054 Heart Disease

Question 1

Globally, there are about 57m deaths per year. How many are dying from cardiovascular disease?

Answer 1

1/3 people (17m)

Question 2

Is cardiovascular disease higher in LIC or HIC?

Answer 2

LIC - smoking, poor nutrition, poor health

Question 3

What are the two top killers of 2030?

Answer 3

Heart disease and stroke

Question 4

Which stages of atherosclerosis are reversible?

Answer 4

Stages 1-4

Question 5

What is the cause of change during stages 1-4 compared to stages 5-6?

Answer 5

Stages 1-4 develop due to increasing accumulation of lipid. Stages 5 and 6 develop due to fibrous thickening and thrombus deposit formation.

Question 6

In the UK, what are the differences in cardiovascular disease epidemiology?

Answer 6

Higher rates in the north, lower rates in south west and south east of London.

Question 7

What are the three layers of a normal large artery?

Answer 7

Intima (endothelial cells on luminal side and elastic fibres on peripheral side)
Media (smooth muscle cells)
Adventitia (connective tissues with interdispersed fibroblasts)

Question 8

What are the three most important cell types involved in atherosclerotic lesion development?

Answer 8

Monocytes
Smooth muscle cells
endothelial cells

Question 9

What is the significance of endothelial cells in the development of atherosclerosis lesions?

Answer 9

Activated endothelial cells will express adhesion molecules and recruit inflammatory cells (monocytes). Lipid formation may also occur in the intima space of vessel wall.

Question 10

What is adaptive thickening

Answer 10

Some people may have defined locations in the blood vessels where smooth muscles have thickened as a self limited response of the intima to thermodynamic forces present due to blood flow etc. These areas are not necessarily places where lesions will occur, although they do occur in areas that are progression prone.

Question 11

Which types of lesions are most frequent >40 year olds

Answer 11

Type V and VI

Question 12

Which types of lesions can be seen in young children?

Answer 12

Type I and II

Question 13

Which types of lesions are symptom producing, and which symptoms are they?

Answer 13

Type V can cause angina due to thickened vessels. Type VI can be a cause of thrombus deposition

Question 14

How do foam cells occur?

Answer 14

Lipid that is deposited gets oxidised by free radicals. Monocytes that have differentiated into macrophages have receptors that uncontrollably ingest the oxidised lipids, causing foam cells.

Question 15

What is the role of macrophages/monocytes in the development of atherosclerosis lesions?

Answer 15

These immune cells will migrate and produce cytokines and growth factors. They will also induce smooth muscle cell migration.

Question 16

What is the role of smooth muscles in the development of atherosclerosis lesions?

Answer 16

Smooth muscle cells change from contractile to repair phenotype. They will form a fibrous cap and generate extracellular matrix. This causes calcification.

Question 17

What do statins do?

Answer 17

Block formation of cholesterol and reducing it by 30%, also increases HDL.

Question 18

What is the relationship between cholesterol and NO production?

Answer 18

LDL inhibits NO production and constricts blood vessels. HDL stimulates and enhances vascular tone.