Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morb...Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.展开更多
Unlike many of our cardiovascular prevention and treat-ment strategies, including antioxidants, vitamin E, folic acidand niacin to name a few, that have disintegrated over time,the ＂truth＂ （i.e., evidence） for the...Unlike many of our cardiovascular prevention and treat-ment strategies, including antioxidants, vitamin E, folic acidand niacin to name a few, that have disintegrated over time,the ＂truth＂ （i.e., evidence） for the benefits of plant-basednutrition continues to mount.展开更多
目的:运用网络药理学分析方法探究黄芪治疗糖尿病合并冠心病的可能性作用靶点以及其作用机制。方法:借助TCMSP平台及Uniprot数据库检索筛选黄芪的活性成分及其相应靶点;在GeneCards数据库、OMIM数据库中检索糖尿病合并冠心病的疾病靶点...目的:运用网络药理学分析方法探究黄芪治疗糖尿病合并冠心病的可能性作用靶点以及其作用机制。方法:借助TCMSP平台及Uniprot数据库检索筛选黄芪的活性成分及其相应靶点;在GeneCards数据库、OMIM数据库中检索糖尿病合并冠心病的疾病靶点,通过Cytoscape 3.9.1得到黄芪-活性成分-靶基因的可视化网络图;将疾病与药物对应靶点共同提交Venny2.1.0生成相交靶点,并通过蛋白质相互作用(STRING)平台构建蛋白质相互作用(PPI)网络。基于Metascape 3.9.1数据库进行GO富集分析和KEGG通路富集分析明确可能涉及到的生物进程及信号通路。最后应用分子对接技术对上述猜想进行粗浅验证。结果:共获取黄芪的关键化合物17个,对应靶点195个,疾病相关靶点3815个,导入Venny2.1.0中生成163个交集靶点。富集分析结果表明:黄芪治疗糖尿病合并冠心病主要涉及激素反应(response to hormone)、细胞有机循环化合物反应(cellular response to organic cyclic compound)、细胞脂质反应(cellular response to lipid)、无机物反应(response to inorganic substance)等生物进程;可能涉及到癌症通路(Pathways in cancer)、脂质及动脉硬化通路(Lipid and atheroscierosis)、糖尿病并发症中的AGE-RAGE信号通路(AGE-RAGE signaling pathway in diabetic complications)、P13K-AKT信号通路(P13K-AKt signaling pathway)等信号通路。分子对接结果提示药物活性分子与核心靶点有较好的结合。结论:该研究揭示了黄芪在机体内可能参与抑制胰岛素抵抗、糖脂代谢调控等众多生物进程,以多成分、多靶点、多通路实现对糖尿病合并冠心病的治疗作用。展开更多
文摘Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.
文摘Unlike many of our cardiovascular prevention and treat-ment strategies, including antioxidants, vitamin E, folic acidand niacin to name a few, that have disintegrated over time,the ＂truth＂ （i.e., evidence） for the benefits of plant-basednutrition continues to mount.
文摘目的:运用网络药理学分析方法探究黄芪治疗糖尿病合并冠心病的可能性作用靶点以及其作用机制。方法:借助TCMSP平台及Uniprot数据库检索筛选黄芪的活性成分及其相应靶点;在GeneCards数据库、OMIM数据库中检索糖尿病合并冠心病的疾病靶点,通过Cytoscape 3.9.1得到黄芪-活性成分-靶基因的可视化网络图;将疾病与药物对应靶点共同提交Venny2.1.0生成相交靶点,并通过蛋白质相互作用(STRING)平台构建蛋白质相互作用(PPI)网络。基于Metascape 3.9.1数据库进行GO富集分析和KEGG通路富集分析明确可能涉及到的生物进程及信号通路。最后应用分子对接技术对上述猜想进行粗浅验证。结果:共获取黄芪的关键化合物17个,对应靶点195个,疾病相关靶点3815个,导入Venny2.1.0中生成163个交集靶点。富集分析结果表明:黄芪治疗糖尿病合并冠心病主要涉及激素反应(response to hormone)、细胞有机循环化合物反应(cellular response to organic cyclic compound)、细胞脂质反应(cellular response to lipid)、无机物反应(response to inorganic substance)等生物进程;可能涉及到癌症通路(Pathways in cancer)、脂质及动脉硬化通路(Lipid and atheroscierosis)、糖尿病并发症中的AGE-RAGE信号通路(AGE-RAGE signaling pathway in diabetic complications)、P13K-AKT信号通路(P13K-AKt signaling pathway)等信号通路。分子对接结果提示药物活性分子与核心靶点有较好的结合。结论:该研究揭示了黄芪在机体内可能参与抑制胰岛素抵抗、糖脂代谢调控等众多生物进程,以多成分、多靶点、多通路实现对糖尿病合并冠心病的治疗作用。
