascular risk factor for this group of patients. Further studies are required in order to elucidate the role of various imaging biomarkers in predicting the development of ISR.
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