二尖瓣脱垂课件.ppt

* * Cardiovascular disease (CVD) remains the primary cause of mortality worldwide for both men and women and is predicted to continue to grow on a global scale.1,2 In developing countries, in particular, there is likely to be an explosion in CVD and diabetes in the next 20 years due to a number of factors, including dramatic changes in lifestyle associated with urbanization and the adoption of Western practices.2 World Health Organization. Global Burden of Disease Estimate 2001. Neal B, Chapman N, Patel A. Managing the global burden of cardiovascular disease. Eur Heart J Suppl. 2002;4(suppl F):F2-F6. Atherosclerosis, the process underlying most CVD, has 3 distinct stages: ─ Initiation - during which lipids are deposited on the vessel wall ─ Progression - during which inflammation increases, plaque formation builds up in the intima, and fibrous caps are formed, increasing the potential for atheroma ─ Clinical disease - when complications result from stenosis or unstable plaque rupture, leading to myocardial infarction (MI), stroke, or death.1 1. Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 2001;104:365-372. There is now a substantial body of research that suggests that the origins of atherosclerosis begin at an early age. This slide shows data from 262 heart transplant donors.1 Sites with an intimal thickness of ≥0.5 mm were defined as atherosclerotic. Results showed that the extent of atherosclerosis increases progressively with advancing age. Among the 13- to 19-year age group, atherosclerotic disease was present in 17% of subjects. By age 40, 70% of individuals had ≥1 atherosclerotic lesion. These data suggest that coronary heart disease (CHD) is highly prevalent and that even relatively young individuals may have a substantial plaque burden that will require aggressive intervention. Tuzcu EM, Kapadia SR, Tutar E, et al. High prevalence of coronary atherosclerosis in asymptomatic teen