Baseline crp levels can predict cardiovascular events

Baseline CRP levels can predict cardiovascular events among health individuals
o Hyperhomocysteinemia
o Homocysteine is derived from the metabolism of dietary methionine
 Methionine: an amino acid that is abundant in animal protein
o Inhibits elements of the anticoagulant cascade & endothelial damage (1 st step in
atherosclerosis)
o Increased lipoprotein (a) levels
o Lipoprotein (a) (Lp[a]): altered form of LDL that contains apoB-100 linked to apoA
o Independent risk factor for the development of atherosclerosis
o Enhances cholesterol delivery to injured blood vessels, suppresses generation of plasmin,
promotes smooth muscle proliferation
o Heritable & are not altered by most cholesterol-lowering drugs
Pathogenesis & Mechanisms of Development
o Fatty Streaks: thin yellow lines running along the major arteries, such as aorta.
o Consists of smooth muscle cells filled with cholesterol & macrophages
o Found in 10 to 14 y/o regardless of gender or race
o Increase in # until 20 y/o
o No symptoms
o Overtime advanced form of atherosclerosis called atheroma or fibrous plaque
o Fibrous atheromatous plaque: basic lesions of clinical atherosclerosis
o Accumulation of intracellular & extracellular lipids,
o proliferation of vascular smooth muscle cells
o formation of scar tissue

o calcification
o gray to pearly white + thickening of vessel intima with a core of extracellular lipid covered by
fibrous cap of connective tissue and smooth muscle
o increase in size  encroach on the lumen of the artery  occlude vessel or predispose to thrombus
formation=  blood flow
o Complicated atherosclerotic lesions
o Develops when the fibrous plaque breaks open, producing hemorrhage, ulceration, scar tissue
deposits.
o Thrombosis – most important complication of atherosclerosis
 Caused by slowing & turbulence of blood flow in the region of the plaque & ulceration of
the plaque
Development of Lesions:
1. Injury to the endothelial vessel is the imitating factor
2. Possible injurious agents
a. products associate with smoking, immune mechanisms, mechanical stress associated with HTN
3. Hemodynamic factors play a role:
4. Hyperlipidemia
5. Interaction between endothelial layer of the vessel wall & white blood cells