Cardiovascular Health Flashcards
___________________ ________________ is a general term for conditions affecting the heart and blood vessels, such as atherosclerosis, hypertension, angine, myocardial infarction and stroke.
Cardiovascular Disease
The cardiovascular system is a closed circuit system (Unlike the lymphatic system). True or false?
True
Name a waste product of the cardiovascular system.
Carbon dioxide (waste from the lungs / breathing out)
How is the cardiovascular system critically linked to the immune system?
White blood cells (immune calls) exist in the circulating blood
Cardiovascular disease is a disease of _____, lifestyle and environment.
Diet
Why does every drug prescribed for CV disease actually drive CV disease?
Because of their drug-related nutrient depletions
The CV system is divided into 2 parts: the pulmonary system and the ___________ system.
Systemic
The heart pumps oxygenated blood through the ________ and around the body.
Aorta
Fill in the missing word:
Arteries, __________, capillaries
Arterioles
Deoxygenated blood returning from the body goes into the _______ atrium.
Right
What is the name of the valve between the right atrium and ventricle called?
Tricuspid valve
Deoxygenated blood passes from the heart, up through the ____________ __________ and into the lungs.
Pulmonary artery
The ________________ is a monolayer of endothelial cells lining the blood interface throughout the CVS, including the cardiac chambers.
The endothelium
Oxygenated blood leaves the lungs and returns into the ______ atrium, via the pulmonary _______.
Left atrium via the pulmonary vein.
Oxygenated blood passes into the left atrium and then the left ventricle, via the __________ valve.
Bicuspid
When the heart pumps blood out around the body, how much is retained for the cardiac system itself?
20%
What are the cells of the heart called?
Cardiac myocytes
Around a third of the content of cardiac myocytes is made up of ______________.
Mitochondria
Which mineral is key to the electrical functioning of the heart?
Calcium
The blood vessels are typically made up of ____ layers.
3 layers
The blood vessels are typically made up of 3 layers:
Tunica _________, tunica media, tunica adventicia / externa.
Intima
In which layer of the blood vessels would you find the endometrial cells?
Tunica intima
Which layer of the blood vessels is made up of vascular smooth muscle cells?
Tunica media
Which layer of the blood vessels contains collagen and elastin?
Tunica media (middle layer)
Normal functioning of the _____________ is critical to vascular health.
Endothelium
What is the glycocalyx and where is it found?
The glycocalyx is a carbohydrate-rich protective layer, covering the endothelium of the CVS.
List 2 functions of the glycocalyx
- Regulates permeability of the endothelium
- Controls nitric oxide production (for vasodilation)
- Acts as a mechanosensor of blood shear stress
- Lubricates red blood cells and prepares them to squeeze into single file to enter capillaries
What kind of junctions are found in the endothelium?
Tight junctions
What is blood ‘shear stress’?
The frictional force of blood on endothelial cells
Why is the control of nitric acid essential in the CVS?
It regulates vasodilation (and therefore blood pressure)
The glycocalyx is easily damaged. List 3 things it can be damaged by.
Inflammation
Hyperglycaemia
Endotoxemia
Oxidised LDL-C
Abnormal blood shear stress
What happens when the glycocalyx is damaged?
The endothelium becomes dysfunctional. This can be the start of atherosclerosis.
List 3 key functions of the endothelium
Semi-permeable barrier
Regulates vascular tone
Produces nitric oxide and endothelin
Produces enzymes (including angiotensin converting enzyme (ACE))
Plays a key role in regulating blood pressure
Angiogenesis - endothelial cells are the origin of all new blood vessels
Haemostasis - the optimum flow of blood through the system
Immune defence
How does the endothelium contribute to haemostasis?
Its surface is non-thrombotic / anticoagulant, to keep the blood flowing optimally.
What role does the endothelium play in immune defence?
Healthy endothelial cells deflect leukocyte adhesion and oppose local inflammation.
Why is it so important that the endothelium is a semi-permeable barrier?
So that it can play an important role in blood fluid balance and selective movement of substances (i.e, glucose and oxygen).
