脂精典课件代谢与动脉粥样硬化.ppt

Cardiovascular disease is the leading causeof death among adults worldwide (1996) Coronary mortality:alarming worldwide forecasts Atherosclerosis:a multifactorial disease Main risk factors for coronary heart disease Global projections for the diabetes epidemic:1995-2010 Atherosclerosis Arterial wall:structure and function Different stages of atherosclerotic plaquedevelopment Vascular endothelium modificationin atherosclerosis Plaque formation1 — Fatty streak Plaque formation2 — Fibrous cap Plaque formation3 — Lipid core From plaque to thrombosis, key event: plaque rupture Lipid core constitutionActivated macrophages accumulate lipids Lipid core constitutionLDL oxidation Parietal vascular inflammationThe activated macrophage produces inflammatory cytokines Parietal vascular inflammationNFkB action in the inflammation process Diabetes and atherosclerosis Tobacco and atherosclerosis Dyslipidemia and atherosclerosis HTN, hemodynamic factor and atheroclerosis How to reduce plaque formationIntervention on risk factors How to reduce the risk of plaque rupture How to reduce the risk of thrombosis ~10% Weight loss = ~30% Visceraladipose tissue loss Characteristics of an unstable plaque Plaque vulnerability factorsIntrinsic factors Modification of extrinsic vulnerability factors Plaque rupture The main releasing factors Classification of lipids and lipoproteins Characteristics of lipoproteins Triglyceride-rich lipoproteins:size, structure and composition Digestion and metabolism of dietary fat HDL metabolism and reverse cholesterol transport Cholesterol efflux and reverse cholesteroltransport is modulated by two receptors Atherogenicity of small dense LDL Size and apolipoprotein composition are the main factors determining atherogenicity of triglyceride-rich particles Size and apolipoprotein composition are the main factors determining atherogenicity of triglyceride-rich particles Apo C-III modulates VLDL Apo C-III in apo B particles is atherogeni