[The role of plasma lipids and of coagulation factors in atherosclerosis. Clinical trials and new prospects].
The relevance that lipids have in the pathogenesis and progression of atherosclerotic lesions is well-known. In these last years further insight has come about the role of hemostatic factors in these processes. Plasma fibrinogen seems directly involved in the genesis of atherosclerotic plaque and in the modulation of endothelium/circulating-cells microenvironment. Epidemiological data show that fibrinogen is a major risk factor for cardiovascular death and ischemic heart, brain and peripheral vessels disease. In this review we considered current data about pathogenetic mechanisms of atherosclerosis and its complication in which hemostatic/hemorheological factors (plasma fibrinogen, factor VIIc, platelets and leucocytes) are involved as well as the prognostic relevance of these components in human vascular pathology. Current knowledge suggests the need for intervention both on altered plasma lipids and on altered hemostatic parameters. At present, the actual possibilities of pharmacological intervention in the second case, apart from antiplatelet agents, are really poor. Among the drugs till now employed, fibrates are considered with interest as they seem to ameliorate both pathogenetic mechanisms: bezafibrate lowers plasma total- and LDL-cholesterol, triglycerides as well as plasma fibrinogen and other hemocoagulative parameters. This drug might be proposed in at risk populations in order to reduce the incidence and prevalence of atherosclerotic complications: at present, unfortunately, longitudinal studies to confirm this therapeutic rationale are not available.
Pagano
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Istituto di Medicina Interna, Università degli Studi, Torino.
Niort
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D001161:Arteriosclerosis / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D001779:Blood Coagulation Factors / Q000502:physiology*; D002986:Clinical Trials as Topic; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D008055:Lipids / Q000097:blood*; D012307:Risk Factors
D001779:Blood Coagulation Factors; D008055:Lipids
Ruolo dei lipidi plasmatici e dei fattori della coagulazione nell'aterosclerosi. Trial clinici e nuove prospettive.