Pathophysiology of CAD ACSM’s Risk Factors Exam return

Response to Injury theory: Review this figure carefully and know corresponding discussion from your assigned reading!

We begin in the coronary arteries

The 3 layers are: adventitia; media; and intima (single layer endothelial cells). An inflamatory response to intimal injury initiates plaque formation.

The Role of Inflammation in CAD

There is mounting evidence that atherosclerosis, unstable angina and heart attacks are all associated with inflammation of the coronary arteries.

• Elevated levels of C-reactive protein (CRP), a protein that appears in the bloodstream during many inflammatory processes, are associated with acute MI and recurrence.
• Acute MI pts with elevated white blood cell counts have poorer outcomes than patients with normal white blood cell counts.
• Older patients (> 65) who had herpes simplex virus antibodies had an increased risk of heart attack and cardiac death.

CAD as an Inflammatory Disease

• Plaque formation is really an immune response!
• The plaque is made of immune cells, cholesterol, and smooth m. cells. It has a fibrous cap separating it from the blood.
• Rupture the cap, and you have an MI!
• The level of inflammation present is correlated to the likelihood the cap will rupture!
• Measuring inflammatory chemical may hold the key! The most promising is: High-sensitivity C-reactive protein (hs-CRP)

We reviewed this recent press release:

Common Cholesterol-Lowering Drug Packs Punch Against Heart Disease American Council on Science and Health

A cholesterol-lowering drug may also help lower heart-disease risk by reducing levels of a common blood marker for inflammation: C-reactive protein. Recent evidence suggests that inflammation may be an important marker of risk for future heart attacks and strokes. Inflammation is one of the processes by which the body responds to injury. The new findings, which appear in the July 20 issue of "Circulation," a journal of the American Heart Association, may someday augment the list of clinically proven ways to reduce heart-disease risk, such as lowering cholesterol, eating a low-fat diet, quitting smoking and exercising regularly.