Cardio APM

Question 1

order of blood sugar/insulin labs becoming abnormal

Answer 1

1. 2 hour PP insulin
2. fasting insulin
3. 2 hour PP glucose
4. fasting glucose

Question 2

homocysteine lowering tx effective for…

Answer 2

primary prevention of CAD

Question 3

lab to assess vulnerable plaques

Answer 3

Lp-PLA2

Question 4

chronically elevated insulin stimulates which enzymes

Answer 4

HMGCoA reductase

via mevalonate pathway

Question 5

insulin’s effect on sex hormones

Answer 5

stimulates estrogen, androgens, progesterone

Question 6

Dx criteria for metabolic syndrome

Answer 6

3/5

increased weight circum (>35 women, >40 men)
TG >150
HDL <50 women, <40 men
BP >130/85 (or on meds)
elevated FBG

Question 7

biomarkers for dyslipidemia/atherosclerosis risk

Answer 7

LDL-P and LDL particle size/pattern
Apo B
Apo B:Apo A-1 ratio
Lp[a]
ApoE
Lp-PLA2
CAC
myeloperoxidase assoc with rupture prone plaques
BMI, WC
CBC w diff
homocysteine, GGT
vit B12, Mag, vit D25OH
CMP (esp AST, ALT)
microalbumin: creatinine ratio

Question 8

lifestyle and nutrition interventions for dyslipidemia/atherosclerosis

Answer 8

fiber – decrease sugar/cholesterol
no processed carbs
low fat – lowers LDL-P
MUFA

Question 9

this lowers LDL, TG and raises HDL

Answer 9

niacin

Question 10

this lowers LDL

Answer 10

RYR

Question 11

this downregulates NFKB

Answer 11

turmeric

Question 12

this lowers LDL

Answer 12

green tea (inhibits HMG CoA reductase and decreases absorption)

Question 13

decreases cholesterol absorption

Answer 13

plant sterols

Question 14

this decreases TC, LDL, APO-B, TG; increases HFL and APO-A1

Answer 14

pantethine

Question 15

this decreases PCSK9, lowers cholesterol

Answer 15

berberine

Question 16

these two supplements block PLA2

Answer 16

vitamin E and quercetin

Question 17

which 2 areas of Matrix does visceral adiposity effect

Answer 17

Defense and Repair (inflammation) and Communication (adipokines, hyperinsulinemia)

Question 18

TMAO assoc w

Answer 18

CVD, IR, CKD, ACS, obesity

Question 19

TG:HDL ratio >/= 3 indicative of

Answer 19

IR

Question 20

which LDL biomarker assoc with cardiometabolic risk

Answer 20

LDL-P

not LDL-C

Question 21

medical conditions outside CVD assoc with metabolic dysfunction

Answer 21

PCOS
osteoporosis
E2 dominant CAs
NAFLD
type 3 DM

Question 22

berberine MOA cardiometabolic

Answer 22

decreases inflammatory cytokines and chemokines, increase microbial diversity, increase SCFA producing bacteria

Question 23

Direct insulin sensitizers

Answer 23

vanadium, chromium, ALA, cinnamon, magnesium

Question 24

Indirect insulin sensitizers: microbiome/anti-inflamm

Answer 24

berberine, probiotics, omega 3s

Question 25

Indirect insulin sensitizers: antiox

Answer 25

NFkB inhibitors, omega 3s

Question 26

genetic SNPs with increased CVD risk

Answer 26

``` ApoE – produced in liver, macrophages, astrocytes, needed for clearance of chylomicrons and IDLs, principal cholesterol carrier in brain MTHFR, MTRR, COMT LDL-R (assoc with FH) ApoB PCSK9 ```

Question 27

ApoE 3 and 4 assoc with

Answer 27

higher cholesterol, increase CA-IMT | increased risk MCI, Alzheimer's, DMII, CHD

Question 28

ApoE 3 and 4 lifestyle recommendations

Answer 28

low fat low carb avoid alcohol, smoking

Question 29

stress and CVD

Answer 29

increases homocysteine, CRP, fibrinogen, deep ab fat vasoconstriction + increased platelet stickiness a fib Takotsubo cardiomyopathy precipitate/worsen CVD reduce HRV and resistance to infection MI (direct damage from norepi)

Question 30

biomarker of ox stress DNA

Answer 30

8OH deoxyguanosine

Question 31

biomarkers of ox stress - fats

Answer 31

lipid peroxides, oxidized LDL, isoprostane F2

Question 32

biomarkers of ox stress - sugars

Answer 32

A1c, AGEs

Question 33

biomarker of ox stress - protein

Answer 33

3 nitrotyrosine

Question 34

biomarker of ox stress - general

Answer 34

total antiox capacity | mincronutrient def

Question 35

risk markers for HTN

Answer 35

``` plasma renin activity and aldosterone asymmetric simethylarginine CIMT hsCRP uric acid Pb, Cd, As TMAO ```

Question 36

low renin HTN tx

Answer 36

volume drugs + nutraceuticals - CCBs, diuretics, spironolactone, alpha blockers

Question 37

high renin HTN tx

Answer 37

ACE, ARB, beta blockers

Question 38

endothelial dysfunction tx

Answer 38

sildenafil, flavonoids, cocoa

Question 39

general HTN tx

Answer 39

``` DASH, low sodium, lose VAT, exercise NAC + arginine taurine + magnesium alpha lipoic acid + acetyl L carnitine MBSR ```

Question 40

waking BP

Answer 40

controlled by sympathetic NS (so use txs that target sympathetic!)

Question 41

sleeping BP

Answer 41

controlled by RAAS (so used txs that target RAAS)

Question 42

ApoE

Answer 42

produced in liver, macrophages, CNS astrocytes required to clear chylomicrons and IDL principal cholesterol carrier in brain

Question 43

Low HRV indicates

Answer 43

high sympathetic and parasympathetic tone, increasing cardiac risk

Question 44

2 meds that deplete CoQ10

Answer 44

Statins and beta blockers