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Atherosclerosis Is The Liver Disease PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Atherosclerosis is the liver disease” by Prof. O. Drapkina.

This medical PowerPoint presentation talks about atherosclerosis, a medical condition characterized by the build-up of plaque inside the walls of arteries. The plaque is composed of fatty substances, cholesterol, cellular waste products, and calcium deposits. Over time, the plaque hardens and narrows the arteries, reducing blood flow to organs and tissues. This can lead to various complications such as heart attack, stroke, and peripheral artery disease.

Atherosclerosis can begin in childhood, and its progression is influenced by many factors, including genetics, lifestyle choices such as diet and exercise, smoking, and underlying medical conditions such as high blood pressure, high cholesterol, and diabetes.

Treatment for atherosclerosis may involve lifestyle changes such as regular exercise, healthy eating habits, and quitting smoking. Medications such as statins may be prescribed to lower cholesterol levels and reduce the risk of heart attack and stroke. In some cases, surgery may be necessary to remove or bypass the blocked arteries. Early detection and management of atherosclerosis are crucial for preventing complications and improving outcomes.

Tags : Atherosclerosis, arteries, Gastroenterology, Gastroenterology PowerPoint presentation

Published on : Apr 26, 2023 | Views : 793 | Downloads : 1

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Slide 1-

Atherosclerosis is the liver disease Prof. O. Drapkina PACE Moscow First Moscow Medical University Chair of cardiology department of the clinic of the Internal Medicine
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Mr. Lipoprotein Professor Emeritus of MedicineFormer Director of Cardiovascular Research InstituteUniversity of California, San Francisco Richard J. Havel
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Lipoprotein Structure Apolipoprotein Free cholesterol Cholesterol esters Triglycerides Phospholipids
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ppt slide no 4 content not found
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Non-alcoholic fatty liver disease NAFLD is probably the most common liver disease in many countries affecting 10% to 24% of the general population. There is a direct correlation between body mass index (BMI) and prevalence and severity of NAFLD. Annals of hepatology 2002; 1(1): January-March: 12-19
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Nonalcoholic steatohepatitis: morphology CMAJ 2005;172(7):899-905
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Prevalence of NAFLD in Europe Total population (people with normal weight) 15 – 20 % children 20 – 24 % adults – on average 22% Increases with age Found more frequently in men More frequently found among Europeans than Latin Americans Fan, 2009, EASL Congress
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NAFLD in Russia 27% of patients seeking help from general practitioners (DIREG, 2007) 30787 primary care patients were enrolled into open multicenter national-wide prospective study Drapkina O, Ivashkin V, EASL, 2010 Drapkina O, Ivashkin V., London, 2009
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27% of primary care patients in Russia (DIREG, 2007)* *Ivashkin V, Drapkina O, EASL, 2010, Drapkina O, Congress on Prediabetes and the Metabolic Syndrome, 2011 NAFLD was found in 100% of MS patients. Simple liver steatosis in 58 % , NASH in 42 % (n=25) of MS patients** NAFLD in Russia
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Obesity - a major ethiologic factor in NAFLD The prevalence of fatty liver in the general population is about 23% The prevalence among alcoholics reaches 46%, among the obese - 76%, and among alcoholics who are overweight - 95% Consequently, fatty liver is caused by obesity in a greater extent than by alcohol Drapkina OM, Smirin VI, VT Ivashkin Nonalcoholic fatty liver disease - a modernapproach to the problem. Attending Doctor. 2010. Т. 5. # 5. pg. 57–61. Drapkina OM, Smirin VI, VT Ivashkin Pathogenesis, treatment and epidemiology ofNAFLD - what's new? Epidemiology of NAFLD in Russia. RMJ. 2011; 28: 1717-1722
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20 – 30 % of population in economically advanced countries, but… Only 5 % in those with normal BMI; 22 % of overweighted patients 60 % of patients with obesity Metabolic syndrome today
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THE METABOLIC SYNDROME HYPERTENSION TYPE II DIABETES MELLITUS ATHEROSCLEROSIS INSULIN RESISTANCE DYSLIPIDEMIA Steatohepatitis..
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Increase in liver free fatty acids inflow (VLDL ) Glucose utilization in peripheral tissues  …  hyperinsulinemia SMC proliferation with phenotypic changes Fasting hypertriglyceridemia  HDL, LDL Visceral obesity
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Liver is a major target of injury in patients with MS Liver in metabolic syndrome American Journal of the Medical Sciences. 330(6):326-335, Dec 2005. Insulin resistance (≈ 30 % of adults) Fat accumulation into hepatocytes (gluconeogenesis, glycogenolysis) Nonalcoholic steatohepatitis Nonalcoholic fatty liver disease (up to 20 % of adults) cirrhosis and end-stage liver disease
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Cardiovascular diseases and NAFLD:disease and mortality rates. Results of prospective studies Adams LA et al. Gastroenterology 2005;129:113–12 Ekstedt M et al. Hepatology 2006;44:865–873.873 Dunn W et al. Am J Gastroenterol 2008;103:2263–2271 Ong JP et al. J Hepatol 2008;49:608–612 . . . . Cardiovascular diseases are the main cause of mortality among patients with NAFLD!
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NAFLD and the risk of cardiovascular disorders Драпкина О.М., Смирин В.И., Ивашкин В.Т. Патогенез, лечение и эпидемиология НАЖБП – что нового? Эпидемиология НАЖБП в России. РМЖ. 2011; 28: 1717-1722 Ghouri N., Preiss D., Sattar N. Liver enzymes, nonalcoholic fatty liver disease, and incident cardiovascular disease: a narrative review and clinical perspective of prospective data. Hepatology 2010; 52:1156–1161.
