【正文】 ronson D, et al. Diabetes and obesity. In: Atherosclerosis and Coronary Artery Disease (Eds. Fuster, Ross, Topor). LippincottRaven Publishers, p327, 1996. ? Figure 27. Stafford RS, et al. Cigarette smoking and atherosclerosis. In: Atherosclerosis and Coronary Artery Disease (Eds. Fuster, Ross, Topor). LippincottRaven Publishers, p303, 1996. ? Figure 28. Chisolm GM, et al. Oxidized lipoproteins and atherosclerosis. In: Atherosclerosis and Coronary Artery Disease (Eds. Fuster, Ross, Topor). LippincottRaven Publishers, 1996. ? Figure 33 and 62. Adapted from Despres JP, Lemieux I and Prud’homme D. Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ 2022。Cardiovascular disease is the leading cause of death among adults worldwide (1996) Coronary disease million Cancer Cerebrovascular disease Acute lower respiratory tract infections Tuberculosis COPD (chronic obstructive pulmonary disease) Diarrhea (including dysentery) Malaria AIDS Hepatitis B Coronary mortality: alarming worldwide forecasts Atherosclerosis: a multifactorial disease Main risk factors for coronary heart disease Global projections for the diabetes epidemic: 19952022 Atherosclerosis Arterial wall: structure and function Different stages of atherosclerotic plaque development Vascular endothelium modification in atherosclerosis Plaque formation 1 — Fatty streak Plaque formation 2 — Fibrous cap Plaque formation 3 — Lipid core From plaque to thrombosis, key event: plaque rupture Lipid core constitution Activated macrophages accumulate lipids Lipid core constitution LDL oxidation Parietal vascular inflammation The activated macrophage produces inflammatory cytokines Parietal vascular inflammation NFkB action in the inflammation process Diabetes and atherosclerosis Tobacco and atherosclerosis Dyslipidemia and atherosclerosis HTN, hemodynamic factor and atheroclerosis How to reduce plaque formation Intervention on risk factors How to reduce the risk of plaque rupture How to reduce the risk of thrombosis ~10% Weight loss = ~30% Visceral adipose tissue loss Characteristics of an unstable plaque Plaque vulnerability factors Intrinsic factors Modification of extrinsic vulnerability factors Plaque rupture The main releasing factors Classification of lipids and lipoproteins Characteristics of lipoproteins Triglyceriderich lipoproteins: size, structure and position Digestion and metabolism of dietary fat HDL metabolism and reverse cholesterol transport Cholesterol efflux and reverse cholesterol transport is modulated by two receptors Atherogenicity of small dense LDL Size and apolipoprotein position are the main factors determining atherogenicity of triglyceriderich particles Size and apolipoprotein position are the main factors determining atherogenicity of triglyceriderich particles Apo CIII modulates VLDL Apo CIII in apo B particles is atherogenic Relationship between apo CIII in apo B containing lipoproteins and atherogenicity PROCAM Study MIIncidence according to LDLcholesterol and triglycerides PROCAM Study CHD risk according to LDLC and TG increased TG confers raised CHD risk at all levels of LDLC HDL: an antiatherogenic lipoprotein HDL metabolism: 5 ke