Dislipidemia Atherosclerosis

7/23/2019 Dislipidemia Atherosclerosis

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DyslipidemiasDyslipidemias

Atherosclerosis AtherosclerosisSnejana Vetrila MD PhDSnejana Vetrila MD PhD



DislipidemiaDislipidemia

Total serum cholesterol greater than 200Total serum cholesterol greater than 200mg/dLmg/dL (!(!0/"!0/"! mmol/l#mmol/l#

LDL cholesterol greater than $00 mg/dLLDL cholesterol greater than $00 mg/dL%DL cholesterol less than "0 mg/dL%DL cholesterol less than "0 mg/dL

Triglycerides greater than $0 mg/dLTriglycerides greater than $0 mg/dL

Lipoprotein(a# less than &0 mg/dLLipoprotein(a# less than &0 mg/dL



Lipoproteins and ApolipoproteinsLipoproteins and Apolipoproteins

'steriied cholesterol and triglycerides are'steriied cholesterol and triglycerides areinsolu)le in )lood and are transported ininsolu)le in )lood and are transported inplasma )y lipoproteinsplasma )y lipoproteins**

high+density lipoprotein (%DL# cholesterol,high+density lipoprotein (%DL# cholesterol,lo-+density lipoprotein (LDL# cholesterollo-+density lipoprotein (LDL# cholesterol

.ery+lo- density lipoproteins (VLDL#.ery+lo- density lipoproteins (VLDL#

intermediate+density lipoproteins (DL#intermediate+density lipoproteins (DL# chylomicronschylomicrons



The density and sie+distri)ution o theThe density and sie+distri)ution o themajor classes o lipoprotein particlesmajor classes o lipoprotein particles



LLipoprotein meta)olism has )een separatedipoprotein meta)olism has )een separatedinto e1ogenous and endogenous path-aysinto e1ogenous and endogenous path-ays



Dietary FatsDietary Fats

Dietary ats are processed )y pancreaticDietary ats are processed )y pancreatic

lipase to atty acids to allo-lipase to atty acids to allo- (permite#(permite#

a)sorption across the intestinal epithelium,a)sorption across the intestinal epithelium, -here they are re+esteriied to triglycerides-here they are re+esteriied to triglycerides



Dietary CholesterolDietary Cholesterol

A)sorption o dietary or recirculated )iliary A)sorption o dietary or recirculated )iliarycholesterol is largely )y diusion across thecholesterol is largely )y diusion across theintestinal )rush )order in the jejunumintestinal )rush )order in the jejunum

It is important to recognize that only half ofIt is important to recognize that only half ofthe intestinal cholesterol is absorbed, mainlythe intestinal cholesterol is absorbed, mainlyin the form of recirculated biliary cholesterol,in the form of recirculated biliary cholesterol,while less than 30 comes from dietarywhile less than 30 comes from dietary

cholesterolcholesterol This e1plains -hy limiting the intae o dietaryThis e1plains -hy limiting the intae o dietarycholesterol oten sho-s only modestcholesterol oten sho-s only modestimpro.ement in cholesterol le.elsimpro.ement in cholesterol le.els



LDL and !DLLDL and !DL

are continuously remodeled in plasma, aare continuously remodeled in plasma, acomple1 process in.ol.ing enymes,comple1 process in.ol.ing enymes,transer proteins, and receptorstranser proteins, and receptors

This allo-s LDL to act as a transporter oThis allo-s LDL to act as a transporter ocholesterol rom the li.er to target tissues,cholesterol rom the li.er to target tissues,-hile %DL carries out the opposite-hile %DL carries out the opposite

unctionunction



"enetics"enetics

only a e- patients ha.e no-nonly a e- patients ha.e no-nmonogenic deects, the most common omonogenic deects, the most common o-hich is amilial hypercholesterolemia-hich is amilial hypercholesterolemia(3%#, occurring in $ in 00 patients(3%#, occurring in $ in 00 patients

aa)normal lipid le.els de.elop in most)normal lipid le.els de.elop in mostpatients aterpatients ater weight gain, with sedentaryweight gain, with sedentarylifestyle, or in the presence of otherlifestyle, or in the presence of other

disorders, such as diabetes mellitus anddisorders, such as diabetes mellitus andrenal or thyroid diseaserenal or thyroid disease



