Atherothrombosis: epidemiology, pathophysiology, and prevention.
Atherothrombosis: epidemiology, pathophysiology, and prevention.
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DOI：
10.1331/154434504322904569
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发表时间：
2004-03-01
期刊：
影响因子：
--
通讯作者：
Hawkins, David W
中科院分区：
文献类型：
--
作者：
Munger, Mark A;Hawkins, David W
目的：回顾动脉粥样硬化血栓形成的病理生理学（动脉粥样硬化与叠加的血小板丰富的血栓形成）和措施，可以采取预防其临床后遗症，通过生活方式的改变和药物治疗，重点是抗血小板药物的作用。最近（1995-2003年）发表的科学文献，作者通过Medline检索使用术语动脉粥样硬化血栓形成，病理生理学，资料选择：选取近期系统性英文综述文章，筛选相关资料。资料综合：动脉粥样硬化血栓形成是一种广泛的、弥漫性的进展过程，累及多个血管床;其临床后果，包括急性冠状动脉综合征心绞痛（不稳定型心绞痛、急性心肌梗死和心源性猝死）、缺血性中风和外周动脉疾病在其时间过程中是不可预测的并且可能危及生命。动脉粥样硬化血栓形成而不是动脉狭窄似乎是动脉粥样硬化过程中大部分急性缺血表现的原因。可以有利地影响动脉粥样硬化进展的干预措施包括生活方式改变（饮食控制、运动和戒烟）和药物治疗（降脂、降压、降糖和抗血小板药物）。血小板在血栓形成中所起的关键作用提供了使用具有互补作用模式的抗血小板药物的基本原理（例如，结论：缺血性脑血管疾病、冠状动脉疾病和外周动脉疾病可以被认为是一种共同的潜在系统性病理学即动脉粥样硬化血栓形成的不同表现。在受影响的动脉床中进行缺血性事件的二级预防，可增加针对其他动脉床中潜在缺血性事件的一级预防的获益。
OBJECTIVES: To review the pathophysiology of atherothrombosis (atherosclerosis with superimposed platelet-rich thrombus formation) and the measures that can be taken to prevent its clinical sequelae through lifestyle modifications and pharmacotherapy, with emphasis on the role of antiplatelet agents.DATA SOURCES: Recent (1995-2003) published scientific literature, as identified by the authors through Medline searches using the terms atherothrombosis, pathophysiology, risk factors, prevention, and reviews on treatment.STUDY SELECTION: Recent systematic English-language review articles were screened for relevant material.DATA SYNTHESIS: Atherothrombosis is a generalized and diffuse progressive process affecting multiple vascular beds; its clinical consequences, including acute coronary syndromes (unstable angina, acute myocardial infarction, and sudden cardiac death), ischemic stroke, and peripheral arterial disease, are unpredictable in their time course and potentially life-threatening. Atherothrombosis rather than arterial stenosis appears to account for most of the acute ischemic manifestations of the atherosclerotic process. Interventions that can favorably influence atherosclerotic progression include lifestyle modifications (dietary control, exercise, and smoking cessation) and pharmacotherapy (lipid-lowering, antihypertensive, antiglycemic, and antiplatelet drugs). The pivotal role played by the platelet in thrombus formation provides the rationale for employing antiplatelet drugs with complementary modes of action (e.g., aspirin, clopidogrel) to prevent atherothrombosis.CONCLUSION: Ischemic cerebrovascular, coronary, and peripheral arterial disease can be regarded as diverse manifestations of a common underlying systemic pathology, namely atherothrombosis. Secondary prevention of an ischemic event in an affected arterial bed confers the added benefit of primary prevention against potential ischemic events in other arterial beds.