Prasad Kailash
Department of Physiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Int J Angiol. 2015 Sep;24(3):158-72. doi: 10.1055/s-0035-1554911. Epub 2015 Jun 23.
Stroke is the third leading cause of mortality. Approximately 80 to 85% strokes are ischemic due to carotid artery stenosis (CAS). The prevalence of significant CAS is 7% in women and 9% in men. Severe asymptomatic CAS varies from 0 to 3.1%. Prevalence of symptomatic CAS is high in patients with peripheral arterial disease. CAS is due to atherosclerosis, the major risk factors for which include dyslipidemia, hypertension, diabetes, obesity, cigarette smoking, advanced glycation end products (AGEs) and its receptors (RAGE, soluble RAGE [sRAGE]), lack of exercise and C-reactive protein (CRP). This article discusses the basic mechanism of atherosclerosis and the mechanisms by which these risk factors induce atherosclerosis. The role of AGEs and its receptors in the development and progression of CAS has been discussed in detail. Lifestyle changes and medical treatment of CAS such as lifestyle changes, lipid-lowering agents, antihypertensive agents, antidiabetic drugs, anti-AGE therapy, measures to elevate soluble receptors of AGE (sRAGE, esRAGE). CRP-lowering agents have been discussed in detail. The drugs especially lipid-lowering agents, and antihypertensive and antidiabetic drugs suppress, regress, and slow the progression of CAS. The possible role of lowering the levels of AGEs and raising the levels of sRAGE in the treatment of CAS has been proposed. Lifestyle changes besides medical treatment have been stressed. Lifestyle changes and medical treatment not only would slow the progression of CAS but would also regress the CAS.
中风是第三大致死原因。约80%至85%的中风是由于颈动脉狭窄（CAS）导致的缺血性中风。显著CAS的患病率在女性中为7%，在男性中为9%。严重无症状CAS的患病率在0至3.1%之间。外周动脉疾病患者中症状性CAS的患病率较高。CAS是由动脉粥样硬化引起的，其主要风险因素包括血脂异常、高血压、糖尿病、肥胖、吸烟、晚期糖基化终产物（AGEs）及其受体（RAGE、可溶性RAGE [sRAGE]）、缺乏运动和C反应蛋白（CRP）。本文讨论了动脉粥样硬化的基本机制以及这些风险因素诱发动脉粥样硬化的机制。详细讨论了AGEs及其受体在CAS发生和发展中的作用。还详细讨论了CAS的生活方式改变和医学治疗，如生活方式改变、降脂药物、抗高血压药物、抗糖尿病药物、抗AGE治疗、提高AGE可溶性受体（sRAGE、esRAGE）的措施。降低CRP的药物。这些药物尤其是降脂药物、抗高血压药物和抗糖尿病药物可抑制、消退并减缓CAS的进展。有人提出降低AGE水平和提高sRAGE水平在CAS治疗中的可能作用。除了医学治疗外，还强调了生活方式的改变。生活方式的改变和医学治疗不仅会减缓CAS的进展，还会使CAS消退。