!istory!istory

lipid proiles o)tained )eore medications -erelipid proiles o)tained )eore medications -erestartedstarted

response to the initial drug and any ad.erseresponse to the initial drug and any ad.erseeects including myalgias and a)normal li.ereects including myalgias and a)normal li.erunction testsunction tests

amily history o early coronary disease oramily history o early coronary disease ordyslipidemia suggests a genetic componentdyslipidemia suggests a genetic component

recent -eight gain or -eight loss should also )erecent -eight gain or -eight loss should also )erecordedrecorded

screen or regular alcohol use as it a re4uentscreen or regular alcohol use as it a re4uentcause o ele.ated triglycerides and -eight gaincause o ele.ated triglycerides and -eight gain



#hysical $%amination#hysical $%amination

ocus on the cardio.ascular systemocus on the cardio.ascular system

)ut maniestations o meta)olic diseases)ut maniestations o meta)olic diseases

are oten missed and include a)dominalare oten missed and include a)dominalpain (enlarged li.er or spleen, gallstones,pain (enlarged li.er or spleen, gallstones,pancreatitis#pancreatitis#

corneal changes, and tendon or erupti.ecorneal changes, and tendon or erupti.e1anthomas1anthomas

truncal o)esity, lipodystrophy, acanthosistruncal o)esity, lipodystrophy, acanthosis



Laboratory AssessmentLaboratory Assessment

LLipid proile should )e o)tained in allipid proile should )e o)tained in alladults 20 years o age or older atadults 20 years o age or older at

least once e.ery yearsleast once e.ery years

The Third 5eport o the 6ational 7holesterol 'ducationThe Third 5eport o the 6ational 7holesterol 'ducationProgram (67'P# '1pert Panel on Detection, '.aluation,Program (67'P# '1pert Panel on Detection, '.aluation,and Treatment o %igh 8lood 7holesterol in Adults (Adultand Treatment o %igh 8lood 7holesterol in Adults (Adult

Treatment Panel (ATP# #Treatment Panel (ATP# #



&asic screening should also include&asic screening should also include

thyroid unction studiesthyroid unction studies li.er unction studies, asting glucose,li.er unction studies, asting glucose,)aseline creatine inase, and urine analysis)aseline creatine inase, and urine analysis

8aseline uric acid le.els may )e needed8aseline uric acid le.els may )e needed)eore starting niacin therapy)eore starting niacin therapy

to estimate cardio.ascular ris, such asto estimate cardio.ascular ris, such as

apo 8, homocysteine, 7+reacti.e proteinapo 8, homocysteine, 7+reacti.e protein(75P#, and lipoprotein+associated(75P#, and lipoprotein+associatedphospholipase A2 (Lp+PLA2#phospholipase A2 (Lp+PLA2#



Vascular studies toolsVascular studies tools

anle+)rachial+inde1 (A8#anle+)rachial+inde1 (A8#

carotid intima+medial thicness (MT#carotid intima+medial thicness (MT#

coronary artery calcium scores (7A7S#coronary artery calcium scores (7A7S#coronary angiography )y computedcoronary angiography )y computedtomography (7TA# estimate su)clinicaltomography (7TA# estimate su)clinical

.ascular disease )urden.ascular disease )urden



'pidemiologic studies suggest that'pidemiologic studies suggest thatin middle+aged menin middle+aged men

higher LDL (each $ mg/dLhigher LDL (each $ mg/dLincrease is associated -ith a $9increase is associated -ith a $9ris increase#ris increase#

lo-er %DL (each $ mg/dLlo-er %DL (each $ mg/dLdecrease is associated -ith a 29decrease is associated -ith a 29ris increase#ris increase#



