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Angina And Acs I Notes

Pharmacology Notes > Drug Development (BIOL10822) Notes

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Drugs: From Molecules to Man - Lecture 14
(16/03/2018)

Angina I: Drugs affecting Plasma
Lipids
Cardiovascular Disorders






Cardiovascular diseases account for around 1 in 3 deaths and so are a major public health concern and a major market for the pharmaceutical industry.
Most of these disorders have both genetic and lifestyle factors that influence their development.
For instance, it is well-known that a diet high in saturated fats and salts is likely to result in problems with the heart and arteries.
In angina and heart attacks (myocardial infarctions) the basic problem is that the heart is deprived of oxygen.
In angina it is a temporary problem, whilst in a heart attack,
it's a permanent one.
Angina is essentially a heart attack in waiting.
Heart failure is a condition in which the heart does not pump efficiently enough to supply the full body's oxygen needs.
It involves changes in the muscular structure of the heart and can develop after a heart attack.
These conditions are interconnected, and they can lead on to further pathological changes such as dysrhythmias.

Statistics in the UK:





1.5 million people have had a heart attack.
11% die within 30 days.

2.6 million people have coronary heart disease.
2 million people have angina.
800,000 people have heart failure.
Heart attack and angina: £6.7 billion cost to UK economy.

The heart is a very active muscle and consumes a lot of oxygen. It does not derive its oxygen from the blood flowing through it, but instead has its own circulation.

Coronary Artery Disease 

Atherosclerosis is the concept of arteries becoming "clogged" by fatty deposits, and there are drug interventions, such as the statins, that can be used to try and treat this disorder.
When this happens in the heart it is termed coronary artery disease.
The fatty deposits (plaques) can restrict the flow of blood and hence oxygen to the muscle of the heart. This can be a very serious problem and is the root cause of most other problems with the heart (eg: heart attacks, angina, dysrhythmias and heart failure).

Preventing CHD

Primary prevention describes how to stop it happening.
Secondary prevention describes how to stop it from recurring or worsening (after angina, heart attack or stroke).

The main techniques mainly involve lifestyle interventions but certain drugs can also be used to prevent CHD.

Lipoproteins

Lipoproteins are responsible for the transport of lipids in the plasma.
Lipoproteins are composed of lipids (triglyceride or cholesterol esters), phospholipids,
cholesterol and proteins.

The lipid metabolism is a very important topic in terms of health care.

Lipids, being hydrophobic, are not transported "naked" in the blood. Instead, they are placed into lipid/protein complexes termed lipoproteins. These consist of lipids,
phospholipids, cholesterol and specific proteins.

The structure of a lipoprotein is designed to allow hydrophobic lipids and cholesterol to be shielded from the aqueous environment by a layer of phospholipids. The apolipoproteins present on the lipoprotein surface come in many different subtypes and help the body recognize the different types of lipoprotein.

Lipoproteins vary in:



Lipid content.
Size.
Type of protein.
Density.

These can be classified into:



HDL (High density).
LDL (Low density).
VLDL (Very low density).
Chylomicrons.

There are five types of lipoprotein (ILDL is the missing one). They all differ in several respects and their density is an important criterion for their classification.

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