This is why it has tight junctions and a layer of glycocalyx (similar to mucin in the gut)
What is the purpose of the vascular smooth muscle cells, found in the tunica media of blood vessels?
- They play a key role in blood vessel contraction and dilation (and therefore blood pressure and pumping around the body)
- They limit immune cell infiltration
Which mineral is needed to keep the vascular smooth muscle cells in the tunica media of blood vessels in working order?
Calcium
____________ dysfunction can lead to deficiency in the action and ability of vascular smooth muscle cells.
Mitochondrial dysfunction
Name a pathological condition that can cause vascular smooth muscle cells to undergo change, altering their structure and function and even allowing them to move/migrate into the tunica intimate.
Inflammation
Oxidative stress
Telomere damage
Up to ____% of atherosclerotic plaque is made up of _________________
Vascular smooth muscle cells
What do fibroblasts produce?
Elastin and collagen
What is eNOS?
Endothelial nitric oxide synthase
List 2 roles of nitric oxide.
Regulates vascular tone
Reduces platelet aggregation
Regulates vascular smooth muscle cell proliferation
Inhibits leukocyte adhesion to blood vessels
Inhibits inflammatory cytokines in blood vessels
Opposes oxidation of LDL-C
Which amino acid is nitric oxide continually generated from?
L-arginine
Which enzyme catalyses the synthesis of nitric oxide from L-arginine?
eNOS - endothelial nitric oxide synthase
Nitric oxide is both water and lipid soluble. True or false?
True
How does vitamin D regulate nitric oxide synthesis?
It mediates the eNOS enzyme
Name one food to support nitric oxide production.
Beetroot
List 2 impacts of oxidative stress and inflammation on the endothelium.
Increased permeability
Increased inflammatory cytokines
Increased leukocyte adhesion
Reduced vasodilation
Increased risk of thrombosis
List 2 impacts of oxidative stress and inflammation on the vascular muscle cells.
Increased inflammatory cytokines
Increased extracellular matrix synthesis
Migration into the tunica intima
Name 2 vasodilator molecules
- Nitric oxide
- Prostacyclin
How do migrating vascular muscle cells (migrating due to damage from oxidative stress / inflammation) contribute to the building of atheroma?
They can similarly to fibroblasts and osteoblasts, laying down elastin and collagen, and calcium deposits on the tunica intima.
Which fuel source does the heart prefer?
Fatty acids
What effect do Peroxisome proliferator-activated receptors (PPARs) on the CV system?
They decrease inflammation and promote endothelial health
Which PPAR (PPAR-a or PPAR-y) increases HDL-C, reduces triglycerides and inflammation, and is anti-atherosclerotic?
PPAR-a (alpha)
Which PPAR (PPAR-a or PPAR-y) reduces blood glucose, fatty acids and insulin?
PPAR-y (gamma)
List 3 PPAR-a agonists
Green tea
Resveratrol
Oregano
Thyme
Rosemary
Naringenin (citrus bioflavonoid)
Omega 3
List 3 PPAR-y agonists
Apigenin
Hesperidin
Curcumin
Resveratrol
EGCG (polyphenol from green tea)
List 3 risk factors for CVD
- Family History
- Genetic SNPs
- Ethnicity (South Asian, sub-saharan)
- Gender (male)
- Dislipidemia
- Hypertension
- Mitochondrial dysfunction
- Elevated homocysteine
What percentage increased risk of CVD do siblings of CVD patients have?
40% increased risk
What percentage increased risk of CVD do the children of premature CVD patients have?
60 - 75% increased risk
Name 2 genetic SNPs associated with increased risk of CVD.
MnSOD
NOS3
MTHFR
ACE
Symptoms of CVD in women age 35 - 54 can often be mistaken for symptoms of the menopause or heartburn. True or false?
True
Which condition is associated with a sedentary lifestyle, excess alcohol, excess saturated/trans fat, menopause, obesity and smoking; and Is the term given to a picture of increased total cholesterol, increased LDL-C, VLDL-C, Lp(a) and triglycerides, and low HDL-C?