3redricson, Lees3redricson, Lees andand Le.yLe.y classiicationclassiication

"enetic,"enetic, familfamily formsy forms 7hilomicroni +7hilomicroni + tipul Itipul I 8eta lipoproteine (LDL# +8eta lipoproteine (LDL# + tipultipul IIIIaa 8eta (LDL# :i pre+)eta (VLDL# lipoproteine +8eta (LDL# :i pre+)eta (VLDL# lipoproteine + tipultipul IIIIbb 8oala )eta e1tins; (<)road )eta= disease# +8oala )eta e1tins; (<)road )eta= disease# + tipul IIItipul III Pre+)eta lipoproteine (VLDL# +Pre+)eta lipoproteine (VLDL# + tipul I'tipul I' 7hilomicroni :i VLDL +7hilomicroni :i VLDL + tipul 'tipul '

ac(uiredac(uired (ar; transmitere ereditar; documentat;#(ar; transmitere ereditar; documentat;#



DislipidemiaDislipidemia

%ypercholesterolemia%ypercholesterolemia

%ypertrigliceridemia%ypertrigliceridemia

Mi1edMi1ed

C



)otal)otal CholeterolCholeterol,, mgdLmgdL

Desira)le > 200Desira)le > 200

8orderline high 200?2&@8orderline high 200?2&@

%igh 2"0%igh 2"0

!DL Cholesterol!DL Cholesterol

Lo- > "0Lo- > "0

%igh 0%igh 0LDLLDL CholesterolCholesterol

BptimalBptimal** > $00> $00

6ear or a)o.e optimal $00?$2@6ear or a)o.e optimal $00?$2@

8orderline high $&0?$@8orderline high $&0?$@ %igh$0?$C@%igh$0?$C@

Very highVery high $@0$@0



Major 5is 3actors (e1clusi.e o LDL+Major 5is 3actors (e1clusi.e o LDL+cholesterol#cholesterol#

7igarette smoing7igarette smoing%ypertension ()lood pressure $"0/@0 mm%ypertension ()lood pressure $"0/@0 mm%g or on antihypertensi.e medication#%g or on antihypertensi.e medication#

Lo- %DL+7 (> "0 mg/dL#Lo- %DL+7 (> "0 mg/dL#3amily history o premature 7AD (7AD in3amily history o premature 7AD (7AD inmale irst+degree relati.e > years 7ADmale irst+degree relati.e > years 7AD

in emale irst+degree relati.e > years#in emale irst+degree relati.e > years# Age (men " years -omen years# Age (men " years -omen years#



!ypertriglyceridemia!ypertriglyceridemia

%%ypertriglyceridemia is not the primary lipidypertriglyceridemia is not the primary lipidtarget in patients -ith 7ADtarget in patients -ith 7AD

'le.ated triglycerides are common (more'le.ated triglycerides are common (more

than 29 o population# and otenthan 29 o population# and otenassociated -ith secondary causes (such asassociated -ith secondary causes (such aso)esity dia)etes renal disease theo)esity dia)etes renal disease the

meta)olic syndrome and a num)er ometa)olic syndrome and a num)er odrugs, including protease inhi)itors anddrugs, including protease inhi)itors andestrogens#estrogens#





!ypertriglyceridemia!ypertriglyceridemia

)reatment)reatment

7hanges in liestyle or treatment o the7hanges in liestyle or treatment o theprimary disease process may )e suicientprimary disease process may )e suicientto reduce triglyceride le.elsto reduce triglyceride le.els

high car)ohydrate intae and alcohol usehigh car)ohydrate intae and alcohol useare re4uently o.erlooedare re4uently o.erlooed

statin therapy in com)ination -ith otherstatin therapy in com)ination -ith otherlipid+lo-ering drugs such as i)rates,lipid+lo-ering drugs such as i)rates,niacin, or omega+& atty acidsniacin, or omega+& atty acids



