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Hyattsville, MD, United States

Umans J.G.,MedStar Research Institute
Clinical journal of the American Society of Nephrology : CJASN | Year: 2012

Preeclampsia, a common and potentially devastating multisystem disorder unique to human pregnancy, represents a novel form of secondary hypertension with complex renal and systemic effects. Recent translational and clinical research reveals key pathophysiologic contributions due to dysregulation of angiogenic factors and of angiotensin signaling. Despite these insights, there are still difficulties in the clinical definition of preeclampsia and in the diagnosis of women with this disorder. Although recent research suggests the potential for new preventive and treatment strategies, most have not yet been shown ready for clinical use. Source

Howard B.V.,MedStar Research Institute | Howard B.V.,Georgetown Howard Universities Center for Clinical and Translational Science | Rossouw J.E.,U.S. National Institutes of Health
Current Opinion in Lipidology | Year: 2013

PURPOSE OF REVIEW: In 2002 and 2004, the Women's Health Initiative found no evidence that hormone therapy with estrogen or estrogen with progestin (E+P) protected against cardiovascular disease (CVD). Since then, further analyses have been performed. This review summarizes current analyses on the effects of hormone therapy on CVD and CVD risk factors. RECENT FINDINGS: The negative effects of hormone therapy vary by the type of CVD event. Estrogen alone and E+P show consistent effects on CVD, but E+P has more impact on coronary heart disease (CHD) and venous thromboembolism. Women of all ethnicities, including those who are obese, have diabetes, or are taking daily aspirin or statins remain at risk for adverse effects from hormone therapy. Although younger women or more recently menopausal women taking hormone therapy may be at relatively lower risk for CHD and myocardial infarction, they remain at risk for stroke, venous thromboembolism and peripheral artery disease. Adverse effects are enhanced in older women with menopausal symptoms. Although hormone therapy lowers LDL cholesterol and lipoprotein (a) and raises high-density lipoprotein cholesterol, it has adverse effects on triglyceride, lipoprotein composition, and inflammatory and hemostatic markers. Baseline metabolic syndrome and high LDL cholesterol increase the CHD risk with hormone therapy. Analyses of discontinuation data in the estrogen-alone and E+P trials suggest that the adverse effects of hormone therapy on CVD are reversible. SUMMARY: Recent analyses do not justify postmenopausal hormone therapy for CVD prevention. Further research on the role of hormone therapy-induced changes in CVD risk factors along with genetic studies may increase understanding and aid in developing safer therapies for menopausal symptoms. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Brewer Jr. H.B.,MedStar Research Institute
Journal of Clinical Endocrinology and Metabolism | Year: 2011

Context: Statin treatment of cardiovascular patients reduces clinical events by 25 to 45%. Highdensity lipoprotein (HDL) has been proposed as a therapeutic target to further reduce this residual cardiovascular risk. Evidence Acquisition: PubMed from 1940 to the present was searched for all relevant citations related to the structure, function, and role of HDL in atherosclerosis. Evidence Synthesis: Epidemiological data, animal models with increased plasma HDL levels, as well as initial clinical and cardiovascular imaging trials suggest that increasing HDL in clinical patients will decrease the risk of cardiovascular disease. Proposed mechanisms by which HDL may reduce atherosclerosis include facilitating cholesterol efflux from cholesterol-loaded foam cells, role as an antiinflammatory lipoprotein, decreasing atherogenic oxidized low-density lipoprotein, increasing nitric oxide synthesis, serving as a plasma transport lipoprotein for biologically important proteins, and as an antithrombotic agent. The identification of the major receptors, enzymes, cellular transporters, and plasma lipid transfer proteins has provided major new insights into the pathways for HDL metabolism and cholesterol transport as well as targets for future drug development to increase HDL. Conclusions: Clinical trials with new HDL-raising drugs are currently under way to provide definitive evidence that increasing HDL will reduce cardiovascular events. The marked increase in our knowledge of the roles of HDL in cholesterol transport and the development of atherosclerosis now provides the framework for a more effective assessment of the plasma level and the function of HDL in an individual patient, as well as the lipoprotein profile after new drugs that increase HDL. Copyright © 2011 by The Endocrine Society. Source

Shara N.M.,MedStar Research Institute
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2010

Morbidity and mortality from cardiovascular disease (CVD) are rising among Middle Eastern women. Despite this threat, awareness and understanding of CVD are low and surveillance data are nonexistent for many populations in this region. In this review, the data available on CVD in Middle Eastern women will be generalized. Population-based studies in the Middle East have been sporadic and most have been cross-sectional with small samples. Many Middle Eastern countries lack reliable surveillance data regarding the prevalence and incidence of CVD and its risk factors in women. This information is crucial for monitoring the scope of the problem and for guiding intervention strategies. Because of the ethnic heterogeneity of this region and the rapidly changing lifestyles, well-designed, longitudinal, large-scale population-based studies that focus on CVD and its risk factors are needed in multiple areas of the Middle East. © 2010 Elsevier B.V. Source

Rosenson R.S.,Mount Sinai School of Medicine | Brewer H.B.,MedStar Research Institute | Rader D.J.,University of Pennsylvania
Circulation Research | Year: 2014

The period following an acute coronary syndrome (ACS) represents a critical time frame with a high risk for recurrent events and death. The pathogenesis of this increase in clinical cardiovascular disease events after ACS is complex, with molecular mechanisms including increased thrombosis and inflammation. Dyslipoproteinemia is common in patients with ACS and predictive of recurrent cardiovascular disease events after presentation with an ACS event. Although randomized clinical trials have provided fairly convincing evidence that high-dose statins reduce the risk of recurrent cardiovascular events after ACS, there remain questions about how aggressively to reduce low-density lipoprotein cholesterol levels in ACS. Furthermore, no other lipid-related interventions have yet been proven to be effective in reducing major cardiovascular events after ACS. Here, we review the relationship of lipoproteins as biomarkers to cardiovascular risk after ACS, the evidence for lipid-targeted interventions, and the potential for novel therapeutic approaches in this arena. © 2014 American Heart Association, Inc. Source

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