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2. Cardiovascular System > 20. Nutritional Aspects of Cardiovascular Diseases > Flashcards

20. Nutritional Aspects of Cardiovascular Diseases Flashcards

1
Q

What is the number 1 mortality cause in Western countries?

A

cardiovascular disease

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2
Q

What is the main cause of cardiovascular disease?

A

atherosclerosis

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3
Q

What happens in coronary heart disease?

A
  • plaque builds up in coronary arteries

- these arteries are vital for supplying the heart with oxygen

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4
Q

What are 3 types of main coronary heart disease?

A
  1. stable/ unstable angina
  2. acuta myocardial infarction (MI; heart attack)
  3. sudden death with or without history of chest pain and/or previous infarction
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5
Q

Define stroke.

A

-sudden localised loss of brain function due to ischaemia OR haemorrhage and lasting longer than 24 hours

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6
Q

What are MOST stroke causes due to in UK?

A

Due to ischaemia; which is due to thrombosis (85%); blood clot in vessel and and emboli; travelling blood clot

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7
Q

What are haemorrhagic strokes due to?

A

consequence of rupture of arterial wall due to aneurysm or wall disease

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8
Q

What are 2 types of strokes?

A
  1. Ischaemic (due to thrombus or embolus)

2. Haemorrhagic (bleeding)

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9
Q

What other disease often co-exists with cardiovascular disease?

A

paripheral vascular disease

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10
Q

What vessels does peripheral vascular disease affect? (3)

A 
disease of the...
1. aorta 
2. iliac arteries 
3. leg arteries
(essentially restricted blood supply to leg muscles)
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11
Q

What are 6 main “groups” of cardiovascular disease?

A
  1. coronary heart disease (CHD)
  2. stroke
  3. peripheral vascular disease
  4. rheumatic heart disease
  5. congenital heart disease
  6. deep vein thrombosis and pulmonary embolism
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12
Q

What does rheumatic heart disease cause?

A

damage to the heart muscle and heart valves from rheumatic fever caused by streptococcal bacteria

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13
Q

What are congenital heart disease?

A

malformations of heart structure existing at birth

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14
Q

With developing atherogenesis, what 3 diseases become increasingly more common particularly?

A
  1. ischaemic heart disease
  2. stroke
  3. peripheral vascular disease
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15
Q

Describe the steps in formation of an atherosclerotic plaque. (4)

A
  1. normal
  2. fatty streak (with foam cells)
  3. fibrous cap and lipid core formed (lipid-rich plaque)
  4. thrombus formed
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16
Q

List the steps of the development of an atheroscletotic lesion. (7)

A
  1. endothelial cell dysfunction (decrease in NO production and LDL production)
  2. endothelial cell activation (VCAM1 and ICAM1 produced with collagen proteins)
  3. infammation (monocyte, t cell and foam cell recruitment)
  4. proteolysis and apoptosis
  5. lipid core and fibrous cap formation
  6. angiogenesis (thrombus attaches to atheroma formed_
  7. thrombosis (formation of established blood clot in blood vessel wall)
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17
Q

What 2 processes occur in the tunica intima which induce cytokine and macrophage production that create proliferation and foam cell production in atheromas?

A
  1. monocyte adhesion

2. diapedesis

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18
Q

What is diapedesis?

A

passage of blood cells through the intact walls of capillaries, typically accompanying inflammation

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19
Q

What are foam cells?

A
  • indication of plaque build up and atherosclerosis
  • formed when macrophages sent to fatty deposits on blood vessel walls
  • macrophages surround fatty tissue to destroy it but become filled with lipids
  • lipids surrounded by macrophages gives it the “foamy” appearance
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20
Q

What are main risks of cardiovascular disease? (9)

A
  1. diet (if excess energy intake)
  2. obesity
  3. hypertension
  4. insulin resistances, diabetes
  5. physical activity
  6. smoking
  7. alcohol
  8. foetal and infant growth
  9. genetic
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21
Q

What substances are pro-atherogenic? (5)

A
  1. cholesterol
  2. saturated fatty acids
  3. trans fatty acids
  4. sodium
  5. alcohol
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22
Q

What substances are anti-atherogenic?