!DL Cholesterol!DL Cholesterol

Lo- %DL is a strong predictor o 7AD andLo- %DL is a strong predictor o 7AD andincreased cardio.ascular mortalityincreased cardio.ascular mortality

Lo- %DL is oten part o the meta)olicLo- %DL is oten part o the meta)olicsyndrome and associated -ith ele.atedsyndrome and associated -ith ele.atedtriglyceridestriglycerides



Major 7auses o 5educed Serum %DLMajor 7auses o 5educed Serum %DL7holesterol7holesterol

7igarette smoing7igarette smoing B)esityB)esityLac o e1erciseLac o e1ercise

Androgenic and related steroids Androgens Androgenic and related steroids AndrogensProgestational agentsProgestational agents Ana)olic steroids Ana)olic steroids Adrenergic+)locing agents Adrenergic+)locing agents

%ypertriglyceridemia%ypertriglyceridemiaEenetic actorsEenetic actorsPrimary hypoalphalipoproteinemiaPrimary hypoalphalipoproteinemia



Dietary *odificationDietary *odification

Very lo-+at diets such as the Dean BrnishVery lo-+at diets such as the Dean BrnishDiet, the Pritiin Diet, and most .egetarianDiet, the Pritiin Diet, and most .egetariandiets can e.en lo-er %DL cholesteroldiets can e.en lo-er %DL cholesterol

n contrast, a diet rich inn contrast, a diet rich inmonounsaturated ats such as themonounsaturated ats such as theMediterranean or South 8each Diets mayMediterranean or South 8each Diets may

increase or maintain %DL le.elsincrease or maintain %DL le.els



$%ercise$%ercise

Physical inacti.ity is a modiia)le ris actor, andPhysical inacti.ity is a modiia)le ris actor, anddaily e1ercise is recommended as an adjunct todaily e1ercise is recommended as an adjunct todietary modiication or the initial treatment odietary modiication or the initial treatment o

hyperlipidemiahyperlipidemiaTThe )eneits o com)ined resistance and aero)iche )eneits o com)ined resistance and aero)ice1ercise ha.e )ecome apparent and should )ee1ercise ha.e )ecome apparent and should )eencouraged in e.ery patientencouraged in e.ery patient

Faling o at least 000 steps daily or a goalFaling o at least 000 steps daily or a goale1ercise o $00 calories -eely should )ee1ercise o $00 calories -eely should )erecommended to all patientsrecommended to all patients



#harmacologic )herapy#harmacologic )herapy

+mega3 Fatty Acids -Fish +il.+mega3 Fatty Acids -Fish +il.

can used in com)ination -ith statins,can used in com)ination -ith statins,

i)rates, and niacin -ithout signiicant sidei)rates, and niacin -ithout signiicant side

eects, )ut re4uently increase LDL ineects, )ut re4uently increase LDL in

higher doseshigher doses



&ile Acid /e(uestrants&ile Acid /e(uestrants

The )ile acid+)inding resinsThe )ile acid+)inding resinscholestyramine, colestipol, andcholestyramine, colestipol, andcolese.elam (Fel7hol# are used ascolese.elam (Fel7hol# are used as

second+line therapy and in com)inationsecond+line therapy and in com)ination-ith other agents to treat-ith other agents to treathypercholesterolemia -ithout concurrenthypercholesterolemia -ithout concurrent

hypertriglyceridemiahypertriglyceridemia



Cholesterol Absorption InhibitorsCholesterol Absorption Inhibitors

'etimi)e, the irst drug in this class,'etimi)e, the irst drug in this class,inhi)its the a)sorption o cholesterol andinhi)its the a)sorption o cholesterol andphytosterols through the intestinal )rushphytosterols through the intestinal )rush

)order and interrupts the enterohepatic)order and interrupts the enterohepaticrecirculation o sterols rom )ile!recirculation o sterols rom )ile!

