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1. Over the past each year. This presumably reflects th
sever- al decades,
advances in the 4. Ongoing medical re- search ha
understanding increased our understanding of the
and treatment of
2. Nevertheless,
heart attacks
occur in over
700,000 people in
the United States
every year. It
remains the most
common cause of
death in adults
overall and,
tragical- ly, the
most common
cause of
3. Despite these
sober- ing
statistics, CAD
mortality rates
have been falling
since 1969 and the
num- ber of people
alive with CAD
(and seek- ing life
insurance) has
been increasing
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acute and chronic coronary artery
disease (CAD) have led to a steady
decline in the mortality of this
impairment. awareness and treatment of CAD risk factors, the improving
survival rates of the acute coronary syndromes, and technical
advances in revasculariza- tion strategies, as well as advances in
the medical treatment of the aging population.
premature death in adults before
the age of 65. In 15-20% of adults
with CAD, their first symptom is their
last symptom, in that they fall victim to
the syndrome of sudden unexpected
death as the first manifestation of
this impairment.
etiology and pathogenesis of atherosclerosis and its clinical
sequelae. Indeed, risk factor analysis and intervention are
major weapons in the fight against atherosclerotic disease.
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5. The association of be included as even
serum lipids with
clin- ical CAD dates 7. The past several decades have also
back to the 1940s witnessed rapid ad- vances in the
and 1950s when medical treatment of coronary artery
total cho- lesterol disease.
and triglyc- erides
were linked
to atherosclerotic
dis- ease in both
cross-sec- tional
and prospective
studies. In the
1960s and 1970s,
focus shift- ed to
the
6. Apolipoproteins
(e.g., B, A1, E,
Lp[a]), meta- bolic
products (homo-
cysteine), and
serum
inflammatory
mark- ers (C-
reactive protein)
have also been
found to be
additional mark-
ers of CAD. Genetic
markers can also
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serum lipoprotein cholesterol
fractions, emphasizing the
protective value of high-density Cardio-selective beta-blockade and calcium channel blockers are
lipoprotein (HDL) and the used ex- tensively, as well as angiotensin-converting enzyme (ACE)
proatherogenic association of inhibitors and, more recently, antiplatelet, and anticoagulant
low-density lipoprotein (LDL) drugs such as clopidogrel (Plavix®).
cholesterol.
stronger predictors of later
atherosclerotic sequelae. Similar
trends can be identified for
other risk factors such as
hypertension, diabetes, and
obesity.
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