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1404. Ateroskleróza: od etiologie po možnosti ovlivnění

Creator:
Vrablík, Michal
Format:
print, text, and regular print
Type:
model:article, article, Text, přehledy, and TEXT
Subject:
lidé, ateroskleróza--etiologie--patofyziologie, kardiovaskulární nemoci--prevence a kontrola, dyslipidemie--farmakoterapie, hypertenze--farmakoterapie, antihypertenzíva--terapeutické užití, anticholesteremika--terapeutické užití, kombinovaná farmakoterapie, lipoproteiny LDL, rizikové faktory, renin-angiotensin systém, zánět, and systémový zánět
Language:
Czech and English
Description:
Ateroskleróza jako zánětlivé postižení cévní stěny má více forem, které se vyskytují většinou současně. Klasická aterosklerotická léze charakterizovaná akumulací lipidů v subendoteliálním prostoru bývá často provázena změnami v hlubších vrstvách arteriální stěny, které jsou typické zmnožením extracelulární matrix a aktivací hladkosvalových buněk. Vlivem skladby rizikových faktorů může dominovat jeden nebo druhý typ postižení. Zatímco v patogenezi klasické formy aterosklerózy hrají zásadní roli aterogenní lipoproteiny (především třídy LDL), při rozvoji změn arteriální medie to jsou jiné rizikové faktory, např. hyperaktivita systému renin-angiotenzin-aldosteron (RAS). Ovlivněním těchto dvou základních mechanizmů prokazatelně zpomalujeme progresi cévních změn a příznivě ovlivňujeme prognózu nemocných. Důležitý je i fakt, že současné působení na tyto faktory má synergické působení doložené na úrovni experimentální i klinické. Důsledné využití možností nabízené intenzivním snižováním hladin aterogenních lipidů i nadměrné aktivity systému RAS snižuje riziko typických aterotrombotických komplikací (akutní koronární syndrom) i příhod podmíněných větší měrou změnami arteriální medie či hypertrofií levé komory srdeční (maligní arytmie, srdeční selhání). Tyto dva směry tak představují předpoklady úspěchu kardiovaskulární prevence. Klíčová slova: ateroskleróza – dyslipidemie – kardiovaskulární prevence – RAS – systémový zánět, Atherosclerosis as an inflammatory process affecting vessel wall has more forms usually occurring together. Classical atherosclerotic vascular lesion characterised by lipid accumulation in the subendothelial space is frequently accompanied by changes in deeper layers of arterial wall, in which increased extracellular tissue mass and smooth muscle cells activation represent the most prominent feature. Due to a specific constellation of risk factors the first or second pathology may be more expressed. While initiation and progression of classical atherosclerosis are mostly driven by lipoproteins (especially of LDL class) the most important factor of arterial media changes seem to be different risk factors e.g. hyperactivity of renin-angiotensin-aldosterone system (RAS). Influencing these two basic pathogenic mechanisms undoubtedly slows down the course of vascular changes and impacts positively on the prognosis of the patients. It is noteworthy, that simultaneous targeting of both of these mechanisms yields syner­gistic effects as evidenced both by experimental and clinical works. Using the opportunities offered by intensive lowering of atherogenic plasma lipids and over activation of the RAS system reduce not only the incidence of typical atherotromobotic complications (e.g. acute coronary syndrome) but also the events caused by changes of medial part of arterial wall or left myocardial ventricle (malignant arrhythmia, heart failure). These two strategies represent necessary conditions for successful cardiovascular prevention. Key words: atherosclerosis – cardiovascular prevention – dyslipidemia – RAS system – systemic inflammation, and Michal Vrablík
Rights:
http://creativecommons.org/publicdomain/mark/1.0/ and policy:public

1405. Atherogenic impact of lecithin-cholesterol acyltransferase and its relation to cholesterol esterification rate in HDL (FERHDL) and AIP [log(TG/HDL-C)] biomarkers: the butterfly effect?

