Coronary Artery Disease
Atherosclerosis
With Professor Rhonda Lawes
Coronary Artery Disease (CAD)
• Coronary artery disease (CAD), which is caused by
atherosclerosis, is the most common
type of heart disease.
• Arteries that supply blood to the heart muscle become
narrowed, hardened, or blocked to the point that
oxygen-rich blood flow is compromised.
What Is Atherosclerosis?
Artery Endothelium Endothelium
Smooth muscles
Plaque
A hardening and narrowing of the arteries caused by a build-up of plaque
How Does Atherosclerosis Happen?
Normal
artery
• A hardening and narrowing
of the arteries caused by a Early
build-up of plaque injury
• Caused by a chronic
inflammatory process that Athero-
starts after damage to the sclerosis
endothelium
Complete
Area of occlusion and blockage
surrounding muscle damage
© by Lecturio
How Does Atherosclerosis Happen?
Normal
artery
• Low-density lipoproteins
(LDLs) cross the damaged
endothelium into the Early
wall of the artery injury
• Over time, cholesterol
becomes part of the plaque: Athero-
circulation is compromised sclerosis
higher risk of stroke or
myocardial infarction (MI)
Complete
Area of occlusion and blockage
surrounding muscle damage
© by Lecturio
Break that down
• First, the artery lining is
injured.
WBCs
• As a response to injury:
fatty materials (LDLs,
cholesterol, triglycerides) plus
the inflammatory mediators,
macrophages, and WBCs
infiltrate the lining of the
damaged artery.
Fatty materials
© by Lecturio
Thickening of the Arterial Wall
• Platelets release growth factor
at the site, and the smooth
muscle is stimulated to
proliferate.
• The lipids and other
substances are trapped in the
wall of the artery, which is
thickening, and blood flow
becomes increasingly reduced
as the opening becomes
smaller.
© by Lecturio
Fatty Deposits to Plaque
• Over time, the fatty deposits harden and
become a tough and fibrous plaque. Normal artery
• These deposits can be on just one side or
all the way around the lumen of the artery.
• As blood flow decreases, the arteries will Atherosclerosis
not be able to supply enough oxygen-rich
blood to meet the demands of the heart
muscle.
• The patient will usually start to experience
ischemia or chest pain and has an Complete
increased risk of MI. blockage
© by Lecturio
Collateral Circulation
If atherosclerosis builds up slowly over time,
the body will create collateral circulation.
© by Lecturio
Atherosclerosis Non-modifiable Risk Factors
Ethnicity Family history Increasing age
and gender
Risk Factors for Atherosclerosis
LDL
High blood Smoking Elevated LDL
pressure cholesterol
Risk Factors for Atherosclerosis
Obesity and diet Physical inactivity Stress or
substance abuse
Additional Risk Factors
Hcy
Diabetes Elevated C-reactive protein
homocysteine (CRP)
levels
Diet Recommendations to Lower LDL
• Reduce intake of saturated fats to
less than 7% per day
• Minimize intake of processed
foods like crackers, commercial
baked goods, fried foods, etc.
• Reduce intake of cholesterol to
200 mg/day or less
• Consider adding more nuts
(walnuts), beans/legumes, and
vegetables
F.t.t.b.: Free-Photos, CC0; fierronegro, CC0
Sources of Cholesterol
Dietary sources Made by cells in our bodies
(Exogenous) (Endogenous)
Intake of saturated fats causes Primarily in the liver
the most significant increase
Cholesterol
Cholesterol part of all cell membranes
Needed to make Needed to make Used in
hormones bile salts the skin
Estrogen, progesterone, Decreases evaporation of
or testosterone water and absorption of
some water-soluble
compounds
HDL vs. LDL
Type of % of total Function Atherosclerosis
cholesterol cholesterol
LDL 60 70% Delivers Elevated levels =
cholesterol to increased risk of
tissues atherosclerosis
High- 20 30% Carries Elevated levels =
density cholesterol from decreased risk of
lipoprotein tissues back to atherosclerosis
(HDL) the liver
Statins HMG-CoA Reductase Inhibitors
LDL LDL
LDL
• The most effective drugs for
lowering LDL cholesterol levels
LDL
• Increase the number of LDL LDL LDL LDL
LDL LDL
receptors in the liver LDL LDL
LDL LDL
• Less LDL in the serum because
more is in the liver
Statins HMG-CoA Reductase Inhibitors
• Must be taken for life if cholesterol
lifestyle/diet
• Lower LDL levels can slow the
progression of atherosclerotic heart
disease and minimize the risk of
cardiovascular events
Statins HMG-CoA Reductase Inhibitors
• Rare adverse effects of
hepatotoxicity and myopathy
(rhabdomyolysis)
• Monitor liver function tests and
creatine kinase (CK) levels
In a Nutshell
Cholesterol is in the membrane of every
cell.
LDL is thought to be the most significant
contributor to atherosclerosis.
Diet and exercise can significantly impact
LDL and HDL levels.
Statins are the most effective drugs for
lowering blood LDL cholesterol levels.
In a Nutshell
Statins increase the number of LDL
receptors in the liver.
The target level is usually LDL < 100
mg/dL or, for high risk patients, it may be
< 70 mg/dL.
Most statins should be given at night for
effectiveness in lowering LDL.
