Cardiology Flashcards
What is the order of abnormal blood sugar lab progression?
- postprandial insulin
- fasting insulin
- two hour postprandial glucose
- fasting glucose
How does elevated insulin increase dyslipidemia?
HMG CoA reeducates synthesizes cholesterol via the mevalonate pathway. insulin and leptin stimulate this enzyme.
What is the rate limiting step of cholesterol production and what suppresses it?
HMG COA reductase, suppressed by internalization of LDL
What is the rate limiting step of cholesterol production and what stimulates it?
HMG COA reductase, Insulin and leptin
what is true regarding folate, hyperhomocysteinemia, and coronary artery disease?
lowering homocysteine is primary prevention
BMI 29, elevated waist circumference, and a normal waist to hip ratio, with normal bioelectrical impedance
increased muscle mass
what TG/HDL ratio is considered insulin resistance?
> 3
what waist/hip ratio is considered high?
Men >1
What are direct nutraceutical insulin sensitizers?
cinnamon, vanadium, ALA, chromium, magnesium
What are indirect insulin sensitizers?
microbiome influencing such as berberine, probiotics, inflammation targeting such as omega 3s or antiox/NFkB inhibitors
insulin resistance increases risk factor for what gyn cancer?
endometrial cancer
29-yo Female with metabolic syndrome and elevated insulin what would you expect the influence to be on sex hormones?
Increase estrogen and androgens
What test is most useful to assess vulnerable plaque?
Lp-PLA2
what is the marker associated with animal fat consumption?
F2 isoprostanes
Which statement is correct regarding heart rate variability (HRV)?
Decreased HRV indicates high sympathetic and parasympathetic tone, increasing cardiac risk
Which IFM food plan would be most indicated for a patient with sleep apnea, elevated blood pressure, elevated HbA1c, and peripheral neuropathy?
Cardiometabolic Food Plan
Elevation of which lipoprotein significantly increases the risk of heart disease?
Apolipoprotein‐B
Which of the following statements accurately describes the relationship between inflammation and the generation of interleukin‐6 (IL‐6) during exercise?
The more muscle used, the greater the release of the anti‐inflammatory myokine IL‐6.
Which pharmacologic interventions are most likely to deplete CoQ10?
Statins and beta‐blockers
Niacin should be used with caution in which group of patients?
Patients with diabetes mellitus type 2.
Which of the following is most likely to stimulate NF‐kappaB production?
Lipopolysaccharides
Which of the following is correct regarding the relationship between leptin and obesity?
Obese patients likely have elevated leptin.
what is the proposed mechanism of berberine?
increasing insulin receptor expression, microbiome effects
which of the following effects of hyperinsulinemia is the most relevant to cardiometabolic risk?
increasing hsCRP - it is pro-inflammatory
relevance of genetic markers of CVD?
MTHFR (homocysteine, cofactors riboflavin and niacin), ApoE (diet), familial hypercholesterolemia (treat)
what food groups should be emphasized in patients with HTN?
(Cardiometabolic food plan emphasis) lycopene, arginine, dietary fiber. NOT on this list if sulfur/brassicas which are on the detox food plan instead. condition specific phytonutrients. review food plan wheels.
what are foods to include in HTN?
soy, whey, legumes (plant fiber), cold water fish (EFA), L-arginine containing (nitric. oxide), cocoa, lycopene (antioxidant)
What is the relationship between heart rate variability and sympathetic tone?
inverse: high HRV, low tone, low risk
low HRV, high tone, high risk
what are the HR exercise intensity cut offs?
low 50-63% mod 64-76% high 77-93% (max 220 - age)
what are the recommended dietary changes for ApoE3 and ApoE4?
low fat, low alcohol, fish oil
Your 25‐year‐old college‐aged patient tells you his dad just had a heart attack at the age of 48. Your patient is known to carry homozygous ApoE 4/4 mutation. Accurate advice about his lifestyle includes:
Encouraging avoidance of alcohol and implementing a low‐fat diet plan to improve lipid profile and reduce cardiovascular risk.
Your 47‐year‐old patient asks how you know she is heading toward insulin resistance (prediabetes) simply by looking at her advanced lipid profile, even though her fasting glucose levels are only 85 mg/dl. Her results would most likely look like:
Normal LDL‐C, elevated LDL‐particle #, low HDL2b, elevated large‐sized VLDL.
In discussing dipping vs. non‐dipping nocturnal blood pressure concerns with your 50‐year‐old female school teacher patient with stage 1 hypertension, you explain:
Patients classified as non‐dippers are at an increased risk for multiple forms of cardiovascular disease
Your patient is a 62‐year‐old female with tender lumps on the distal interphalangeal joints of her fingers. On examination, you note that she has seborrheic dermatitis around her scalp. Which of the following nutrient deficiencies might explain these findings?
Vitamin B6
On which of the following biomarkers does insulin resistance have a direct effect?
It increases small, dense LDL particles
Which of the following is the most useful marker in assessing levels of oxidative damage to DNA?
8-hydroxydeoxyguanosine
What biomarker is associated with rupture-prone plaque?
Myeloperoxidase
Which of the following would be most effective in reducing risk of cardiovascular disease
Reducing oxidized LDL and high sensitivity C-reactive protein (hs-CRP)
A 56-year-old male presents to your office with a five-year history of diabetes. He has recently had a hemoglobin A1c, which was elevated at 8.2. He reports tingling in both feet and on physical exam shows a loss of vibratory sensation in his toes. What supplemental nutritional intervention would you suggest?
High dose lipoic acid and methylcobalamin
What aspects of exercise should an “exercise prescription” address?
Frequency, duration, and intensity
The following is true regarding HMG-CoA reductase:
It is stimulated by leptin and insulin and suppressed by internalization of LDL.
Which of the following nutrient combinations would be most helpful to support endothelial function in a patient with atrial fibrillation?
CoQ10 and taurine
Which of the following dietary recommendations is associated with decreased LDL, increased HDL, and decreased triglycerides?
Mediterranean diet