Creator:
Milada Dobiášová
Format:
print, bez média, and svazek
Type:
article, články, journal articles, model:article, and TEXT
Subject:
Fyziologie člověka a srovnávací fyziologie, ateroskleróza, atherosclerosis, lecithin-cholesterol acyltransferase (LCAT), FERHDL (fractional esterification rate in HDL), AIP (atherogenic index of plasma, log(TG/HDL-C), biomarkers of cardiometabolic risk, lipoprotein particle size, 14, and 612
Language:
English
Description:
The atherogenic impact and functional capacity of LCAT was studied and discussed over a half century. This review aims to clarify the key points that may affect the final decision on whether LCAT is an anti-atherogenic or atherogenic factor. There are three main processes involving the efflux of free cholesterol from peripheral cells, LCAT action in intravascular pool where cholesterol esterification rate is under the control of HDL, LDL and VLDL subpopulations, and finally the destination of newly produced cholesteryl esters either to the catabolism in liver or to a futile cycle with apoB lipoproteins. The functionality of LCAT substantially depends on its mass together with the composition of the phospholipid bilayer as well as the saturation and the length of fatty acyls and other effectors about which we know yet nothing. Over the years, LCAT puzzle has been significantly supplemented but yet not so satisfactory as to enable how to manipulate LCAT in order to prevent cardiometabolic events. It reminds the butterfly effect when only a moderate change in the process of transformation free cholesterol to cholesteryl esters may cause a crucial turn in the intended target. On the other hand, two biomarkers - FERHDL (fractional esterification rate in HDL) and AIP [log(TG/HDL-C)] can offer a benefit to identify the risk of cardiovascular disease (CVD). They both reflect the rate of cholesterol esterification by LCAT and the composition of lipoprotein subpopulations that controls this rate. In clinical practice, AIP can be calculated from the routine lipid profile with help of AIP calculator www.biomed.cas.cz/fgu/aip/calculator.php., M. Dobiášová., and Obsahuje bibliografii
Rights:
http://creativecommons.org/publicdomain/mark/1.0/ and policy:public

1406. Atherogenic lipoprotein profile in families with and without history of early myocardial infarction

Creator:
Milada Dobiášová, Katarína Rašlová, Hana Rauchová, Branislav Vohnout, Kateřina Ptáčková, and Jiří Frohlich
Format:
print, bez média, and svazek
Type:
article, články, model:article, and TEXT
Subject:
Fyziologie člověka a srovnávací fyziologie, ateroskleróza, atherosclerosis, cholesterol esterification rate (FERHDL), spouses, offspring, log (TG/HDL cholesterol), 14, and 612
Language:
English
Description:
a1_In this study we compared several parameters characterizing differences in the lipoprotein profile between members of families with a positive or negative family history of coronary artery disease (CAD). In addition to regular parameters such as the body mass index (BMI), total plasma cholesterol (TC), low density (LDL-C) and high density (HDL-C) cholesterol and triglycerides (TG) we estimated the fractional esterification rate of cholesterol in apoB lipoprotein-depleted plasma (FERHDL) which reflects HDL and LDL particle size distribution. A prevalence of smaller particles for the atherogenic profile of plasma lipoproteins is typical. Log (TG/HDL-C) as a newly established atherogenic index of plasma (AIP) was calculated and correlated with other parameters. The cohort in the study consisted of 29 young (< 54 years old) male survivors of myocardial infarction (MI), their spouses and at least one offspring (MI group; n=116). The control group consisted of 29 apparently healthy men with no family history of premature CAD in three generations, their spouses and at least one offspring (control group; n=124). MI families had significantly higher BMI than the controls, with the exception of spouses. Plasma TC did not significantly differ between MI and the controls. MI spouses had significantly higher TG. Higher LDL-C had MI survivors only, while lower HDL-C had both MI survivors and their spouses compared to the controls. FERHDL was significantly higher in all the MI subgroups (probands 25.85±1.22, spouses 21.55±2.05, their daughters 16.93±1.18 and sons 19.05±1.33 %/h) compared to their respective controls (men 20.80±1.52, spouses 14.70±0.98, daughters 13.23±0.74, sons 15.7±0.76 %/h, p<0.01 to p<0.05). Log (TG/HDL-C) ranged from negative values in control subjects to positive values in MI probands., a2_High correlation between FERHDL and Log (TG/HDL-C) (r = 0.80, p<0.0001) confirmed close interactions among TG, HDL-C and cholesterol esterification rate. The finding of significantly higher values of FERHDL and Log (TG/HDL-C) indicate higher incidence of atherogenic lipoprotein phenotype in members of MI families. The possibility that, in addition to genetic factors, a shared environment likely contributes to the familial aggregation of CAD risk factors is supported by a significant correlation of the FERHDL values within spousal pairs (control pairs: r = 0.51 p<0.01, MI pairs: r = 0.41 p<0.05)., M. Dobiášová, K. Rašlová,H. Rauchová, B. Vohnout, K. Ptáčková, J. Frohlich., and Obsahuje bibliografii
Rights:
http://creativecommons.org/licenses/by-nc-sa/4.0/ and policy:public

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