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Chronic kidney disease in acute coronary syndromes

World Journal of Nephrology 2012年第5期1卷 134-145页

作者： giancarlo marenzi Angelo Cabiati Emilio Assanelli Centro Cardiologico Monzino IRCCS Department of Cardiovascular Sciences University of Milan

Chronic kidney disease(CKD) is associated with a high burden of coronary artery disease. In patients with acute coronary syndromes(ACS), CKD is highly prevalent and associated with poor short- and long-term outcomes. Management of patients with CKD presenting with ACS is more complex than in the general population because of the lack of well-designed randomized trials assessing therapeutic strategies in such patients. The almost uniform exclusion of patients with CKD from randomized studies evaluating new targeted therapies for ACS, coupled with concerns about further deterioration of renal function and therapy-related toxic effects, may explain the less frequent use of proven medical therapies in this subgroup of high-risk patients. However, these patients potentially have much to gain from conventional revascularization strategies used in the general population. The objective of this review is to summarize the current evidence regarding the epidemiology and the clinical and prognostic relevance of CKD in ACS patients, in particular with respect to unresolved issues and uncertainties regarding recommended medical therapies and coronary revascularization strategies.

关键词： Chronic kidney disease Acute coronary syndromes Non-ST-elevation myocardial infarction STelevation myocardial infarction Percutaneous coronary intervention Renal insuffciency

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Vitamin D and acute myocardial infarction

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World Journal of Cardiology 2017年第1期9卷 14-20页

作者： Valentina Milazzo Monica De Metrio Nicola Cosentino giancarlo marenzi Elena Tremoli Centro Cardiologico Monzino I.R.C.C.S.20138 MilanItaly

Vitamin D deficiency is a prevalent condition,cutting across all ethnicities and among all age groups,and occurring in about 30%-50% of the population. Besides vitamin D established role in calcium homeostasis,its deficiency is emerging as a new risk factor for coronary artery disease. Notably,clinical investigations have suggested that there is an association between hypovitaminosis D and acute myocardial infarction(AMI). Not only has it been linked to incident AMI,but also to increased morbidity and mortality in this clinical setting. Moreover,vitamin D deficiency seems to predispose to recurrent adverse cardiovascular events,as it is associated with post-infarction complications and cardiac remodeling in patients with AMI. Several mechanisms underlying the association between vitamin D and AMI risk can be involved. Despite these observational and mechanistic data,interventional trials with supplementation of vitamin D are controversial. In this review,we will discuss the evidence on the association between vitamin D deficiency and AMI,in terms of prevalence and prognostic impact,and the possible mechanisms mediating it. Further research in this direction is warranted and it is likely to open up new avenues for reducing the risk of AMI.

关键词： Vitamin D Acute myocardial infarction Incidence Prognosis

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