Block 3 - Lecture 1 Notes Flashcards
Traditional risk factors for cardiovascular disease
- dyslipidemia
- obesity
- hypertension
- smoking
- diabetes
Clinical conditions that are additional risks for cardiovascular disease
- Insulin resistance
- Hyperinsulinemia
- Glucose intolerance
Clustering conditions or risk factors that put individuals at risk for CVD and Type II
Raised blood pressure
Dyslipidemia
Raised fasting glucose
Central obesity
Metabolic syndrome
Condition in humans where there is clustering of specific pathologies that represent increased CVD.
Other names for metabolic syndrome
Syndrome X
Insulin resistance syndrome
Cardio Metabolic syndrome (CMS)
Prevalence of metabolic syndrome
Over 40% over adults over 50
Adipocyte dysfunction
Dysregulation of adipokine secretion
Accelerate atherosclerosis
Increased cardiovascular morbidity and mortality
Endothelial dysfunction
Dysregulation of microcirculatory responses
Renal dysfunction
Micro or macro albuminuria
Hepatic steatosis
Elevated lipid storage
Inflammation
Increased inflammatory markers such as C-reactive Proteins (CRP)
Hypercoagulability
Increased fibrinogen and plasminogen activator inhibitor-1
Visceral obesity
Increase in visceral or abdominal adipose tissue
Assessment of overall weight or obesity
Body-mass index (BMI)
BMI equation
Kg/M^2
Normal BMI
18.5-24.9
Overweight BMI
25.0-29.9
Obese BMI
30.0 - 39.99
Extreme Obesity BMI
Greater than 40.0
Ways to assess visceral obesity
Waist circumference and MRI
M Value
Measurement of insulin sensitivity
Insulin resistance
The state in which normal or elevated circulating insulin levels don’t elicit the expected biological response in organism or tissue
Primary organ of insulin resistance
Skeletal muscle
Other major organs of insulin resistance
Liver and adipose tissue
What is an early defect in the development of metabolic syndrome
Insulin resistance
When do we refer to someone as pre-diabetic?
When individuals who are insulin resistant but do not yet show symptoms of hyperglycemia
Hyperinsulinemia
Condition in which an increase in insulin secretion is brought about in order to compensate for established insulin-resistant state and keep blood glucose close to normal
Abnormal response to oral glucose tolerance test
Glucose intolerance
Oral glucose tolerance test
Ingestion of 75 g of glucose and assessment of the blood glucose levels over the next 2-3 hours.
Glucose intolerance
Glucose levels increase to high levels and remain high for longer than normal
The development of glucose intolerance is closely associate with…
the development of insulin resistance
Dyslipidemia is traditionally composed of…
- Excess plasma triglycerides and FFA (fasting and PP)
- Decreased HDL and PHLA
- Increased LDL
Post-prandial
After a meal
PHLA
Post-heparin lipolytic activity –> decreased ability to catabolize lipids in response to heparin
Essential hypertension
Elevation in both systolic BP and diastolic BP (> 135 mm Hg / > 90 mm Hg)
Insulin resistance and compensatory hyperinsulinemia of metabolic syndrome may cause…
- Increased central sympathetic outflow
- Peripheral vasoconstriction
- Renal retention of Na and water
- Increased blood volume and total peripheral resistance (hypertension)
How does hyperinsulinemia result in hypertension.
Insulin resistance –> hyperinsulinemia –> increased SNS activity / increased Na and water retention –> hypertension
