Atherosclerotic coronary heart disease

Atherosclerotic coronary heart disease (CHD) is a significant disease around the globe and is one of the major causes of death and cardiovascular morbidity in humans. Risk factors for CHD include hypertension, diabetes mellitus, male gender, cigarette smoking etc. but the most dominating risk factor is the serum cholesterol. 

Regional Differences in Prevalence, Incidence and Mortality from Atherosclerotic Coronary Heart Disease, de Haas, J.H., Hemker, H.C. and Snellen, H.A., eds. 

Ischemic heart disease (IHD) is also called coronary heart disease (CHD) or coronary artery disease. The term ischemic refers to a decreased supply of oxygenated blood, in this case to the heart muscle. Ischemic heart disease is caused by the narrowing of one or more of the major coronary arteries that supply blood to the heart, most commonly by atherosclerotic plaques. Atherosclerotic plaques may impede coronary blood flow to the extent that cardiac tissue distal to the site of the coronary artery narrowing is deprived of sufficient oxygen in the face of increased oxygen demand. Ischemic heart disease results from... 

CAD, clinical atherosclerotic disease CHD, coronary heart disease. 

Goal BP values are <140/90 for most patients, but <130/80 for patients with diabetes mellitus, significant chronic kidney disease, known coronary artery disease (myocardial infarction [MI], angina), noncoronary atherosclerotic vascular disease (ischemic stroke, transient ischemic attack, peripheral arterial disease [PAD], abdominal aortic aneurysm), or a 10% or greater Framingham 10-year risk of fatal coronary heart disease or nonfatal MI. Patients with LV dysfunction have a BP goal of <120/80 mm Hg. 

The role of Lp(a) as a primary genetic risk factor for coronary heart disease, therefore, seems firmly established. However, in blacks, despite mean Lp(a) levels twice as high as in whites, the incidence of cardiovascular disease is apparently identical (G37, S40). The role of Lp(a) in atherosclerotic vascular disease in blacks therefore remains to be established. 

Lowering cholesterol levels can arrest or reverse atherosclerosis in all vascular beds and can significantly decrease the morbidity and mortality associated with atherosclerosis. Each 10% reduction in cholesterol levels is associated with an approximately 20% to 30% reduction in the incidence of coronary heart disease. Hyperlipidemia, particularly elevated serum cholesterol and low density lipoprotein (LDL) levels, is a risk factor in the development of atherosclerotic cardiovascular disease. 

Atherosclerotic effect. Hot water extract of the roasted coffee, administered orally to 85,747 female nurses, produced no correlation between coffee consumption and coronary heart disease . 

Atherosclerotic cardiovascular disease HMG co-A reductase inhibitors Lovastatin Pravastatin Simvastatin Primary and secondary prevention of coronary heart disease (CHD) reduced hospitalizations, percutaneous transluminal coronary angioplasties (PTCA), and coronary artery bypass graft surgeries (CABG) reduced all-cause mortality 4S AFCAPS CARE LIPID WOSCOPS >30,000 7,8... 

The major clinical effects of estrogen deficiency are coronary heart disease and osteoporosis. Estrogen supplements in postmenopausal women have been directed mainly at slowing the process of osteoporosis. Nevertheless, atherosclerotic heart disease is the leading cause of death in women, accounting for more than 30%... 

CAD-related deaths occurring before 65 years of age. There are approximately 78 million 20- to 39-year-olds in the U.S. today compared with 72 million in 1980.2 More than 25% or 19.5 million have plasma LDL-C greater than 144 mg/dl, making this population a vast reservoir of futnre patients to bnrden healthcare facilities and resources as they age into their 50s and 60s. Effective prevention strategies focnsed on the yonng adult age group could potentially decrease the incidence of advanced atherosclerosis or considerably delay its onset, improve qnality of life at older ages, and ease the financial bnrden associated with atherosclerotic diseases, which is approximately 146.2 billion a year for coronary heart disease and stroke combined. ... 

For several years, lovastatin represented the commerically most successful drug from nature. Named mevinolin, it was discovered as a metabolite from Aspergillus terreus cultures at the US company Merck by a target-directed screening for inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, a key enzyme of cholesterol biosynthesis [32]. Cholesterol, which in humans more than one-half of the total body cholesterol is derived from its de novo biosynthesis in the liver, is the major component of atherosclerotic plaques built up as fatty deposits on the inner walls of arteries, thus contributing to arteriosclerosis and coronary heart diseases [33]. 

Under normal physiological conditions, HDL exists in two forms HDL2 (d = 1.063-1.125 g/mL) and HDL3 d = 1.125-1.210 g/mL). Fluctuations in plasma HDL levels have been principally associated with changes in HDL2. This fraction is often found in much higher concentration in females and may be associated with their reduced risk for atherosclerotic disease. Clinically, the cholesterol fraction of total HDL (d = 1.063-1.210) is commonly measured, and low values are frequently associated with increased risk of coronary heart disease. 

An abnormal lipoprotein profile increases the risk of atherosclerosis and coronary heart disease in patients with nephrotic syndrome. It is therefore prudent to treat patients with persistent nephrotic syndrome and sustained dyshpidemia, especially those with high VLDL and LDL cholesterol levels in the presence of a normal or low HDL cholesterol level (see Chaps. 21 and 43). Therapy is especially needed for those with concurrent atherosclerotic cardiovascular disease, or with additional risk factors for atherosclerosis, such as smoking and hypertension. Whether correction of hpoprotein abnormahties will slow the progression of renal disease as demonstrated in animal studies requires clinical confirmation. ... 

A 9-year prospective follow-up study was conducted by Virtamo et al. (1987) on a group of men in Finland. At the beginning of the study, blood samples were taken as part of a study of coronary heart disease and other atherosclerotic diseases. Cancer data were collected from central registries for the years 1976 through 1983. The results indicated no association between low serum selenium levels (<0.045 mg selenium/L) and an increased risk of cancer. Evidence suggests that combined dietary deficiencies of vitamin E and selenium may be associated with increased cancer risk (Salonen et al. 

Cardiovascular Effects. In humans, vascular atherosclerotic changes are a primary effect following long-term exposure to carbon disulfide. This is supported by epidemiological studies that have established a relationship between occupational exposure to carbon disulfide and increased mortality due to coronary heart disease (Hemberg et al. 1970, 1971, 1973 MacMahon and Monson 1988 Tiller et al. 1968 Tolonen et al. 1979) and circulatory disease deaths (Swaen et al. 1994). Milder manifestations such as angina have also been documented (Hemberg et al. 1971 Tolonen et al. 1979). 

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