2. Epidemiology of ischaemic heart disease

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Revision as of 21:33, 30 November 2022 by Nikolas (talk | contribs) (Created page with "* 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/pro...")
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  • 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