Prevalence of Cardiovascular Disease by Race American Heart Association.
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Transcript of Prevalence of Cardiovascular Disease by Race American Heart Association.
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Hispanics
African Americans
Caucasians
Whole
0 10 20 30 40 50 60WomenMen Prevalence of CVD (%)
Prevalence of Cardiovascular Disease by Race
American Heart Association
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2002 200532
33
34
35
36
37
38
MenWomen
Year
Prev
alen
ce o
f CVD
(%)
Prevalence of Cardiovascular Disease
American Heart Association
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CleanArteryCleanArtery
Fatty SteaksFatty
Steaks
Fibrous PlaqueFibrous Plaque
Clinical LesionClinical Lesion
NATURAL HISTORY OF ATHEROSCLEROSISNATURAL HISTORY OF ATHEROSCLEROSIS
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Lumen
Subendothelial Space
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NOL-arginineO2
NADPH
Lumen
↑NO
↑NO
Subendothelial Space
eNOS
BH4
PI-3 kinase
Blood FlowInsulinAcetylcholine
Anti-AdhesionAnti-CoagulationFibrinolysis
Vasodilation
Nitric Oxide
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NOL-arginineO2
NADPH
Lumen
↑NO
↑NO
Subendothelial Space
eNOS
BH4
PI-3 kinase
Blood FlowInsulinAcetylcholine
Anti-AdhesionAnti-CoagulationFibrinolysis
Vasodilation
Oxidative Stress
O2-
ONOO-
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NOL-arginineO2
NADPH
↓NO
Subendothelial Space
eNOS
BH4
PI-3 kinase
Blood FlowInsulinAcetylcholine
Anti-AdhesionAnti-CoagulationFibrinolysis
Vasodilation
Oxidative Stress
O2-
↓NO
ONOO-
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NOL-arginineO2
NADPH
↓NO
Subendothelial Space
eNOS
BH4
PI-3 kinase
Blood FlowInsulinAcetylcholine
Anti-AdhesionAnti-CoagulationFibrinolysis
Vasoconstriction
Oxidative Stress
O2-
↓NO
ONOO-
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NOL-arginineO2
NADPH
↓NO
Subendothelial Space
eNOS
BH4
PI-3 kinase
Blood FlowInsulinAcetylcholine
Anti-AdhesionAnti-CoagulationFibrinolysis
Vasoconstriction
Oxidative Stress
O2-
↓NO
ONOO-
O2-
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ENDOTHELIAL FUNCTIONENDOTHELIAL FUNCTIONVASODILATIONVASODILATION
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VASODILATIONVASODILATION
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VASODILATIONVASODILATION
Shear Stress
PI-3-KinasePI-3-Kinase
OxygenL-ArginineNADPH
OxygenL-ArginineNADPH
Nitric
Oxide
Nitric
Oxide
eNOSeNOS
CofactorsCofactors
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VASODILATIONVASODILATION
Shear Stress
PI-3-KinasePI-3-Kinase
OxygenL-ArginineNADPH
OxygenL-ArginineNADPH
Nitric
Oxide
Nitric
Oxide
eNOSeNOS
CofactorsCofactors
NONO
i
cGMP
↓Ca++
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ARTERIAL HEALTHARTERIAL HEALTH
Flow-Mediated DilationFlow-Mediated Dilation
Pre
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ARTERIAL HEALTHARTERIAL HEALTH
Flow-Mediated Dilation = 8%Flow-Mediated Dilation = 8%
PrePre Post
4.1 mm4.1 mm 4.7 mm4.7 mm
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Series10
1
2
3
4
5
6
7
8
9
10
Healthy
Aging
Heart Disease
Visceral Fat
Diabetes
HypertensionFM
D (
%)
Faulx, et al, American Heart Journal 145:943-951, 2003
Iiyama, et al. American Heart Journal 132:779-782, 1996
Hashimoto, et al. International Journal of Obesity: Relar Metab Disord 22:477-484, 1998.
Caballero, A.E., Obesity Research 11:1278-1289, 2003.
Celermajer,et al. J Am Coll Cardiol 24:471-476, 1994.
Faulx, et al, American Heart Journal 145:943-951, 2003
Iiyama, et al. American Heart Journal 132:779-782, 1996
Hashimoto, et al. International Journal of Obesity: Relar Metab Disord 22:477-484, 1998.
Caballero, A.E., Obesity Research 11:1278-1289, 2003.
Celermajer,et al. J Am Coll Cardiol 24:471-476, 1994.
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02468
1012141618
FMD (%)
Men
Women
Children
Hasimoto, et al. Circulation 92:3431-3435, 1995.Hasimoto, et al. Circulation 92:3431-3435, 1995.
Apparently HealthyApparently Healthy
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0
2
4
6
8
10
12
FMD (%)Normal Weight
Obese
Woo, et al, International Journal of Obesity 28:852-857, 2004Woo, et al, International Journal of Obesity 28:852-857, 2004
ChildrenChildren
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0
2
4
6
8
10
12
20 30 40 50 60 65 70
Years
FMD (%)Men
Women
Celermajer,et al. J Am Coll Cardiol 24:471-476, 1994.Celermajer,et al. J Am Coll Cardiol 24:471-476, 1994.
AgingAging
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0123456789
FMD (%)Normal
Subcutaneuous
Visceral Fat
Hashimoto, et al. International Journal of Obesity: Relar Metab Disord 22:477-484, 1998. Hashimoto, et al. International Journal of Obesity: Relar Metab Disord 22:477-484, 1998.
