Cardiovascular Health Flashcards
What is the general term given to conditions affecting the heart and blood vessels, such as atherosclerosis, hypertension, angina, myocardial infarction and stroke?
Cardiovascular Disease (CVD)
Name 3 conditions that may be grouped under Cardiovascular Disease (CVD)
Atherosclerosis
Hypertension
Angina
Myocardial infarction
Stroke
List 3 things that greatly increase CVD risk.
High intake of processed foods
++ Sugar
++ Salt
Unhealthy fats
Alcohol
Lack of exercise
Excess body fat
Stress
Smoking
What is the endothelium?
A monolayer of endothelial cells lining the blood interface throughout the CVS, including cardiac chambers.
Normal functioning of the endothelium is CRITICAL to vascular health. True or false?
True
What is the glycocalyx?
A carbohydrate-rich protective layer covering the endothelium.
What is the name given to the carbohydrate-rich protective layer that covers the endothelium?
Glycocalyx
What is the function of the glycocalyx?
Regulate endothelial permeability
Control nitric oxide production
Acts as a mechanosensor of blood shear stress
What is blood shear stress, and what acts as a mechanosensor of it?
Blood shear stress is the force of flowing blood on the endothelial surface of the blood vessel.
The glycocalyx is the sensor of this.
Where would you find the glycocalyx?
Covering the endothelium (throughout the cardiovascular system)
List 3 things that may damage the glycocalyx
Inflammation
Hyperglycaemia
Endotoxemia
Oxidised LDL
Abnormal blood shear stress
Damage to the ___________ commonly precedes further damage to the endothelium, promoting lipid deposition and atherosclerosis
Glycocalyx
What name is given to the frictional force of blood on endothelial cells?
Blood shear stress
List 3 key functions of the endothelium
Semi-permeable barrier: fluid balance, host defence, movement of substances
Regulates vascular tone: secretes vasodilators and vasoconstrictors
Enzymes: Contains angiotensin converting enzyme (ACE) - key role in regulating blood pressure
Angiogenesis: endothelial cells are the origin of all new blood vessels
Haemostasis: the luminal surface of endothelium prevents platelet adherence and coagulation
Immune defence: healthy endothelial cells deflect leucocyte adhesion and oppose local inflammation
Name one vasodilator and one vasoconstrictor secreted by the endothelium.
Nitric oxide (vasodilator)
Endothelin (vasoconstrictor)
Which part of the cardiovascular system contains angiotensin-converting enzyme (ACE)?
The endothelium
Which type of cells are the origin of all new blood vessels?
Endothelial cells
What is the role of nitric oxide in the cardiovascular system?
Vasodilator
What is the role of endothelin in the cardiovascular system?
Vasoconstrictor
Which type of cells, located in the tunica media of blood vessels, regulate blood circulation and pressure by playing a key role in vessel contraction and dilation?
Vascular Smooth Muscle cells (VSMCs)
In which layer of blood vessels would you find vascular smooth muscle cells?
In the tunica media
What is the role of vascular smooth muscle cells and where would you find them?
They regulate blood circulation and blood pressure.
Found in the tunica media
Which cells maintain the integrity and elasticity of blood vessels, whilst limiting immune cell infiltration?
Vascular smooth muscle cells.
What is phenotype modulation?
Altering of physical form/structure through the interaction between the genotype and environment.
List 2 things that may cause phenotypic modulation of vascular smooth muscle cells.
Inflammation
Oxidative stress
Telomere damage
Why are phenotypic changes to vascular smooth muscle cells central to vascular disease, especially atherosclerosis and hypertension?
Because vascular smooth muscle cells regulate blood circulation and pressure, and limit immune cell infiltration.
What does nitric oxide play in cardiovascular health? (List 3 things)
Regulates vascular tone
Reduces platelet aggregation
Inhibits leukocyte adhesion
Inhibits inflammatory cytokines
Opposes oxidation of LDLs
Which enzyme is required to generate nitric oxide from L-arginine?
eNOS
(endothelial nitric oxide synthase)
Nitric oxide is continuously generated from the amino acid L-___________ by the enzyme eNOS.
L-arginine
Nitric oxide diffuses easily from the endothelium into _____________ cells and the bloodstream.
Vascular smooth muscle cells
Which vitamin regulates nitric acid synthesis by mediating eNOS?
Vitamin D
What role does vitamin D play in the cardiovascular system?
