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Cardiovascular disease (CVD) Flashcards

1
Q

Whos dying from cardiovascular disease (CVD)?

A

The people dying of CVD are in Russia and labour heavy countries.

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2
Q

The deaths due to CVD have been falling since…

A

…the 1960s

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3
Q

Rate of CVD isnt too high in the…

A

…west

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4
Q

There are certain areas which are much higher in CVD than neighbouring countries which are called …

A

…hot spots

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5
Q

What are DALYs?

A

DALYs are disability- adjusted life years

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6
Q

One DALY can be thought of as…

A

…one lost year of “healthy” life

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7
Q

CVD is so prevalent in ‘red’ countries like Russia/Ukraine that …

A

…it is affecting peoples lives.

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8
Q

Describe the epidemiology of CVD in the uk 2014.

A
  • CVD contributes to 29% of deaths due to diseases in men. 28% in women.
  • Biggest cause of death = coronary heart disease followed by stroke.
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9
Q

Describe the percentage of National Health Service (NHS) expenditure on cardiovascular disease by care setting, England 2012/2013.

A
  • 20% of the money owned by primary care services is spent treating and managing cardiovascular diseases.
  • 63.4% of the money owned by secondary care services spent on treating and managing cardiovascular diseases.
  • Causes tax to increase
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10
Q

You often can’t get up-to-date date from…

A

…peer reviewed papers or Government sources – but charities often have the data

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11
Q

How many people will die from a heart or circulatory disease?

A

460

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12
Q

What rank does coronary heart disease (CHD) get in top 5 causes of death?

A

number 3

stroke got number 4

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13
Q

around […] of the 460 people who die will be younger than […]

A

around 130 of the 460 who die will be younger than 75

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14
Q

How many people in uk today are living with a heart or circulatory disease?

A

7.6 million

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15
Q

How many hospital admission will be due to heart attack?

A

260

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16
Q

How many people will die from coronary heart disease?

A

180

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17
Q

how many babies will be diagnosed with a heart defect?

A

13

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18
Q

How many males and females are currently living with heart and circulatory diseases in the uk?

A

4 mil males 3.6 females

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19
Q

How many people living with heart disease rn?

A

7.6 milly

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20
Q

We estimate that in the uk more than […] of us will get heart or circulatory conditions in our lifetime?

A

We estimate that in the uk more than HALF of us will get heart or circulatory conditions in our lifetime?

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21
Q

How many ppl will die from heart disease this year vs today?

A

more than 160,000 ppl will die ths year

460 ppl today

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22
Q

Each year how many ppl under the age of 75 die from heart and cirfculatory disease?

A

48000

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23
Q

Rates of death of CVD/heart diseases are going…

A

…down and have already dropped in both men and women from 1969 to 2020

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24
Q

What does the human circulatory system consist of?

A
  • the heart
  • blood
  • blood vessels
    —Arteries
    —Capillaries
    —Veins
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25
Q

Function of artieries

A

Arterys deliver the blood from the heart to the tissues

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26
Q

At tissues, arteries turn into….

A

…capilleries to transfer nutrients from blood to tissues.

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27
Q

Function of veins

A

Veins collect blood and take it back to the heart

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28
Q

Theres a lot of capilleries around the …

A

gastrointestinal tract.

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29
Q

Function of capilleries

A

These load the blood with nutrients

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30
Q

Function of renal arteries

A

The renal artieries get rid of waste products from the blood.

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31
Q

How is blood pumped through the legs?

A

Blood pumped through the legs due to muscle contractions which squeeze the blood vessels, causing the valves to open and allows the flow of blood. Muscles uncontracted – valves closed – no flow of blood.

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32
Q

What are CVD-related Conditions

A

A complex of conditions that have the same underlying pathology

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33
Q

What do CVD-related Conditions cause a change in?

A

change in the structure of vascular wall

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34
Q

What do CVD-related Conditions mainly affect?

A

arteries

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35
Q

The most serious diseases are caused due to …

A

…changes in the structure of the arteries

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36
Q

Two main pathologies of artery structure?

A
  • Atherosclerosis
  • Aneurysm
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37
Q

In the veins the major issue is…

A

…varicose veins

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38
Q

Atherosclerosis characterized by …

A

…the deposition of atheromatous plaques on the innermost layer of the walls of large and medium-sized arteries

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39
Q

What is the plaque made of in atherosclerosis?

A

made up of fat, cholesterol, smooth muscle cells, calcium, and other substances found in the blood.

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40
Q

What happens to (atherosclerosis) plaques over time?