Dyslipidemia
CVD pathologies tend to appear __ years earlier in those with hypertension.
5 years earlier
Why is mitochondrial dysfunction a risk factor for CVD?
Because mitochondrial dysfunction = reduced production of ATP. ATP is required to pump Ca ions out of the myocardial calls, allowing them to relax and maintaining the electrochemical gradient across the cell membrane.
Elevated ____________ is associated with LDL oxidation monocyte adhesion and endothelial dysfunction.
Homocysteine
Why is low folate and B12 a risk factor for elevated homocysteine and therefore, CVD?
Folate and B12 are needed for the re-methylation of homocysteine to methionine.
Which vitamin is an important co-factor in the conversion of homocysteine to cysteine in the methylation cycle?
Vit B6
B9 and B12 are required for the re-methylation of homocysteine. The other route for methylating homocysteine is dependant on which 2 nutrients?
Choline and Betaine
What is lipoprotein A (Lp(a)) and why does it increase CVD risk?
Lp(a) is a form of LDL-C. It acts as a clotting factor.
Why can minor thyroid hormone changes alter cardiovascular homeostasis?
Because TH receptors are present in myocardial and vascular tissue.
Hypo and hyperthyroidism are linked with endothelial dysfunction, dislipidemia and blood pressure changes. True or false?
True
List 3 potential origins of inflammation
- Dyslipidemia
- Dysbiosis
- Intestinal permeability
- Oxidative stress
- Diabetes
- Excess adipose tissue
- Smoking
Polymorphisms of EDN1 may increase levels of ________________, a potent vasoconstrictor peptide linked with inflammation.
Endothelin-1
How does excess adipose tissue enhance CVD risk?
It perpetuates inflammation, contributing to vascular breakdown and metabolic complications.
Which peptide that protects against CVD by increasing insulin sensitivity and influencing expression of endothelial cells, is decreased in obesity?
Adiponectin
Low levels of adiponectin contribute towards _________ resistance.
Insulin resistance
Name 3 peptide hormones associated with increased CVD risk in obesity.
Endothelin-1
Adiponectin
Leptin
Insulin resistance is a risk factor for CVD. It contributes to the ‘lipid triad’ and dyslipidemia. What 3 things make up the lipid triad?
High plasma triglycerides
Low HDL-C
Small, dense LDLs
How does insulin resistance increase the risk of CVD?
It generates chronic hyperglycaemia, which leads to oxidative stress, inflammation and cellular damage to the endothelium.
Insulin resistance means that glucose is not cleared from the bloodstream as quickly as needed, increasing the risk of ___________ reactions and the production of damaging compounds known as AGEs.
Glycosylation reactions
What are Advanced Glycosylation end products (AGEs)?
Harmful compounds formed when protein or lipids become glycated after exposure to glucose.
_____________ = the chemical addition of glucose molecules to lipids or proteins
Glycation
Which vitamin plays a role in nitric oxide production, ameliorates AGEs and plays a role in the RASS system, monitoring blood pressure?
Vitamin D
Which vitamin is a major antioxidant and can reduce triglycerides and LDL-C
Vitamin C
Name a medication that reduces Mg in the body.
Proton Pump Inhibitors
Vitamin C re-energises Vitamin __
E
Name a drug that can interact with high doses of Vitamin E.
Warfarin.
Which form of niacin (B3) has a lower risk of GI disturbance and niacin flushing, often making it better for use in practice?
Niacinamide
Which is the most bioavailable/efficient form of supplemental CoQ10 - Ubiquinol or ubiquinone?
Ubiquinol.
Ubiquinone requires conversion to ubiquinol in the body
Which might L-Citrulline work better than L-arginine as a supplement to increase nitric oxide in the body?
Because L-arginine is subject to arginase enzyme breakdown in the intestine AND goes through hepatic first pass, so the actual usable amount is significantly reduced. L-citrulline isn’t subject to either of these and travels straight to the kidneys where it can be converted to arginine.
L-_________ is the precursor to L-___________, which is the precursor to nitric oxide.
L-citrulline is the precursor to L-arginine, which is the precursor to nitric oxide
