Morphology of AS
fibrous cap + lipid core
Risk factor - risk increase AS
2 risk factors - 4 fold increase
3 risk factors - 7 fold increase
Constitutional risk factors for AS (3)
- Age
- Gender (until menopause)
- Genetics (hypertension, hypercholesterol)
Modifiable risk factors for AS (6)
- hypercholesterinaemia
- Hypertension
- Smoking
- Diabetes
- Inflammation
- Stressful life
Role of LDL
deliver cholesterol to peripheral tissues
What increases LDL?
obesity, smoking
What decreases LDL?
omega 3 fatty acids
What is the role of HDL?
mobilize cholesterol from plaque, transports to liver
What increases HDL?
alcohol
What decreases HDL?
obesity, smoking
What is Lip(a)?
modified LDL, high risk for IHD
Phases of AS formation (6)
- damage of endothelium
- endothelial dysfunction
- inflammation of vessel wall
- activation of macrophages
- activation of smooth muscle cells
- calcification of plaque
Steps of endothelial dysfunction (4)
- pb with vasodilation : decreased NO production
- produce inflammatory cytokines
- production of adhesion molecules
- endothelial barrier is broken so LDL can enter vessel wall
What happens to the macrophages?
digest oxydized LDL and die
What is the role of SMC in the formation of AS?
proliferate + produce ECM, forming fibrosis
3 morphologies of AS
- fatty streak
- AS plaque
- complicated plaque
What is the fatty streak?
lipid filled foam cells in the intima, cause no disturbance in flow
What is the complicated plaque?
depositing of Ca causes calcification, more dangerous
Consequences of complicated AS plaque (5)
- rupture
- ulceration
- erosion / thrombosis
- atheroembolism
- aneurysm
Preventions of AS
- primary prevention
- secondary prevention (prevent symptoms)
What is hyaline AS?
Narrowing of the lumen in diabetes and hypertension
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