Causation of Cardiovascular Risk Factors in Children (aláírt példány) [antikvár]

Much has been learned about atherosclerosis over the past 30 years. From originaldescriptive characterizations of lesions, research has extended into mechanismscontributing to the disease process. As a corollary of the anatomic and biophysiologicinvestigations, epidemiologic observations are attempting to put the natural historyinto focus on a course to prevention. The complexity of the development of coronaryartery and hypertensive diseases becomes apparent, whether these are studied atthe level of vascular lesions or at the biochemical, clinical, or epidemiologic level.Clearly, atherogenesis and essential hypertension begin in early life and proceedthrough various stages over several decades. Attempts to study and explain eitherdisease process in terms of clinical events, laboratory observations, or cellular andmolecular biology often lead to oversimplification. Nevertheless, advances duringthe last three decades have led to a far better understanding of these diseases. Thisunderstanding has undoubtedly contributed to a decline of cardiovascular diseasenoted during the past decade. Certainly, technical advances and approaches totreatment have made vast progress, and the future will provide the opportunity tolearn prevention beyond that of our current capability for intervention.For the past decade, our group has studied the traditional cardiovascular riskfactors as they may be identified in childhood and is attempting to extrapolate thosefindings to the question of why some individuals are especially prone to cardiovas-cular disease in adult life. Despite the major gap in distinguishing the precisecontribution of genetic and environmental influences to the development of athero-sclerosis and hypertension, the considerable knowledge gained from internationalepidemiologic studies, clinical observations, and experimental models indicates re-markable opportunities for prevention of the major adult cardiovascular diseases.Epidemiologic studies on children have focused on cardiovascular risk factorssimilar to those defined in adults. It is even possible to link clinical observations inchildhood, long before the disease process takes its toll, with the changes that areoccurring in target organs and the actual cardiovascular disease itself. Consequently,it is now possible to relate observations in childhood conceptually with such studiesas Framingham, Tecumseh, Evans County and other major epidemiologic studiesof adult heart disease.The major thrust of investigations on the early natural history needs to be directedto the question of why certain individuals living in the same environment havenormal or aberrant risk factor variables, and ultimately, why certain individuals areprone to develop coronary heart disease or hypertensive cardiac and cerebrovasculardisease in adulthood. That is the underlying theme of the discussions in this book.There is a certain amount of overlap in subject matter between chapters. Eventhough each chapter has one or more individuals designated as author(s), the materialis derived from a team effort of multiple investigators and supporting staff.