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Chapter 6

Cardiovascular Health:

Role of Stearic Acid on Atherogenic and Thrombogenic Factors Penny M. Kris-Etherton and Terry D. Etherton

Coronary heart disease (CHD) is the leading cause of morbidity and mortality in developed countries (1). CHD is a progressive disease characterized by atherosclerosis, which is a pathological condition resulting from the development of fibrous plaques or lesions in coronary arteries (1). The formation of these plaques results from complex biological processes initiated by chronic endothelial injury or damage (2). As atherosclerosis progresses, plaques increase in size, project into the arterial lumen, occlude the artery and block or reduce blood flow to the heart, brain and/or extremities, resulting in a heart attack, stroke or gangrene of the extremities. Although thought to begin in childhood, CHD usually is not manifested clinically until the fourth decade of life or later. Thus, CHD is a chronic disease that develops silently over decades.

CHD results from chronic exposure to both modifiable and non-modifiable risk factors (3). Modifiable risk factors include an elevated plasma total cholesterol level, specifically low-density lipoprotein (LDl) cholesterol, low levels of high-density lipoprotein (HDL) cholesterol as well as smoking, hypertension, obesity, physical inactivity and diabetes mellitus. In addition, elevated levels of some blood coagulation factors, fibrinogen and factor VII, and elevated plasma triglycerides and lipoprotein (a) (Lp(a)) levels also are considered to be modifiable risk factors for CHD. Furthermore, altered production of important bioactive compounds (e.g. prostaglandins, thromboxanes and leukotrienes) which affect platelet function, and in turn thrombosis tendency, also are thought to affect CHD risk. Non-modifiable risk factors include a strong family history and age (i.e. in men age 45 years and older, and in women due to menopausal status age 55 years and older, is a positive risk factor).

Diet plays a major role in the development and treatment of many modifiable CHD risk factors including an elevated total and LDL cholesterol level, hypertension, obesity and diabetes mellitus. In addition, diet also affects plasma tri-

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