Aterosklerozun Patofizyolojisi ve Risk Faktörleri

Abstract

Dünyada ve ülkemizde ateroskleroz ve komplikasyonları en önde gelen ölüm nedenidir. Ateroskleroz, tipik lezyonu ateroma plakları olan orta ve büyük çaplı arterlerin intima tabakalarını etkileyen bir hastalıktır. Endotel disfonksiyonu aterosklerotik süreçteki temel mekanizmalardan biridir. Klasik ve yeni belirlenen risk faktörleri endotelde vazodilatatör cevabın azalmasına yol açan kronik hasarlanma oluştururlar. Böylece endotelde oluşan vazokonstriksiyon, inflamatuvar hücrelerin birikimi, düz kas hücrelerinin migrasyonu, sitokin üretiminin artışı gibi olaylar aterosklerotik plak oluşumuna neden olurlar. Endotel disfonksiyonu yalnız plak oluşumuna neden olan aterosklerotik sürecin ilk basamağı olmakla kalmaz, ayrıca oluşan plağın büyümesine, çatlamasına ve trombojenik olayların tetiklenmesine de neden olur. Hiperkolesterolemi; ateroskleroz patogenezinde rol oynayan en önemli faktördür. Epidemiyoloji çalışmaları, pek çok genetik ve çevresel faktör arasında artmış serum kolesterol düzeylerinin, diğer bilinen risk faktörlerinin yokluğunda bile ateroskleroz gelişimine tek başına yeterli olduğunu göstermektedir. Bu çalışmada köpük hücrelerin oluşumunu sağlayarak ateroskleroz patogenezine katkısı bulunduğu düşünülen lipoproteinler incelenirken, bu fenomene katıldığı düşünülen pek çok parametrenin de ele alınarak değerlendirilmesi amaçlanmıştır. 

Keywords

• Ateroskleroz,risk faktörleri,aterosklerozun patofizyolojisi

Aterosklerozun Patofizyolojisi ve Risk Faktörleri

Abstract

Atherosclerosis and its complications is the leading cause of death both in our country and in the world. Atherosclerosis is a disease that affects the intima layers of medium and large arteries with its typical lesions “atherosclerotic plaques”. Endothelial dysfunction is one of the basic mechanisms in the atherosclerotic process. Classic and newly identified risk factors leading to a decrease in the vasodilator response creates chronic injury. Thus, vasoconstriction composed in endothelium, accumulation of inflammatory cells, smooth muscle cell migration, cytokine production cause the increase of events such as the formation of atherosclerotic plaques. Endothelial dysfunction is not only the first step of the atherosclerotic plaque formation process, but also cause triggering of atherogenic events cracking and the growth of plaque. The most important factor that plays a role in the pathogenesis of atherosclerosis is hypercholesterolemia. Epidemiological studies indicate that along many genetic and environmental factors, increased serum cholesterol levels is enough alone for development of atherosclerosis in the absence of other known risk factors. In this study, lipoproteins that are considered to contribute formation of the pathogenesis of atherosclerosis by creating foam cells were examined and it is aimed to evaluate this phenomenon considering the many parameters joining it.

Keywords

• Atherosclerosis,risk factors,pathophysiology of atherosclerosis

References

1. Halit Z. Ateroskleroz patogenezi. Deneysel ve Klinik Tıp Dergisi. 2012; 29: 101-106.2.
2. Vallace, P., 1996. Vascular endothelium, its physiology and pathophysiology. In: Weatherall DJ et al. Oxford text book of medicine, 3rd ed. Oxford Medical Publications. 2, 2295-2300.3.
3. Akçakoyun M. Koroner arter hastalığı olgularında koroner risk faktörleri ile endotel fonksiyonları arasındaki ilişki. (uzmanlık tezi). İstanbul: Koşuyolu Kalp Eğitim ve Araştırma Hastanesi; 2004.
4. Yalın T.Y., Mete K. Endotel Disfonksiyonu. Pamukkale Tıp Dergisi. 2011; 4:152-157.
5. Gauthier TW, Scalia R, Murohara T, et al. Nitric oxide protects against leukocyte-endothelium interactions in the early stages of hypercholesterolemia. Arterioscler Thromb Vasc Biol. 1995;15:1652–1659.
6. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135–1143.
7. Cominacini L, Rigoni A, Fratta Pasini A, et al. The binding of oxidized low-density lipoprotein (ox-LDL) to ox-LDL receptor-1 in endothelial cells reduces the intracellular concentration of nitric oxide through an increased production of superoxide. J Biol Chem. 2001;276:13750–13755.
8. Harrison DG. Endothelial function and oxidant stress. Clin Cardiol. 1997;20:11-17.

