2.5 Primary and Secondary Prevention of Atherosclerosis Flashcards
List some modifiable risk factors for atherosclerosis
- Physical Activity
- Smoking
- Stress
- Hyperlipidemia
- Hypercholesterolemia
- Alcohol intake
- Hyperglycaemia
List some non-modifiable risk factors for atherosclerosis
- Gender
- Age
- Ethnicity
- Genetics
Stenosis vs occlusion
Stenosis: Narrowing
Occlusion: Blockage (such as in STEMI)
True or false: atherosclerosis tends to start relatively late in life
- False
- Atherosclerosis can start earlier than we may think, sometimes in people younger than 20 years old (!)
What percentage of CVD risk factors are preventable?
90% (!!!!)
List some secondary preventative measures for cardiovascular disease (medications)
- ACE inhibitor
- Antiplatelet (aspirin + ticagrelor)
- Beta blocker
- High-strength statin
List some secondary preventative measures for cardiovascular disease (non-pharmacological)
- Increase exercise
- Decrease stress
- Smoking cessation
- Improve diet
- Decrease salt consumption
- Educate patients on risk factors
Hyperlipidemia vs hypercholesterolemia
- Hypercholesterolemia is a type of hyperlipiedmia
- However, hyperlipidemia can also be used for any raise in lipids (such as hypertriglyceridemia)
Role of HDL in cholesterol transport
- Carries cholesterol back to the liver
- Cholesterol can then be broken down or excreted
Role of LDL in cholesterol transport
- Carries cholesterol to cells
- If there’s too much cholesterol, it can build up in the arteries, leading to atherosclerosis
When we eat food, what does our body convert the calories that we don’t need into?
It converts them into triglycerides
What does total cholesterol represent?
HDL + LDL + 20% of TAG
What are apolipoproteins? What is the most atherogenic form of apolipoprotein, and where is it most commonly found?
- Apolipoproteins are the main proteins that make up lipoproteins
- Most commonly found in LDL cholesterol
- Most atherogenic is Apolipoprotein B
What is the relationship between LDLC and Cardiovascular risk? What is the lower bound of this relationship?
- Lower LDLC, lower cardiovascular risk
- There is no evidence of lower bound (or harm) for low levels
Lifestyle ways to lower LDLC
- Diet
- Exercise
- Stop smoking
- Cardiac rehab
Pharmacological ways to lower LDLC
- Statin
- Non-statin lipid therapy
Per 1mmol/L reduction in LDL cholesterol, a person’s risk of cardiac death, MI, or stroke lowers by…
22%
Acceptable LDL range
<1.8mmol/L
Acceptable HDL range
> 1mmol/L
Acceptable TG range
<2.0mmol/L
What are the two most common statins used in Australia?
Rosuvastatin and atorvastatin
How do statins increase LDL removal?
- Increase hepatic LDL receptors
- Increase removal of LDL from bloodstream
What types of fats are associated with higher LDLC and Triglycerides?
- Saturated fat
- Trans fat
Which foods are linked to high HDL cholesterol?
- Monounsaturated fats (e.g. olive oil)
- Omega 3 and EPA
What types of fats/oils are mostly saturated?
- Animal fats
- Coconut oil
- Palm oil
What types of fats/oils are monounsaturated?
- Olive
- Canola
- Peanut
What types of fats/oils are polyunsaturated?
Vegetable and seed oils
Why might it be that cooked vegetables do not reduce risk of cardiovascular disease, but raw vegetables do?
- Cooking increases salt and fat content
- Cooking decreases some micronutrients such as vitamin C
How can an increase in fibre decrease CVD risk?
- 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
How do sterol and stanol fortification decrease cholesterol
Similar structure to cholesterol, competes with cholesterol for absorption.
Alcohol standards limit
No more than 10 per week
No more than 4 per day
Why is it not the case that red wine is good for lowering lipids in a practical sense?
- 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
Summarise the mediterranean diet
- High in fruit, veg, whole grains, nuts, and seeds
- Moderate fish and seafood
- Slightly less dairy, eggs and poultry
- Very little sweets and meats
How does pasture grazing influence omega 3 of meat and dairy?
Higher in omega 3
List five lifestyle modifications that reduce blood pressure
- Weight reduction
- DASH eating plan
- Physical activity
- Sodium restriction
- Moderating alcohol consumption
What is the maximum recommended amount of sodium per 100g that we should aim for?
<400mg
How much sodium in “low salt” products?
<120mg/100g
