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12 Cards in this Set

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Atherosclerosis
slowly progressive disease

ARTERIES: elevated fibro-fatty intimal plaques

INTIMAL PLAQUES
lipid deposition
SMC proliferation
ECM synthesis
Constitutional risk factors
AGE: risk INC. with advancing age

SEX: F protected before menopause

Familial disposition
Controllable major risk factors
Hyperlipidemia

HT

Smoking

DM

Note: it follows that the risks can be reduced by measures that manage or prevent the ‘controllable’ risk factors.
Other minor risk factors
Obesity (>30% overweight)

Sedentary lifestyle with low physical activity

Stress or type A personality behaviour (aggressive competitive)

HI homocystine levels = HI lipoprotein

HI CHO diet: hardened unsaturated fat intake

POST MENO oestrogen deficiency
Hyperlipidemia
lipids in atheromatous plaques consist mainly of cholesterol;

DEC. cholesterol (by drugs) = DEC atheroma and the risks of compx
Hyperlipidemia

how do chol. levels + risk correlate?
Risk ~ level of serum low-density lipoprotein (LDL), formed from the catabolism VLDL

LDL carries 70% of total serum cholesterol thus high levels of which are important risk factors

Total cholesterol: >6.2mmol/L (normal <5.2)

LDL cholesterol: > 4.2mmol/L (normal <3.4)

Elevated LDL levels =accelerated atherosclerosis.
Hyperlipidemia and hypercholesterolemia

Causes?
Familial abnormalities (of LDL receptor gene or in various apolipoprotein genes)

Diet high in CHO + SAT FAT

DM: major risk factor in itself

Hypothyroid

Others : uraemia, nephrotic syndrome, obs. liver d.
Role of HDL?
Ris = inversely related to the level of HDL

HDL involved in reverse transport of cholesterol from cells; potentially helps clear cholesterol from vessel wall lesions = protective effect.

HDL levels

INC. by EXERCISE + moderate ALOCHOL intake

DEC. by SMOKING + OBESITY
Hypertension
MAJOR esp. >40

BP>160/95 = x5 incidence of IHD compared to BP<140/90
Diabetes mellitus
INC. risk of developing MI 2 (hypercholesterolemia)
Smoking
>1 pack a day for years will INC. death rate from IHD by x2

i.e. STOP smoking will DEC. risk
Multiple risk factors?
Multiple risk factors have additive effects!

2 major risk factors INC. risk of IHD by x4

3 major risk factors INC. risk of IHD by x7