ch6atxtATHEROSCLEROSI1

ch6atxtATHEROSCLEROSI1 - MPET2008CH6a -1- THE METABOLIC...

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MPET2008CH6a - 1 - THE METABOLIC SYNDROME Cardiovascular disease is one of the major causes of death. One of the major causes is the process of atherosclerosis. This is promoted by obesity and diabetes, which are related. Recently the concept of « metabolic syndrome » was defined as a syndrome of 5 components that are collaborating to promote diabetes and cardiovascular disease: (1) degree of abdominal obesity (2) fasting or 2 hour postprandial glucose values (3) elevated average Blood Pressure (4) decreased circulating HDL (5) high triglyceride levels One way of looking at it is to see abdominal adipose tissue as an endocrine organ that releases FFA (free fatty acids), adipokines and angiotensin II into the circulation. Blood FFA inhibit uptake of glucose by the muscle. Excess FFA and angiotensin II damage the pancreas, and adipokines induce insulin resistance. Circulating FFA increase triglycerides and decrease HDL. Angiotensin II furthermore increases blood pressure. Also (sub ) inflammation is part of it. Preferred therapy is lifestyle changes: weight reduction, exercise, adherence to the Mediterranean diet, and smoking cessation.
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MPET2008CH6a - 2 - ATHEROSCLEROSIS The normal vasculature: The structure of the vascular wall is dependent on the various functional requirements in diverse parts of the vasculature. So, the wall will be thicker and more robust in the arteries than in the veins to cope with the pulsatile and higher blood pressure. When the vessels become smaller the size of the arterial wall will become smaller but the relation between size and lumen will increase. Arteries can be divided in three categories: (1) large or elastic arteries (e.g. aorta) (2) medium sized or muscular arteries « distributing arteries » (e.g. kidney arteries, coronaries) (3) small arteries The vascular wall consists of endothelial cells, smooth muscle cells, and an extracellular matrix, build in concentric layers: the intima (at the luminal side), the media and the adventitia. The intima is composed of a layer of endothelial cells with minimal underlying subendothelial connective tissue. This is separated from the media by a dense elastic membrane, the
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ch6atxtATHEROSCLEROSI1 - MPET2008CH6a -1- THE METABOLIC...

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