Atherosclerosis

Question 1

Coronary Artery Disease (CAD) most common cause

Answer 1

Also known as coronary heart disease, most common cause of this disease is atherosclerosis

Question 2

Arteriosclerosis

Answer 2

Hardening of arteries

Question 3

Arteriolosclerosis

Answer 3

Hardening of small arteries (arterioles)

Question 4

Atherosclerosis

Answer 4

Specific type of arteriosclerosis due to buildup of plaques on arterial wall

Question 5

Atheromas

Answer 5

An abnormal accumulation of material in the inner layer of the wall of an artery (plaque)

Question 6

Components of blood vessels

Answer 6

Arteries
Capillaries
Veins

Question 7

Blood vessel structure (each layer)

Answer 7

Lumen: open space where blood flows
Tunica intima (inner layer): lined by endothelium, subendothelial layer
Tunica media (middle layer): smooth muscle, elastin
Tunica adventitious (outer layer): connective tissue

Question 8

Atherosclerosis characterization

Answer 8

Deposit of cholesterol and lipids primarily within intimacy wall of artery
Endothelial lining altered result of inflammation and injury to blood vessel wall

Question 9

How does atherosclerosis occur? (Pathogenesis)

Answer 9

Injury to endothelium
Accumulation of lipoproteins
Monocyte adhesion to endothelium
Platelet adhesion
Smooth muscle cell proliferation
Lipid accumulation 
*Inflammation
-C-reactive protein (CRP) is marker of inflamm., associated with unstable plaques and oxidation of LDL cholesterol (bad cholesterol)

Question 10

Clinical outcome of atherosclerosis (what can it lead to?)

Answer 10

Can lead to rupture of blood vessel(aneurysm)
Build-up (thrombus) increases risk of blood clots which can break off and travel thru body which can lead to a stroke
Complete stoppage of blood flow (critical stenosis)

Question 11

Signs, symptoms and complications of atherosclerosis: coronary arteries

Answer 11

Angina, SOB, arrhythmias, MI (stroke)

Question 12

Signs, symptoms and complications of atherosclerosis: carotid arteries

Answer 12

Sudden weakness, paralysis, confusion, stroke symptoms

Question 13

Signs, symptoms and complications of atherosclerosis: peripheral arteries

Answer 13

Numbness, pain, infections

Question 14

Signs, symptoms and complications of atherosclerosis: renal arteries

Answer 14

Fatigue, loss of appetite, nausea, edema, itching

Question 15

Is heart disease the leading cause of death for men and women and of most races/ethnic groups in US?

Answer 15

Yes

Question 16

Is CAD the most common type of heart disease?

Answer 16

Yes

Question 17

Risk factors for cardiovascular disease (modifiable)

Answer 17

Lifestyle
Diet
Cigarette smoking
Hyperlipidemia 
Hypertension
Diabetes

Question 18

Risk factors for cardiovascular disease (unmodifiable)

Answer 18

Genetics
Age
Gender
Family history

Question 19

Additional Risk factors for cardiovascular disease

Answer 19

Inflammation: key marker for inflamm. Is C-reactive protein (CRP)
Hyperhomocystinemia: high homocysteine levels correlated with inc. risk of CV disease
Metabolic syndrome: obesity, insulin resistance
Lipoprotein a: inc. levels = inc CAD and CVD (type of LDL)

Question 20

Framingham Study

Answer 20

Helped identify risk factors and importance of healthy diet, reg exercise and risks of obesity, smoking, age, blood pressure, cholesterol levels, diabetes
First identified risks of LDL cholesterol and benefits of HDL cholesterol

Question 21

Hyperlipidemia

Answer 21

Major risk factor for atherosclerosis
LDL is major component assoc. w/ inc risk
Higher HDL reduces risk

Question 22

Optimal levels for lipid values

Answer 22

Total cholesterol <200mg/dl
LDL ch <100mg/dl
HDL >60mg/dl
Triglycerides <150mg/dl

Question 23

Pharmacotherapy for heart disease

Answer 23

Statins- HMG CoA reductase inhibitors
Fibrates- lower triglycerides and raise HDL (not common, add on therapy)
PCSK9 inhibitors- proprotein converstase subtilisin kexin 9 inhibitors
Ezetimibe- dec absorption of cholesterol in small intestine
Bile acid sequestrants- inhibit enterohepatic reuptake of intestinal bile salts which inc fecal loss of LDL

Question 24

Factors statins would benefit

Answer 24

Secondary ASCVD prevention
Severe hypercholesterolemia
Adults 40-75 with diabetes and higher LDL