Alcohol and coronary heart disease

Koronarna bolest srca za posljedicu može imati pet zasebnih kategorija, a tu spada angina pektoris, akutni koronarni sindrom, poremećaji srčanog ritma i provođenja, dekompenzacija srca i iznenadna smrt. U ovom radu naglasak je stavljen na akutni koronarni sindrom. Akutni koronarni sindrom (AKS) stanje je koje označava akutnu, kritičnu ishemiju miokarda i podrazumijeva dva entiteta: nestabilnu anginu pektoris i infarkt miokarda. Unutar dijagnoze AKS-a nalazi se podjela ovisno o ranim elektrokardiografskim (EKG) obilježjima na AKS bez elevacije ST-segmenta, tj. nestabilna angina pektoris i infarkt miokarda bez elevacije ST-segmenta (NSTEMI, prema engl. Non ST-Elevation Myocardial Infarction) te infarkt miokarda s elevacijom ST-segmenta (STEMI, prema engl. ST-Elevation Myocardial Infarction). Glavni krivac za razvoj bolesti koronarnih arterija je ateroskleroza jer ona primarno sužava ili zatvara u potpunosti lumen same koronarne arterije. Danas su nam poznati različiti rizični čimbenici koji mogu doprinijeti razvoju ateroskleroze, a samim time i koronarne bolesti srca. Najčešći su pušenje, šećerna bolest, hiperlipidemiija, hipertenzija, muški spol, homocisteinemija te stanje nakon menopauze. Još od davnina ljudi pripisuju raznolike blagotvorne zdravstvene učinke umjerenoj konzumaciji alkohola. Prije svega, ovdje ćemo govoriti o pozitivnim i negativnim učincima konzumacije alkohola na kardiovaskularni sustav. Mnoga znanstvena istraživanja su potvrdila kardioprotektivan učinak umjerene konzumacije alkohola. Najveći blagotvoran učinak je pokazalo crno vino jer ima najvišu koncentraciju polifenola i resveratrola kao glavnog predstavnika polifenola. Pivo je također pokazalo blagotvoran učinak na kardiovaskularni sustav, premda manje nego vino jer pivo ima manji udio polifenola od vina. Sam etanol u žestokom alkoholnom piću je također pokazao određeni pozitivni zdravstveni učinak na kardiovaskularni sustav. Svjetska zdravstvena organizacija je klasificirala etanol kao ljudski karcinogen. Ipak, postoje dokazi da umjerena konzumacija vinskih alkoholnih pića može smanjiti rizik od razvoja nekoliko karcinoma, uključujući kolorektalni karcinom, bazocelularni i karcinom jajnika te karcinom prostate. Vino ima sposobnost inhibirati karcinogenezu kao antioksidans, anti-inflamatorni agens, antimutagen, anti-angiogen, djelujući proapoptotički i kao anti-proliferativni agens. Može modulirati imunosni odgovor, transkripcijske faktore, hormone rasta, citokine, kaspaze, interleukine, prostaglandin sintezu i na taj način utjecati na prevenciju razvoja karcinoma.Coronary heart disease can be divided in five different categories which includes angina pectoris, acute coronary syndrome, disorders of cardiac rhythm and sudden cardiac death. In this thesis I have emphasized acute coronary syndrome. Acute coronary syndrome is a condition which indicates acute, critical myocardial ischemia and pertains to two entities: unstable angina pectoris and myoardial infarction. The dignose of acute coronary syndrom includes classification according to early electrocardiographic signs to myocardial infarction without ST elevation which means unstable angina pectoris and non ST-Elevation Myocardial Infarction (NSTEMI) and to ST-Elevation Myocardial Infarction (STEMI). The main cause for coronary arteries disease development is atherosclerosis because it primarily narrows or occludes the lumen of the coronary artery. Nowadays are well known different risk factors that could contribute to development of the athersceloris and by that, also coronary heart disease. The most common risk factors are smoking, diabetes, hyperlipidaemia, hypertension, male sex, homocysteinaemia and after menopause condiotion. Since ancient times, people have attributed a variety of health benefits to modearte consumption of alcohol. First of all here will be written about positive and negative effects of alcohol consumption on cardiovascular system. Many scientific studies have proved cardioprotective effect of moderate alcohol consumption. Red wine has shown the biggest positive effect due to its highest polyphenol concentration, specially resveratol as the representative of polyphenols. Beer has also shown cardioprotective effect, although it was less significant when compared to wine, because of lower concentraion of the polyphenols. Ethanol in spirit alcohol beverages also showed some positive effect on cardiovascular system. World Health Organization has classified ethanol as as carcinogenic to humans. However, there is evidence that moderate wine consumption may decrease the risk of several cancers, including colon, basal cell carcinoma, ovarian and prostate cancer. Wine may inhibit carcinogenesis by acting as an antioxidant, anti-inflammatory, antimutagen, anti-angiogenic, antiproliferative and proapoptotic agent. It can modulate immune response, transcription factors, growth factors, cytokines, caspases, interleukins, prostaglandin synthesis and by that it can affect on the prevention of carcinoma development