Smoking and vasculature disease 2.ppt

7/30/2019 Smoking and vasculature disease 2.ppt

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Smoking

and Vascular

disease

By Allan R. Handysides, M.B., Ch.B.. FRCPc, FRCSc, FACOG.

Director, GC Health Ministries Department
http://www.amazon.com/exec/obidos/ASIN/0811814491/thesmokingsectio


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Impact of the smoking on

disease

Not of disease onpeople

2


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Relative Risk

Condition Male FemalePeripheral

vascular

Disease

13.5 2.2

Aortic

Aneurysm4.7 3.9

CAD (35-64

yrs.)

2.8 3.0

CAD (65 +) 1.6 1.6

CVD (35-64) 3.7 4.8

CVD (65 +) 1.9 1.5


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Pathology

Plaque made up of blood fats,

smooth muscles cells,collagen,

proteins, and calcium deposits

The fats are for a large partoxydated LDL cholesterol

What is the sequence of events?


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Atherosclerosis

The leading cause of death in

the developed world

Increasing in the developing

world

Affects many vessels


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ATHEROSCLEROSIS

1 Some kind of injury occurs, eg. toxins in

smoke

bacterial toxins, platelet aggregation, LDL

cholesterol deposits, oxidation of these LDL

cholesterol deposits.

2 White blood cells migrate to the area

3 These cells ingest oxidized LDL

The cells transform into foam cells

Since oxidized LDL is toxic to the blood vessel

lining more white cells are attracted

Smooth muscle cells stimulated by growth factors

released by the damaged lining as well as the

white cells migrate into the intima where they

multiply


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SO

BUILDING UP THE

PLAQUE !


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Atherosclerosis does not

respect the vessel ! ! !


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Plaque


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Fatty Streak


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Is a focal disorder

Prefers bifurcations

Narrows and dilates

Progresses in spurts

Cardiac, Peripheral,CNS. . .


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Fatty Streak

Damaged intima

Oxidized LDLs

Breakdown products of fattyacids

Breakdown products of cells

Smooth muscle cells

Fibrin

Platelets


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Tobacco

Destabilizes the Plaque

Promotes thrombosisCessation of smoking

results in a rapid risk

reduction


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PlaqueTakes up space in

the vascular wall

Decreases thevascular reactivity

Tobacco makes theplaque friable

Leading to pluggingof the vessel


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Damaged Vascular Medial

Coat

Dilated with loss ofelastin fibers


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Aorta and Iliac 30%

Femoral and

popliteal

80-90%

Tibeal 40-50%

Peripheral Vascular Disease


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Symptom

Intermittent Claudication


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Signsweakening or loss of pulses

muscle wasting

bruitshair loss in involved area

thickened nails

smooth shining skin

pallor or cyanosis

peripheral BP falls


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Prognosis

50% have CHD

70% a 5 yr. survival rate

50% a 10 yr. survival rate

5% come to amputation

Diabetes and continuedsmoking make the prognosis

worse19


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Therapy

Bypass surgery

Grafts

Angioplasties


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Buergers Disease

Involves small and intermediate vessels

Distinct relationship to smoking,

Infiltration by monocytes, fibroblasts,giant cells into the muscular wall of the

vessel,Painful claudication, ischaemiaeventually gangrene.

AMPUTATION!!!


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Aortic Aneurysm

RR =4.7 in male smokers and

3.9 in female smokers

Shape eg fusiform or saccular

Site eg thoracic or abdominalAtheroma and smoking

association


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Size a major

determinant5cms+ in

abdomen=

20-40% risk

of rupture

in one year


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Aneurysmal Pain


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Coronary artery disease

Tobaccoassociated with

the SUDDEN event

Clot

Lifting of plaque26


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RelativeRisk

Males Females

Smokers

Risk

3.4 4.8

In Smokers an increased relative

risk of Strokes and resultantParalysis

Cerebro Vascular Disease


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Goodbye to tobacco
http://www.amazon.com/exec/obidos/ASIN/0811814491/thesmokingsectiohttp://www.amazon.com/exec/obidos/ASIN/0811814491/thesmokingsectio

Smoking and vasculature disease 2.ppt

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