Cardiovascular disease

Question 1

What is cardiovascular disease?

Answer 1

Umbrella term

CHD is an important component

Biggest cause of death in the UK

Question 2

What has happened to the rates of CVD in the last years?

Answer 2

They have risen

Due to changes in the lifestyle of humans

Question 3

What is an important molecular aspect of CHD?

Answer 3

Atherosclerosis

Chronic inflammatory condition characterised by the development of plaques on the artery walls

Question 4

What are the plaques formed in atherosclerosis?

Answer 4

Patchy deposits of fatty material

Question 5

Is atherosclerosis fatal?

Answer 5

No

But the rupture of the atherosclerotic plaque often leads to thrombosis, which can cause life-threatening complications

Question 6

4 stages of atherosclerosis development

Answer 6

Endothelial dysfunction - healthy arteries undergo injury, increasing the permeability of the walls

Fatty streak - immune cells and low-density lipids are recruited. Monocytes mature into macrophages which ingest cholesterol to form foam cells

Plaque progression - smooth muscle cells migrate into intimal layer and form fibrous cap over the plaque by releasing collagen

Plaque rupture - when the contents of the plaque are exposed to blood, coagulation forms a thrombus

Question 7

What are the two types of risk factors of atherosclerosis?

Answer 7

Modifiable

Non-modifiable

Question 8

Examples of modifiable risk factors

Answer 8

Dyslipidemia

Hypertension

Smoking

Diabetes Mellitus

Obesity

Question 9

Examples of non-modifiable risk factors

Answer 9

Age

Male gender

Hereditary

Question 10

How do risk factors increase the development of atherosclerosis?

Answer 10

Cause damage to the endothelial cells lining the artery

Trigger an immune response that leads to migration of leukocytes, lipids and other materials into the artery wall

Question 11

Describe cardiac ageing

Answer 11

Over time the heart shows dysfunction to the heart muscle wall and stiff aorta

This is due to hypertrophy and fibrosis

Leads to reduced ejection fractions

Question 12

What is an important factor underlying cardiac ageing?

Answer 12

Angiotensin 2 release

Question 13

Changes in ECM of ageing heart

Answer 13

Increase collagen concentration

Decreased elastin concentration

Question 14

What is seen in vascular ageing?

Answer 14

More ROS, inflammation and angiotensin II

Decreased bioavailability of the precursor of NO

Question 15

How is iNOS pathogenic in vascular ageing?

Answer 15

Instead of producing NO, it produces superoxides which damage the vessel

Question 16

What is the superoxide produced by iNOS?

Answer 16

Peroxynitrite

Destroys plasma membranes, decreases NO availability, decreases vasodilation and causes endothelial dysfunction

Question 17

How is angiotensin dysfunctional in vascular ageing?

Answer 17

Increases production of MMPs

Decreases NO

Increases vessel thickness

Question 18

TRUE or FALSE

Men are always more likely to develop CVD

Answer 18

FALSE

Men are more likely to develop CVD up to a certain age

Women are protected due to oestrogen, which activates second messengers leading to mitochondrial biogenesis and increased fatty acid utilisation

Question 19

How does increased mitochondrial bioavailability protect against CVD?

Answer 19

Protects from ROS through production of antioxidant defences

Question 20

Compare the mitochondrial function of men and women

Answer 20

Females = high ATP, less ROS, little calcium, cell survival is more efficient

Males = mitochondria are more prone to damage, cell survival is less efficient

Question 21

TRUE or FALSE

After menopause, women are equally as likely to develop CVD as men

Answer 21

FALSE

Women have higher CVD risks after menopause

Question 22

How is ethnicity linked to CVD?

Answer 22

CHD, Type II DM and stroke rates are higher in South Asians

High BP and Type II DM rates are higher in African Caribbeans

Question 23

Which system is faulty in arterial hypertension?

Answer 23

Renin angiotensin system

Arterial stiffness and ventricular changes activate this system

Question 24

How does the renin angiotensin system increase chances of CVD?

Answer 24

Remodelling arterial walls

Calcification

Elastic fibre degradation

Question 25

Effects of hypertension

Answer 25

Increased afterload

Increased stroke volume

Increased myocardial oxygen demand

Arterial damage

Heart failure

Question 26

What is one of the most important risk factors of CVD?

Answer 26

Smoking

Question 27

How does smoking increase CVD rates?

Answer 27

Tobacco has a high number of substances that activate endothelial cell dysfunction

This facilitates the development of atherosclerosis

Question 28

How is cholesterol linked to CVD?

Answer 28

The higher the cholesterol, the higher the risk

Question 29

What are the two types of cholesterol important in CVD?

Answer 29

LDL = deposits cholesterol in blood vessels

HDL = removes cholesterol from blood vessels to the liver

Question 30

What is important regarding cholesterol and CVD?

Answer 30

The correct balance between HDL and LDL levels

Question 31

How is obesity related to CVD?

Answer 31

Not a direct risk factor

Increases the incidence of underlying mechanisms relating to CVD

Question 32

How is diabetes related to CVD?

Answer 32

Increases inflammation

Question 33

How much does diabetes increase the chances of developing CVD?

Answer 33

Diabetic individuals are 3 times more likely to develop CVD compared to normal

Question 34

Two important therapies that help prevent CVD

Answer 34

Fibre

Exercise - most important

Question 35

How does fibre decrease the chances of developing CVD?

Answer 35

Helps lower the cholesterol content in the blood

Forms a gel which binds some cholesterol in the small intestines

Takes it out of the body

Question 36

Beneficial effects of exercise

Answer 36

Reverses endothelial dysfunction

Anti-atherogenic effects

Anti-inflammatory effects