Patrick Couture,MD, FRCP(C), PhD, Lipid Research Center, Laval University Medical Center, Laval,QC.
Nancy Gilbert, RN, Lipid Research Center, Laval University Medical Center, Laval,QC.

Several lines of evidence suggest that triglyceride-rich lipoproteins contribute significantly to the development of atherosclerosis. However, the relationship between cardiovascular disease and plasma levels of triglyceride remains complex due to the presence of two major confounders: (1) the inverse relationship between plasma triglyceride levels and highdensity lipoprotein-cholesterol and (2) the heterogeneity in triglyceriderich lipoprotein size, number, and composition between individuals. Plasma apo-B measurement is recommended for patients with high triglyceride levels to identify their risk category.The goals of lipidmodifying therapy for these patients are to reduce the atherogenic lipoprotein number and to increase HDL particle number.
Keywords: triglyceride, lipoprotein, atherosclerosis, coronary heart disease, cholesterol.

Kevin L. Billups, MD, Urologist & Medical Director, The EpiCenter for Sexual Health & Medicine, Edina; Adjunct Assistant Professor, Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN, USA.

Erectile dysfunction (ED) is a prevalent vascular disorder that, like cardiovascular disease, is now believed to cause endothelial dysfunction. In fact, a growing body of literature now suggests that ED may be an early marker for atherosclerosis, increased cardiovascular risk, and subclinical vascular disease. The emerging awareness of ED as a barometer of overall cardiovascular health represents a unique opportunity for primary prevention of vascular disease in all men. Although the implications of this relationship for primary and secondary prevention of cardiovascular disease are not yet fully appreciated, the available literature makes a strong argument for the role of erectile dysfunction as an early marker for the development of significant cardiovascular risk factors and cardiovascular disease. Early detection of erectile dysfunction could play a major role in improving male cardiovascular health.
Key words: erectile dysfunction, cardiovascular disease, atherosclerosis, endothelium, prevention.

Colin P. Derdeyn, MD, Associate Professor, Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.

The brain requires the continuous delivery of oxygen and glucose for normal function. Even brief interruption or impairment of this supply can cause permanent injury, most dramatically and catastrophically in the form of stroke. There is emerging data that in addition to stroke, microvascular arterial obstructive disease may be a common cause of dementia. With normal aging, and as an effect of a number of diseases common in older adults such as hypertension, several pathological conditions of the brain vasculature may develop. This brief review will discuss a few common cerebrovascular diseases of older adults and recent data regarding their treatment. These conditions include intracranial aneurysms, atherosclerosis and atherosclerotic stenosis, and vascular dementia.

Key words: intracranial aneurysms, atherosclerosis, stroke, brain vasculature, vascular dementia.

Gustavo A. Cardenas, MD, Carl J. Lavie, MD and Richard V. Milani, MD, Department of Cardiology, Ochsner Medical Institutions, New Orleans, LA, USA.

There is growing evidence that risk factors, which predict cardiovascular disease in younger people, are also predictive in older adults. Given the huge burden of cardiovascular disease in this latter population, older adults should not be excluded from primary or secondary prevention strategies, such as management of dyslipidemia. Low levels of high- density lipoprotein cholesterol (HDL-C) have a stronger association with cardiovascular disease than do high levels of low-density lipoprotein cholesterol (LDL-C). This article focuses on the importance of HDL-C as a risk factor for older patients, the evidence that exists supporting this association, the factors associated with low levels of HDL-C, and the mechanisms by which low HDL-C is related to an increased risk of cardiovascular diseases.
Key words: high-density lipoprotein cholesterol, aging, older adults, dyslipidemia, lipoprotein, atherosclerosis, cardiovascular disease.

Lucie Lavoie, MD, FRCP(C), Resident in Geriatrics, Faculty of Medicine, Université Laval, Quebec City, QC.
Claude Gagné, MD, Service of Lipidology, Department of Medicine, Université Laval, Quebec City, QC.

Complications of coronary artery disease are the leading causes of morbidity and mortality in older persons of both sexes. The control of risk factors may prevent, retard and reverse the evolution of atherosclerosis in older adults, as in younger persons. Thus, treatment of hypercholesterolemia should not be negated on the pretext of age. In addition to non-pharmacological approaches, pharmacological tools are available. Recently, ezetimibe, an inhibitor of intestinal cholesterol absorption, has been launched. We will discuss the usefulness and the potential place of this medication for the treatment of hypercholesterolemia in the older population.
Key words: cholesterol absorption inhibitor, ezetimibe, dyslipidemia, atherosclerosis.

I. W. Fong, MB, BS, FRCPC, Department of Medicine, Division of Infectious Diseases, University of Toronto, St. Michael's Hospital, Toronto, ON.

Atherosclerosis and its vascular complications are the leading causes of death in older people in developed countries. There are accumulating, albeit conflicting, data suggesting that infections, particularly Chlamydia pneumoniae, may play a role in atherogenesis and vascular events. Although prospective epidemiological and clinical studies have provided conflicting results, pathological studies have confirmed the association of C. pneumoniae with atherosclerotic disease. Moreover, many in vitro studies on biological mechanisms and studies in animal models have largely supported a plausible role of infections in atherogenesis. These data suggest that infections, especially C. pneumoniae, may be involved in the initiation and acceleration of atherosclerosis and potentially could lead to acute ischemic events by influencing plaque stability and coagulation.
Key words: atherosclerosis, Chlamydia pneumoniae, infections, older people.

Ernane D. Reis, MD, Assistant Professor, Department of Surgery, Mount Sinai School of Medicine, New York, NY.
Nicholas Morrissey, MD, Assistant Professor, Department of Surgery, Mount Sinai School of Medicine, New York, NY.

Prevalence of peripheral arterial disease (PAD) increases with age. PAD is not only associated with disability (e.g., claudication, limb loss), but also with increased mortality from cardiac and cerebrovascular events. A thorough assessment of symptoms, risk factors and physical signs--including ankle-brachial indices--can be sufficient to determine whether PAD is present. Further testing--such as Duplex examination, magnetic resonance imaging and conventional arteriography--is often required to determine progression and accurate localization of lesions, as well as to direct therapeutic intervention. Early detection of PAD can help prevent functional impairment and death in the elderly.
Key words: atherosclerosis, peripheral arterial disease, ankle-brachial index, diabetes, claudication.

A new study indicates that drinking purple grape juice may fight atherosclerosis in two additional ways. The research from the University of Wisconsin Medical School, published in the September 7th issue of Circulation, monitored fifteen people with coronary artery disease. When drinking purple grape juice daily for two weeks, the elasticity of their blood vessels significantly decreased and the rate at which their LDL cholesterol oxidized was significantly decreased. When oxidized, LDL cholesterol contributes to the build-up of plaque in the arteries.

John Folts, PhD, the senior author of the study and director of the Coronary Thrombosis Research and Prevention Laboratory commented: "This is of great interest, because it suggests that consuming purple grape juice could positively affect the atherosclerotic process in several important ways."

"There are a number of primary contributors to atherosclerosis," explains Folts, "Three of them are the stickiness of our blood, the reduced flexibility of our arteries, and the speed at which we oxidize LDL cholesterol. In previous studies, we saw that drinking purple grape juice reduced blood stickiness. Now this study suggests that drinking the juice has a beneficial effect on two other primary contributors as well."

Further Reading: Stein JH, Keevil JG, Wiebe DA, Aeschlimann S, Folts JD. Purple grape juice improves endothelial function and reduces the susceptibility of LDL cholesterol to oxidation in patients with coronary artery disease. Circulation 1999;100:1050-1055.