Cardiovascular Disease Flashcards
Define Cardiovascular Disease?
An umbrella term for all the diseases of the heart and circulation, including CHD, angina, heart attack, stroke and congenital heart disease.
-Other types of CVD include heart valve disease and cardiomyopathy (disease of the heart muscle)
What may cause Coronary Heart Disease and Stroke
Atherosclerosis- When your arteries become narrowed by a gradual build-up of fatty material (atheroma) within walls.
Stenosis
Reduced blood flow- a narrowing of the lumen that disturbs blood flow.
How does atheroma build up?
Fatty deposits cause a narrowing and restrict the flow of blood through the artery.
-Less surface area for the blood to flow through- heart has to work harder to pump.
-In time, arteries become so narrow that they cannot deliver enough oxygen-rick blood to the heart- ANGINA- pain or discomfort in your chest.
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How does a heart attack occur?
-A piece of atheroma breaks away from the arteries- causes a BLOOD CLOT.
-If the blood clot blocks the Coronary artery and cuts off the supply of oxygen-rich blood to the heart muscle.
-The heart muscle may become permanently damaged- HEART ATTACK.
How does a stroke occur?
When a blood clot blocks an artery that carries blood to the brain, it can cut off the blood supply to part of the brain.
Facts about Atherosclerosis
When arteries become narrowed by a gradual build-up of fatty material (atheroma)
-Can cause CHD (angina and heart attack) and stroke.
-Doesn’t have any symptoms at the start-many unaware they have it-can eventually cause life-threatening problems, eg heart attack and stroke.
-Is largely preventable with a healthy lifestyle.
-If left to get worse- can lead to serious conditions, such as CVD (no symptoms until CVD develops)
What are the types of CVD?
-CORONARY HEART DISEASE- Main arteries that supply the heart (coronary arteries) become clogged with plaque/atheroma.
-ANGINA- short periods of tight, dull/ heavy chest pain caused by CHD- may precede to a heart attack.
-HEART ATTACK (myocardial infaction)- Blood supply to the heart is blocked- causes sudden crushing/indigestion-like chest pain- can radiate to nearby areas, as well as shortness of breath, dizziness.
-STROKE- blood supply to brain is interupted- causes face to drop to one side, weakness on one side of body and slurred speech.
-TRANSIENT ISCHAEMIC ATTACKS (TIAs)- mini stroke- temporary stroke symptoms
-PERIPHERAL ARTERIAL DISEASE- blood supply to legs is blocked- causes leg pain when walking- lead to blood clot in legs.
What are the Non-Modifiable Risk Factors (can’t change/control)
-Genetics
-Gender
-Age
-Socio-economic status
-Ethnicity
-Low birth weight
Explain the Non-Modifiable Risk Factors?
GENETICS
GENETICS (Family History)-
-Family History of CVD indicates a person’s risk.
-First-degree blood relative (mother, father, brother) has had Coronary Heart Disease/ stroke before 55 years (male) or 65 (female)- risk increases.
GENDER
Man is at greater risk of heart disease than a pre-menopausal woman
-Once past menopause- woman’s risk is similar to male
-Risk of stroke- similar in men and woman
Progesterone and Oestrogen levels in woman (pre-menopausal) play a protective role in heart disease/health
AGE
-CVD becomes increasingly common with age.- as person ages, heart undergoes subtle physiologic changes, even in absence of disease.
-Heart muscle of aged heart relax between beats- results in pumping chambers becoming stiffer and work less efficiently.
-When CVD affects heart, age-related changes can compound (worsen) or its treatment.
-Don’t engage in as much physical activity
-Important to do physical activity when younger- strengthens heart-keeps heart powerful for then aging.
SOCIO-ECONOMIC STATUS
-Research shows- those from a low socio-economic background have a 50% greater chance of developing CVD than the wealthy, better educated counterparts.
-Due to less knowledge + understanding of risk factors involved in development-
-less money to purchase fresh fruit and vegetables and low fat products
-less money to be involved in physical activity, eg join a gym/sports club
-May be less sociable due to a job- lead to stress/depression-turn to smoking/alcohol as a coping mechanism
-Housing-dust/dampness- breathing in
-Less educated- not know abt importance of physical activity
ETHNICITY
-Ethnic Backgrounds, eg South Asians- live in UK- twice as likely to develop CHD compared to rest of UK population-
-Indian/Chinese- their diet- high fat (frying)- body composition (naturally more apple shaped in comparison to pear shaped)- bigger waist circumference- visceral fat.