Overweight & ObesityOverweight & Obesity
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0
5
10
15
20
Normal BloodPressure
High BloodPressure
Iiyama, et al. American Heart Journal 132:779-782, 1996Iiyama, et al. American Heart Journal 132:779-782, 1996
HypertensionHypertension
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0
2
4
6
8
10
12
14
FMD (%)
Normal
GlucoseIntolerance
Diabetes
Caballero, A.E., Obesity Research 11:1278-1289, 2003.Caballero, A.E., Obesity Research 11:1278-1289, 2003.
DiabetesDiabetes
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NOL-arginineO2
NADPH
Lumen
↑NO
↑NO
Subendothelial Space
eNOS
BH4
PI-3 kinase
Blood FlowInsulin ResistanceAcetylcholine
Anti-AdhesionAnti-CoagulationFibrinolysis
Vasodilation
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NOL-arginineO2
NADPH
Lumen
Subendothelial Space
eNOS
BH4
PI-3 kinase
Blood FlowInsulinAcetylcholine ↓NO
Anti-AdhesionAnti-CoagulationFibrinolysis
↑NO
Vasodilation
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NOL-arginineO2
NADPH
Lumen
Subendothelial Space
eNOS
BH4
PI-3 kinase
Blood FlowInsulinAcetylcholine ↓NO
↓NO
Anti-AdhesionAnti-CoagulationFibrinolysis
Vasoconstriction
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Non-Smokers Current Smokers Past Smokers0
2
4
6
8
10
12FM
D (%
)
Celemajer, D, et al Circulation 88:2149-2155, 1999
Endothelial Function of Smokers
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Non-Smokers
1-4 yrs 5-8 yrs 10-19 yrs >20 yrs0
2
4
6
8
10
12FM
D (%
)
Celemajer, D, et al Circulation 88:2149-2155, 1999
Endothelial Function of Smokers
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0
100
200
300
400
500
600
NonobeseGynoid ObesityAndriod Obesity
8 PG
F2al
pha
(pg/
ml)
OXIDATIVE STRESS IN OBESITY
Davi, et al. JAMA 288:2008-2014, 2002
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Non Obese Obese0
0.5
1
1.5
2
2.5
3
3.5
PrePost
Lipi
d H
ydro
pero
xide
s (n
mol
/ml)
*
OXIDATIVE STRESS FOLLOWING MAXIMAL EXERCISE
Vincent, et al. Med Sci Sport Sci, 37:213-219, 2005.
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Triglyceride Storage Triglyceride Release
Resistin
TNF - α
AdiponectinPlasminogen activator inhibitor
Leptin
Agiotensin
Adipocyte
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Exercise
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0123456789
10
Pre-Meal Post-Meal
Bra
chia
l Art
ery
FM
D (
%)
Healthy
Healthy
Diabetes
Tsai, et al. Clinical Science 106:315-319, 2004Anderson, et al, Atherosclerosis 154:475-483, 2001Ceriello, et al, Circulation 106:1211-1218, 2002
Tsai, et al. Clinical Science 106:315-319, 2004Anderson, et al, Atherosclerosis 154:475-483, 2001Ceriello, et al, Circulation 106:1211-1218, 2002
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0
1
2
3
4
5
6
7
8
9
10
Series 1
FMD
(%)
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0
1
2
3
4
5
6
7
8
9
10
Series 1
FMD
(%)
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Β Oxidation
↑Electron Donors
Electron Transport Chain
↑FADH2
↑ O2-
TCA Cycle
↑FFA
↑ NADH+H+NAD+
e-
Complex I
Complex IIIComplex II
Complex IVQ-
e-
e-
e-
FAD
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0
2
4
6
8
10
12
14
FMD (%)O
W
Ob C
hld
Met S
ynd
Dia
bete
s
Heart D
is
Pre-Training
Post-Training
Hamby et al, Diabetes Care 26:2119-2125, 2003Watts, et al, Journal Pediatrics 144:620-625, 2004Walsh, et al, JAP 95:20-25, 2003
Hamby et al, Diabetes Care 26:2119-2125, 2003Watts, et al, Journal Pediatrics 144:620-625, 2004Walsh, et al, JAP 95:20-25, 2003
EXERCISE IMPROVES ENDOTHELIAL FUNCTIONEXERCISE IMPROVES ENDOTHELIAL FUNCTION
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NITRIC OXIDENITRIC OXIDE
i
Eight weeks of training in healthy adults
Maeda, et al. Life Sciences 69:1005-1016, 2001
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0
2
4
6
8
10
12
Before After
Art
eria
l Hea
lth (F
MD
)
High Fat
Low Fat
HFM &Exercise
Padilla, et al., European Journal of Applied Physiology, 98:256-262, 2006 Padilla, et al., European Journal of Applied Physiology, 98:256-262, 2006
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Johnson, B. et al.
ACTIVE vs. INACTIVE
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Johnson, B. et al.
ACTIVE vs. INACTIVE
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Johnson, B. et al.
ACTIVE vs. INACTIVE
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Johnson, B. et al.
ACTIVE vs. INACTIVE
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Johnson, B. et al.
ACTIVE vs. INACTIVE
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3
4
5
6
7
8
9
Baseline Post Exercise
FMD (%)Sedentary
Active
Harris, et al, Obesity, 2008Harris, et al, Obesity, 2008
Active & Inactive
Overweight Men
Active & Inactive
Overweight MenFMD
ResponseFMD
ResponseTreadmillExerciseTreadmillExercise
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Oxidative Source
Oxidative Stress( 8 PG F2alpha)
Endothelial Function
Single Physical Activity Session
NO bioavailability Blood Flow
Anti-inflammatory
Myokine( IL-6)
Inflammatory Stress( TNF-alpha)
Antioxidant Defense(SOD)
Insulin Resistance
Visceral Fat ( TNF-alpha)
SystemicInflammation
( CRP)
Habitual Physical Activity
Insulin Resistance