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Factori de risc 2
4 diabetul zaharat
5 obezitatea
Sindrom metabolic - obezitate viscerala
2007
80 cm femei 94 cm barbati (IDF)
- HTA
- diabet zaharat
- HDL scazut
- Tri crescute
Altii: sedentarism, homocisteina , Lp (a), fibrinogen ,
PAI 1, r. imune / autoimune,
componenta infectioasa (Chlamidia, B. Kawasaki)
Dislipidemia
endoteliu normal
Balanta endoteliala
Vasodilatatie
Inhibitia cresterii
Antitrombotic
Antiinflamator
Antioxidant
Vasoconstrictie
Promovarea cresterii
Protrombotic
Proinflamator
Prooxidant
eroziune endotelial
Classificarea lipoproteinelor
Chilomicrons
Very low-density lipoprotein (VLDL)
Intermediate-density lipoprotein (IDL)
Low-density lipoprotein (LDL)
High-density lipoprotein (HDL)
bazata pe densitate
LDL-Colesterol
asociat aterosclerozei si evenimentelor
cardiovascular ischemice
10% crestere a LDL = 20% crestere a riscului
cardiovascular
factori de potentare
Scadere HDL-colesterol
fumat
hipertensiune
diabet
Trigliceride
Asociat cu risc crescut de evenimente cardiace
ischemice
Cresterea riscului intermediata de:
HDL csazut
LDL-colesterol, izoenzime inalt aterogene
Hiperinsulinemia / rezistenta la insulina
Status procoagulant
hipertensiune
Obezitate abdominala
trigliceride normale <150 mg/dL
triglycerides foarte mari (>1000 mg/dL,
11.3 mmol/L) creste riscul de pancreatita
HDL-Colesterol
Classification of Dyslipidaemias:
Fredrickson (WHO) Classification
Phenotype Lipoprotein
Serum
Serum Atherogenicity Prevalence
elevated
cholesterol triglyceride
I
Chylomicrons Normal to
None seen
Rare
+++
Common
IIa
LDL
IIb
+++
Common
III
IDL
+++
Intermediate
IV
VLDL
Normal to
Common
VLDL and
Normal to
chylomicrons
Rare
Normal
Boala cerebrovasculara
AIT,AVC
Crystals of cholesterol
in the bloodstream
Growth of thrombus
Blood Flow
Intraplaque thrombus
Lipid pool
Echografie intravasculara
Principii terapeutice
1. preventia primara se adreseaza factorilor de risc
si combaterii lor
2. tratamentul manifestarii actulale si combaterea lor
3. preventia secundara a altor manifestari
ateromatoase
risc CV
combaterea DZ
combaterea DZ (2)
fumatul
- oprirea definitiva
- cea mai cost-eficienta masura profilactica