-Those from African Caribbean background- higher average risk of developing hypertension.
LOW BIRTH WEIGHT
-Low birth weight- increase inflammatory processes- CVD in adulthood
-Inflammation- normal physiologic response of body- provides a protective response to infection/ tissue injury.
If the infection/injury is not repressed, low grade inflammation can persist + may promote development of heart disease in later life.
-Born with congenital conditions (neural tube defects, down syndrome)- continue in later life.
-MODIFIABLE RISK FACTORS -SMOKING
Smokers- twice as likely to suffer heart attack
-Experience shortness of breath + increased heart rate- carboxyhaemoglobin
-Damages lining of artery-lead to build up of atheroma- narrows artery-cause angina/heart attack/stroke
-Carbon Monoxide in TOBACCO- reduces amount of oxygen in blood- heart pumps harder to supply body with oxygen
-ALSO, attaches to haemoglobin- tissues starved of oxygenated blood-suffocate + die
-NICOTINE- stimulates body to produce adrenaline- heart beats faster + raise blood pressure- make heart work faster
-Blood likely to clot- increases risk of heart attack/stroke
-ACROLEIN- causes increased blood cholesterol levels- affects way body processes cholesterol- greater amount stays in blood- decreases ratio of HDL to LDL- atherosclerosis
PHYSICAL ACTIVITY
-Adult- 150m- moderate intensity per week
1hr vigorous activity per week
- STUDIES show this reduces risk of CVD by 30%
-Small increases in physical fitness- associated with significant reduction in CVD
-Regulates weight- overweight increases risk
-Active- beneficial- lowers blood pressure- risk factor for CVD
-Exercise- regulates blood glucose levels- risk factor- lowers LDL(leads to heart disease) + raises HDL (protects against heart disease)
-Reduces inflammation- powerful factor in development
-More difficult for blood clots- cause blockage in coronary arteries
-Releases endorphins (feel good hormone)- reduces stress- risk factor
-strengthens heart muscle
FRUIT AND VEGETABLE INTAKE
-Naturally contain antioxidants- fight against free radicals- cause CVD.
-Eg, Vit A (beta-carotene), C+E- offer protection against CVD-prevent free radicals from damaging arteries+cells that repair damage-if arteries damaged- atheroma likely to build up
-Contain:
-Folate- along with vitamin B6 + B12- help to make enzymes- remove amino acid homocysteine- damages artery lining- cause atheroma build up
-Mag, Pottassium + Calcium- lower blood pressure-CVD risk factor
-Calcium- reduce CVD- fatty acids in bowel attach to unabsorbed calcium- leave body in faeces
-Dietary Fibre- not eating 30g-factor
-Soluble fibre- reduce total LDL- reduce risk of CVD
-NSP- improves satiety- less likely to snack on HFSS foods- reduces obesity-factor
-naturally low in saturated fat + calories
EXCESSIVE ALCOHOL INTAKE
-Men + women- no more than 14 units per week.
