Cardiovascular Disease Prevention Part 1 Flashcards
The goal of primordial disease prevention. Outline the korean war studies
, to prevent the development of atherosclerotic cardiovascular disease. In order to realize this goal, it is critically important to understand that atherosclerotic cardiovascular disease starts early.
In the Korean War and the Vietnam war, autopsy studies from soldiers who had barely lived into their 20s demonstrated that a significant minority of them already had well-established atherosclerosis and a small percentage of them had severe obstructive triple vessel coronary artery disease, even in the complete absence of recognized risk factors. The disease starts early.
The early appearance of asymptomatic atherosclerosis was well documented in the Bogalusa Heart Study. Autopsy studies were performed on 204 young persons, aged 2 to 39 years, who died from various non-CVD causes, principally trauma. The prevalence of raised fibrous plaque lesions in the aorta and coronary arteries increased with age. By age 26 to 39, 60% had lesions in the aorta and 69% had coronary artery lesions (P=0.001). Fatty streaks in the aorta and coronary arteries were even more prevalent, also increasing with age. The extent of fatty streaks was associated with the traditional cardiovascular risk factors of __, __, __, and ___.
The early appearance of asymptomatic atherosclerosis was well documented in the Bogalusa Heart Study. Autopsy studies were performed on 204 young persons, aged 2 to 39 years, who died from various non-CVD causes, principally trauma. The prevalence of raised fibrous plaque lesions in the aorta and coronary arteries increased with age. By age 26 to 39, 60% had lesions in the aorta and 69% had coronary artery lesions (P=0.001). Fatty streaks in the aorta and coronary arteries were even more prevalent, also increasing with age. The extent of fatty streaks was associated with the traditional cardiovascular risk factors of diabetes, dyslipidemia, hypertension, and smoking.
NOTE: Firstly, the older the individual, the more likely they are to have established atherosclerotic cardiovascular disease.
Secondary, looking at the J shaped curves on the slide, it is also evident that the greater the exposure of an individual to the drivers of vascular inflammation, the greater the likelihood that they will have evidence of atherosclerotic cardiovascular disease
AND, based on the shape of the curves, that this process accelerates with age.
is evidence that atherosclerotic cardiovascular disease can begin in utero.
It tends to be most prevalent in mothers who have high cholesterol values.
LDL-C does not cross the placental barrier. Rather, it is believed that the high LDL-C levels result in lipid peroxidation which can affect gene expression in the fetuses, thereby elevating LDL-C levels and promoting atherosclerosis. The disease starts early.
50% of people in first world countries have athersclerotic CVD, but most fall in “normal” risk factor distribution. Outline how first world population data is not actually normal
And if risk factor values are normal and fall well within the normal distribution, how or why do they cause atherosclerosis?
Arguably, in first world populations, BMI, blood pressure, blood sugars, blood lipids, physical activity levels, mental health, are frequently not normal. They are 20%-70% higher than true normal. But how does one define normal? Is normal confined to the first standard deviation of a normal distribution, the second standard deviation, or even the third? And what if the normal distribution of the population of interest is completely shifted compared to true biochemical norms. You may believe that your biomarkers and physiologic variables are normal, based on a normal distribution within your population, but you may not realize that your normal distribution is in fact significantly shifted towards a pro-inflammatory, pro-atherosclerotic vascular milieu.
Understanding this physiologic reality is critical to understanding why atherosclerosis is so ubiquitous in first world populations but is almost unheard of in third world populations who have achieved healthy vascular environments from before birth and established health maintenance behaviours after birth.
LDL-cholesterol is 70% higher, blood pressure is 20% higher in BMI is 20% higher in North America.
All of these are demonstrated initiators and accelerators of vascular __.
LDL-cholesterol, oxidized LDL-cholesterol to be specific, is rapidly taken up by arterial __ cells and sequestered in the ___ ___ space.
Elevated blood pressure, or hypertension, is arguably a byproduct of this cholesterol ___ process. As cholesterol is incorporated into arterial walls and as cholesterol plaques become progressively established, arteries become stiffer and blood pressures go higher.
BMI, as a marker of adiposity, reflects the reality that __ cells produce a vast number of __ ___ proteins. However, it is cholesterol levels, in particular, which stand out in this study as being particularly higher in a typical North American population.
LDL-cholesterol is 70% higher, blood pressure is 20% higher in BMI is 20% higher in North America.
All of these are demonstrated initiators and accelerators of vascular inflammation.
LDL-cholesterol, oxidized LDL-cholesterol to be specific, is rapidly taken up by arterial endothelial cells and sequestered in the intima media space.
Elevated blood pressure, or hypertension, is arguably a byproduct of this cholesterol sequestration process. As cholesterol is incorporated into arterial walls and as cholesterol plaques become progressively established, arteries become stiffer and blood pressures go higher.
BMI, as a marker of adiposity, reflects the reality that adipose cells produce a vast number of vascular inflammatory proteins. However, it is cholesterol levels, in particular, which stand out in this study as being particularly higher in a typical North American population.
In summary, the goal of primordial prevention is the establishment of vascular health, preferably before birth, the maintenance of vascular health throughout life, and achieving and maintaining true normal when it comes to cholesterol levels, blood sugar levels, body weights, physical activity levels, BMI, etc.
