Cardiometabolic health

Question 1

What are the steps of Atheroscelrotic CVD?

Answer 1

Silent progression over decades (20y onwards usually)
↑ LDL
Foam cell formation, arterial streaks
Fibrous plaque formation: foam cell apoptosis, smooth muscle proliferation

Clinical events (MI, stroke) after 50y
Plaque growth
Plaque rupture, thrombosis

p5:
https://keats.kcl.ac.uk/pluginfile.php/6564695/mod_resource/content/0/Cadiometabolic%20Health%20-%20Dietary%20fat%20quality%20part%201.pdf

Question 2

Pathology of CVD?

Answer 2

2 main steps:
a) Atherosclerosis of large and medium arteries,
occurs silently over 20-30y

b) Thrombosis- rupture of the atherosclerotic plaque- MI Stroke

Prevention has to occur in atherosclerosis

p6

Question 3

Hypothesised effects of dietary fat on atherosclerotic CVD

Answer 3

Saturated and trans fatty acids ↑ LDLcholesterol.
• ↑ intakes of total fat may increase risk of
thrombosis.
• Long-chain omega-3 fatty acids may ↓ risk
of clinical events by decreasing cardiac

Question 4

Fun facts about Coronary Heart Disease (CHD)

/Ischemic Heart Disease (IHD)

Answer 4

• The major cause of premature death worldwide.
• Rates are ↑ in the economically developed countries and low among the rural population of developing countries.
• Transmigration studies: CHD is a lifestyle disease.
• ↑ age and male gender are major risk factors
• Elevated serum cholesterol carried by LDL is a causative factor of premature CHD.
• As heart attacks often occur without warning, it is important to focus lifestyle factors that help prevent CHD.

Question 5

Risk Factors for CHD

Answer 5

Cigarette smoking
Stress
Overweight
BP
Blood Cholesterol
 ↓ Exercise
DM
Heriditary

Question 6

Conclusions regarding dietary fatty acids and

fasting low density lipoprotein cholesterol (LDL-C)

Answer 6

• Replacing SFA with MUFA, PUFA or carbohydrate
lowers LDL-C by about 0.24 mmol/L for each 5%
dietary SFA replaced.
• Trans fatty acids have a similar effect on LDL-C to
SFA but are present in much lower amounts in the
diet (i.e. less than 2% vs. 12-15%).

aka former more imp than latter

Industrial trans fats have been absent from the UK food chain since about 1998.

Question 7

Lipid hypothesis and CHD

Answer 7

↑ dietary SF
         ↓ - ?? 
↑ blood cholesterol 
         ↓ - proven
↑ atherosclerosis
         ↓ - proven
↑ CHD

Other factors:
Weight gain
Ageing
Hormones
Genes 
Envi/social factors

Question 8

effect of reducing saturated fatty acids intake on LDL cholesterol?

Answer 8

• 1 mmol/L ↓ in LDL - 20% ↓ in risk of CVD events and
10% - CVD death
• Dietary advice to ↓ saturated fatty acid intake
results in ~ 0.3 mmol/L ↓ in LDL & risk reduction of nonfatal CVD -6%
Fatal CVD - 3%
• statins ↓ LDL by at least 1 mmol/L.

Question 9

Dietary Guidelines for Americans, 2015-20

Answer 9

1. Balance calories with physical activity to manage weight.
2. Consume more of certain foods and nutrients such as fruits,
   vegetables, whole grains, fat-free and low-fat dairy products,
   and seafood.
3. Consume fewer foods with sodium (salt), saturated fats, trans
   fats, added sugars, and refined grains.