-Drinking can increase risk of CVD:
-Increases risk of hypertension- important risk factor for heart attack/stroke.Increased blood pressure also caused by weight gain from excessive drinking
-Heavy drinking- weakens heart muscle-heart can’t pump blood as efficiently- CARDIOMYOPATHY- cause premature death- through heart failure
-Increases TRIGLYCERIDES + VLDL (very low density lipoprotein)- cause sudden heart attack+death (VDL=BAD)
HIGH BLOOD CHOLESTEROL
-Fatty substance found in blood- too much can increase risk of CVD:
-fatty substance carried around body by proteins:
Cholesterol + Protein combined- LIPOPROTEINS-2 types:
-LOW DENSITY LIPOPROTEIN- BAD- carry cholesterol from liver to cells that need it
-HIGH DENSITY LIPOPROTEIN- GOOD- carry cholesterol away from cells to liver to be broken down
-Too much LDL in blood- cause fatty material to build up in artery walls
HIGH RISK= high levels of BAD + low levels of GOOD
measured in millimols per litre (mmol/l) aim for total cholesterol under 5mmol/l
aim for LDL under 3mmol/l + HDL above 1mmol/l
-Cholesterol level- determined by amount body produces + type of fat eaten
TRIGLYCERIDES
-Type of fat found in blood
-When you eat- any calories not used immediately- converted to triglycerides
-Triglycerides stored in fat cells- later hormone release triglycerides for energy between meals- if you eat regularly more than you burn, eg “easy” calories- carbs and fats- high triglycerides- HYPERTRIGLYCERIDEMIA
-Unclear how- high triglycerides contribute to hardening of arteries/thickening of artery walls- ATHEROSCLEROSIS- increases risk of stroke, heart attack + heart disease
-HIGH TRIGLYCERIDES- sign of other conditions that increase risk of heart disease + stroke-inc. obesity + metabolic syndrome- cluster of conditions that includes too much fat around waist, hypertension, high triglycerides, high blood sugar + abnormal cholesterol levels
HOW TO LOWER TRIGLYCERIDES
-LOSE WEIGHT- If overweight, losing 5-10pounds can lower triglycerides
-CUT BACK ON CALORIES- Extra calories converted to TRIGLYCERIDES-stored as fat
-AVOIMD SUGARY + REFINED FOODS- simple carbs- eg. sugar + foods made with white flour- increase triglycerides
-CHOOSE HEALTHIER FATS- Swap SATURATED FAT- found in meats for healthier MONOSACCHARIDES- found in plants- eg olive + peanut oils.
Substitute fish- high in OMEGA-3 fatty acids, eg mackerel+salmon- for red meat
LIMIT ALCOHOL CONSUMPTION- alcohol- high in CALORIES + sugar + potent effect on TRIGLYCERIDES- small amounts can raise TRIGLYCERIDES
-EXERCISE REGULARLY- lower TRIGLYCERIDES and boost GOOD (HDL) cholesterol
TOTAL FAT
Contribution to dietary energy should be reduced to 35%- effect of dietary fats on blood cholesterol + triglyceride levels- influences risk of CVD
SATURATED FATS
Contribution of saturated fats to dietary energy- reduced to 10% because:
-Increases TOTAL BLOOD CHOLESTEROL= ATHEROSCLEROSIS
-Increases LDL (Bad) cholesterol
-Make blood more sticky- likely to clot
-Contribute to obesity- risk of CVD
-MYRISTIC ACID- main fat acid responsible for raising serum(blood) cholesterol levels:
-SOURCES: Butter, cheese, milk, eggs, meat
-Suppresses the cleaning mechanism at LDL receptors- hence raising blood levels
MONOUNSATURATED FATTY ACIDS
better than polyunsaturated
-Contribution of MONOUNSATURATED to dietary energy- no more than 13%
-They will:
- lower LDL (bad) cholesterol
-Maintain/ raise HDL (good) cholesterol
-Not lower HDL (good) cholesterol
POLYUNSATURATED FATTY ACIDS
(n-6 and n-3)
Contribution of POLYUNSATURATED FATTY ACIDS to dietary energy- no more than 6.5%
N-3- INCREASED FROM 0.1g to 0.2g per day as:
-Lower LDL (bad) cholesterol
-NO EFFECT on HDL (good) cholesterol
-LOWER blood TRIGLYCERIDES
N-6- SHOULD NOT INCREASE FROM CURRENT LEVEL as:
-LOWER LDL (bad) cholesterol
-LOWER HDL (good) cholesterol
-Can cause artery damage- encourage build up of ATHEROMA in coronary arteries
TRANS FAT
AS BAD AS SATURATED FATS, IF NOT WORSE!!
-INCREASE- LDL (bad) cholesterol
-REDUCE HDL (good) cholesterol
-INCREASE blood TRIGLYCERIDES
ANTI OXIDANT STATUS
-Natural substances that exist as vitamins(ACE), minerals (selenium)
-Believed to prevent disease by fighting free radicals- substances that harm body when left unchecked
-Free radicals- formed by normal bodily processes- eg. breathing+ environmental contaminants- cigarette smoke.
