11e. CV Health - Atherosclerosis Flashcards
What is atherosclerosis?
Narrowing and hardening of the large and medium arteries
Reduces blood flow
How does atherosclerosis develop?
Endothelium dysfunction aids formation of fatty streaks
Increased permeability facilitates entry of LDL into the intima
LDL becomes trapped within vessel wall and is oxidised to mLDL (modified LDL)
mLDL recruit leukocytes expressing high levels of pro-inflam cytokines
Macrophages imbibe lipoproteins to form foam cells
Cellular debris is incorporated
Inflammation drives plaque formation
A cap is formed over the plaque to wall off the plaque from blood
What are the main causes of atherosclerosis?
Dyslipidaemia
Inflammation
Endothelial dysfunction
What is endothelial dysfunction?
Disturbance to the protective glycocalyx layer and damage to the endothelial cells
What factors contribute to endothelial dysfunction?
Inflammation
Increased OS
Oxidised LDLs
Hyperglycaemia
Endotoxaemia
Abnormal sheer stress
How does endothelial dysfunction lead to atherosclerosis?
Leads to altered regulation of inflammatory cytokines
Upregulation of chemo-attractant molecules promotes migration of phagocytic and inflammatory immune cells into blood vessels
Disturbs NO metabolism which increases hypertension risk
Increases shear stress worsening endothelial dysfunction = plaque development
How does inflammation play a role in the progression of atherosclerosis?
ED dysfunction, subintimal cholesterol accumulation and T-cell recruitment drives the inflammatory response
Monocytes become resident in sub-endothelium and form inflammasomes, releasing cytokines which activate IL-6 and stimulate CRP production
Cytokines increase plaque formation
Inflammation thins fibrous plaque cap
How does dyslipidaemia play a role in the progression of atherosclerosis?
Lipids are a key component of atherosclerotic plaques
TG-rich lipoproteins are prone to endothelial accumulation and uptake by foam cells
High TGs are linked to low HDLs
Natural approach to atherosclerosis
Apply general approach to CVD
Promote healthy lipid profile
Increase dietary fibre
Support endothelial health/vasodilation
Support liver detoxification
How can we promote a healthy lipid profile?
Avoid high intake of saturated fat
Increase O3 - avocado, EVOO
Red yeast rice - contains monacolin K - cholesterol inhibitor
How can we increase dietary fibre to support atherosclerosis?
Soluble fibre - veg/fruit, psyllium husk, pectin
Associated with decrease in TC and LDL-C
Include dietary sources of beta-glucans (soluble and insoluble fibre) - oats, mushrooms, seaweed, barley
Source of SCFAs - decrease liver cholesterol synthesis and increase bile excretion
How can we support endothelial health and vasodilation for atherosclerosis?
Hawthorn berries/blueberries/blackcurrants - AO, support blood vessel integrity/tone
Citrus/quercetin/garlic/OO - lower ET-1 levels
Beetroot - contains inorganic nitrates that convert to NO
B6/B9/B12/betaine - lowers homocysteine
Med style diet/exercise - lowers fibrinogen levels
How can we support liver detoxification for atherosclerosis?
Ensure availability of all substrates required for detoxification pathways
Schisandra fruit - P1 activator without increasing harmful bioactivation
Enhances P2
2-3 dried fruit infused 2/day
Why is it important to support liver function during atherosclerosis?
Poor liver function can:
Increase circulation of inflammatory mediators
Impede cholesterol metabolism
Compromise essential fatty acid status
Nutrients/herbs to support atherosclerosis
L-citrulline
B5
B3
O3
Pomegranate
Pycogenol
Lycopene
Bergamot
Globe artichoke
Why is L-citrulline important for supporting atherosclerosis?
Enhances arginine and NO bioavailability
Not affected by arginase in intestinal enterocytes and first pass metabolism (unlike L-arginine)
Dosage of L-citrulline to support atherosclerosis
500-3000mg/day
Why is B5 important for supporting atherosclerosis?
Increases HDL
Reduces TC, LDL and TG
Reduces lipid deposition, oxidation and fatty streak formation
Dosage of B5 to support atherosclerosis
300mg x3/day
Why is B3 important for supporting atherosclerosis?
Reduces TC, LDL, TGs and VLDL
Decreases fibrinogen
Dosage of B3 to support atherosclerosis
500-3000mg/day
Why is O3 important for supporting atherosclerosis?
Reduces TG, VLDL, LDL
Reduces Lp-PLA2
Anti-inflammatory
Lowers HR, BP and IR
PPAR-a agonist
Reduces CVD progression
Stabilises plaques
Why is pomegranate important for supporting atherosclerosis?
Improves HDL function
Potent AO
Reduces BP
Dosage of pomegranate to support atherosclerosis
250ml of juice/day
1-2 cups of seeds/day
