2.5 Primary and Secondary Prevention of Atherosclerosis

Question 1

List some modifiable risk factors for atherosclerosis

Answer 1

• Physical Activity
• Smoking
• Stress
• Hyperlipidemia
• Hypercholesterolemia
• Alcohol intake
• Hyperglycaemia

Question 2

List some non-modifiable risk factors for atherosclerosis

Answer 2

• Gender
• Age
• Ethnicity
• Genetics

Question 3

Stenosis vs occlusion

Answer 3

Stenosis: Narrowing
Occlusion: Blockage (such as in STEMI)

Question 4

True or false: atherosclerosis tends to start relatively late in life

Answer 4

• False
• Atherosclerosis can start earlier than we may think, sometimes in people younger than 20 years old (!)

Question 5

What percentage of CVD risk factors are preventable?

Answer 5

90% (!!!!)

Question 6

List some secondary preventative measures for cardiovascular disease (medications)

Answer 6

• ACE inhibitor
• Antiplatelet (aspirin + ticagrelor)
• Beta blocker
• High-strength statin

Question 7

List some secondary preventative measures for cardiovascular disease (non-pharmacological)

Answer 7

• Increase exercise
• Decrease stress
• Smoking cessation
• Improve diet
• Decrease salt consumption
• Educate patients on risk factors

Question 8

Hyperlipidemia vs hypercholesterolemia

Answer 8

• Hypercholesterolemia is a type of hyperlipiedmia
• However, hyperlipidemia can also be used for any raise in lipids (such as hypertriglyceridemia)

Question 9

Role of HDL in cholesterol transport

Answer 9

• Carries cholesterol back to the liver
• Cholesterol can then be broken down or excreted

Question 10

Role of LDL in cholesterol transport

Answer 10

• Carries cholesterol to cells
• If there’s too much cholesterol, it can build up in the arteries, leading to atherosclerosis

Question 11

When we eat food, what does our body convert the calories that we don’t need into?

Answer 11

It converts them into triglycerides

Question 12

What does total cholesterol represent?

Answer 12

HDL + LDL + 20% of TAG

Question 13

What are apolipoproteins? What is the most atherogenic form of apolipoprotein, and where is it most commonly found?

Answer 13

• Apolipoproteins are the main proteins that make up lipoproteins
• Most commonly found in LDL cholesterol
• Most atherogenic is Apolipoprotein B

Question 14

What is the relationship between LDLC and Cardiovascular risk? What is the lower bound of this relationship?

Answer 14

• Lower LDLC, lower cardiovascular risk
• There is no evidence of lower bound (or harm) for low levels

Question 15

Lifestyle ways to lower LDLC

Answer 15

• Diet
• Exercise
• Stop smoking
• Cardiac rehab

Question 16

Pharmacological ways to lower LDLC

Answer 16

• Statin
• Non-statin lipid therapy

Question 17

Per 1mmol/L reduction in LDL cholesterol, a person’s risk of cardiac death, MI, or stroke lowers by…

Answer 17

22%

Question 18

Acceptable LDL range

Answer 18

<1.8mmol/L

Question 19

Acceptable HDL range

Answer 19

> 1mmol/L

Question 20

Acceptable TG range

Answer 20

<2.0mmol/L

Question 21

What are the two most common statins used in Australia?

Answer 21

Rosuvastatin and atorvastatin

Question 22

How do statins increase LDL removal?

Answer 22

• Increase hepatic LDL receptors
• Increase removal of LDL from bloodstream

Question 23

What types of fats are associated with higher LDLC and Triglycerides?

Answer 23

• Saturated fat
• Trans fat

Question 24

Which foods are linked to high HDL cholesterol?

Answer 24

• Monounsaturated fats (e.g. olive oil)
• Omega 3 and EPA

Question 25

What types of fats/oils are mostly saturated?

Answer 25

- Animal fats - Coconut oil - Palm oil

Question 26

What types of fats/oils are monounsaturated?

Answer 26

- Olive - Canola - Peanut

Question 27

What types of fats/oils are polyunsaturated?

Answer 27

Vegetable and seed oils

Question 28

Why might it be that cooked vegetables do not reduce risk of cardiovascular disease, but raw vegetables do?

Answer 28

- Cooking increases salt and fat content - Cooking decreases some micronutrients such as vitamin C

Question 29

How can an increase in fibre decrease CVD risk?

Answer 29

- Bile salts produced by liver, usually used to emulsify fats and then reabsorbed. - However, soluble fibre binds to bile salts, increasing excretion of bile salts and thus prompting the liver to make more bile salts from cholesterol - As such, LDL decreases - Therefore, CVD risk decreases

Question 30

How do sterol and stanol fortification decrease cholesterol

Answer 30

Similar structure to cholesterol, competes with cholesterol for absorption.

Question 31

Alcohol standards limit

Answer 31

No more than 10 per week No more than 4 per day

Question 32

Why is it not the case that red wine is good for lowering lipids in a practical sense?

Answer 32

- Resveratrol has shown to decrease lipid in rodent studies - However, to get the same effects, you would need to consume up to 1000 glasses of red wine

Question 33

Summarise the mediterranean diet

Answer 33

- High in fruit, veg, whole grains, nuts, and seeds - Moderate fish and seafood - Slightly less dairy, eggs and poultry - Very little sweets and meats

Question 34

How does pasture grazing influence omega 3 of meat and dairy?

Answer 34

Higher in omega 3

Question 35

List five lifestyle modifications that reduce blood pressure

Answer 35

- Weight reduction - DASH eating plan - Physical activity - Sodium restriction - Moderating alcohol consumption

Question 36

What is the maximum recommended amount of sodium per 100g that we should aim for?

Answer 36

<400mg

Question 37

How much sodium in "low salt" products?

Answer 37

<120mg/100g