A

Over time, plaque hardens and narrows your arteries.

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41
Q

What is the effect of atherosclerosis on arteries?

A

Artery loses elasticity – arteriosclerosis (hardening of the arteries)

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42
Q

When does atherosclerosis start and develop?

A

Atherosclerosis starts in early teens and develops over the next 5+ decades

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43
Q

underlying causes of atherosclerosis are…

A

…still under much debate

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44
Q

Where is the position of formation thought to start?

A

at a site of hemodynamic stress

  • Due to raised blood pressure, infection, trauma, or other injurious agent
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45
Q

What does hemodynamic stress cause?

A

inflammation and adaptive tunica intima thickening

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46
Q

Intima thickening is often…

A

…asymmetrical

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47
Q

Sites of intima thickening is consistent with …

A

…increased production of sulfate-containing proteoglycans and extending the extracellular matrix.

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48
Q

The thickening of the tunica intima is usually where…

A

…atherosclerotic plaques form

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49
Q

What happens to lipid inducing cholesterol in the thickening intima?

A
  • lipid including cholesterol gets trapped in this matrix and becomes oxidised
  • This does not occur in vessels with a normal intima
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50
Q

the inflammatory process produces copious amounts of…

A

…oxidants

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51
Q

Due to this being a site of inflammation …

A

…immune cells enter this matrix

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52
Q

What happens when monocytes enter the inflamed matrix?

A
  • Monocytes are then enter the matrix and are stimulated to differentiate in to macrophages
  • These macrophages engulf the lipid and initiate an inflammatory response
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53
Q

What happens to the macrophages after they initiate an immune response?

A
  • These swollen vacuolated macrophage filled with lipid inclusions are termed foam cells and give the appearance of fatty streaks in the arterial wall
  • The plaque increases in size
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54
Q

What happens to the macrophages after they cause the plaque to increase in size?

A

The macrophages now start a process of calcification – it is almost like they are trying to wall the extracellular matrix from the body

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55
Q

What are the two types of calcification macrophages can cause?

A
  • Macrocalcification = leads to plaque stability
  • Microcalcification = is more likely to be associated with plaque rupture
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56
Q

What is macrocalcification associated with?

A

macrophages in healing mode

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57
Q

What is microcalcification associated with?

A

macrophages that are still in a pro- inflammatory mode

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58
Q

Rupture of plauqes lead to…

A

…a possible blockage

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59
Q

If inflammation persists, fatty streaks become …

A

…more complicated

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60
Q

the atheromatous plaques contains…

A

…collagen and other fibrous molecules, migrating smooth muscle cells, calcium and T- lymphocytes

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61
Q

What happens if portions of plaque break free?

A

If portions of plaque break free they can travel in the blood and block small arteries, as do blood clots

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62
Q

What is blockage of vascular caused by a plaque termed?

A

Blockage of vascular by plaque, clots etc termed an embolism

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63
Q

Define hypertension (high blood pressure)

A

systolic blood pressure consistently 140 mmHg or greater, and/or diastolic blood pressure is consistently 90 mmHg or greater

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64
Q

What causes hypertension (high blood pressure) in teenagers?

A

Causes include genetic factors, excess body weight, diet, lack of exercise, and diseases such as heart disease or kidney disease.

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65
Q

What is hypertension also known as?

A

high blood pressure

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66
Q

WHAT is CHD the abbreviation for?

A

Coronary Heart Disease (or coronary disease)

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67
Q

What is Coronary Heart disease?

A
  • Refers to the failure of coronary circulation to supply adequate circulation to cardiac muscle and surrounding tissue.
  • Due to Atheroma
  • Resultant pain referred to as angina (Chest pain)
68
Q

The atherosclerosis becomes known as an …

A

…atheroma

69
Q

Why might the atheroma cause the heart to fail?

A

If the heart has too much work, it will fail due to a lack of oxygen because of the atheroma blocking the flow of blood.

70
Q

What is angina?

A

Chest pain due to transient ischaemia - occurs when O2 supply to myocardium is insufficient for its needs.

71
Q

What is angina a symptom of?

A

‘symptom of CAD’

72
Q

Angina is an indicator of…

A

…CAD development/progression

73
Q

Whats CAD the abbreviation for?

A

Coronary artery disease

74
Q

Whats angina triggered by?

A
  • Physical exertion – increased blood pressure / increased volume of blood pumped out by heart.
  • Eating – heart requires oxygen for eating to expend energy.
  • Cold, windy weather  increased pumping in attempt to warm body
  • Anger / excitement – stress  increased pumping.
75
Q

CHD is a type of…

A

…ischaemic heart disease

76
Q

The term Ischaemia refers to…

A

…a restricted blood supply and leads to oxygen shortage

77
Q

Whats a coronary thrombosis?

