View source for 2. Epidemiology of ischaemic heart disease

* Leading cause of death in US and the world
* Higher risk in men than women
* Rising tendency in developing countries
* Accounts for nearly 30% of all disability cases
* Especially affects middle aged population
* Proposed theories
** Lipid theory
*** Decreasing blood cholesterol decreases IHD
*** Oxidized LDL enters vessel wall
** Blood coagulation theory
*** Increased coagulation tendency
*** Evidence:
**** Increased plasma fibrinogen
**** Increased thromboxane A2/prostaglandin ratio
**** Increased lipoprotein(a) (inhibits fibrinolysis)
** Blood vessel wall theory
*** Collagen increases, elastic fibres decrease
*** Increases microthrombi formation and lipid infiltration
* Pathomechanism of atherosclerosis
** Endothelial dysfunction
*** HT
*** Smoking
*** Diabetes
*** High LDL
*** Aging
** Leukocyte migration into tunica intima
** Proliferation of smooth muscle cells in tunica intima
** Oxidized LDL accumulates, macrophages transform into foam cells
** Foam cells and smooth muscle cells produce collagen -> forms fibrous plaque
** Inflammation in fibrous plaque weakens the fibrous cap
** Plaque ruptures, exposing thrombogenic material

[[Category:Public health 5 - Detailed epidemiology]]