'etimi)e lo-ers LDL )ut does not aect'etimi)e lo-ers LDL )ut does not aect

triglyceridestriglycerides



FibratesFibrates

3i)rates reduce plasma triglycerides and3i)rates reduce plasma triglycerides andconcurrently raise %DL cholesterol le.elsconcurrently raise %DL cholesterol le.els

Their eects on LDL cholesterol are lessTheir eects on LDL cholesterol are lessmared and more .aria)lemared and more .aria)le

3i)rates are irst+line therapy to reduce the3i)rates are irst+line therapy to reduce theris o pancreatitis in patients -ith .eryris o pancreatitis in patients -ith .eryhigh le.els o plasma triglycerideshigh le.els o plasma triglycerides



iaciniacin

a -ater+solu)le .itamin, has )een sho-na -ater+solu)le .itamin, has )een sho-nto lo-er VLDL and LDL le.els and toto lo-er VLDL and LDL le.els and toincrease %DL le.els -hen gi.en in largeincrease %DL le.els -hen gi.en in large

dosesdoses t is gi.en either as a long+acting ormt is gi.en either as a long+acting ormonce daily or as regular niacin in highonce daily or as regular niacin in high

doses three times dailydoses three times daily ts use is oten limited )y side eects andts use is oten limited )y side eects andpatient noncompliancepatient noncompliance



/tatins/tatins

7oA reductase inhi)itors produce su)stantial7oA reductase inhi)itors produce su)stantialreduction in le.els o LDL cholesterol and, to areduction in le.els o LDL cholesterol and, to alesser e1tent, triglyceride le.elslesser e1tent, triglyceride le.els

n modest daily doses, statins reduce total andn modest daily doses, statins reduce total andLDL cholesterol at a rate o $?09 and mayLDL cholesterol at a rate o $?09 and mayreduce triglycerides )y $0?&09reduce triglycerides )y $0?&09

''ecti.e as monotherapy, statin inhi)itors can )eecti.e as monotherapy, statin inhi)itors can )ecom)ined -ith eetimi)e -hen LDL goals are notcom)ined -ith eetimi)e -hen LDL goals are noto)tained, or -ith i)rates or niacin or an additi.eo)tained, or -ith i)rates or niacin or an additi.eeect on triglycerideseect on triglycerides



Statins ha.e re.olutionied the treatmentStatins ha.e re.olutionied the treatmento hyperlipidemia )y their potency, eicacy,o hyperlipidemia )y their potency, eicacy,

and tolera)ility and ha.e e.ol.ed into irst+and tolera)ility and ha.e e.ol.ed into irst+line therapy or most orms oline therapy or most orms ohyperlipidemiahyperlipidemia

6umerous studies -ith statins in.ol.ing6umerous studies -ith statins in.ol.ingprimary and secondary pre.ention o 7ADprimary and secondary pre.ention o 7ADha.e demonstrated a reduction in 7ADha.e demonstrated a reduction in 7ADe.ents, 7AD mortality, stroe, ande.ents, 7AD mortality, stroe, and

mortality rom all other causesmortality rom all other causes



n addition, statins e1hi)it pleiotropic eectsn addition, statins e1hi)it pleiotropic eects

)eyond the lo-ering o LDL cholesterol le.els)eyond the lo-ering o LDL cholesterol le.elsand are postulated to possess antiinlammatoryand are postulated to possess antiinlammatoryproperties, contri)ute to coronary pla4ueproperties, contri)ute to coronary pla4uesta)iliation, and impro.e endothelial cellsta)iliation, and impro.e endothelial cell

unction, conditions that are increasinglyunction, conditions that are increasinglyrecognied as emerging areas o therapy or therecognied as emerging areas o therapy or thetreatment o 7ADtreatment o 7AD

