Coronary heart disease etiology

Hypertension is one of the two principal risk factors of many cardiovascular diseases, such as coronary heart disease (CHD), stroke, and CHF. Individuals are considered hypertensive if their systoHc arterial blood pressure is over 140 mm Hg (18.7 Pa) or their diastoHc arterial blood pressure is over 90 mm Hg (12 Pa). Over 60 million people, or one-third of the adult population in the United States are estimated to be hypertensive (163). About 90% of these patients are classified as primary or essential hypertensive because the etiology of their hypertension is unknown. It is generally agreed that there is a very strong genetic or hereditary component to this disease. 

Disorders in lipoprotein metabolism are critical in the etiology of several disease states, such as coronary heart disease and atherosclerosis. Thus, there is considerable interest in the development of novel methods for the analysis of lipoprotein complexes. A simple chromatographic method for the separation of high-density lipoprotein (HDL), low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL) from intact serum or plasma has been reported recently [65]. The separation was achieved by using an hydroxyapatite column and elution with pH 7.4 phosphate buffer with lOOpl injections of whole... 

Jamrozik K, Anderson CA, Stewart-Wynne EG (1994). The role of lifestyle factors in the etiology of stroke. A population-based case-control study in Perth Western Australia. Stroke 25 51-59 Jespersen CM, Als-Nielsen B, Damgaard M etal. (2006). Randomized placebo controlled multicentre trial to assess short term clarithromycin for patients with stable coronary heart disease CLARICOR trial. British Medical Journal 332 22-27 Jorgensen HS, Nakayama H, Raaschou HO etal. (1994). Stroke in patients with diabetes. The Copenhagen Stroke Study. Stroke 25 1977-1984... 

However, the reduction in coronary heart disease risk was substantially less than the maximum anticipated benefit/ perhaps reflecting the fact that atherosclerosis is a chronic and largely irreversible process with a multifactorial etiology. 

Even though the mortality from coronary heart disease has declined recently, atherosclerosis and related vascular disorders still are the leading cause of death in the Western world. The etiology of this disease is multifactorial, with hyperlipidemia, smoking, diabetes mellitus, hypertension, and obesity being well-established risk factors for the development of atherosclerosis. Dietary fat affects plasma lipids, lipoproteins, and vascular inflammation and, thus, is linked to atherosclerosis. 

One of the most important research advances since World War II is the delineation of the chief mechanism of the etiologic effect of dietary lipid on atherogenesis. This has been the demonstration - as illustrated in the last three figures - that populations differing in habitual intake of saturated fat and cholesterol also differ markedly in serum cholesterol levels, i.e., interpopulation levels of these two sets of variables are highly correlated. So also are dietary saturated fat-cholesterol intake and coronary heart rates, and serum cholesterol level and coronary heart disease rates. 

Etiology - In the study of the causes of atherosclerosis. the factors found most likely to be present in the living system prior to death, in relation to the proven presence of coronary atherosclerosis at autopsy, are advanced age, elevated serum cholesterol, and elevated blood pressure, with elevated blood lipids and the presence of diabetes appearing influential. Other measurable metabolic parameters found to correlate as coronary heart disease risk factors are elevated serum uric acid, , lowered serum albumin levels, lowered lipoprotein lipase and lowered endogenous heparin. Of these factors, "cholesterol" continues as a favorite research topic. 

Dietary Fiber and the Etiology of Coronary Heart Disease... 

Tudapaty 1., and Altura, B. M. (1980). Magnesium depletion produces spasms of coronary arteries Relationship to etiology of sudden death ischemic heart disease- Scj ettce 208, 198-200. 

Heart disease is the leading cause of death in the United States and is responsible for approximately 870,000 deaths per year (1). Sudden cardiac death (SCD) is responsible for almost half of these deaths, claiming 350,000 to 400,000 lives per year (2). SCD is defined by the World Health Organization as death due to any cardiac disease that occurs out of hospital, in an emergency room, or a patient who is dead on arrival to a care facility. Of note, the death must occur within one hour after the onset of symptoms. The majority of SCD is likely arrhythmic in etiology. In women, up to 88% of sudden cardiac arrests may be due to arrhythmic causes (3). Of SCD due to cardiac arrhythmias, greater than 80% of events are due to ventricular tachycardia (VT) and ventricular fibrillation (VF), with the remainder due to bradyarrhythmias and asystole (4). Coronary artery disease (CAD), manifesting acutely as ischemic ventricular arrhythmias or chronically as scar-mediated... 

Class I Indications for an ICD (1) Survivors of cardiac arrest secondary to ventricular tachycardia and ventricular fibrillation except when due to a reversible cause. (2) Sustained vaitricular tachycardia associated with structural heart disease. (3) Syncope of unclear etiology with an inducible ventricular tachycardia or ventricular fibrillation at electrophysiology study. (4) Nonsustained ventricular tachycardia in patients with coronary artery disease, left ventricular dysfunction, and inducible ventricular tachycardia or fibrillation at electrophysiology study that is not suppressed will by an antiarrhythmic drug. (5) Spontaneous sustained ventricular tachycardia in patients without structural heart disease who are not amenable to medical therapy. 

Candidates for transplantation have refractory heart failure with marked left ventricular decompensation due to a variety of etiologies including coronary artery disease (45%) cardiomyopathy (45%) - idiopathic, hypertensive, peripartum, or viral valvular heart disease (3%-4%) and congenital heart disease (2%) (Taylor et al. 2004 Win-KEL et al. 1999). Candidates are typically less than 65 years of age (although older patients have been transplanted at some centers) and have an estimated 2-year survival of less than 60% without transplantation (Kirklin et al. 2004). 

The first step in the management of chronic heart failure is to determine the etiology (see Table 14—1) and/or any precipitating factors. Treatment of underlying disorders such as anemia or hyperthyroidism may obviate the need for treatment of heart failure. Patients with valvular diseases may derive significant benefit from valve replacement or repair. Revascularization or anti-ischemic therapy in patients with coronary disease may reduce heart failure symptoms. Drugs that aggravate heart failure (see Table 14—3) should be discontinued, if possible. 

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