Cardiovascular Disease

Question 1

Why has mortality from CVD dropped since the 80s?

Answer 1

Better treatment, not lower prevalence

Question 2

What is CHD caused by, directly mechanistically?

Answer 2

Atherosclerosis, hardening of artery walls due to cholesterol deposited by LDL and VLDL

Question 3

What are the three layers of the artery wall, and their composition?

Answer 3

Intima: Endothelium
Media: Smooth muscle and collagen
Adventitia: Collagen, Elastin and Extracellular Matrix Proteins

Question 4

What are the two main roles of the intima with reference to naturally preventing atherosclerosis?

Answer 4

Secreting substances that prevent clotting, and prevent substances getting from the blood circulation past it

Question 5

What is the first step in the process of atherosclerosis?

Answer 5

Irritants to the endothelium will damage it, exposing spots for LDL to deposit itself and collect under the endothelium

Question 6

What is the term describing the initial collection of LDL under the artery endothelium in the early stages of atherosclerosis?

Answer 6

the ‘Fatty Streak’

Question 7

What is the stage in athrosclerosis after formation of the fatty streak?

Answer 7

Monocyte white blood cells arrive and turn into macrophages to try to remove the fatty streak from under the endothelium but becomes engorged and die, staying under the endothelium and becoming what are called ‘foam cells;. When they die they release signals telling more macrophages to come, exaggerating the process

Question 8

What is the stage in atherosclerosis after accumulation of foam cells?

Answer 8

The smooth muscle layer below the endothelium creeps up and attempts to form a fibrous collagen/elastic protein cap over the plaque formation to shield it from clot formation.

Question 9

What is the stage involving the foam cells in atheosclerosis after the inital fibrous cap formation?

Answer 9

When the foam cells die, thy induce the smooth muscle into depositing calcium into the plaque, hardening the plaque deposit even more.

Question 10

What is the ‘final’ stage of atherosclerosis?

Answer 10

The core of the plaque deposit becomes necrotic, and eventually the fibrous cap ruptures, releasing all the thrombogenic plaque, causing clotting and eventually complete stoppage of bloodflow in that coronary artery

Question 11

Why is blockage of blood flow in the coronary artery bad?

Answer 11

Myocardium cannot survive without oxygen. All tissue downstream of the blockage will die after 20 minutes of deprivation. This is a Myocardial Infarction

Question 12

What are the risk factors for CHD?

Answer 12

Smoking
Inappropriate blood lipid profile
Hyperglycemia
Obesity
Age
Family History
Personality/Stress
Inactivity

Question 13

What were the names of the two early epidemiological studies showing the relationship between physical activity and CHD risk?

Answer 13

Morris et al 1953

Morris et al 1980

Question 14

What were the results of Morris et al 1953 on the relationship between physical activity and CHD risk?

Answer 14

Rate of CHD much higher in bus drivers than bus conductors due to reduced relative physical activity of drivers

Question 15

What were the results of later research by Morris et al in 1980 about the relationship betwen physical activity and CHD risk?

Answer 15

English civil servants that did vigorous exercise in their leisure time had much lower CHD incidence in late life than those who did not.

Question 16

What did Blair et al 1998 find about fitness and CVD death rates?

Answer 16

positive relationship between fitness and decreased CVD death rates

Question 17

What were the results of the cooper longitudinal study by Radford et al 2018?

Answer 17

-The effect of fitness on CHD events incidence is greatest among people with the most atherosclerosis.

Question 18

What were the results of Sattelmair et al 2011?

Answer 18

Meta analysis showing dose response relationship between kcal per week of leisure time physical activity and CHD

Question 19

What were the results of Kramsch et al 1981?

Answer 19

Exercise decreases development of atherosclerosis but also makes the lumen larger

Question 20

What are the primary methods by which exercise reduces risk of CHD?

Answer 20

• Widening of lumen
• Slowing of atherosclerosis
• Decreasing blood pressure
• Decreasing LDL/Improving blood lipid profile
• Improving glycaemic control
• Reducing stress
• reducing bodyfat
• Inactivity is itself a risk factor for CHD

Question 21

What did Naci and Ionnadis 2013 find about physical activity and CHD?

Answer 21

Exercise may be as effective as/comparable to common drugs which target major risk factors

Question 22

What are the risks of exercise for people at high risk of a CVD event?

Answer 22

Majority of heart attachs (67%) occur within seconds of exertion, according to Ragosta et al 1984

Question 23

What did Siscovick et al 1984 find about exercise habits and risk of CVD events during exercise?

Answer 23

Habitual exercisers were at a lower risk of death during exercise than among infrequent exercisers.

Question 24

What are the common drugs used to treat CHD risk factors?

Answer 24

• Blood lipids: Statins
• Hyperglycaemia: Metformin
• Hypertension: ACE inhibitors
• Obesity: Orlistat
• Stress: SSRIs

Question 25

What role could exercise have for TREATING rather than preventing CHD?

Answer 25

Joliffe et al 2001 found a 27% reduction in overall mortality following exercise treatment for cardiac rehabilitation following a cardiac event.

Question 26

Stats on cardiac rehab attendence in the UK

Answer 26

only 43%of people attend when prescribed it