Statins may also play a role in the treatment oStatins may also play a role in the treatment ocongesti.e heart ailure, osteoporosis, sepsis,congesti.e heart ailure, osteoporosis, sepsis,aortic stenosis, and chronic idney diseaseaortic stenosis, and chronic idney disease



Statins are contraindicatedStatins are contraindicated

in pregnancy and lactationin pregnancy and lactation

nn the coadministration -ith immunosuppressi.e drugs,the coadministration -ith immunosuppressi.e drugs,i)rates, niacin, macrolides, calcium channel )locers,i)rates, niacin, macrolides, calcium channel )locers,and etoconaoles that all may increase the ris oand etoconaoles that all may increase the ris o

rha)domyolysisrha)domyolysis Although statins are -ell tolerated, $09 o patients Although statins are -ell tolerated, $09 o patientse1perience some degree o side eects! Asymptomatice1perience some degree o side eects! Asymptomaticand transient ele.ation in li.er unction studies occur inand transient ele.ation in li.er unction studies occur inup to 29 o patients! t is recommended that treatmentup to 29 o patients! t is recommended that treatment)e stopped i li.er unction studies increase to three)e stopped i li.er unction studies increase to threetimes the upper limit o normal! Values usually re.ert totimes the upper limit o normal! Values usually re.ert to)aseline ater discontinuation o treatment!)aseline ater discontinuation o treatment!



Lipid $ffects of onLipidLoweringLipid $ffects of onLipidLowering

DrugsDrugs Selecti.e $+)locers ha.e )een sho-n to reduceSelecti.e $+)locers ha.e )een sho-n to reducetriglycerides and increase %DL to a modesttriglycerides and increase %DL to a modestdegree and are neutral -ith regard to glucosedegree and are neutral -ith regard to glucose

controlcontrolestrogens in postmenopausal -omen can lo-erestrogens in postmenopausal -omen can lo-erLDL and total cholesterol -ith additionalLDL and total cholesterol -ith additionalincreases in %DLincreases in %DL

The selecti.e estrogen receptor modulatorThe selecti.e estrogen receptor modulatorralo1iene also lo-ers total and LDL cholesterol,ralo1iene also lo-ers total and LDL cholesterol,al)eit -ith much lo-er ris o side eectsal)eit -ith much lo-er ris o side eects





AtherosclerosisAtherosclerosis



DeinitionDeinition

Atherosclerosis is a c Atherosclerosis is a chronic, progressi.e,hronic, progressi.e,multiocal disease o the .essel -all intimamultiocal disease o the .essel -all intima-ithin large elastic arteries and-ithin large elastic arteries and

large/medium sied muscular arterieslarge/medium sied muscular arteries



Atheroma or pla4ue ormation Atheroma or pla4ue ormation Gntimal thicening (smooth muscle cellGntimal thicening (smooth muscle cell

prolieration#prolieration# Lipid accumulation (monocyteLipid accumulation (monocytephagocytosis#phagocytosis#



%istology o a normal artery%istology o a normal artery

http://www.siumed.edu/~dking2/crr/cvguide

The medial layercontributes most to themechanical strength of anartery



42

AT%'5BS7L'5BT7 PLAHI' AT%'5BS7L'5BT7 PLAHI'

N!"#$ #!T%!&N!"#$ #!T%!& #T'%!()$%!T*)#T'%!()$%!T*)

+$#,-%+$#,-%



4


7BMMB6 5SJ 3A7TB5S A5'7BMMB6 5SJ 3A7TB5S A5'

$ 675'AS6E AE'$ 675'AS6E AE'

