Atherosclerosis Flashcards
Coronary Artery Disease (CAD) most common cause
Also known as coronary heart disease, most common cause of this disease is atherosclerosis
Arteriosclerosis
Hardening of arteries
Arteriolosclerosis
Hardening of small arteries (arterioles)
Atherosclerosis
Specific type of arteriosclerosis due to buildup of plaques on arterial wall
Atheromas
An abnormal accumulation of material in the inner layer of the wall of an artery (plaque)
Components of blood vessels
Arteries
Capillaries
Veins
Blood vessel structure (each layer)
Lumen: open space where blood flows Tunica intima (inner layer): lined by endothelium, subendothelial layer Tunica media (middle layer): smooth muscle, elastin Tunica adventitious (outer layer): connective tissue
Atherosclerosis characterization
Deposit of cholesterol and lipids primarily within intimacy wall of artery
Endothelial lining altered result of inflammation and injury to blood vessel wall
How does atherosclerosis occur? (Pathogenesis)
Injury to endothelium Accumulation of lipoproteins Monocyte adhesion to endothelium Platelet adhesion Smooth muscle cell proliferation Lipid accumulation *Inflammation -C-reactive protein (CRP) is marker of inflamm., associated with unstable plaques and oxidation of LDL cholesterol (bad cholesterol)
Clinical outcome of atherosclerosis (what can it lead to?)
Can lead to rupture of blood vessel(aneurysm)
Build-up (thrombus) increases risk of blood clots which can break off and travel thru body which can lead to a stroke
Complete stoppage of blood flow (critical stenosis)
Signs, symptoms and complications of atherosclerosis: coronary arteries
Angina, SOB, arrhythmias, MI (stroke)
Signs, symptoms and complications of atherosclerosis: carotid arteries
Sudden weakness, paralysis, confusion, stroke symptoms
Signs, symptoms and complications of atherosclerosis: peripheral arteries
Numbness, pain, infections
Signs, symptoms and complications of atherosclerosis: renal arteries
Fatigue, loss of appetite, nausea, edema, itching
Is heart disease the leading cause of death for men and women and of most races/ethnic groups in US?
Yes
Is CAD the most common type of heart disease?
Yes
Risk factors for cardiovascular disease (modifiable)
Lifestyle Diet Cigarette smoking Hyperlipidemia Hypertension Diabetes
Risk factors for cardiovascular disease (unmodifiable)
Genetics
Age
Gender
Family history
Additional Risk factors for cardiovascular disease
Inflammation: key marker for inflamm. Is C-reactive protein (CRP)
Hyperhomocystinemia: high homocysteine levels correlated with inc. risk of CV disease
Metabolic syndrome: obesity, insulin resistance
Lipoprotein a: inc. levels = inc CAD and CVD (type of LDL)
Framingham Study
Helped identify risk factors and importance of healthy diet, reg exercise and risks of obesity, smoking, age, blood pressure, cholesterol levels, diabetes
First identified risks of LDL cholesterol and benefits of HDL cholesterol
Hyperlipidemia
Major risk factor for atherosclerosis
LDL is major component assoc. w/ inc risk
Higher HDL reduces risk
Optimal levels for lipid values
Total cholesterol <200mg/dl
LDL ch <100mg/dl
HDL >60mg/dl
Triglycerides <150mg/dl
Pharmacotherapy for heart disease
Statins- HMG CoA reductase inhibitors
Fibrates- lower triglycerides and raise HDL (not common, add on therapy)
PCSK9 inhibitors- proprotein converstase subtilisin kexin 9 inhibitors
Ezetimibe- dec absorption of cholesterol in small intestine
Bile acid sequestrants- inhibit enterohepatic reuptake of intestinal bile salts which inc fecal loss of LDL
Factors statins would benefit
Secondary ASCVD prevention
Severe hypercholesterolemia
Adults 40-75 with diabetes and higher LDL
