11a. CV Health - General

Question 1

What is CVD?

Answer 1

General term for conditions affecting the heart and blood vessels

Question 2

What is the endothelium?

Answer 2

Single layer of endothelial cells lining the blood interface throughout the CVS

Question 3

What is the glycocalyx?

Answer 3

Carb-rich protective layer covering the ED
Regulates permeability
Controls NO production
Mechanosensor of blood shear stress

Question 4

What can damage the glycocalyx?

Answer 4

Inflammation
Hyperglycaemia
Endotoxaemia
Oxidised low density proteins
Abnormal blood sheer stress

Question 5

What can further damage to the glycocalyx do?

Answer 5

Further damage to the endothelium
Promotes lipid deposition
Atherosclerosis

Question 6

What are the functions of the endothelium (ASHIER)?

Answer 6

Angiogenesis
Semi-permeable barrier
Haemostasis
Immune defence
Enzymes
Regulates vascular tone

Question 7

What is the function of the endothelium in angiogenesis?

Answer 7

Endothelium cells are the origin of all new blood vessels

Question 8

What is the function of the endothelium as a semi-permeable barrier?

Answer 8

Fluid balance
Host defence
Selective movement of substances e.g. glucose, O2

Question 9

What is the function of the endothelium in haemostasis?

Answer 9

Luminal surface of endothelium prevents platelet adherence and coagulation

Question 10

What is the function of the endothelium in immune defence?

Answer 10

Healthy endothelium cells deflect leukocyte adhesion and oppose local inflammation

Question 11

What is the function of the endothelium in enzymes?

Answer 11

Endothelium contains angiotensin converting enzyme (ACE)
Plays a key role in regulating blood pressure

Question 12

What is the function of the endothelium in regulating vascular tone?

Answer 12

Secretes vasodilators (e.g. NO) and vasoconstrictors (e.g. endothelin)

Question 13

What are vascular smooth muscle cells (VSMCs)?

Answer 13

Play a key role in vessel contraction and dilation
(regulate blood circulation and pressure)
Maintain the integrity and elasticity of blood vessels
Limits immune cell filtration

Question 14

Where are VSMCs located?

Answer 14

Tunica media

Question 15

What happens to VSMCs under pathological conditions?

Answer 15

They undergo phenotypic modulation where the cell structure and function is altered
(central to atherosclerosis/hypertension)

Question 16

What is the role of NO in CV health (RRRIO)?

Answer 16

Regulates vascular tone
Reduces platelet aggregation
Reduces VSMC proliferation
Inhibits leukocyte adhesion and inflammatory cytokines
Opposes oxidation from LDLs

Question 17

Which amino acid generates NO?

Answer 17

L-arginine

Question 18

Which enzyme generates NO from L-arginine?

Answer 18

eNOS

Question 19

Which vitamin regulates NO synthesis by mediating eNOS?

Answer 19

D

Question 20

How does NO exert its physiological effects?

Answer 20

Diffuses from endothelium into VSMCs and bloodstream of large vessels

Question 21

What does reduced NO contribute to?

Answer 21

Atheroma formation
CVD

Question 22

How do normal endothelial cells work?

Answer 22

Impermeable to large molecules
Anti-inflammatory
Deflects leukocyte adhesion
Enhance vasodilation
Resist thrombosis

Question 23

How do endothelial cells impacted by OS and inflammation work?

Answer 23

Increased permeability
Inflammatory cytokine and leukocyte adhesion
Reduced vasodilator molecules
Increased risk of thrombosis

Question 24

How do normal VSMCs work?

Answer 24

Normal contractile function maintaining extracellular matrix
Contained within the tunica media

Question 25

How do VSMCs impacted by OS and inflammation work?

Answer 25

Increased inflammatory cytokines and extracellular matrix synthesis Migration into the tunica intima Proliferation of VSMCs

Question 26

What are peroxisome proliferator-activated receptors (PPARs)?

Answer 26

Nuclear transcription factors that control gene expression involved in adipogenesis, lipid and glucose metabolism and cellular proliferation/apoptosis Decrease inflammation and promote endothelium health

Question 27

What physiological changes occur when PPAR-a is activated?

Answer 27

Increased HDL-C Reduced triglycerides Reduced inflammation Anti-atherosclerotic

Question 28

Which nutrients/herbs work with PPAR-a?

Answer 28

Green tea Resveratrol Oregano Thyme Rosemary Naringenin O3

Question 29

What is the role of PPAR-y?

Answer 29

Reduced blood glucose Reduced fatty acids Reduced insulin

Question 30

Which nutrients/herbs work with PPAR-y?

Answer 30

Hesperidin EGCG Resveratrol Curcumin

Question 31

Examples of CV markers on tests

Answer 31

Cardiac risk tools Cardiac troponin Lipid profile Lp-PLA2 hsCRP MPO

Question 32

What are cardiac risk tools?

Answer 32

e.g. QRISK Calculate score based on CV risks - age, BMI, smoking

Question 33

What are cardiac troponin markers on a test?

Answer 33

Cardiac troponin proteins hs-cTnT and hs-cTnI are released into blood when heart muscle is damaged Often used alongside ECG

Question 34

What are lipid profiles on a test?

Answer 34

TC Non-HDL TG LDL-C TC:HDL ratio

Question 35

What are the normal levels for lipid profiles on a test?

Answer 35

TC - <5 mmol/L Non-HDL - <4 mmol/L LDL-C - <3 mmol/L HDL - >1 mmol/L (m); >1.2 mmol/L (f)

Question 36

What lipid levels on a test pose a higher risk for CVD?

Answer 36

TG - >2.3 mmol/L TC:HDL ratio - >6 mmol/L

Question 37

What is Lp-PLA2?

Answer 37

Enzyme produced by monocytes, macrophages, T cells Upregulated in atherosclerotic plaques and vascular inflammation

Question 38

What is hsCRP?

Answer 38

Inhibits NO and eNOS Involved in plaque deposition

Question 39

What is low risk hsCRP on a test?

Answer 39

<1.0 mg/L

Question 40

What is high risk hsCRP on a test?

Answer 40

>3.0 mg/L

Question 41

What diet and lifestyle factors elevate both Lp-PLA2 and hsCRP?

Answer 41

Western diet Sedentary lifestyle Periodontal disease

Question 42

What is MPO on a cardiac test?

Answer 42

Released by macrophages Measures body's response to damaged arterial walls

Question 43

What is high MPO associated with?

Answer 43

Inflammation OS Poor prognosis

Question 44

What are MPO levels exacerbated by?

Answer 44

High BP Obesity Smoking

Question 45

What is LDL-P on a cardiac marker test?

Answer 45

Number of particles Correlates with atherosclerosis Closely associated with obesity, diabetes and IR