A

A coronary thrombosis is a clot (thrombus) that lodges in the cardiac blood vessels usually at the site of an atheroma

78
Q

What can coronary thrombosis lead to?

A

myocardial infarction

79
Q

What is myocardial infarction?

A

death (infarction) of heart muscle (myocardium); Heart attack

80
Q

What is stroke?

A

Low supply of oxygen in the brain leading to brain damage

81
Q

What are the two types of stroke?

A

Ischaemic and Haemorrhagic

82
Q

Whats ischaemic stroke?

A

interrupted blood supply to the brain caused by thrombosis or an embolism

–> oxygen deprivation –> stroke

83
Q

Whats Haemorrhagic stroke?

A

ruptured blood vessels disrupting blood supply due to high blood pressure. Occurs in the brain, vessels pop, blood leaks, squashes brain –> oxygen deprivation –> stroke.

84
Q

What is thrombosis?

A

the formation of a clot or thrombus inside a blood vessel in the legs, obstructing the flow of blood through the circulatory system. The blood can get in but cant get out because the vessels are blocked.

85
Q

Causes of aneurysms?

A

Atherosclerosis
Hypertension
Congenital defects
Vasculitis
Trauma / infection

86
Q

True Aneurysms categorised by:

A

Excessive connective tissue degradation
Loss of smooth muscle cells or change in morphology

87
Q

Two main reasons in CVD

A
  • Atherosclerotic plaques impede the diffusion of nutrient from blood
  • Hypertension crushes vasa vasorum again reducing nutrient access
88
Q

Whats the vasa vasorum ?

A

the capillary bed that services the outer wall of artery

89
Q

In true aneurysms, the main issue is if…

A

…they rupture

90
Q

The larger an aneurysm becomes, the more likely it is to …

A

…rupture and may lead to death

91
Q

What is an aneurysm?

A

Blood-filled dilation of a blood vessel caused by disease or weakening of the vessel wall

92
Q

Where do aneurysms mostly occur?

A

Most commonly occurs in arteries at the base of the brain and in the aorta

93
Q

Aneurysms also can occur in arteries in the:

A

brain, heart, intestine, neck, spleen, back of the knees and thighs, and in other parts of the body.

94
Q

If an aneurysm in the brain ruptures, it causes a…

95
Q

When found in time, aneurysms can usually be…

A

…treated successfully with medicines or surgery

96
Q

Large aortic aneurysms, if found in time, can often be …

A

…repaired with surgery to replace the diseased portion of the aorta

97
Q

The valves force blood to flow in only …

A

…one direction, toward the heart.

98
Q

When do varicose veins develop?

A
  • Varicose veins develop when the valves become weakened, damaged, or don’t work well.
  • especially in the legs, pump the blood to the heart against gravity
99
Q

One-way valves help with…

A

…pumping action and prevent blood from flowing backward.

100
Q

What are varicose veins often due to?

A

Often due to weakness in the walls of the veins.

101
Q

What causes weakness in the walls of the veins?

A

associated with increasing age, a family history of varicose veins, high pressure inside veins due to overweight or pregnancy, or poor diet

102
Q

In varicose veins, weak walled veins lose their elasticity making them …

A

… longer and wider and causes the flaps of the valves to separate.

  • Blood is then able to flow back through the valves, filling the vein and stretching it even more.
103
Q

In varicose veins, the vein becomes…

A

enlarged, swollen, and often twisted trying to squeeze into its normal space.

104
Q

Hairless legs are often a sign of …

A

…varicose veins

105
Q

What are the main modifiable (lifestyle-related) factors for CVD?

A

Hypertension
Smoking
Hypercholesterolemia
Diabetes mellitus
Being obese / over weight
Being Sedentary

106
Q

What are the main non modifiable (non lifestyle related) risk factors for CVD?

A

Genetics / race / family history
Sex
Age

107
Q

Hypercholesterolemia =

A

high cholesterol

108
Q

Why is the high cholesterol risk factor for CVD debatable?

A

This risk factor is debatable since the high cholesterol may not be due to heart problems but something else the body is trying to manage.

109
Q

the younger you are, the less likely you are to get CVD. Because…

A

…you can take steps to reduce the risk.

110
Q

Symptoms of CVD?