2 MAL' E'6D'52 MAL' E'6D'5 & 3AMLK %STB5K& 3AMLK %STB5K

" E'6'T7 A86B5MALT5S" E'6'T7 A86B5MALT5S



44

#+)$)IAL C+)1+LLA&L$ 1I/2 FAC)+1/#+)$)IAL C+)1+LLA&L$ 1I/2 FAC)+1/

$ %KP'5LPD'MA$ %KP'5LPD'MA

2 %KP'5T'6TB62 %KP'5T'6TB6

& DA8'T'S M'LLTIS& DA8'T'S M'LLTIS

" 7EA5'TT' SMBJ6E" 7EA5'TT' SMBJ6E



4


BT%'5 5SJ 3A7TB5S A5'BT%'5 5SJ 3A7TB5S A5'

$ B8'STK$ B8'STK

2 P%KS7AL 6A7TVTK2 P%KS7AL 6A7TVTK

& ST5'SS& ST5'SS

" PBSTM'6BPBISAL 'ST5BE'6 D'37'67K" PBSTM'6BPBISAL 'ST5BE'6 D'37'67K



40


BT%'5 5SJ 3A7TB5S A5'BT%'5 5SJ 3A7TB5S A5' %E% 7A58B%KD5AT' 6TAJ' %E% 7A58B%KD5AT' 6TAJ'

LPBP5BT'6S LPBP5BT'6S

!A1D$$D 4/A)41A)$D FA) I)A2$ !A1D$$D 4/A)41A)$D FA) I)A2$

5 C!LA*6DIA #$4*+IA5 C!LA*6DIA #$4*+IA



The maor cellular events in



%ndothelial cell "onocyte "acrophage

1oam cell (mooth musclecell

Internalelasticlamina

Vessellumen

1.Endothelialpermeability

4. SMCmigration

2. Monocyteadhesionandtransmigration

Increasedstifness

3.Macrophagetransormation into oam

cells

The maor cellular events inthe progression of

atherosclerosis



!asic processes in ather



Stage I

monocyte adhesion"mig

Stage IIoam cells #lipid

containingmacrophages$ inintima

Stage IIIappearance o e%tracell



Stage IVCore ormation#e%tracellular lipid

coalescing into thecenter o the pla&ue$

Stage V'ibrous Cap and Core ormation#ully ormed lipid core and (ell de)elopedcap o *brous tissue seperating the core

rom the lumen$

Stage VI+hrombosis

3B5MS B33B5MS B3



2

3B5MS B33B5MS B3 AT%'5BS7L'5BSS AT%'5BS7L'5BSS

7'5'85AL A5T'5'S 6I5K7'5'85AL A5T'5'S 6I5K

7A5DA7 A5T'5'S 6I5K7A5DA7 A5T'5'S 6I5K

5'6AL A5T'5'S 6I5K5'6AL A5T'5'S 6I5K AB5TA 6I5K AB5TA 6I5K

6T'ST6AL A5T'5'S 6I5K6T'ST6AL A5T'5'S 6I5K

'T5'MTK A5T'5'S 6I5K'T5'MTK A5T'5'S 6I5K



7ardiac orm o atherosclerosis7ardiac orm o atherosclerosis

Acute orm occurs as myocardial inarction Acute orm occurs as myocardial inarction

or acute ischemic heart diseaseor acute ischemic heart disease

7hronic orm consists o chronic orms o7hronic orm consists o chronic orms oischemic heart diseaseischemic heart disease



3lood tests: used to evaluate kidney and thyroid function aswell as to check cholesterol levels and the presence ofanemia.

3)hest 56ray: shows the si7e of your heart and whether there

is 8uid build up around the heart and lungs.3%chocardiogram: shows a graphic outline of the heart9smovement

3%ection fraction %1;: determines how well your heartpumps with each beat.



Many people are a)le to manageMany people are a)le to managecoronary artery disease -ith liestylecoronary artery disease -ith liestyle

changes and medicationschanges and medications

Bther people -ith se.ere coronaryBther people -ith se.ere coronary

artery disease may need angioplasty orartery disease may need angioplasty orsurgerysurgery

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Dislipidemia Atherosclerosis