动脉硬化血栓病理生理学课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/8/9 Sunday,#,2024/11/13,动脉硬化血栓病理生理学,2023/9/27动脉硬化血栓病理生理学,1,Atherothrombosis*is theLeading Cause of Death Worldwide,1,*Atherothrombosis defined as ischemic heart disease and cerebrovascular disease.,1,The World Health Report 2001,.Geneva.WHO.2001.,22.3,19.3,12.6,9.7,9,6.3,0,5,10,15,20,25,30,Atherothrombosis*,Infectious Disease,Cancer,Injuries,Pulmonary Disease,AIDS,Causes of Mortality(%),Atherothrombosis*is theLeadi,2,Atherothrombosis Significantly Shortens Life,Analysis of data from the Framingham Heart Study.,Peeters A,et al.,Eur Heart J.,2002;23:458,-,466.,Atherothrombosis reduces life expectancy by around 8-12 years in patients aged over 60 years,1,Average Remaining Life Expectancy at Age 60(Men),0,4,8,12,16,20,Healthy,Years,History of AMI,-9.2 years,History of,Cardiovascular Disease,-7.4 years,History of Stroke,-12 years,Atherothrombosis Significantly,3,3.2 Million Hospital Admissions,Coronary,Atherosclerosis,Acute Myocardial Infarction,1,153,000,Admissions,829,000 Admissions,Hospitalizations in the USDue to Vascular Disease,Cerebrovascular Disease,961,000 Admissions,Vascular Disease,Other IschemicHeart Disease,280,000 Admissions,Popovic JR,Hall MJ.,Advance Data,.2001;319:1-20.,3.2 Million Hospital Admission,4,Preventable Deaths,Approximately 57,000 deaths could be avoided each year in the US if patients were given appropriate care.,National Committee for Quality Assurance.Washington,DC 2003.,700,Cervical-cancer screening,Prenatal care,-blocker treatment,Breast-cancer screening,Smoking cessation,Cholesterol management,Diabetes care,High-blood pressure control,1500,1700,2500,2700,6500,13,600,28,300,Preventable DeathsApproximatel,5,*Based on data from the ARIC study of the National Heart,Lung,and Blood Institute,1987-1994.Includes Americans hospitalized with definite or probable MI or fatal CHD,not including silent MIs.ACS,acute coronary syndrome;MI,myocardial infarction;ARIC,Atherosclerotic Risk in Communities,CHD,coronary heart disease.American Heart Association,.Heart Disease and Stroke Statistics2003 Update.,Epidemiology of ACS in the United States,Single largest cause of death,515,204 US deaths in 2000,1 in every 5 US deaths,Incidence,1,100,000 Americans will have a new or recurrent coronary attack each year and about 45%will die*,550,000 new cases of angina per year,Prevalence,12,900,000 with a history of MI,angina,or both,*Based on data from the ARIC,6,Epidemiology of Stroke in the United States,Prevalence,4.7 million cases,Incidence,700,000 new or recurrent strokes each year,Morbidity/mortality,Third leading cause of death,1 of every 14 deaths(,168,000 deaths),Stroke:a leading cause of long-term disability,American Heart Association,.Heart Disease and Stroke Statistics2003 Update.,Epidemiology of Stroke in the,7,Peripheral Arterial Disease,PAD affects 12%of the adult population,1,2,20%of the population aged 70,Associated with 6-fold increase in CV mortality,3,Underrecognized and undertreated,4,Measurement simple,inexpensive,and noninvasive,Appropriate for risk assessment and screening,Patients at high risk need aggressive risk-factor modification and antiplatelet drugs,4,PAD,peripheral artery disease;CV,cardiovascular.,1,Nicolaides AN.,Symposium,.Nov.1997.,2,Hiatt WR,et al.,Circulation.,1995;91:1472-1479.,3,Criqui MH,et al.,N Engl J Med.,1992;326:381-386.,4,Hirsch AT,et al.,JAMA.,2001;286:1317-1324.,Peripheral Arterial Disease PA,8,Diabetes:Impact in United States,12 million people with diabetes,1,Diabetes is the 5th leading cause of death,1,Half of diabetic patients will experience kidney failure,1,Diabetes is the leading cause of new adult cases of blindness,2,Direct and indirect diabetes costs were estimated at$132 billion,1,in 2002,1,American Diabetes Association.,Diabetes Care.,2003;26:917-932.,2,Juvenile Diabetes Research Foundation International.Diabetes Figures,jdrf.org.,Diabetes:Impact in United Sta,9,Cerebral,Ischemic stroke,Transient ischemic attack,Cardiac,Myocardial infarction,Angina pectoris(stable,unstable),Peripheral Arterial Disease,Critical limb ischemia,claudication,Clinical Manifestations of Atherothrombosis,CerebralClinical Manifestation,10,Overlap of Vascular Disease in Patients With Atherothrombosis,PAD,peripheral artery disease.,Adapted from,TransAtlantic Inter-Society Consensus Group.,J Vasc Surg,.2000;31:S16.,Coronary Disease,PAD,12%,33%,15%,5%,14%,13%,8%,Cerebral Disease,Coronary Disease,PAD,19%,30%,25%,4%,12%,7%,3%,Cerebral Disease,CAPRIE,Aronow&Ahn,Overlap of Vascular Disease in,11,Common Underlying Atherothrombotic Disease Process,MI,myocardial infarction;PAD,peripheral arterial disease;CV,cardiovascular.,Ness J,et al.,J Am Geriatr Soc,.1999;47:1255-1256.,Schafer AI.,Am J Med,.1996;101:199-209.,Atherothrombotic Events(MI,Stroke,or CV Death),Plaque Rupture,Platelet Adhesion,Activation,and Aggregation,Thrombus Formation,MI,Atherothrombotic Stroke,PAD,Unstable Angina,Common Underlying Atherothromb,12,Risk of a Second Atherot