Atherosclerosis

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Risk Factors for Atherosclerosis, continued
  • Physical Activity
    •  Habitual physical activity associated with reduced incidence of sudden death
      • lowers blood pressure
      • lowers triglyceride levels
      • raises HDL cholesterol levels
      • reduces/maintains body weight & muscle tissue
    •  Beneficial effects may be primarily due to exercise-mediated reduced BP & serum cholesterol levels, reduced weight {decreased body fat}, better glucose tolerance and increased fibrinolytic activity.
  • Obesity
    •  Independent risk predictor (Framingham Study) for both sexes
    •  Increased weight positively & independently correlated with:
      • coronary artery disease
      • stroke
      • congestive heart failure
      • cardiovascular deaths
    •  Obesity is correlated with other risk factors, e.g. hypertension, hypertriglyceridemia, lack of exercise, hyperinsulinemia & varies inversely with serum HDL cholesterol

 

  • Platelets
    • May promote coronary vasospasm
    • Possibly increased platelet coagulant activity in patients with coronary artery disease 
  • Family History
    • Familial aggregation of risk factors: hypercholesterolemia spacer + hypertension + diabetes & obesity
    • Homocystinuria-associate disaster disease
    • Genetics may influence:
      • extent, time,  course, atherosclerosis severity, & symptoms
  •  Behavioral Factors Predisposing to Coronary Vascular Disease (CAD) 
    • Emotional distress 
    • Circadian rhythm variations
    • "Educational" Level: inverse relationship between educational level & cardiovascular disease/death
      • Interpretation: relationship between educational level and ability/willingness to modify behavior and alter other CAD risk factors
  • Stress (type A personality)
    • Type "A"personality consistent with competitiveness, impatience, ambition
    • Possible positive correlation between CAD & type A personality
      • Independent risk factor possibly a strong as hypertension, serum cholesterol, tobacco use ( smoking)
  • Glucose Intolerance
    • Diabetes mellitus {impaired glucose tolerance}
    • Frequency: 20% of the population
    • Diabetes: major risk factor highly correlated with obesity, hypertension, & lipid abnormalities {Framingham Study}
      • Additional adverse effects secondary to:
        • platelet dysfunction
        • increased erythrocyte adhesion
    •  Cardiovascular morbidity/mortality: increased 4-6-fold in patients with type II diabetes*
      •  High prevalence: due to many factors including specific cardiac risk factors {hypertension & hyperlipidemia}
      •  Characteristics of type II diabetes:
        •  insulin resistance, hyperinsulinemia, altered carbohydrate/lipid metabolism (causing hyperglycemia), increased blood very low density & low-density lipoproteins & decreased blood high-density lipoproteins
      •  Pathophysiology: Type II diabetes:
        •  Vasculopathy-predisposing factors -- vessel wall lipid deposition, resulting/associated with:
          • monocyte infiltration, atrial mural fibrosis, thrombosis, vascular smooth muscle filtration
      • Treatment issues:
        •  Limited efficacy associated with angioplasty &coronary bypass surgical interventions
        •  Important to reduce other cardiac risk factors, i.e. hypertension
        •  Important to reduce/reverse insulin resistance; improve metabolic control without worsening hyperinsulinemia
        •  Pharmacological treatment: biguanides & thiozolidinediones which sensitize tissues to insulin
        •  Other treatment: diet & exercise
  • Gender
    • Decreased atherosclerosis incidence: women
    • Males: increased likelihood for myocardial infarction (10 X)
  • Alcohol Use:
    • Probable inverse relationship between alcohol use (moderate) and coronary vascular disease
      •  > 2 or more drinks/day: elevated blood pressure
      • Heavy drinking: increased mortality, many etiologies

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  • Primary Reference: Katz, J.,  Evaluation Risk Assessment of Patients with Vascular Disease in Principles and Practice of Anesthesiology (Longnecker, D.E., Tinker, J.H. Morgan, Jr., G. E., eds)  Mosby, St. Louis, Mo., pp. 201-218, 1998.
  • * Schneider, D.J. & Sobel, B.E. Determinants of Coronary Vascular Disease in Patients with Type II Diabetes Mellitus and their Therapeutic Implications, Clin. Cardiol. May; 20(5): 433-440. Review, 1997.