1、Atherosclerosis&Coronary heart diseasesZhengzhouUniversity,FirstaffiliatedHospitalDept.ofCardiologyHaiyuLi,M.D.第一页，共一百一十五页。Cardiovascular Diseases第二页，共一百一十五页。Atherosclerosis第三页，共一百一十五页。leading cause of death and disabilityCommon location:Coronary circulation:Proximal left anterior descending coronar
2、y artery(LAD)Proximal portion of renal arteriesExtracranialcirculation to the brainCarotid bifurcationAtherosclerosis第四页，共一百一十五页。Coronary heart diseaseatherosclerosisCoronary stenosiscoronary spasmMyocardial ischemia,anoxaemiaCoronary heart disease,CHDIschemic heart disease第五页，共一百一十五页。Atherosclerosi
3、sStable angina pectoris(SAP)Acute coronary syndromeUnstable angina(UAP)and non-STEMI (UA/NSTEMI)ST elevation myocardial infarction(STEMI)第六页，共一百一十五页。Three fundamental biological processes of atherosclerosis1.Accumulationofintimalcells:smoothmusclecellsMacrophagesT-lymphocytes2.Proliferatedconnective
4、tissuematrix:collagenelastic fibersproteoglycans3.Accumulationoflipid:cholesterolestersfreecholesterol第七页，共一百一十五页。PathologyandpathophysiologyFattysteakFibrousplaqueComplicatedlesionAtherosclerosisAtherosclerosis第十页，共一百一十五页。Initiation of AtherosclerosisFatty steak formation第十一页，共一百一十五页。Initiation of
5、AtherosclerosisFatty steak formation Lipoproteinoxidation NonenzymaticglycationLeukocyte recruitmentFoam cell formation第十二页，共一百一十五页。Atheroma evolution:fibrous plaqueAtheroma evolution and complicationsVascular remodeling:compensatory enlargementVascular remodeling:compensatory enlargement第十三页，共一百一十五
6、页。Atheroma evolution:Involvement of arterial smooth-muscle cellsBlood coagulationmicrovesselsAtheroma evolution and complications第十四页，共一百一十五页。炎症炎症细胞细胞少量平滑肌少量平滑肌细胞细胞激活的巨噬细胞激活的巨噬细胞血栓血栓Complicated lesion:thrombosisAtheroma evolution and complications第十五页，共一百一十五页。Atheroma evolution and complicationsVuln
7、erableplaque:Vulnerableplaque:ThinfibrouscapThinfibrouscapRelativelylargelipidcoreRelativelylargelipidcoreHighcontentofmacrophagesHighcontentofmacrophagesInflammatorymediatorsInflammatorymediators第十六页，共一百一十五页。Intravascular ultrasound 第十七页，共一百一十五页。Classicification of atherosclerotic lesion using IVUS
8、第十八页，共一百一十五页。CliniclstagesandclassificationAbsenceofsymptomorstageofdelitescenceischemianecrosis(targetorgan)fibrosisAtherosclerosis第十九页，共一百一十五页。GeneralmanifestationAorticatherosclerosisCoronaryarteryatherosclerosisCerebralatherosclerosisMesentericatherosclerosisPeripheralarteryatherosclerosisAthero
9、sclerosisclinicalmanifestation第二十页，共一百一十五页。laboratoryexaminationLackofsensitiveandspecificmethodsforearlydiagnosisDyslipidemia：X-ray：DSAshowseverityofstenosisDopplerultrasound:bloodflowradionuclide：detectionofischemiaEchocardiogram：CHDECGandstresstest:CHDNewtechniques:intravascularultrasound,angiosc
10、opeCT,MRIAtherosclerosis第二十一页，共一百一十五页。Risk factors and prevention1.Lifestyle modification2.Lipid disorders(Dyslipidemia):cholesterol screening in all 20yrsElevated:cholesterol(TcandLDL-c),TG,ApoB/ApoA,Lp(a),Low:HDL-cLDLloweringbyHMG-CoAreductase(statins):cardiovascularevents30%，riskofMI62%3.Hyperten
11、sion：4.DM,Metabolicsyndromeorinsulinresistancesyndrome:BP,BMI,TG,seruminsulinHDL-c第二十二页，共一百一十五页。Diabetes mellitus(DM):RR1.9formale,3.3forfemalemorediffuselesion.CADequivalent75-80%causeofdeathinadultDMarevasculardiseases:CAD,cerebrovasculardisease,orperipheralvasculardiseaseRisk factors and preventi
12、on第二十三页，共一百一十五页。7yearsincidenceofdeath/non-fatalMI(EastWestStudy)*These patients had no history of myocardial infarction Haffner SM,et al.N Engl J Med.1998;339:229234.05101520253035404550EventsofMIin7yearsNohistoryofMIOMINohistoryofMI*OMInon-diabeticsdiabeticsn=1373n=1059P 0.001P 40yrsadults，4/5fata
13、lmyocardialinfarctionoccuredinpatiens65yrs8.Male gender/postmenopausal state：male:female=2：1,mandevelopCHD10-15yrsearlierthanwoman9.alcohol10.Others:diet,homocysteine,hemostaticfactorsinflammation/infectionRisk factors and prevention第二十五页，共一百一十五页。Drug therapy：anti-platelet：aspirin,clopidogrel,GPIIb/
14、IIIa inhitibor,Dipyridamole,cilostazolLipid-lowering Risk factors and prevention第二十六页，共一百一十五页。1.HMG-CoAreductaseinhibitors（statins）Atorvastatin,Fluvastatin,Lovastatin,Pravastatin,Simvastatin,Cerivastatin,Rosuvastatin：*elevationofaminopherase,rhabdomyolysis2.Bileacid-bindingResinscholestyramine，coles
15、tipol3.NicotinicAcid：4.Fibricacidderivatives（fibrates）Gemifibrozil,clofibrate,Fenofibrate5.Cholesterolabsorptioninhibitors:ezetimibe6.ProbucolLipid-lowering drugs第二十七页，共一百一十五页。PreventionofCADA:aspirin,ACEIB:blood pressure,-blocker,C:cigarette smoking,CholesterolD:diet,diabetesE:exercise,education第二十
16、八页，共一百一十五页。ThirdReportoftheNationalCholesterolEducationProgram(NCEP)ExpertPanelonDetection,Evaluation,andTreatmentofHighBloodCholesterolinAdults ATPIII(adulttreatmentpanelIII)Circulation 2002 17/24:3144-3373Atherosclerosis第二十九页，共一百一十五页。Coronary heart disease(CHD)第三十页，共一百一十五页。Coronary heart disease(CHD)most common cause:obstruction of atheromatous plaqueother causes:spasm arterial thrombi coronary emboli ostial narrowing due to luetic aortitis congenital abnormalities severe LV hypertrophy 第三十一页，
