SummaryAngiotensin converting enzyme inhibitors (ACE-I) have been reported to prevent the recurrence of cardiovascular events. The mechanism of this decrease, however, can not be completely explained by anti-hypertensive and anti-hypertrophic effects of ACE-I. To investigate the mechanism of this decrease, we studied the regulation of plasminogen activator inhibitor-1 (PAI-1), tissue type plasminogen activator (TPA), tissue factor (TF), and tissue factor pathway inhibitor (TFPI) by angiotensin II (Ang II) in cultured rat aortic endothelial cells. Ang II increased PAI-1 and TF mRNA expression without affecting that of TPA or TFPI. These inductions were accompanied by increases in PAI-1 and TF activities and were inhibited by a type 1 Ang II receptor antagonist. The results suggest that Ang II decreases the antithrombotic properties of endothelial cells which increases the chance of thrombosis. Thus, inhibition of the renin-angiotensin system may be beneficial to prevent thrombus formation in treatment of ischemic heart disease.

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp arly primary percutaneous coronary intervention (PCI) gives the higher rate of recanalization, contributing to decrease in prevalence of cardiac events and improvement of left ventricular (LV) contractility and survival prognosis. 1-3 Although additional therapies have been reported for cardioprotection after acute myocardial infarction (AMI), 4-6 LV remodeling after AMI is complicated by cardiac failure accompanying enlargement of LV chamber to worsen long-term prognosis. 7, 8 We have often noticed that patients with AMI develops remarkable LV remodeling in the chronic phase in spite of the early recanalization by PCI. Editorial p 2290Erythropoietin (EPO), which controls erythropoiesis, is a glycoprotein hormone with a molecular weight of 34,000 consisting of 165 amino acid residues, and is secreted from the kidney in response to hypoxic stimuli. 9 EPO is expressed by hypoxic-ischemic vascular endothelial cells and myocytes, 10 whose EPO receptors make them potential targets of EPO-mediated endocrine and autocrine/paracrine actions, such as anti-apoptosis and pro-angiogenic properties, resulting in the observation that high-dose EPO reduces infarct size and preserves ventricular function in animal models of reper-

Background Patients with cerebral infarction have a high prevalence of asymptomatic coronary artery disease (CAD) and other vascular diseases, but there is a lack of such data for Japanese patients, so the present study investigated the prevalence of cardiovascular disease (CVD) in Japanese patients and determined the predictors of CAD. Methods and ResultsThe study group comprised 104 patients with cerebral infarction who had no history of CVD. All patients underwent coronary computed tomographic angiography, and systematic evaluation was done on the basis of the presence of other vascular diseases, CVD risk markers, and the degree of atherosclerosis. Of the total, 39 patients (37.5%) had CAD, 9 (8.7%) had carotid artery stenosis, 9 (8.7%) had peripheral artery disease of the lower limbs, and 3 (2.9%) had atherosclerotic renal artery stenosis. Multiple regression analysis showed that the presence of CAD was independently associated with metabolic syndrome (odds ratio (OR) 5.008, 95% confidence interval (CI) 1.538-16.309; p<0.01) and intracranial large artery atherosclerosis (OR 4.979, p<0.01). Conclusion Japanese patients with cerebral infarction have a high prevalence of CVD, especially asymptomatic CAD. Both metabolic syndrome and intracranial large artery atherosclerosis may be potential predictors for identifying patients with cerebral infarction who are at the highest risk of asymptomatic CAD. (Circ J 2008; 72: 404 -408)

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The evaluation of intracranial artery stenosis and SBI may be useful to identify ischemic stroke patients at high risk for subclinical CAD.