CAD Flashcards
CAD
coronary artery disease: specific to what’s goin on in the arteries in the heart
most common form of CV disease
type of atherosclerosis
chronic and progressive
fat deposits in intima of the coronary artery, endothelial injury, inflammation, plaque formation, clot formation
What is cholesterol?
naturally occurring waxy substance made of proteins and lipids; needed to form cell walls, hormones, Vitamin D, bile
made in the liver; broken down in the liver
needed in right amounts and proportions
LDL
Low density lipids
transport cholesterol to artery wall
contain more cholesterol than any other lipoprotein
want low amounts of these
HDL
High density lipids
remove cholesterol from blood and take to liver where it is broken down
want high amounts of these
VLDL
Very low density lipids
contain more triglycerides and can deposit directly on the wall of the arteries
Triglycerides
most common type of fat in the blood
store excess energy for diet, best way to get rid of these is through diet and exercise
Guidelines for Cholesterol Levels
used to assess risk for developing CAD/CHD (through fasting blood work)
Total cholesterol: <200 mg/dL
HDL: >40 mg/dL
Triglycerides: <150 mg/dL
LDL (treat to specific target goals):
- no risk factors: low <130mg/dL
- 2 or less risk factors: <100 mg/dL
- high risk: < 70 mg/dL
Cholesterol Meds
Bile Acid Sequestrants: increase cholesterol conversion to bile acid which is excreted in feces; lowers LDL (ex. cholestryamin, colestipol, colesevelam)
Cholesterol Absorption Inhibitor: inhibits absorption along intestinal wall from bringing it into the body (ex. ezetimibe)
Niacin: lowers cholesterol and triglyceride levels by inhibiting synthesis; also increase the HDL levels; controversial drug w/ terrible SE - N/V (ex. niaspan)
Fibric Acid Derivatives: decrease the making and secretion of VLDL which will reduce triglycerides; also increase HDL (ex. fenofibrate, gemfibrozil)
HMG Coa Reductase Inhibitors - Statins: reduce synthesis of cholesterol in liver by blocking the key enzyme in its synthesis of cholesterol (HMG Coa); also increases LDL receptor activity in liver cells
- statins are most common type of cholesterol med prescribed
- pt’s need to report muscle pain as CoA plays role in muscle cell energy production (can take CoQ10 supplement from store to help)
Natural Products that Manage Cholesterol
Red yeast
Rice
Soy
Omega 3 fatty acids
Overall Goal of Cholesterol Meds
decrease LDL
decrease triglycerides
increase HDL’s
CAD: Men vs. Women
Highest incidence in middle age men
but higher mortality in women (especially african american females)
CAD: Risk Factors
HTN Hyperlipidemia PMHx and FHx of CV disease Smoking Sedentary Lifestyle Obesity (central/apple shaped) DM Metabolic Syndrome Substance Abuse
CAD: Gerontologic Considerations
Leading cause of death of older folks
More likely to make lifestyle changes if they’ve been hospitalized or have had sx associated with CAD
PMHx and FHx
Hx of: MI unstable angina CAD PVD AAA Carotid stenosis TIA CVA HTN FHx: Premature heart disease -male: first degree relative <55 -female: first degree relative <65
Diet for CAD
low fat
low cholesterol
increased fiber