A
  1. polyunsaturated fatty acid (PUFA)
  2. carbohydrate rich diet
  3. non-starch polysaccharides
  4. monounsaturated fatty acids (MUFA)
  5. antioxidants
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23
Q

What are 2 miscellaneous factors (different elements) that decrease risk of CV disease?

A
  1. homocysteine

2. B12 and folate

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24
Q

What type of cholesterol has a strong link with coronary heart disease?

A

LDL cholesterol in plasma

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25
Q

What is plasma concentration of LDL influenced by? (2)

A
  1. fat content

2. quality in diet

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26
Q

How does reduction in plasma cholesterol affect risk of coronary heart disease?

A

1% reduction in plasma cholesterol translates to 2-3% lower risk of coronary heart disease

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27
Q

What can hypercholesterolaemia be caused by?

A
  1. poor lifestyle

2. genetic

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28
Q

What is HDL cholesterol associated with?

A

associated with LOWER risk of coronary heart disease but only when LDL cholesterol is high

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29
Q

When is dietary cholesterol a problem to health?

A

when there is a presence of hypercholesterolaemia

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30
Q

What feature of saturated fatty acids affects its effect on modulating cholesterol level.

A

the chain length of saturated FA (shorter chained length do NOT modulate cholesterol level)

31
Q

Describe the action of saturated fatty acids for modulating cholesterol.

A
  1. act on LDL receptors (inhibition and suppression)

2. have aggregatory effect (combines molecules)

32
Q

Replacing 1% of energy from saturated fats with unsaturated fats, reduces coronary heart disease risk by how much?

A

by 2-3%

33
Q

What is the current recommendation for daily saturated fatty acid intake for men and women?

A

men: no more than 30g/day
women: no more than 20/day

34
Q

What percent of UK population exceed the maximum recommended fat intake?

A

over 80% of UK population

35
Q

What should the fat intake from food energy be?

A

recommended 11%

36
Q

What effect do trans fatty acids have on: LDL cholesterol, plasma TAG and HDL?

A
  • raise LDL cholesterol
  • raise plasma TAG
  • lower HDL cholesterol
37
Q

By replacing 1% of energy from trans fats with unsaturated fats, by how much is coronary heart disease risk reduced?

A

by 2-3%

38
Q

What is the daily recommendation for trans fatty acids for an adult?

A

~5g a day (no more than 2% of total energy per day)

39
Q

Is sodium atherogenic?

A

No, but influences thrombosis by its effect on blood pressure

40
Q

What should happen to Na and K intake to decrease BP?

A
  • Na intake decreased

- K intake increased

41
Q

What is the current average salt intake and what is the current recommendation?

A
  • current salt intake on average: 7.2g/day

- current recommendation: don’t exceed 6g NaCl (2.3g Na)

42
Q

How many units of alcohol per week can raise BP significantly?

A

30 units weekly (habitual heavy as well as acute consumption increases risk of stroke)

43
Q

What effect does polyunsaturated fatty acid have on LDL and HDL cholesterol?

A
  • lowers LDL
  • lowers HDL
    Generally has anti-atherogenic properties
44
Q

What is the main monounsaturated fatty acid that can be used to substitute saturated fatty acids with?

A

oleic acid

45
Q

What are 2 types of polyunsaturated fatty acids (PUFA)?

A
  1. n-6 PUFA

2. n-3 PUFA (marine origin, not plant origin)

46
Q

What effect does MUFA oleic acid have on plasma properties?

A
  • reduces total cholesterol in plasma

- reduces LDL cholesterol in plasma

47
Q

What effect does n-3 PUFA (polyunsaturated fatty acid) have TAG, LDL and HDL levels (plasma properties)?

A
  • reduces TAG levels

- minimal effect on LDL and HDL effect

48
Q

What extra properties does n-3 PUFA have?

A
  • anti-infammatory
  • anti-thrombotic

Effects due to long chain one (EPA and DHA) but not α18:3.

49
Q

What percentage of total energy intake should carbohydrates make up?

A

50% (biggest part out of all food groups)

50
Q

Why do carbohydrates reduce risk of coronary heart disease?

A

by consuming carbohydrates, it decreases fat intake ultimately

51
Q

What should the daily intake of free sugars be?

