systemic_disease_affecting_cardiovascular_handout_format.pdf

10/2/23 The effects that systemic conditions have on the cardiovascular system October 2023 1 Learning objectives • To appreciate how systemic conditions affect the cardiovascular system – for example – – – – – – – – – – Diabetes mellitus Hypertension Chronic obstructive pulmonary disease Amyloi...

10/2/23 The effects that systemic conditions have on the cardiovascular system October 2023 1 Learning objectives • To appreciate how systemic conditions affect the cardiovascular system – for example – – – – – – – – – – Diabetes mellitus Hypertension Chronic obstructive pulmonary disease Amyloidosis Rheumatoid arthritis Vasculitides & SLE Thyroid disease Sarcoidosis Nutrition Drugs 2 1 10/2/23 If you have a spare moment look at Seeing Disease for a broad brush overview of disease processes • eg Seeing Disease section 6 to revise thrombosis https://sway.office.com/kyen3WcSyrK6jWrb • Nothing else in particular to read, try different sections in textbooks and explore Pubmed or Medscape 3 Diabetes mellitus Type 1 Type 2 Multi-organ effects We already know that the cardiovascular system is sometimes a target for conditions that occur elsewhere 4 2 10/2/23 Shen GX Mitochondrial Dysfunction, Oxidative Stress and Diabetic Cardiovascular Disorders. Cardiovasc Hematol Disord Drug Targets. 2012 http://www.ncbi.nlm.nih.gov/pubmed/23030449 The dominant cause of mortality in diabetic patients is cardiovascular complications. Mechanism for the susceptibility of diabetic patients to cardiovascular disorders remains unclear. Elevated oxidative stress was detected in diabetic patients or in animal models. Diabetes-associated metabolic disorders, including hyperglycemia, hypertriglyceridemia, hypercholesterolemia, hypoalphalipoproteinemia, and increased levels of advanced glycation end products, glycated and oxidized lipoproteins, are associated with oxidative stress.. 5 http://www2.warwick.ac.uk/fac/med/research/csri/proteindamage/physiology/formation/ 6 3 10/2/23 • Accelerated vascular damage 7 Hypertension • Is cardiovascular damage cause, effect or a combination? • “Essential” versus “accelerated” • Importance of terms – dynamic or static implications 8 4 10/2/23 9 Familial hyperlipidaemias Theme: diabetes, familial disease, hypertension cause vascular damage and accelerate known mechanisms Multiple comorbidities 10 5 10/2/23 Chronic obstructive pulmonary disease 11 Causing systemic blood pressure to the normally low pressure pulmonary system – think of other causes of chronic pulmonary hypertension 12 6 10/2/23 Amyloidosis Underwood, Elsevier 13 General and systematic pathology / edited by James C.E. Underwood, Simon S. Cross. Edinburgh : Churchill Livingstone, 2009. 14 7 10/2/23 Rheumatoid arthritis & Vasculitides & SLE Patient information sites – a reminder that many patients become specialists in their own disease https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/otherdiseases/arthritis-and-heart-disease People with Rheumatoid Arthritis have a 50% to 70% higher risk for cardiovascular disease than the general population. People with Osteoarthrosis face a 24% higher risk for cardiovascular disease than the general population. 15 Granulomatosis with polyangiitis General and systematic pathology / edited by James C.E. Underwood, Simon S. Cross. Edinburgh : Churchill Livingstone, 2009. 16 8 10/2/23 Endocrine disease and cardiovascular problems Thyroid Cushing’s syndrome HGH/grow factor For a brief review see here 17 Which comes first? • The importance of feedback regulation and compensation • Remember co-morbidity is the norm particularly in older people 18 9 10/2/23 Sarcoidosis 19 Nutrition van Abeelen AF et al. Cardiovascular consequences of famine in the young. Eur Heart J. 2012 Feb;33(4):538-45. Epub 2011 Aug 25. PMID: 21868476 7845 women from the Prospect-EPIC cohort who had been exposed at various degrees to the 194445 Dutch famine when they were aged between 0 and 21 years. We adjusted for potential confounders, including age at famine exposure, smoking, and level of education as a proxy for socio-economic status. Overall, stronger famine exposure was associated with higher CHD risk. Among those who experienced the famine between ages 10 and 17 years, CHD risk was significantly higher among severely exposed women compared with unexposed women. Exposure to under-nutrition during postnatal periods of development, including adolescence, may affect cardiovascular health in adult life. 20 10 10/2/23 Drugs • • • • Anticancer Immunosuppressive Diabetogenic Anti-inflammatory – this is an important historical study Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, Egger M, Jüni P. BMJ. 2011 Jan 11;342:c7086. doi: 10.1136/bmj.c7086. 21 Learning objectives • To appreciate how systemic conditions affect the cardiovascular system – for example – – – – – – – – – – Diabetes mellitus Hypertension Chronic obstructive pulmonary disease Amyloidosis Rheumatoid arthritis Vasculitides & SLE Thyroid disease Sarcoidosis Nutrition Drugs 22 11