Current vascular pharmacology
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Curr Vasc Pharmacol · Nov 2013
Neutrophil gelatinase-associated lipocalin (NGAL) and endothelial progenitor cells (EPCs) evaluation in aortic aneurysm repair.
Acute kidney injury (AKI) develops in 10% of patients after surgical abdominal aortic aneurysm (AAA) repair. Neutrophil gelatinase-associated lipocalin (NGAL) is a predictor of AKI and Endothelial Progenitor Cells (EPCs) represent a potential repair mechanism for vascular lesions. We evaluated the diagnostic power of serum (s) and urine (u) NGAL in detecting a possible event of AKI in patients undergoing surgical treatment for AAA repair. We also investigated the influence of vascular injury on EPCs. ⋯ NGAL represents an independent renal predictor of incidence of AKI. EPCs reflect the degree of vascular damage and could be considered as an indicator of disease with a reparative-regenerative vascular-endothelial function.
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Statins are well-established and effective drugs in the treatment of hyperlipidemias. However the effects of statins extend beyond lipid-lowering. The pleiotropic effects of statins have been shown to modify inflammatory cell signaling of the immune response to infection. ⋯ Some analyses also provide evidence for statins as an adjuvant therapy in sepsis. Because of the divergent results of studies, the potential benefit needs to be validated in randomized, controlled trials. In this review, we describe current evidence on the use of statins in the prevention and treatment of sepsis.
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Curr Vasc Pharmacol · Jul 2013
Review Comparative StudyReview of trans-atlantic cardiovascular best medical therapy guidelines - recommendations for asymptomatic carotid atherosclerosis.
The annual rate of ipsilateral stroke associated with asymptomatic carotid stenosis has fallen from 2-4% to <1% in the last 20 years due to improvements in medical therapy. The fundamental benefits of this are relevant to whether patients undergo revascularisation or not. We aimed to evaluate existing international guidelines for the management of carotid stenosis, identifying important similarities and differences. ⋯ There is now clear, evidence based guidance from British, European and US cardiovascular bodies regarding optimal targets for risk factor modification. These can be adopted as standard operating procedure for clinical practice and the medical arms of carotid interventional trials. In the future imaging biomarkers may help provide an understanding of the risk of an individual carotid lesion to help guide therapy.
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Microcirculatory dysfunction has been recently recognized as a key pathophysiologic process in the evolution of sepsis. In the present review, we discuss fundamental aspects of microcirculatory abnormalities during septic shock, including pathogenic mechanisms, technological assessment, clinical correlates and potential therapies. The most important function of the microcirculation is the regulation and distribution of flow within the different organs. ⋯ Therefore, severe septic shock patients could represent a more precise target for interventions, particularly in microcirculation-oriented clinical trials. Clinical research has identified various therapeutic approaches that are successful in modifying the microcirculation. Future research must determine whether some of these approaches are successful in improving outcome of critically ill patients by recruiting the microcirculation.