A

This depends on organ / tissue affected:

  • Cardiovascular heart disease
  • Peripheral vascular disease
    — Functional: Changes in vessel diameter due to inappropriate control by body
    — Organic: Due to atherosclerosis
  • Stroke
    — Ischemic: due to blockage of vessel by a blood clot or part of an atherosclerotic plaque
    — Haemorrhagic: Pressure on brain tissue due to a ruptured blood vessel (bleed on the brain)
  • Aortic disease
    —Abdominal aortic
    —Thoracic aortic disease
111
Q

CHD is sometimes called …

A

…ischaemic heart disease or coronary artery disease.

112
Q

Cardiovascular Heart Disease (CHD) is due to…

A

…atherosclerotic plaque build up in the arteries affecting performance

  • Not enough oxygen reaching tissues
  • Poor return of blood from extremities
  • Poor response of heart to physiological changes
113
Q

Symptoms of Cardiovascular Heart Disease?

A

Symptoms include:
chest pain
pain, weakness or numb legs and/or arms
breathlessness
very fast or slow heartbeat, or palpitations
feeling dizzy, lightheaded or faint
fatigue
swollen limbs.

114
Q

Diagnosis for cardiovascular heart disease (CHD)?

A

1) Diagnosis includes:
- Check for hypertension
- Check for hypercholesterolemia
- Looking for information regarding family history

2) The heart may also be image using:
- MRI scans
- CT scans
- X-rays (e.g. coronary angiography)
- Ultrasound (echocardiogram)

3) Or the function tested
- Electrocardiogram (ECG)
- Exercise stress tests

115
Q

Peripheral arterial disease (organic) is due to…

A

…the build up of atherosclerotic plaques in the arteries

116
Q

In peripheral arterial disease (organic) many people…

A

…have no symptoms

117
Q

In peripheral arterial disease (organic) some people develop a…

A

…painful ache in their legs when walking, which disappears after rest

118
Q

Symptoms of Peripheral arterial disease (organic)?

A

Symptoms include:
hair loss on your legs and feet
numbness or weakness in the legs
brittle, slow-growing toenails
ulcers (open sores) on your feet and legs, which do not heal
changing skin colour on your legs, such as turning pale or blue
shiny skin
in men, erectile dysfunction
the muscles in your legs shrinking (wasting)

119
Q

How is peripheral arterial disease diagnosed by comparing blood pressure in your arm and ankle?

A
  • Peripheral arterial disease (PAD) is usually diagnosed by comparing the blood pressure in your arm and your ankle.
  • A difference between the two may indicate PAD and the ratio between the two is termed the ankle brachial pressure index (ABPI)
  • ABPI = Pleg / Parm
  • Range 1-1.2: OK
  • 0.9-0.99: Acceptable
  • Below 0.9 management needed
120
Q

What does it mean if ABPI is 1 - 1.2 ?

121
Q

What does it mean if ABPI is 0.9 - 0.99 ?

A

Acceptable

122
Q

What does it mean if ABPI is Below 0.9 ?

A

management needed

123
Q

What is ABPI the abbreviation for?

A

ankle brachial pressure index (ABPI)

124
Q

What is ABPI?

A

the ratio between blood pressure of the arm and blood pressure of the ankle

125
Q

Whats the equation for ABPI?

A

ABPI = Pleg / Parm

126
Q

What general diagnosis methods are used for Peripheral arterial disease (organic)?

A
  • An ultrasound scan may be used to produce an image of the arteries to look for atherosclerotic plaques causing blockages or narrowing
  • An angiogram is when a contrast agent is injected into a vein of the arm and used to increase the ability to distinguish the arteries from the surrounding tissue in order to get a more detailed image
  • Both a CT or MRI scan can be used to produce the image.
127
Q

What is aortic disease?

A

Aortic diseases are a group of conditions affecting the aorta.

128
Q

One of most common aortic diseases is an …

A

…aortic aneurysm

129
Q

Aortic diseases are usually…

A

…symptom-less but may have:

  • Pulsating sensation in abdomen
  • Abdominal &/or back pain
130
Q

Rupture of an aneurysm can cause a…

A

…life-threatening bleed

131
Q

How is aortic disease diagnosed?

A
  • Detected by a scan
  • Normally have one every year to monitor its size.
132
Q

What are the two causes of stroke?

A

Ischemic stroke
Haemorrhagic stroke

133
Q

How fast is the onset of symptoms of stroke?

A

Onset of symptoms very quickly – you need to act quickly

134
Q

What are the symptoms of stroke?

A
  • Physical signs of loss of control of parts of the body e.g. facial tone, garbled speech, Weakness or numbness (partly) down one side of the body
  • Mini strokes
135
Q

What are mini strokes also known as?

