脂代谢与动脉粥样硬化

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1、Cardiovasculardiseaseistheleadingcauseofdeathamongadultsworldwide(1996)Coronarydisease7.2millionCancer6.3Cerebrovasculardisease4.6Acutelowerrespiratorytractinfections3.9Tuberculosis3.0COPD(chronicobstructivepulmonarydisease)2.9Diarrhea(includingdysentery)2.5Ma

2、laria2.1AIDS1.5HepatitisB1.2Coronarymortality:alarmingworldwideforecastsAtherosclerosis:amultifactorialdiseaseMainriskfactorsforcoronaryheartdiseaseGlobalprojectionsforthediabetesepidemic:1995-2010AtherosclerosisArterialwall:structureandfunctionDifferentstageso

3、fatheroscleroticplaquedevelopmentVascularendotheliummodificationinatherosclerosisPlaqueformation1—FattystreakPlaqueformation2—FibrouscapPlaqueformation3—LipidcoreFromplaquetothrombosis,keyevent:plaqueruptureLipidcoreconstitutionActivatedmacrophagesaccumulatel

4、ipidsLipidcoreconstitutionLDLoxidationParietalvascularinflammationTheactivatedmacrophageproducesinflammatorycytokinesParietalvascularinflammationNFkBactionintheinflammationprocessDiabetesandatherosclerosisTobaccoandatherosclerosisDyslipidemiaandatherosclerosisH

5、TN,hemodynamicfactorandatheroclerosisHowtoreduceplaqueformationInterventiononriskfactorsHowtoreducetheriskofplaqueruptureHowtoreducetheriskofthrombosis~10%Weightloss=~30%VisceraladiposetissuelossCharacteristicsofanunstableplaquePlaquevulnerabilityfactorsIntrin

6、sicfactorsModificationofextrinsicvulnerabilityfactorsPlaqueruptureThemainreleasingfactorsClassificationoflipidsandlipoproteinsCharacteristicsoflipoproteinsTriglyceride-richlipoproteins:size,structureandcompositionDigestionandmetabolismofdietaryfatHDLmetabolisma

7、ndreversecholesteroltransportCholesteroleffluxandreversecholesteroltransportismodulatedbytworeceptorsAtherogenicityofsmalldenseLDLSizeandapolipoproteincompositionarethemainfactorsdeterminingatherogenicityoftriglyceride-richparticlesSizeandapolipoproteincomposi

8、tionarethemainfactorsdeterminingatherogenicityoftriglyceride-richparticlesApoC-IIImodulatesVLDLApoC-IIIinapoBparticlesisatherogenicRelationshipbetweenapoC-IIIinapoBcontaini