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Cardiovascular Disease Flashcards

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1
Q

Define Cardiovascular Disease?

A

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)

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2
Q

What may cause Coronary Heart Disease and Stroke

A

Atherosclerosis- When your arteries become narrowed by a gradual build-up of fatty material (atheroma) within walls.

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3
Q

Stenosis

A

Reduced blood flow- a narrowing of the lumen that disturbs blood flow.

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4
Q

How does atheroma build up?

A

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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5
Q

How does a heart attack occur?

A

-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.

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6
Q

How does a stroke occur?

A

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.

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7
Q

Facts about Atherosclerosis

A

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)

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8
Q

What are the types of CVD?

A

-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.

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9
Q

What are the Non-Modifiable Risk Factors (can’t change/control)

A

-Genetics
-Gender
-Age
-Socio-economic status
-Ethnicity
-Low birth weight

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10
Q

Explain the Non-Modifiable Risk Factors?
GENETICS

A

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.

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11
Q

GENDER

A

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

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12
Q

AGE

A

-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.

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13
Q

SOCIO-ECONOMIC STATUS

A

-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

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14
Q

ETHNICITY

A

-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.

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15
Q

LOW BIRTH WEIGHT

A

-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.

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16
Q

-MODIFIABLE RISK FACTORS -SMOKING

A

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

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17
Q

PHYSICAL ACTIVITY

A

-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

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18
Q

FRUIT AND VEGETABLE INTAKE

A

-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

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19
Q

EXCESSIVE ALCOHOL INTAKE

A

-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)

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20
Q

HIGH BLOOD CHOLESTEROL

A

-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

21
Q

TRIGLYCERIDES

A

-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

22
Q

HOW TO LOWER TRIGLYCERIDES

A

-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

23
Q

TOTAL FAT

A

Contribution to dietary energy should be reduced to 35%- effect of dietary fats on blood cholesterol + triglyceride levels- influences risk of CVD

24
Q

SATURATED FATS

A

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

25
Q

MONOUNSATURATED FATTY ACIDS
better than polyunsaturated

A

-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

26
Q

POLYUNSATURATED FATTY ACIDS
(n-6 and n-3)

A

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

27
Q

TRANS FAT

A

AS BAD AS SATURATED FATS, IF NOT WORSE!!
-INCREASE- LDL (bad) cholesterol
-REDUCE HDL (good) cholesterol
-INCREASE blood TRIGLYCERIDES

28
Q

ANTI OXIDANT STATUS

A

-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

29
Q

HGIH SODIUM INTAKE

A

-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

30
Q

LOW SOLUBLE FIBRE INTAKE

A

FIBRE- not meet daily recommentdatiom- 30g- increase risk of CVD

31
Q

Propose and Justify DIETARY and LIFESTYLE recommendations to prevent CVD

A
32
Q

DIETARY
Do not start smoking or give up smoking

A

-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

33
Q

LIFESTYLE
150mins (21/2hrs) moderate physical activity/ 1 hour of vigorous physical activity every week

A

-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

34
Q

DIETARY
EAT AT LEAST 5 PORTIONS OF FRUIT + VEG EVERY DAY

A

-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
-

35
Q

LIFESTYLE
MEN AND WOMAN SHOULD NOT DRINK MORE THAN 14 UNITS OF ALCOHOL

A

-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)

36
Q

DIETARY

REDUCE CHOLESTEROL LEVELS

A

-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

37
Q

DIFFERENCE BETWEEN TRIGLYCERIDES AND CHOLESTEROL

A

-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

38
Q

DIFFERENCE BETWEEN TRIGLYCERIDES AND CHOLESTEROL

USES

A

-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

39
Q

DIFFERENCE BETWEEN TRIGLYCERIDES AND CHOLESTEROL

MISCONCEPTIONS

A

-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

40
Q

WHAT ARE TRIGLYCERIDES

A

-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)

41
Q

DIFFERENCE BETWEEN TRIGLYCERIDES AND CHOLESTEROL

A

-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)

42
Q

WHY DO HIGH TRIGLYCERIDES MATTER?

A

-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)

43
Q

WHATS THE BEST WAY TO LOWER TRIGLYCERIDES

A

-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

44
Q

MEDICATION FOR TRIGLYCERIDES

A

-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)

45
Q

EFFECTS ON DEVELOPMENT OF CVD

OVERWEIGHT/OBESITY

A

-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

46
Q

EFFECTS ON DEVELOPMENT OF CVD

HYPERTENSION

A
  • 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

47
Q

TYPE 2 DIABETES

A

-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

48
Q

SATURATED AND UNSATURATED FATTY ACIDS

A

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

49
Q

HOMOCYSTEINE

A

-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

Nutrition and Food Science (3 decks)

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