9. Özdoğu H. İnflamasyonda baş aktör endotel. (6. ilk basamak kursu) Ankara: Türkiye Hematoloji Derneği; 2007.
10. Stary HC,Chandler A,Dinsmore R,et al.A definition of advanced types of atherosclerotic lesions and histological classification of atherosclerosis .A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis ,American Heart Association .Circulation 1995 ;92:1355-13.
11. Kardiyoloji Miniatlas. 1. Baskı. AND Danışmanlık, Eğitim, yayıncılık ve Organizasyon Ltd. Şti. 2003. p. 155-162.
12. Seyfettin Ü. Hiperkolesterolemi İle Oluşabilecek Oksidatif Stresin ve Monosit CD36 Reseptör Ekspresyonunun Ateroskleroz Riski Açısından Değerlendirilmesi. Uzmanlık Tezi, M.Ü. Tıp Fakültesi Biyokimya Anabillim Dalı. 2012;10:11.
13. Yılmaz G. Atorvastatin kullanan dislipidemi hastalarında tedavi öncesi ve 3 ay sonrası serum PARAOKSONAZ-1 ve okside LDL düzeyleri. (uzmanlık tezi). İstanbul: Taksim Eğitim ve Araştırma Hastanesi; 2008.
14. Binder CJ, Chang M, Shaw PX, Miller YI, Hartvigsen K et al.: Innate and acquired immunity in atherogenesis. Nature Medicine 2002;8(11):1218-1226.
15. Steinberg D: Atherogenesis in perspective: Hypercholesterolemia and inflammation as partners in crime. Nature Medicine 2002;8(11):1211-1217.
16. Carr, A. C., McCall, M. R., Frei, B. Oxidation of LDL by myeloperoxidase and reactive nitrogen species: reaction pathways and antioxidant protection. Arterioscler. Thromb. Vasc. Biol. 2000;20:1716-1723.
17. Doi H, Kugiyama K, Oka H, Sugiyama S, Ogata N, Koide SI, Nakamura SI, Yasue H. Remnant lipoproteins induce proatherothrombogenic molecules in endothelial cells through a redox-sensitive mechanism. Circulation 2000;102:670-676.
18. Stiko-Rahm, A., Hultgardh-Nilsson, A., Regnstrom, J., Hamsten, A., Nilsson, J. Native and oxidized LDL enhances production of PDGF AA and the surface expression of PDGF receptors in cultured human smooth muscle cells. Arterioscler. Thromb. 1992;12:1099-1109.
19. Boulanger, C. M., Tanner, F. C., Bea, M. L., Hahn, A. W., Werner, A., Luscher, T. F. Oxidized low density lipoproteins induce mRNA expression and release of endothelin from human and porcine endothelium. Circ. Res. 1992;70:1191-1197.
20. Liao, J. K., Shin, W. S., Lee, W. Y., Clark, S. L. Oxidized low-density lipoprotein decreases the expression of endothelial nitric oxide synthase. J. Biol. Chem. 1995;270:319-324.
21. Kockx, M. M. Apoptosis in the atherosclerotic plaque: quantitative and qualitative aspects. Arterioscler. Thromb. Vasc. Biol. 1998;18:1519-1522.
22. Kugiyama, K., Sakamoto, T., Misumi, I., Sugiyama, S., Ohgushi, M., Ogawa, H., Horiguchi, M., Yasue, H. Transferable lipids in oxidized low-density lipoprotein stimulate plasminogen activator inhibitor-1 and inhibit tissue-type plasminogen activator release from endothelial cells. Circ. Res. 1993;73:335-343.
23. Chen XP, DU GH. Lectin-like oxidized lowdensity lipoprotein receptor-1: protein, ligands, expression and pathophysiological significance. Chin Med J. 2007;120 (5):421-426.
24. Özlem K., Hülya Y.A. Okside LDL Reseptörü-1 (LOX-1) ve Kardiyovasküler Hastalıklarla İlişkisi. Tıp Araştırmaları Dergisi. 2014;12:145-152.
