Coronary Artery Disease Overview

Study Notes

Low-density lipoprotein molecules (LDL) become oxidized by oxygen free
When oxidized LDL comes in contact with an artery wall, a series of reactions occur to repair the damage caused by oxidized LDL
The body's immune system responds by sending specialized white blood cells (macrophages and T-lymphocytes) to absorb the oxidized-LDL, forming specialized foam cells
These white blood cells are not able to process the oxidized-LDL, and ultimately grow then rupture
Eventually, the artery becomes inflamed
The cholesterol plaque causes the muscle cells to enlarge and form a hard cover over the affected area
This hard cover causes a narrowing of the artery, reduces the blood flow and increases blood pressure

Lipoproteins are referred to as low-density lipoproteins (LDL) and high-density lipoproteins (HDL)
LDL (normal level, less than 130 mg/dL) are the primary transporters of cholesterol and triglycerides into the cell
HDL (normal range in men, 35 to 65 mg/dL; in women, 35 to 85 mg/dL) have a protective action. They transport cholesterol away from the tissue and cells of the arterial wall to the liver for excretion
Cholesterol (normal level, less than 200 mg/dL, High: = 240 mg/dL)
Triglycerides (normal range, 40 to 150 mg/dL) composed of free fatty acids and glycerol, are stored in the tissue and are a source of energy

Stage	Description
Healthy artery	Normal artery with no plaque build up
Plaque forms	Small deposits of plaque begin to form on the artery walls
Cholesterol deposited	Plaque starts to build up in the artery
Build-up begins	Plaque continues to build up restricting blood flow

Normal Heart and Artery	Artery with Plaque Buildup
* Normal artery wall

Advanced age
Male sex
Having close relatives who have had some complication of atherosclerosis (e.g., coronary heart disease or stroke)
Genetic abnormalities, e.g.familial hypercholesterolemia

Being obese (in particular central obesity (also referred to as abdominal obesity))
A sedentary lifestyle
High carbohydrate intake
Elevated serum levels of triglycerides
Stress

Depend on the degree of narrowing of the arterial lumen, thrombus formation and obstruction of blood flow
Inadequate supply of blood that leads to deprives in oxygen in muscle (ischemia)
Angina pectoris, chest pain that is brought about by myocardial ischemia
If blood supply decreases is great and longer, myocardial infarction produce
Damaged myocardium replaced by scar tissue causing various degrees of myocardium dysfunction
Inadequate cardiac output and heart failure occur

Non-pharmacological means are usually the first method of treatment, such as cessation of smoking and regular exercise
If these methods do not work, medicines are usually the next step
- Statins: block cholesterol synthesis, lower low density lipoprotein (LDL) and triglyceride levels and increase high density lipoprotein (HDL)
- Nicotinic acids: lower LDL and increase HDL
- Fibrates: Reduce triglycerides, lowers LDL, and elevate HDL
- Bile Acid Sequestrants: binds to bile acids in the intestine and prevents their reabsorption
- Ezetimibe: inhibit the absorption of cholesterol from the small intestine