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【正文】 heral vascular disease Risk factors and prevention 第二十三页，共一百一十五页。 laboratory examination Lack of sensitive and specific methods for early diagnosis Dyslipidemia： Xray： DSA show severity of stenosis Doppler ultrasound: blood flow radionuclide： detection of ischemia Echocardiogram： CHD ECG and stress test: CHD New techniques: intravascular ultrasound, angioscope CT, MRI Atherosclerosis 第二十一页，共一百一十五页。 Clinicl stages and classification Absence of symptom or stage of delitescence ischemia necrosis(target an ) fibrosis Atherosclerosis 第十九页，共一百一十五页。 Intravascular ultrasound 第十七页，共一百一十五页。 炎症 细胞 少量平滑肌 细胞 激活的巨噬细胞 血栓 Complicated lesion: thrombosis Atheroma evolution and plications 第十五页，共一百一十五页。 Atheroma evolution: fibrous plaque Atheroma evolution and plications Vascular remodeling: pensatory enlargement 第十三页，共一百一十五页。 Initiation of Atherosclerosis Fatty steak formation 第十一页，共一百一十五页。 Three fundamental biological processes of atherosclerosis 1. Accumulation of intimal cells: • smooth muscle cells • Macrophages • Tlymphocytes 2. Proliferated connective tissue matrix : • collagen • elastic fibers • proteoglycans 3. Accumulation of lipid: • cholesterol esters • free cholesterol 第七页，共一百一十五页。 Coronary heart disease atherosclerosis Coronary stenosis coronary spasm Myocardial ischemia, anoxaemia Coronary heart disease, CHD Ischemic heart disease 第五页，共一百一十五页。 Atherosclerosis 第三页，共一百一十五页。Atherosclerosis Coronary heart diseases Zhengzhou University, First affiliated Hospital Dept. of Cardiology Haiyu Li, . 第一页，共一百一十五页。 Cardiovascular Diseases 第二页，共一百一十五页。 •leading cause of death and disability •Common location: Coronary circulation: Proximal left anterior descending coronary artery(LAD) Proximal portion of renal arteries Extracranial circulation to the brain Carotid bifurcation Atherosclerosis 第四页，共一百一十五页。 •Atherosclerosis •Stable angina pectoris(SAP) •Acute coronary syndrome Unstable angina(UAP) and nonSTEMI (UA/NSTEMI) ST elevation myocardial infarction(STEMI) 第六页，共一百一十五页。 Pathology and pathophysiology Fatty steak Fibrous plaque Complicated lesion Atherosclerosis 第十页，共一百一十五页。 Initiation of Atherosclerosis Fatty steak formation  Lipoprotein oxidation  Nonenzymatic glycation Leukocyte recruitment Foam cell formation 第十二页，共一百一十五页。 Atheroma evolution: Involvement of arterial smoothmuscle cells Blood coagulation microvessels Atheroma evolution and plications 第十四页，共一百一十五页。 Atheroma evolution and plications Vulnerable plaque: Thin fibrous cap Relatively large lipid core High content of macrophages Inflammatory mediators 第十六页，共一百一十五页。 Classicification of atherosclerotic lesion using IVUS 第十八页，共一百一十五页。 General manifestation Aortic atherosclerosis Coronary artery atherosclerosis Cerebral atherosclerosis Mesenteric atherosclerosis Peripheral artery atherosclerosis Atherosclerosis clinical manifestation 第二十页，共一百一十五页。 Risk factors and prevention modification disorders (Dyslipidemia): cholesterol screening in all 20yrs Elevated: cholesterol (Tc and LDLc), TG, ApoB/ApoA,Lp(a), Low: HDLc LDL lowering by HMGCoA reductase(statins): cardiovascular events 30%， risk of MI 62% ： ,Metabolic syndrome or insulin resistance syndrome: BP, BMI ,TG, serum insulin HDLc 第二十二页，共一百一十五页。 7 years incidence of death/nonfatal MI (East West Study) * These patients had no history of myocardial infarction Haffner SM, et al. N Engl J Med. 1998。 5. Cigarette smoking： more thrombogenic 6. Family history： geic factor 7. Aging： 40yrs adults ， 4/5 fatal myocardial infarction occured in patiens 65 yrs 8. Male gender/ postmenopausal state： male:female = 2： 1, man develop CHD 1015 yrs earlier than woman 9. alcohol 10. Others: diet,homocysteine, hemostatic factors inflammation/infection Risk factors and prevention 第二十五页，共一百一十五页。 1. HMGCoA reductase inhibitors〔 statins〕 Atorvastatin,Fluvastatin,Lovastatin,Pravastatin,Simvastatin,Cerivastatin, Rosuvastatin： 2. *elevation of aminopherase, rhabdomyolysis 3. 2. Bile acidbinding Resins 4. cholestyramine， colestipol 5. 3. Nicotinic Acid： 6. 4. Fibric acid derivatives〔 fibrates〕 7. Gemifibrozil, clofibrate, Fenofibrate 8. 5. Cholesterol absorption inhibitors: ezetimibe 9. 6. Probucol Lipidlowering drugs 第二十七页，共一百一十五页。 Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults ATP III (adult treatment panel III) Circulation 2024 17/24: 31443373 Atherosclerosis 第二十九页，共一百一十五页。 Coronary heart disease (CHD) •most mon cause: obstruction of atheromatous plaque •other causes: spasm arterial thrombi coronary emboli ostial narrowing due to luetic aortitis congenital abnormalities severe LV hypertrophy 第三十一页，共一百一十五页。 Coronary heart disease Type： •slient ischemia: delitescence： (ECG change) •Angina pectoris： angina, caused by myocardial ischemia • myocardial infarction： acute myocardial ischemic necrosis caused by the occlusion of coronary artery •Ischemia cardiomyopathy (Heart failure and arrhythmia)： cardiac enlargement, heart failure, arrhythmia, caused by the myocardial fibrosis as the consequence of chronic mycardial ischemia •Sudden death： sudden cardiac arrest caused by ventricular fibrillation/flutter 第三十三页，共一百一十五页。 Acute Coronary Syndrome(ACS) Resting ischemia NonST elevation STelevation Unstable angina NonQ wave AMI Q wave AMI *positive serum cardiac markers * * * *