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Cholesterol synthesis Pool of cholesterol (~140 g) Сholic acid (500-700 mg) Bile cholesterol (600 mg) Cell membranes (85 mg) Steroids (40 mg) Exogenously (300-500 mg) synthesis in the liver (1g) Acetyl CoA
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Cholesterol synthesis in NASH 18 Acetyl CoA Free cholesterol LDL-C LDLR HMGCR (srebp-2) LAL Min et al, Cell Metabol, 2012
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NAFLD The thickness of the epicardial fat and DCHF Endothelial dysfunction Systemic inflammation Traditional atherosclerosis markers Drapkina O 2011 Targer G., Day P.D., Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med 2010; 363:1341–50.
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Epicardial fat – fat shell of the heart EF and the myocardium share the same microcirculation, so the epicardial fat should be considered the true visceral fat depot of the heart. Epicardial fat and … steatosis of the heart
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MEASUREMENT OF EPICARDIAL FAT USINGECHOCARDIOGRAPHY EF is measured from 2D parasternal longaxis at the point on the free wall of the right perpendicular to the aortic valve
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POTENTIAL USES OF ECHOCARDIOGRAPHIC EPICARDIALFAT THICKNESS FOR DIAGNOSIS 14 NASH (biopsy) vs 14 controls EF was associated with intrahepatic fat accumulation (7.9±2.1 vs 4.1±1.8 mm) EF was associated with visceral fat, BMI, Waist circumferences, HOMA-IR and ALT (p<0.01) Capristo E, 2010 >7,5-9,5 mm - MS 7.9±1.6 (MS) vs. 5.1±1.9 mm (no MS) >9,5 mm - IR > 7 mm - atherosclerosis and CAD (only in woman) >4,5 мм - low coronary flow reserve in women. >3 мм - independent risk factor of CAD
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Epicardial fat: marker of metabolic syndrome, early vascular damage and diastolic dysfunction Patients with MS had significantly higher epicardial fat thickness than controls (4.95±2.6 and 2.69±1.8 mm, p=0.01). Age, BMI, waist circumference, fasting glucose, HOMA-IR, intima-media thickness were significantly higher in subjects with MS and increased epicardial fat than without, while the echocardiographic diastolic function index early/atrial peak flow (E/A) was significantly lower. At multivariate analysis HOMA-IR remained the independent variable associated with epicardial fat (p=0.04, OR1.8, 95% CI1.037-3.58). Heart Failure 2012 Congress, Belgrad, 20 May 2012 Drapkina O,Korneeva O
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NAFLD The thickness of the epicardial fat and DCHF Endothelial dysfunction Systemic inflammation Traditional atherosclerosis markers Drapkina O 2011 Targer G., Day P.D., Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med 2010; 363:1341–50.
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NAFLD and endothelial dysfunction vasodilatation % Villanova N, et al. Hepatology,2005
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Salvi P., Ruffini R., Agnoletti D. et al. Increased arterial stiffness in nonalcoholic fatty liver disease: the Cardio-GOOSE study. J Hypertens. 2010; 28(8): 1699-707. Arterial stiffness and : the Cardio-GOOSE study The study population consisted of 220 participants (123 women), aged between 30 and 70 years, who participated in the GOOSE study. Arterial stiffness was determined by measuring the carotid-femoral pulse wave velocity (PWV) by means of the PulsePen device. Preclinical atherosclerosis was detected by carotid intima-media thickness (IMT) measurement. PWW Norma NAFLD NAFLD+MS
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Arterial stiffness SI 9,8 м/с RI 25,6% AIx 31,6% AIx75 21,1% Spa, мм.рт.ст. 120
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NAFLD The thickness of the epicardial fat and DCHF Endothelial dysfunction Systemic inflammation Traditional atherosclerosis markers Drapkina O 2011 Targer G., Day P.D., Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med 2010; 363:1341–50.
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NAFLD - a chronic inflammatory process In non-smoking patients with hepatic steatosis observed elevated levels of CRP, fibrinogen, v-WF, PAI-1, when compared with patients without evidence of steatosis Excluding the impact of other factors such as age, BMI, BP, insulin resistance, triglyceride levels Targher G et al. Diabet Med 2005;22:999–1004
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NAFLD - a chronic inflammatory process There is a correlation between levels of CRP and IL-6 and the degree of inflammation and fibrosis in NAFLD Wieckowska A et al. Am J Gastroenterol 2008;103:1372–1379
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Statins and NAFLD Safety: ↑ AST / ALT in 1-3% of patients There are no convincing data on the relationship between ↑ AST / ALT and histologicallyverified liver damage against statins Atorvastatin (80 mg) reduced the AST / ALT, and possibly reduced steatosis[Gomez-Dominguez, 2006; Kiyici, 2003] Pravastatin (80 mg) reduced ALT [Lewis et al. 2007] Possible mechanisms - Reduction of TNF-alpha, IL-6, CRP, - Reduced delivery of FFA to the liver, the effect on insulin through adiponectin
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Statins are safe to use (GREACE study) Time (months) 0 36 18 Athyros et al, Lancet. 2010 Dec 4;376(9756):1916-22. N= 1600
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Statins for NAFLD: molecular mechanisms Argo C.K., Loria P., Statins in liver disease: a molehill, an iceberg, or neither? // Hepatology. 2008 Aug;48(2):662–9. Effect on the metabolism of the gene sonic hedgehog (sHh) - progression of fibrosis and reparative mechanisms Inhibition of sHh reduces weight gain from dietary habits sHh: effects on stellate cells and possible involvement in the pathogenesis of C sonic hedgehog
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The Liver-Heart Connection