A

Transient Ischaemic Attack (TIA)

136
Q

Why do strokes occur?

A
  • Due to temporary disruption of the blood supply to an area of the brain
  • Usually due to a blood clot or part of an atherosclerotic plaque formed elsewhere in the body blocking a blood vessel
137
Q

How are strokes diagnosed?

A

1) Physical tests:
- Includes swallow test to ensure they can eat properly
- Food not swallowed properly can enter the lungs and lead to infection
2) Followed by a brain scan to determine which part(s) and how much of the brain is affected.
- CT scan
- MRI scan
3) Further tests to look for CVD may be carried out

138
Q

What are some treatments for Cardio vascular disease?

A

1) Surgery
- Angioplasty – insertion of a mesh ‘balloon’ to open up artery
- Heart bypass – replace blocked heart blood vessels with other from else ware in the body
2) Pharmaceutical drugs

139
Q

The NHS recommends the following to reduce your risk of CVD:

A

Stop smoking
Have a balanced diet
Exercise regularly
Maintain a health weight
Reduce alcohol consumption

140
Q

In the study “Intensive Lifestyle Changes for reversal of coronary heart disease”, what were the conclusions?

A

More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.”

141
Q

What is the major aim of lifestyle adjustment?

A

The major aim is preventing &/or reducing inflammation

142
Q

Anti-inflammatory Lifestyle to reduce risk of CVD and related conditions?

A

Diet
Exercise
Weight loss
Quit smoking
Don’t skip meals
Stress management
Psychological background
Socialization (friends & family & hobbies)

143
Q

What is the Basis of an Anti-inflammatory Diet?

A

1) Good balance of omega 3 and 6
2) ‘Rainbow’ of vegetables and fruits and rich in herbs and spices
- Rich in antioxidants
3) Omission of food intolerances
- Allergies are inflammatory
4) Reduce trans fats
- Inflammatory when degraded
- Not an issue in the UK

144
Q

Essential fatty acids (EFAS) - omega 3 and omega 6 cannot be…

A

…synthesised so have to be obtained from the diet

145
Q

What diets are rich in omega 6?

A

A cereal-based diets like that in the UK are rich in omega 6

146
Q

Omega 6 EFAs are the …

A

…precursors of series 1 & 3 prostaglandins

147
Q

EFA =

A

Essential fatty acids

148
Q

Series 1 and 3 prostaglandins are…

A

…pro inflammatory

149
Q

Where are omega 3 EFAs found?

A

in cold water fish, green veg, and some nuts

150
Q

Omega 3 EFAs are the precursors of …

A

…series 2 prostaglandins

151
Q

Series 2 prostaglandins are…

A

…anti-inflammatory

152
Q

The omega 6 : omega 3 ratio turns out to be…

A

…very important

153
Q

The current average omega 6 : omega 3 ratio in the UK is between…

A

…10:1 to 20:1

  • This is pro-inflammatory
154
Q

The evidence suggests that a omega 6 : omega 3 ratio below…

A

…5:1 is anti-inflammatory

155
Q

A 5:1 ratio of omega 6 : omega 3 is more akin to…

A

… the ratio found in the diets of hunter gatherers

156
Q

The lack of Ω3 is likely to be a …

A

…major promoter of CVD in the UK

157
Q

What were the conclusion of the study called “Fish Consumption and the Risk of Chronic Disease: An umbrella review of metal analyses of prospective cohort studies”?

A

“In conclusion, evidence of moderate quality suggests that fish consumption is associated with a lower risk of cardiovascular disease, depression, and mortality and, therefore, can be considered as a healthy animal-based dietary source of protein.”

158
Q

Trans fat is no longer an issue in …

A

…the UK.

159
Q

Why is trans fat no longer an issue in the UK?

A

the UK government passed legislation restricting it’s levels to those naturally found in food

160
Q

processed food containing trans fat has undoubtedly …

A

…shortened many lives in the UK, with older generations still living with the consequences

161
Q

Trans fats were a problem in foods such as…

A

…cakes, cookies, and pies.

162
Q

The inflammatory cytokine interleukin-6 (IL-6) has been linked to …

A

…poor health outcomes in older adults

163
Q

Oxidative stress triggers the production of…

164
Q

antioxidant micronutrients play a critical role in decreasing …

A

…production of inflammatory cytokine IL-6

165
Q

specific antioxidant nutrients may play an important role in …

A

…suppressing IL-6 levels in disabled older women.

Health and Disease (26 decks)

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