tailieunhanh - Ebook Harrison's cardiovascular medicine (2nd edition): Part 2

(BQ) Part 2 book "Harrison's cardiovascular medicine" presents the following contents: Disorders of lipoprotein metabolism, the metabolic syndrome, ischemic heart disease, hypertensive vascular disease, diseases of the aorta, cardiovascular atlases,. | SECTION V DISORDERS OF THE VASCULATURE CHAPTER 30 THE PATHOGENESIS PREVENTION AND TREATMENT OF ATHEROSCLEROSIS Peter Libby PATHOGENESIS Atherosclerosis remains the major cause of death and premature disability in developed societies. Moreover current predictions estimate that by the year 2020 cardiovascular diseases notably atherosclerosis will become the leading global cause of total disease burden. Although many generalized or systemic risk factors predispose to its development atherosclerosis affects various regions of the circulation preferentially and has distinct clinical manifestations that depend on the particular circulatory bed affected. Atherosclerosis of the coronary arteries commonly causes myocardial infarction MI Chap. 35 and angina pectoris Chap. 33 . Atherosclerosis of the arteries supplying the central nervous system frequently provokes strokes and transient cerebral ischemia. In the peripheral circulation atherosclerosis causes intermittent claudication and gangrene and can jeopardize limb viability. Involvement of the splanchnic circulation can cause mesenteric ischemia. Atherosclerosis can affect the kidneys either directly . renal artery stenosis or as a common site of atheroembolic disease Chap. 38 . Even within a particular arterial bed stenoses due to atherosclerosis tend to occur focally typically in certain predisposed regions. In the coronary circulation for example the proximal left anterior descending coronary artery exhibits a particular predilection for developing atherosclerotic disease. Similarly atherosclerosis preferentially affects the proximal portions of the renal arteries and in the extracranial circulation to the brain the carotid bifurcation. Indeed atherosclerotic lesions often form at branching points of arteries which are regions of disturbed blood flow. Not all manifestations of atherosclerosis result from stenotic occlusive disease. Ectasia and the development of aneurysmal disease for example frequently occur in .