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Atherosclerotic plaque --- Atherosclerosis

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Cholesterol is a vital compound for humans. However higher total cholesterol levels are able to lead to important health hazards, like cardiovascular diseases (Rozner & Garti 2006). ln the case of hypercholesterolemia, a 10 % decrease of cholesterol rate in the blood reduces cardiovascular diseases risks of 19 to 54% (Quilez et al. 2003).
The aim of this master thesis is to describe succinctly the cholesterol metabolism and the health effects of this molecule. We also explained the different therapies against hypercholesterolemia and exposed the phytosterols roles in these medications.
The phytosterols are sterols that are found in vegetable species. These compounds have a structure similar to cholesterol and reduce the dietary cholesterol intake. All the mechanisms are not yet well understood, but they are well studied. Some hypotheses are suggested (Rozner & Garti 2006). The phytosterols could inhibit the cholesterol intake by competition for solubilisation in mixed micelles, by co-crystallisation to form insoluble mixed crystals in the gastrointestinal tract, by competition for pancreatic cholesterol esterases, etc (Trautwein et al. 2003, Rozner & Garti 2006). Unfortunately to obtain the 2 gr of phytosterols per day (quantity that allows a 10%reduce for the LDL rate (Brufau et al. 2008)), vegetables have to be consumed in huge amounts (1.5 kg ofwalnut or 4.5 kg of broccoli or 100 slices of wholemeal bread, etc.). So the use of enriched phytosterol foods as functional ingredient in diet seems to be a good and save option to improve the cholesterol rate in the population (Quilez et al. 2003). The main disadvantage to consume phytosterols is that they are. able to interfere with the carotenoids and vitamins intakes (Rozner & Garti 2006).
Nevertheless, the phytosterols place in hypercholesterolemia treatments is not defined yet. A lot of questions still remain. More studies are necessary to define the population for which they may give the best benefits and to measure clinically these benefits (Lecerf 2007) Le cholestérol est un composé vital pour l'Homme. Néanmoins, à des taux trop élevé, il peut mener à des complications de santé importantes, comme le développement de maladies cardio-vasculaires (Rozner & Garti 2006). Dans le cas d'hypercholestérolémie, on estime qu'une diminution de 10 % du taux de cholestérol dans le sang réduit le risque de maladies cardio-vasculaires de 19 à 54 % (Quilez et coll. 2003).
L'objectif de ce travail est de décrire succinctement le métabolisme du cholestérol et ses effets sur la santé. Nous exposerons également les différentes thérapies hypocholestérolémiantes existantes. Enfin, nous présenterons la place des phytostérols dans ces thérapies.
Les phytostérols sont des stérols présents naturellement dans les espèces végétales. Ces composés de structure similaire à celle du cholestérol réduiraient l'absorption du cholestérol alimentaire. Le mécanisme n'est pas complètement compris, mais est largement étudié et plusieurs hypothèses ont déjà été suggérées (Rozner & Garti 2006). Les phytostérols pourraient inhiber l'absorption du cholestérol par compétition de solubilisation au niveau des micelles, par co-cristallisation dans le tractus gastro-intestinal, par compétition au niveau des cholestérols estérases pancréatiques, etc. (Trautwein et coll. 2003, Rozner & Garti 2006). Malheureusement, pour consommer 2 g de stérols végétaux par jour (quantité qui permet une réduction du taux de LDL de 10% (Brufau et coll. 2008)), la quantité de certains aliments devant être consommée est considérable (1,5 kg de noix ou 4,5 kg de brocolis ou 100 tranches de pain complet, etc.). C'est pourquoi l'utilisation de phytostérols comme ingrédients fonctionnels dans l'alimentation apparaît être une option pratique et sure pour améliorer le taux de cholestérol dans la population (Quilez et coll. 2003). Le seul désavantage à la consommation de phytostérols est qu'ils peuvent interférer avec l'absorption de caroténoïdes et des vitamines (Rozner & Garti 2006).
La place des phytostérols dans l'arsenal thérapeutique de la prévention cardio- vasculaire n'est pas encore définie. De nombreuses questions restent posées. Des études complémentaires pour mieux définir les sujets qui pourraient en bénéficier et pour mesurer cliniquement leur intérêt sont nécessaires (Lecerf 2007).

Phytosterols --- Anticholesteremic Agents --- Cholesterol --- Atherosclerosis --- Dyslipidemias

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Athérosclérose. --- Athérothrombose. --- Atherosclerosis. --- Athérosclérose. --- Athérothrombose.

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Atherosclerosis is a degenerative process affecting blood vessels, which determines narrowing of the lumen, plaque growth, and hardening of the walls. It is a risk factor for cardiovascular diseases. The focus of this book is on the management of the atherosclerotic disease. The coverage spans from histological presentation of the various stages of atherosclerotic lesions to the earliest studies in atherosclerosis therapy, from advanced clinical diagnosis to monitoring, follow-up, and home-care of the atherosclerotic patient. This book shows well-established diagnostic techniques covering several medical imaging modalities such as Ultrasounds, IVUS, MRI, Computer Tomography, along with new trends in early and advanced atherosclerosis diagnosis (innovative drugs and tissue characterization procedures). Surgical standards will be presented along with innovative experimental trials for the treatment of the atherosclerotic patient. The book also covers emerging techniques based on molecular imaging and vibro-acoustics.