Without adequate amounts of antioxidants- free radicals travel throughout body, damaging cells
-Part of cellular damage- leads to one of major known factors in development of heart disease- OXIDATION OF CHOLESTEROL
OXIDATION- addition of oxygen to LDL- contributes to build up of fatty plaque on artery walls (atherosclerosis)- eventually slows down/block blood flow to heart
HGIH SODIUM INTAKE
-No more than 6g- reduces risk of hypertension- contributory factor of CVD
Findings from DASH-Dietary Approach to Stop Hypertension- research suggest lowering sodium intake + include low fat dairy products, nuts, fruit + veg, potassium, calcium+magnesium- help control hypertension
LOW SOLUBLE FIBRE INTAKE
FIBRE- not meet daily recommentdatiom- 30g- increase risk of CVD
Propose and Justify DIETARY and LIFESTYLE recommendations to prevent CVD
DIETARY
Do not start smoking or give up smoking
-smokers are twice as likely to have a heart attack compared to non smokers
-toxins in tobacco- damages lining of arteries- lead to build up of atheroma- cause angina/stroke
-CARBON MONOXIDE in tobacco smoke- reduces amount of oxygen in blood- means heart pumps harder to supply body with oxygen
-NICOTINE in cigarettes- stimulates body to produce adrenaline- makes heart beat faster + raises blood pressure- makes heart work harder
-Blood is more likely to CLOT- increased risk of having a heart attack/stroke
-CARBON MONOXIDE- attaches to haemoglobin- results in tissues being starved of oxygenated blood- suffocate + die
-Smokers likely to experience shortness of breath + increased heart rate- result of carboxyhaemoglobin levels
-Smoking increases total blood cholesterol- increased acrolein- affects the way the body processes cholesterol- allows greater amounts to remain in blood- decreases ratio oh HDL/LDP- ATHEROSCLEROSIS
LIFESTYLE
150mins (21/2hrs) moderate physical activity/ 1 hour of vigorous physical activity every week
-Studies show will reduce risk of CVD by 30%
-middle aged woman’s risk of dying of CVD is doubled by doing less than an hr of physical activity
-small increases in physical fitness- associated with significant reduction in CVD
-protects you- regulates weight- being overweight increases risk of CVD
-lowers blood cholesterol- CVD risk
-regulates blood glucose levels- reduces CVD risk
-helps lower LDL- leads to heart disease + raises HDL protects against heart disease
-reduces inflammation- powerful factor in development of CVD
-exercise makes it more difficult for blood to clot- cause blockage in artery
-releases endorphins (happy hormone)- reduce stress- risk factor for CVD
-strengthens heart muscle
DIETARY
EAT AT LEAST 5 PORTIONS OF FRUIT + VEG EVERY DAY
-contain naturally occurring antioxidants- fight against the action of free radicals- cause CVD (not getting enough essential antioxidants (ACE))
-ANTIOXIDANTS- A (beta carotene), C and E- offer some protection against CVD- preventing free radicals from damaging arteries + cells that repair this damage- if arteries are damaged- atheroma more likely to build up
-contribute to number of nutrients that most don’t get enough of
-FOLATE (B9)- along with B6 + B12- help make enzymes- remove amino acid homocysteine- damages artery lining- cause atheroma build up
-MAGNESIUM, POTASSIUM + CALCIUM- help lower blood pressure- CVD risk
-CALCIUM- food intake- reduce CVD- fatty acids in bowel attach to unabsorbed and leave the body- faeces