A

~5% daily ( they don’t have anti-atherogenic properties)

52
Q

What are the benefits of Non-Starch Polysaccharides (NSP)? (4)a

A
  • decrease risk of coronary heart disease
  • reduce cholesterol levels
    but no effect on VLDL and TAG levels
  • benefit insulin secretion
  • beneficial effects on gut health
53
Q

What is the job of antioxidants?

A
  • essential components of the cellular defence against activated oxygen species (protects body from free radicals)
  • Free radicals are unstable molecules generated by sun exposure, stress and as part of the natural aging process. - They damage cells, DNA and collagen.
54
Q

What are some examples of antioxidants?

A

They include Se, Zn, Mn, vit C and E, as well as carotenoids (βcarotene, luthein and lycopene) and flavonoids

55
Q

What vitamins are associated with lowering risk of cardiovascular disease?

A

vitamins C and E (found in fruit and vegetables)

56
Q

What 2 less common factors have anti-atherogenic properties?

A
  1. Green tea due to catechin (natural oxidant)

2. Garlic due to allicin

57
Q

What benefits does allicin in garlic have?

A
  • reduces platelet aggregation
  • increases fibrinolysis
    -decreases plasma fibrinogen
    (effects on cholesterol still debatable)
58
Q

What type of fatty acids have shown to be very effective in reducing sudden death and non-fatal MI (when there are not enough lipid lowering mechanisms)?

A

n-3 PUFA (polyunsaturated fatty acid)

59
Q

What effect does omega 3 in reducing cardiac death?

A

90% reduction risk

60
Q

What effect does N3 LCPUFA (long chain polyunsaturated fatty acids) have on lipoprotein metabolism? (1)

A

fasting and post-prandial triglycerides

61
Q

What effect does N3 LCPUFA (long chain polyunsaturated fatty acids) have on smooth muscle cells? (1)

A

growth factors

62
Q

What effect does N3 LCPUFA (long chain polyunsaturated fatty acids) have on immune cells? (3)

A
  1. chemo-attractants
  2. pro-inflamamtory cytokines
  3. pro-inflammatory eicosanoids
63
Q

What effect does N3 LCPUFA (long chain polyunsaturated fatty acids) have on vascular endothelium? (6)

A
  1. growth factors
  2. chemoattractants
  3. pro-inflammatory cytokines
  4. pro-inflammatory eicosanoids
  5. blood pressure
  6. adhesion molecule expression
64
Q

What effect does N3 LCPUFA (long chain polyunsaturated fatty acids) have on platelets?(1)

A

thrombosis

65
Q

What effect does N3 LCPUFA (long chain polyunsaturated fatty acids) have on heart? (1)

A

arrhythmias

66
Q

Which food tend to have high levels of n-3 LCPUFA? (4)

A
  • mackerel
  • trout
  • salmon
    -cod
    (roast lamb, beef and chicken have smaller quantities)
67
Q

What effect do whole grain foods generally have on the heart?

A

generally protective (cardio-protective)

68
Q

What effect does Beta-glucan have in metabolism? (2)

A
  • decreases cholesterol/bile acid absorption

- increases cholesterol mobilisation

69
Q

Increased levels of what organic compound is linked to increased risk of cardiovascular disease?

A

TMA; trimethylamine (oxidised to trimethylamine oxide; TMAO)

70
Q

Which products lead to production of TMA which can increase risk of CV disease? (3)

A
  1. meat
  2. eggs
  3. cheese
    ( phosphatidylcholine changes to choline which produced TMA)
71
Q

What is the current recommendation in UK for wholegrain intake?

A
  • not very specific

- choosing wholegrain varieties of starchy food whenever people can

72
Q

What are 3 other components which are very important in good cardiovascular health?

A
  1. vitamin D
  2. carotenoids
  3. phytochemicals
73
Q

What polymorphism causes homozygous individuals to be more susceptible to dietary salt (NaCl) than those without?

A

A-6G polymorphism in the angiotensinogen gene

74
Q

How can dietary componenets alter body process which can lead to complications in the CV system?

A
  • alter DNA structure
  • alter gene expression and metabolism
  • affects disease development and progression
  • gene variation affects how nutrients are assimilated, metabolised, stored and excreted

2. Cardiovascular System (42 decks)

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