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Common Congenital Heart Lesions - page 28 / 126

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1. Identify the risk factors for atherosclerosis and their role in the pathogenesis of atherosclerosis

Major, potentially modifiable risk factors include the following:

  • Dyslipidemia

  • Hypertension

  • Smoking

  • Diabetes Mellitus

  • Obesity

  • Low levels of physical activity

Dyslipidemia

  • Refers to abnormal circulating lipid levels

  • Higher levels of total serum cholesterol & LDLÆincreased risk of atherosclerosis and ischemic heart disease…thus, LDL is often termed the “bad cholesterol.”

  • Elevated LDL may result from diets high in saturated fat or genetics defects in the LDL receptor (familial hypercholesterolemia).

  • All cholesterol-carrying lipoproteins aren’t harmful, though as HDL helps to transport excess cholesterol back to the liver (reverse cholesterol transport)…thus HDL is commonly known as “good cholesterol” since it protects against lipid accumulation.

Tobacco Smoking

  • Studies have shown that smoking (in even minimal amounts) is correlated with an increased risk for atherosclerosis & ischemic heart disease.

  • Fortunately, smoking cessation can reverse tobacco’s adverse effects and lower the risk for disease.

  • Contributions to the development of atherosclerosis include:

    • o

      Enhanced modification of LDL

      • o

        Decreased levels of HDL

      • o

        Tissue hypoxia & increased oxidant stressÆendothelial dysfunction

      • o

        Increased WBC adhesion molecules & other inflammatory markers

      • o

        Inappropriate stimulation of the sympathetic NS via nicotine

      • o

        Oxygen displacement from Hb by CO

Hypertension

  • Elevated BP increases ones risk of developing atherosclerosis, coronary heart disease, and stroke

  • Especially in the elderly, the higher the systolic pressure (since it predicts adverse events more reliably than diastolic pressure), the higher the risk

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