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LIFESTYLE
MEN AND WOMAN SHOULD NOT DRINK MORE THAN 14 UNITS OF ALCOHOL
-Drinking excess alcohol- increases risk of HIGH BLOOD PRESSURE- one of the most important risk factor for heart attack/stroke
-Increase in blood pressure- caused by weight gain
-Heavy drinking- weakens heart muscle- heart can’t pump efficiently- CARDIOMYOPATHY- premature death- heart failure
INCREASED TRIGLYCERIDES + VLDL- cause sudden death/ heart attack (VLDL- BAD)
DIETARY
REDUCE CHOLESTEROL LEVELS
-fatty substance found in blood
-too much- increased risk of CVD
-carried around the body by proteins- cholesterol + protein- LIPOPROTEIN
-LDL- BAD- carry cholesterol from liver to cells that need it
-HDL- good- carry cholesterol away from cells to liver to be broken down
DIFFERENCE BETWEEN TRIGLYCERIDES AND CHOLESTEROL
-TRIGLYCERIDES + CHOLESTEROL- both lipids/fats
-BOTH circulate in bloodstream +carried through blood vessels- lipoproteins
-high levels of EITHER- cause heart/circularly problems
-DIFFERENCE- how they PERFORM in body
DIFFERENCE BETWEEN TRIGLYCERIDES AND CHOLESTEROL
USES
-MAJOR DIFFERENCE- TRIGLYCERIDES- burned to create energy- CHOLESTEROL- used to build cells + certain hormones
-CHOLESTEROL- builders inside body
-TRIGLYCERIDES- broken down by body
-BOTH- manufactured in body-
body produces as much CHOLESTEROL as it needs on its own- body relies on consumption to create TRIGLYCERIDES
DIFFERENCE BETWEEN TRIGLYCERIDES AND CHOLESTEROL
MISCONCEPTIONS
-TRIGLYCERIDE levels- just as important as cholesterol levels when determining overall health
-FACT- HIGH CHOLESTEROL- lead to CHD
-ROLE of TRIGLYCERIDES when discussing heart disease is disputed
HIGH TRIGLYCERIDE- at least a warning for CHD- individuals with HIGH TRIGLYCERIDE levels have health characteristics, eg obesity, HBP + Diabetes- lead to CHD
WHAT ARE TRIGLYCERIDES
-type of fat/lipid found in body
-when you eat- body converts any calories not needed straight away to triglycerides- stored in fat cells
-later- hormones release triglycerides for energy between meals
-if you regularly eat more calories than you burn- particularly “easy” calories- carbs + fats- lead to HIGH TRIGLYCERIDES (hypertriglyceridemia)
DIFFERENCE BETWEEN TRIGLYCERIDES AND CHOLESTEROL
-separate types of lipids- circulate in blood
-TRIGLYCERIDES- store unused calories + provide body with energy
-CHOLESTEROL- build up cells + certain hormones
-CAN’T dissolve in blood- circulate throughout body with help of proteins- transport lipids (lipoproteins)
WHY DO HIGH TRIGLYCERIDES MATTER?
-may contribute to hardening/ thickening of artery walks (atherosclerosis)- increased risk of stroke, heart attack or heart disease.
-high triglycerides are often a sign of other conditions that increase risk of heart disease + stroke, as well including obesity + metabolic syndrome (cluster of conditions that includes too much fat around waist, high blood pressure, high triglycerides, high blood glucose + abnormal cholesterol levels
-high triglycerides are also a sign of poorly controlled toe 2 diabetes/ rare genetic conditions that affect how the body coverts fat to energy
-also be a side effect of taking medications(beta blockers, birth control pills, steroids)
WHATS THE BEST WAY TO LOWER TRIGLYCERIDES
-LOSE WEIGHT- losing 5-10 pounds- help lower triglycerides.
