第19章治疗冠心病药物.ppt

文档介绍：第19章治疗冠心病药物Agents to treat CHD
coronary heart disease
Background: IHD is the leading single cause of death in the US and is responsible for 1 of every deaths. About half of the patients with IHD initially present with chronic stable angina. IHD manifests as an imbalance in myocardial oxygen supply and demand that results in myocardial hypoxemia.
IHD is usually due to atherosclerotic disease of the coronary arteries (coronary heart disease [CHD] and coronary artery disease [CAD])。
病因学Etiology
The exact pathogenesis of CAD is not clear, and no single theory adequately explains the atherosclerotic process. Two main explanations have been proposed: the lipid hypothesis and the chronic endothelial injury hypothesis. These explanations are probably interrelated and are certainly not mutually exclusive.
Risk Factors
Positive family history, particularly with onset before age 50 in same-sex parent
Male gender
Age
Abnormalities in blood lipids/lipid metabolism,
High Waist/Hip Ratio (Rexrode et al, 1998)
Elevated blood homocysteine
Elevated fibrinogen (Bielak et al, 2000)
High ultra-sensitive C-reactive protein High levels of iron stores (Salonen et al, 1992)
Low levels of selenium (Suadicani et al, 1992)
Sedentary lifestyle/poor physical fitness
Cigarette smoking
Alcohol abuse
Diets high in animal fat and calories and low in fruits, vegetables, and fiber
Diets low in polyunsaturated fatty acids
Diets high in trans fats (Willett et al, 1993)
Poor stress management
High blood levels of insulin
Decreased oxidative radical antioxidant capacity (ORAC) (Fazendas et al, 2000)
Diabetes mellitus
Hypertension
Hypothyroidism
Marital stress (Orth-Gomer, 2002)

动脉粥样硬化是冠心病的病理基础。
胆固醇等脂质沉着在大中动脉血管壁,形成粥样斑块,尤其在动脉分叉处。在心外膜下中等动脉分支的内膜下胆固醇沉着,管腔内新月形隆起,表面为纤维帽,含增殖平滑肌、胶原、脂质及泡沫细胞,内膜下形成坏死区,含胆固醇结晶、胆固醇酯,钙盐等。
冠脉狭窄为偏狭窄,开始为新月形,狭窄<50%为轻度,对供血影响不大,无明显症状;狭窄50%-70%为重度,供血大减,可出现心绞痛。若管腔被血栓迅速阻塞,可产生急性心肌梗死。
冠脉痉挛亦导致缺血性心脏病,可造成心绞痛(如变异型心绞痛),甚至心肌梗死。

冠心病共分为五型,分述