Arteriosclerosis. --- Atherosclerosis. --- Cerebrovascular disease. --- Coronary heart disease. --- Atherosclerosis --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Arteriosclerosis --- Arterial Occlusive Diseases --- Diagnosis --- Vascular Diseases --- Cardiovascular Diseases --- Diseases --- Medicine --- Health & Biological Sciences --- Treatment --- Disease management. --- Medicine. --- Cardiology. --- Biomedicine. --- Biomedicine general. --- Clinical medicine --- Health services administration --- Medical care --- Decision making --- Cost control --- Heart --- Internal medicine --- Clinical sciences --- Medical profession --- Human biology --- Life sciences --- Medical sciences --- Pathology --- Physicians --- Biomedicine, general. --- Health Workforce

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Carotid artery --- Investigative Techniques --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Cerebrovascular Disorders --- Publication Formats --- Cardiovascular Surgical Procedures --- Brain Diseases --- Vascular Diseases --- Publication Characteristics --- Surgical Procedures, Operative --- Cardiovascular Diseases --- Central Nervous System Diseases --- Diseases --- Nervous System Diseases --- Methods --- Vascular Surgical Procedures --- Carotid Artery Diseases --- Diagnosis --- Congresses --- Medicine --- Health & Biological Sciences --- Cardiovascular Surgical Procedure --- Procedure, Cardiovascular Surgical --- Procedures, Cardiovascular Surgical --- Surgical Procedure, Cardiovascular --- Surgical Procedures, Cardiovascular --- Cardiovascular System --- Thoracic Surgery --- Cerebrovascular Diseases --- Cerebrovascular Insufficiency --- Cerebrovascular Occlusion --- Brain Vascular Disorders --- Intracranial Vascular Disorders --- Vascular Diseases, Intracranial --- Brain Vascular Disorder --- Cerebrovascular Disease --- Cerebrovascular Disorder --- Cerebrovascular Insufficiencies --- Cerebrovascular Occlusions --- Disease, Cerebrovascular --- Diseases, Cerebrovascular --- Insufficiencies, Cerebrovascular --- Insufficiency, Cerebrovascular --- Intracranial Vascular Disease --- Intracranial Vascular Diseases --- Intracranial Vascular Disorder --- Occlusion, Cerebrovascular --- Occlusions, Cerebrovascular --- Vascular Disease, Intracranial --- Vascular Disorder, Brain --- Vascular Disorder, Intracranial --- Vascular Disorders, Brain --- Vascular Disorders, Intracranial --- Investigative Technics --- Investigative Technic --- Investigative Technique --- Technic, Investigative --- Technics, Investigative --- Technique, Investigative --- Techniques, Investigative --- Antemortem Diagnosis --- Diagnoses and Examinations --- Examinations and Diagnoses --- Postmortem Diagnosis --- Diagnose --- Antemortem Diagnoses --- Diagnoses --- Diagnoses, Antemortem --- Diagnoses, Postmortem --- Diagnosis, Antemortem --- Diagnosis, Postmortem --- Postmortem Diagnoses --- Disease --- Arterial Diseases, Carotid --- Arterial Diseases, Common Carotid --- Arterial Diseases, External Carotid --- Arterial Diseases, Internal Carotid --- Atherosclerotic Disease, Carotid --- Carotid Artery Disorders --- Carotid Atherosclerotic Disease --- Common Carotid Artery Diseases --- External Carotid Artery Diseases --- Internal Carotid Artery Diseases --- Carotid Atherosclerosis --- Arterial Disease, Carotid --- Artery Disease, Carotid --- Artery Diseases, Carotid --- Artery Disorder, Carotid --- Artery Disorders, Carotid --- Atherosclerotic Diseases, Carotid --- Carotid Arterial Disease --- Carotid Arterial Diseases --- Carotid Artery Disease --- Carotid Artery Disorder --- Carotid Atheroscleroses --- Carotid Atherosclerotic Diseases --- Disorders, Carotid Artery --- Plaque, Atherosclerotic --- Procedure, Vascular Surgical --- Procedures, Vascular Surgical --- Surgical Procedure, Vascular --- Surgical Procedures, Vascular --- Vascular Surgical Procedure --- Blood Vessels --- Methodological Studies --- Methodological Study --- Procedures --- Studies, Methodological --- Study, Methodological --- Method --- Procedure --- Nervous System Disorders --- Neurological Disorders --- Neurologic Disorders --- Disease, Nervous System --- Diseases, Nervous System --- Disorder, Nervous System --- Disorder, Neurologic --- Disorder, Neurological --- Disorders, Nervous System --- Disorders, Neurologic --- Disorders, Neurological --- Nervous System Disease --- Nervous System Disorder --- Neurologic Disorder --- Neurological Disorder --- Neurology --- CNS Diseases --- Central Nervous System Disorders --- CNS Disease --- Central Nervous System Disease --- Central Nervous System Disorder --- Cardiovascular Disease --- Disease, Cardiovascular --- Diseases, Cardiovascular --- Cardiology --- Ghost Surgery --- Operative Procedures --- Operative Surgical Procedure --- Operative Surgical Procedures --- Procedure, Operative Surgical --- Procedures, Operative Surgical --- Surgery, Ghost --- Surgical Procedure, Operative --- Surgical Procedures --- Operative Procedure --- Procedure, Operative --- Procedure, Surgical --- Procedures, Operative --- Procedures, Surgical --- Surgical Procedure --- General Surgery --- Disease, Vascular --- Diseases, Vascular --- Vascular Disease --- Brain Disorders --- CNS Disorders, Intracranial --- Central Nervous System Disorders, Intracranial --- Central Nervous System Intracranial Disorders --- Encephalon Diseases --- Encephalopathy --- Intracranial CNS Disorders --- Intracranial Central Nervous System Disorders --- Brain Disease --- Brain Disorder --- CNS Disorder, Intracranial --- Encephalon Disease --- Encephalopathies --- Intracranial CNS Disorder --- surgery --- diagnosis --- surgery. --- diagnosis. --- methods. --- Diseases.