-CUT BACK ON CALORIES- extra calories are converted to triglycerides + stored as fat-reducing calories will reduce triglycerides
-AVOID SUGARY + REFINED FOODS- simple carbs (sugar and foods make with white flour) increase triglycerides
-CHOOSE HEALTHIER FATS- swap saturated fats found in meats for healthier mono saturated fat(PLANTS), eg olive, peanut oil
Substitute fish high in omega 3 PUFA( mackerel + salmon) for red meat
-LIMIT ALCOHOL- high in calories + sugar- potent effect on triglycerides
-REGULAR EXERCISE- at least 30 minutes per week- lower triglycerides + boost “good” cholesterol
MEDICATION FOR TRIGLYCERIDES
-STATINS- cholesterol-lowering drugs for if you also have low high -density lipoprotein (HDL), high low-density lipoprotein (LDL), or a history of blocked arteries or diabetes- Side effect (muscle pain)
-FISH OILS- omega 3 fatty acids- fish oil supplement can help lower triglycerides (high doses needed)
-NIACIN- also called nicotinic acid, can lower triglyceride + “bad” cholesterol (LDL)
EFFECTS ON DEVELOPMENT OF CVD
OVERWEIGHT/OBESITY
-OVERWEIGHT- increases risk of hypertension + lack of oxygen to heart- risk factors for CVD
-EXCESS WEIGHT/ place extra burden on heart, therefore optimum weight should be maintained
-APPLE SHAPED- greater risk of CVD- fat around middle has greater access to blood supply of liver- production of VLDL
-Obese people tend to have:
•increased TOTAL blood CHOLESTEROL
•HIGH LDL cholesterol
•HIGHER TRIGLYCERIDE levels
•HBP
•INCREASED risk of developing TYPE 2 DIABETES- causes high levels of glucose in blood- this affects artery walls- more likely to develop fatty deposits (atheroma)
If atheroma builds up in coronary arteries( arteries that supply oxygen rich blood to heart)- develop coronary heart disease- lead to heart attack/ angina
EFFECTS ON DEVELOPMENT OF CVD
HYPERTENSION
- Blood pressure- pressure of blood in arteries
HIGH BLOOD PRESSURE defined as a SYSTOLIC (max pressure in arteries when heart contracts) blood pressure at/ above 140mmHg and/ or a diastolic ( min pressure in arteries between hearts contractions) at/above 90mmHg
-HYPERTENSION- risk factor for CHD and single most important factor for stroke
•Stresses body’s blood vessels- cause them to clog/weaken- lead to ATHEROSCLEROSIS + narrowing of blood vessels- make them more likely to block from blood clots/bits of fatty material breaking off from lining of blood vessel wall
•Damage to arteries can also create weak places that rupture easily/ thin spots that balloon out to artery wall- ANEURISM
- HBP in those less than 50- associated with increased CVD risk- as you get older- systolic (max) blood pressure becomes a more important predictor of risk of CVD
-Although increasing blood pressure is part of aging, a healthy low salt diet, physical activity + maintaining a healthy weight can reduce risk
-DIETARY SALT- massive factor in raising blood pressure in ppl with hypertension + some with normal blood pressure
TYPE 2 DIABETES
-causes high glucose levels in blood- due to a problem with hormone insulin in pancreas
Insulin- responsible for moving glucose(sugar) from bloodstream into cells of body for energy.
If little/ no insulin being produced/ body has become resistant to insulin, glucose stays in bloodstream + can’t move across to cells to give them energy to work- LETHARGIC
-DIABETES increases CVD risk- due to high levels of glucose in blood- can affect artery walls, make them more likely to develop ATHEROMA
-If atheroma builds up in coronary arteries ( those that supply oxygen rich blood to heart)- can develop CHD- cause heart attack/ angina
SATURATED AND UNSATURATED FATTY ACIDS
CHOLESTEROL + TRIGLYCERIDES
-Cholesterol + Protein
•LDL- BAD- carry cholesterol from liver to cells
•HDL- good- carry cholesterol away from cells back to liver to be broken
-Too much LDL- atheroma build up
-Cholesterol level determined by amount body produces + type
TRIGLYCERIDES
-calories not used straight away- converted to triglycerides (stored in fat cells)
-high- increase heart disease, stroke + obesity
FAT:
-TOTAL- reduced to 35%
-SATURATED- reduced to 10%-
•Increases blood cholesterol
•Increase LDL
•Blood becomes sticky- more likely to clot
MONOUNSATURATED
-No more that 13%
•lowers LDL + maintains/slightly increases HDL
POLYUNSATURATED:
•Omega 3- increased from 0.1-0.2
•Omega 6- shouldn’t increase from its current level
TRANS-
-AT LEAST as bad, if not WORSE
HOMOCYSTEINE
-Homocysteine changed the coagulation factor levels- encourages blood clots to form within arteries + therefore increases risk of heart attack/ stroke
-high levels of amino acid homocysteine- damages lining of arteries + cholesterol builds up inside arteries- lead to blockages
-Folate + Vitamins B6 and B12- needed to make enzymes that remove homocysteine from body- if there is a low intake of folate, excess homocysteine is not removed- therefore increasing risk of CVD
