CORONARY ARTERY DISEASE Etiology and Pathophysiology
806 Section 7 Problems of Oxygenation: Perfusion ing can be injured as a result of tobacco use, hyperlipidemia, hy- 493,623 pertension, diabetes, hyperhomocysteinemia, and infection (e.g., 500 433,825 Males Chlamydia pneumoniae, herpes) causing a local infl ammatory re- sponse3,4 (Fig. 34-2, A). 400 Females C-reactive protein (CRP), a nonspecifi c marker of infl amma- tion, is increased in many patients with CAD. Chronic exposure to 300 288,768 268,503 even minor elevations of CRP can trigger the rupture of plaques Cardiovascular System Cardiovascular and promote the oxidation of low-density lipoprotein (LDL) cho- 200 lesterol, leading to increased uptake by macrophages in the endo- 5,6 64,103 thelial lining. Deaths in thousands 69,257 41,877 100 60,713 Developmental Stages. CAD is a progressive disease that 34,301 38,948 takes many years to develop. When it becomes symptomatic, the 0 disease process is usually well advanced. The stages of development ABCDE ABDEF in atherosclerosis are (1) fatty streak, (2) fi brous plaque resulting from smooth muscle cell proliferation, and (3) complicated lesion. A Total CVD (Preliminary) D Chronic Lower Respiratory Diseases B Cancer E Diabetes Mellitus Fatty Streak. Fatty streaks, the earliest lesions of atherosclero- 2 C Accidents F Alzheimer’s Disease sis, are characterized by lipid-fi lled smooth muscle cells. As streaks of fat develop within the smooth muscle cells, a yellow FIG. 34-1 Leading causes of death for all men and women. CVD, Cardiovas- cular disease. tinge appears. Fatty streaks can be observed in the coronary arter- ies by age 15 and involve an increasing amount of surface area as the patient ages.
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