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1、Atherothrombosis Pathophysiology,What Is Atherothrombosis?,The formation of a thrombus on an existing atherosclerotic plaque Atherothrombosis is a new term recognizing that atherosclerosis (plaque development) and acute thrombosis are integrally related to the presentation of vascular events A gener
2、alized progressive disease of large- and mid-size arteries that affects multiple vascular beds, including cerebral, coronary, and peripheral arteries The underlying disease leading to myocardial infarction (MI), peripheral arterial disease (PAD), ischemia and many forms of stroke,MI, myocardial infa
3、rction; PAD, peripheral artery disease. Fuster V, et al. Vasc Med. 1998;3:231-239. Rauch U, et al. Ann Intern Med. 2001;134:122-238.,Atherothrombosis* is the Leading Cause of Death Worldwide1,* Atherothrombosis defined as ischemic heart disease and cerebrovascular disease. 1 The World Health Report
4、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 Significantly Shortens Life,Analysis of data from the Framingham Heart Study. Peeters A, et al. Eur Heart J. 2002;
5、23:458-466.,Atherothrombosis reduces life expectancy by around 8-12 years in patients aged over 60 years1,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,3.2 Million Hosp
6、ital Admissions,Coronary Atherosclerosis,Acute Myocardial Infarction,1,153,000 Admissions,829,000 Admissions,Hospitalizations in the US Due to Vascular Disease,Cerebrovascular Disease,961,000 Admissions,Vascular Disease,Other Ischemic Heart Disease,280,000 Admissions,Popovic JR, Hall MJ. Advance Dat
7、a. 2001;319:1-20.,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.,Cervical-cancer screening,Prenatal care,-blocker treatment,Breast-cancer screening,Smoking ces
8、sation,Cholesterol management,Diabetes care,High-blood pressure control,* 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;
9、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 Incid
10、ence 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,Epidemiology of Stroke in the United States,Prevalence 4.7 million cases Incidence 700,000 new or r
11、ecurrent 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.,Peripheral Arterial Disease,PAD affects 12% of the adult popul
12、ation1,2 20% of the population aged 70 Associated with 6-fold increase in CV mortality3 Underrecognized and undertreated4 Measurement simple, inexpensive, and noninvasive Appropriate for risk assessment and screening Patients at high risk need aggressive risk-factor modification and antiplatelet dru
13、gs4,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.,Diabetes: Impact in United States,12 million people wi
14、th diabetes1 Diabetes is the 5th leading cause of death1 Half of diabetic patients will experience kidney failure1 Diabetes is the leading cause of new adult cases of blindness2 Direct and indirect diabetes costs were estimated at $132 billion1 in 2002,1 American Diabetes Association. Diabetes Care.
15、 2003;26:917-932. 2 Juvenile Diabetes Research Foundation International. Diabetes Figures, http:/www.jdrf.org.,Cerebral Ischemic stroke Transient ischemic attack Cardiac Myocardial infarction Angina pectoris (stable, unstable) Peripheral Arterial Disease Critical limb ischemia, claudication,Clinical
16、 Manifestations of Atherothrombosis,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,Common Underlying Atherothrombotic Disease Process,