25. Sakurai K., Sawamura T. Stress and Vascular Responses: Endothelial Dysfunction via Lectin- Like Oxidized Low-Density Lipoprotein Receptor-1: Close Relationships with Oxidative Stress. J Pharmacol Sci 2003; 91: 182-186.
26. Beaumont JL, Hyperlipidemia caused by anti-beta-lipoprotein autoantibodies. A new pathological entity. C R Acad Sci 1965; 261: 4563-6.
27. Riesen W, Noseda G. Antibodies against lipoproteins in man. Occurence and significance. Klin Wschr 1975; 53: 353-61.
28. Salonen JT, Yla-Herttuala S, Yamamoto R, et al. Autoantibody against oxidized LDL and progression of carotid atherosclerosis. Lancet 1992; 339: 883-7.
29. Shaw Px, Horkko A, Tsimikas S, et al. human –derived anti-oxidized LDL autoantibody blocks uptake of oxidized LDL by macrophages and localizes to atherosclerotic lesions in vivo. Arterioscler Thromb Vase Biol 2001; 21:1333-9.
30. Bernstein RK. 2008 American Diabetes Association Clinical Guidelines Comments. Avaible from: http://www.diabetesbook.com/cms/articles/9-diabetes-in-control/5576-richardk-bernstein-md-face-facn-fccws- Last access: 16th May 2011.
31. Summary of Revisions for the 2009 Clinical Practice Recommendations. Diabetes Care 2009; 32 Suppl 1: S3-5. Erratum in: Diabetes Care 2009; 32:754.
32. Assmann, G. Dabetic Dyslipidaemia Results From the Prospective Cardiovascular Münster Procam Study. Clinician 1990; 8 (l): 3-11.
33. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation 2012;125(1):e2-e220.
34. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106(25):3143-421.
35. Leren P, I Heirman, A Helgeland, S Engen: HDLcholesterol and antihypertensive drugs, The Oslo Study, Br. Med. J 1978;168:403.
36. Sokolow M, ME Mcilory: Clinical cardiology, W.B. Saunders Com., New York, Second edition, 1979, p. 124.
37. Tetik, Ş., Ak, K., & Yardımcı, K. T.. Trombosit fonksiyon testlerini etkileyen faktörler. Cumhuriyet Medical Journal, 2012; 34: 123-127.
38. Wallentin L, Lindahl B, Siegbahn A. Unstable angina and non-ST-elevation MI. In: Crawford MH, DiMarco JP, Paulus WJ, editors. Cardiology 1st ed. USA.Elsevier Science Limited;2001. p. 2.13.1-19.
39. Yuvanç U, Çiçek D, Yesilbursa D ve ark. Akut miyokard infarktüsünde ortalama trombosit hacminin bir yıllık mortalite ve revaskülarizasyon ihtiyacı üzerine etkisi. MN-Kardiyoloji Derg 2004;11:416-20.
40. Toft AD, Boon NA. Thyroid disease and the heart. Heart 2000;84:455-60.
41. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med 2001;344:501-9.
42. Chen C, Halkos ME, Surowiec SM, et al. Effects of homocysteine on smooth muscle cell proliferation in both cell culture and artery perfusion culture models. J Surg Res 2000;88:26-33.
43. Tetik, Ş., & Ak, K.. Kardiyovasküler hastalıklarda trombosit fonksiyon testleri: patofizyolojiden klinik yaklaşıma. Cumhuriyet Medical Journal, 2010; 32: 264-274.
44. Carlson JT, Rangemark C, Hedner JA. Attenuated endothelium dependent vascular relaxation in patients with sleep apnea. J Hypertens 1996; 14: 577-84.
45. Faller DV. Endothelial cell responses to hypoxic stress. Clin Exp Pharmacol Physiol 1999; 26: 74-84.