Atherosclerosis
1. Pathogenesis
1) Initiation Fig 241-1
¨ç lipoprotein accumulation & modification
i) fatty streak formation
ii) lipoprotein oxidiation
iii) nonenzymatic glycation: DMȯÀÚ¿¡¼ atherosclerosis¸¦ ÃËÁø½ÃŰ´Â ±âÀü
¨è leukocyte recruitment
i) adhesion molecules(VCAM-1, ICAM-1, P-selectin)
ii) cytokines : monocyte & lymphocyte¿¡ ÀÇÇØ IL-1, TNF-¥áºÐºñ
=> VCAM-1, ICAM-1 expressionÀ¯µµ
2) Atheroma
¨ç ¾ïÁ¦ÀÎÀÚ
NO, HDL(="reverse cholesterol transport")
thrombomodulin, tissue and urokinase-type plasminogen activator,
heparin sulfate proteoglycan, prostacyclin
¨è À§ÇèÀÎÀÚ
DM, Lp(a), fibrinogen, PAI-1, homocysteine, tobacco, Kawasaki disease
viral & microbial pathogen: Herpesviridiae(CMVÆ÷ÇÔ), Chlamydia
2) atheroma evolution
i) PDGF : smooth muscle cell migration¡è
ii) TGF-¥â: interstitial collagen production¡è
iii) serotonin: low molecular weight mediator, smooth muscle fxÀ» º¯È½ÃÅ´
3) clinical syndromes Fig 241-2
atheromaÇü¼º Ãʱ⿡ plaque°¡ ¹ÛÀ¸·Î ÀÚ¶ó¹Ç·Î(abluminal direction) Á÷°æÀº Ä¿Áø´Ù.
ÀÌ Çö»óÀ» "compensatory enlargment"¶ó Çϸç angiography½ÃÇà½Ã atherosclerosis¸¦
underestimationÇÏ°Ô µÈ´Ù.
2. ¿¹¹æ ¹× Ä¡·á
1) Risk factors Tab 242-1
homocysteine, Lp(a), infectionÀº controversialÇÏ´Ù(nontraditional risk factor)
¨ç lipid disorder Tab 242-2 NCEP ATP II
HMG CoA reductase inhibitor´Â cerebrovascular event¿¡ ´ëÇÏ¿© LDL lowering benefitÀ»
º¸À̴µ¥ 6-24°³¿ùÀÇ Ä¡·á°¡ ÇÊ¿äÇÏ´Ù.
¨è hypertension
thiazide diuretics, ¥â-blocker´Â lipid profile¿¡ ³ª»Û ¿µÇâÀ» ³¢Ä¡¹Ç·Î CHD risk factor or
atherosclerosis°¡ ÀÖÀ»¶§´Â "lipid-neutral" antihypertensive agent(ACE inhibitor &
¥á-blocker)°¡ ÁÁ´Ù.
¨é DM & insulin resistance
insulin resistance¿Í °ü·ÃÇÑ abnormal lipoprotein profileÀ» "diabetic dyslipidemia"¶ó ÇÑ´Ù.
HDL¡é, TG¡è
* ADA recommendation: target LDL = 100 mg/dL¡é
¨ê male gender/postmenopausal state
Æó°æÀü ¿©¼ºÀº HDL¡è, Æó°æÈÄ¿£ HDL¡é : coronary risk¡è
Æó°æÈÄ ERT: LDL¡é, HDL¡è
¨ë dysregulated coagulation or fibrinolysis
PAI-1, Lp(a)
¨ì homocysteine
¨í infection/inflammation : Chlamydia pneumoniae, CMV
¨î life-style modification
±Ý¿¬, wt reduction, ¿îµ¿ÇÒ°Í