Introduction to Cardiovascular Disease PDF

Introduction to Cardiovascular Disease Assoc. Prof. Cristian Guţu, MD, PhD „Dunarea de Jos” University of Galați Faculty of Medicine and Pharmacy Summary overview of cardiovascular disease (CVD) clinical approach to cardiac patients evidence...

Introduction to Cardiovascular Disease Assoc. Prof. Cristian Guţu, MD, PhD „Dunarea de Jos” University of Galați Faculty of Medicine and Pharmacy Summary overview of cardiovascular disease (CVD) clinical approach to cardiac patients evidence-based medicine principles explores risk factors prevention strategies, and treatment options for atherosclerosis https://infectionsinsurgery.org/lets-support-evidence-based-medicine/ https://infectionsinsurgery.org/lets-support-evidence-based-medicine/ https://toolbox.eupati.eu/wp-content/uploads/sites/4/2020/07/Levels-of-evidence-v2_EN.png Risk factor. Cardiovascular risk Risk= probability that an action will determine an outverse outcome (%) Risk factor = probability thar a certain element (behavior,genetics,etc) increases the likelyhood of developing a certain disease (called „X”is a risk factor for „Y”) Prevention Strategies Primordial Prevention: Preventing risk factors from developing in the first place (e.g., promoting healthy lifestyles from a young age). Primary Prevention: Reducing risk factors in individuals without existing CVD (e.g., controlling blood pressure, managing cholesterol levels). Secondary Prevention: Preventing further CVD events in those with existing CVD (e.g., statin therapy). Tertiary Prevention: Managing complications of CVD (e.g., rehabilitation after a heart attack). https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-016-0546-4 Modifiable Risk Factors Smoking Dyslipidaemia (abnormal lipid levels) Hypertension (high blood pressure) Diabetes mellitus (high blood sugar) Sedentary lifestyle Non-Modifiable Risk Factors Age: >55 y males, >65y females Sex: higher risk in males Family history of premature CVD: ✓linked with early atherosclerosis Inflammation – hsCRP, IL-6, ICAM-1 ; high fibrinogen Homocysteine – prothrombotic effect Smoking Elevates CV risk 2-3x ->highest risk of stroke Proportional to no. cigarettes/day/year (pack-years) Mechanisms: ✓LDL oxidation ✓HDL down-regulation ✓Stops vasodilation ✓Increases fibrinogen and hsCRP ✓Pro-agregant Dyslipidemia INTERHEART trial -> 50% of coronary artery disease attributable to high LDL and only 25% to high BP Values of high-risk LDL cholesterol depend on global CV risk ✓Determined parameters are: total cholesterol, HDL, LDL, triglycerides Needs management in patients with: ✓Known CV disease ✓Type 2 DM ✓CKD ✓Familial hypercholesterolemia Type 2 diabetes mellitus 3-5x increase in CV risk Mechanisms: ✓LDL glycosylation ✓Endothelial dysfunction ✓Pro-thrombotic ✓Modification of lipid profile Obesity Correlates with ✓Insulin resistance ✓Lipid alterations ✓hypertension Metabolic syndrome CENTRAL OBESITY (abd. Circumference males>94cm, females>80cm – Caucasians) +at least 2 of the following: Triglycerides >150 mg/dL or on triglyceride-lowering treatment Low HDL: 85 mmHg or on anti- hypertensive drugs Fasting glucose>100 mg/dL (5,6 mmol/L) or known type-2 DM Sedentary lifestyle Predisposing factor for weight gain Poor effect on: weight control, BP, glucose tolerance, lipid profile, endothelial function General recommendation: minimum of 30 minutes/day of moderate-intensity workout Cumulative risk ATHEROSCLEROSIS Definition Chronic inflammatory disease of the arterial wall, especially in the muscular and elastic arteries Etymology: “Atheros”= mush “sclerosis”=induration Clinical implications of atherosclerosis Coronary arteries: ✓ Silent ischemia ✓ Angor pectoris ✓ Acute coronary syndromes Cerebral arteries: ✓ Transient ischemic attack (TIA) ✓ Stroke Peripheral arteries ✓ Peripheral arteries disease ✓ Critical ischemia Abdominal arteries ✓ Mesenteric ischemia ✓ Aortic abdominal aneurism Renal arteries ✓ Renal infarction ✓ Renal failure Initiation of atherogenesis Sub-endothelial lipid accumulation ✓Proteoglican binding ✓Endothelial dysfunction Lipid structure modification ✓Oxidation ✓Glycosylation (DM) Interventions in atherosclerosis Lifestyle interventions ✓Smoking cessation ✓Diet – Mediterranean ✓Increase in physical activity BP control Weight loss Dyslipidemia treatment Glycemic control Dyslipidemia treatment Diet Physical exercise Drugs: ✓HMG-CoA reductase inhibitors (statins): Atorvastatin, Rosuvastatin ✓Intestinal cholesterol absorption inhibitors: ezetimibe ✓LDL receptor modulator: bempedoic acid ✓Monoclonal antibodies- PCSK9 inhibitors: alirocumab, everlocumab ✓mRNA modulator for PCSK9: inclisiran https://www.sciencedirect.com/science/article/abs/pii/S0304419X2030113X https://www.ecrjournal.com/articles/emerging-role-pcsk9-inhibitors-preventive-cardiology