It regulates nitric oxide synthesis by mediating eNOS.
Reduced ________ _________ contributes to atheroma formation and CVD.
Nitric oxide
List 3 ways in which oxidative stress and inflammation impacts endothelial cells / the endothelium
Increases permeability
Increases inflammatory cytokines
Increases leukocyte adhesion
Reduces vasodilators
Increases risk of thrombosis
List 3 ways in which oxidative stress and inflammation impacts vascular smooth muscle cells.
Increases inflammatory cytokines
Increases extracellular matrix synthesis
Causes them to migrate into the tunica intima
Causes them to proliferate
What are PPARs?
Nuclear transcription factors that control gene expression
What do PPARs control?
Gene expression
What is the name given to the nuclear transcription factors that control gene expression?
PPARs
What do PPARs do for CV health (2 things)?
Decrease inflammation
Promote endothelial health
PPAR__ activation increases HDL-C, reduces triglycerides and inflammation and is anti-artherosclerotic.
PPARa
What does PPAR-a do in the CV system (list 2 things)?
Increases HDL-C
Reduces triglycerides
Reduces inflammation
Anti-atherosclerotic
List 3 PPARa agonists
Green tea
Resveratrol
Oregano
Thyme
Rosemary
Naringenin (citrus bioflavonoid)
Omega-3
What does PPAR-y do for the CV system (list 2 things)
Reduces blood glucose
Reduces fatty acids
Reduces insulin
List 3 natural PPAR-y agonists
Apigenin
Hesperidin
Curcumin
Resveratrol
EGCG
What does PPAR stand for?
Peroxisome proliferator-activated receptor (PPAR)
List 3 risk factors for cardiovascular disease
Family history - siblings and parents
Genetics - various polymorphisms including MTHFR and ACE
Ethnicity - particularly south asian / African
Gender - primarily male but female risk is increasing
Dislipidemia
Hypertension
Mitochondrial dysfunction
Elevated homocysteine
Low folate and B12
Thyroid dysfunction
Inflammation
Obesity
Insulin resistance
Chronic stress
Periodontal disease
Heavy metals
Melatonin deficiency
Why is risk of CVD underestimated in women?
Because women tend to experience more vague physical signs
List 2 of the vague CVD signs that may be seen in women
Lightheaded with exertion
Symptoms easily mistaken for the menopause or heartburn
Describe dyslipidemia
Increased total cholesterol, LDL, VLDL, IDL, Lp(a), triglycerides, with decreased HDL-C
________, a form of LDL, also acts as a clotting factor, further increasing CVD risk.
Lp(a) - lipoprotein A
List 3 things associated with the development of dyslipidaemia
Sedentary lifestyle
Excess alcohol
Smoking
Obesity
High sat & trans fat intake
Menopause
T2DM
Hypothyroidism
Chronic kidney disease
Dyslipidemia is largely preventable, true or false?
True
CVD pathologies tend to appear 5 years earlier in those with hypertension. True or false?
True
Why does mitochondrial dysfunction contribute to CVD?
ATP is required to pump Ca ions out of myocardial cells, allowing relaxation and maintaining the electrochemical gradient across the myocardial cell membrane.
Elevated homocysteine is associated with LDL oxidation, monocyte adhesion and endothelial dysfunction.
List 3 things that elevated homocysteine may be related/due to.
Low folate and B12 - needed for re-methylation of homocysteine to methionine.
Low B6 - a co-factor in conversion of homocysteine to cysteine in the methylation cycle
Genetic polymorphisms - MTHFR, FUT2, TCN, etc
Thyroid dysfunction - Thyroid hormone receptors are present in the myocardium and vascular tissue. Minor thyroid changes can impact CV homeostasis.
Inflammation - from various origins
Which common SNP may contribute to elevated homocysteine?
MTHFR - impacts supply of methyl groups needed to methylate B12 and in turn, re-methylate homocysteine to methionine.
Why are hypo and hyperthyroidism linked to endothelial dysfunction, dyslipidemia and BP changes?
Because thyroid hormone receptors are present in the myocardium and vascular tissue. Minor thyroid hormone changes can alter CV homeostasis.
Inflammation is a CVD risk factor. But where might it come from?
Dyslipidaemia
Gut dysbiosis
Intestinal permeability
Oxidative stress
Diabetes
Excess adipose tissue
Smoking
Endothelial dysfunction
Obesity / excess adipose tissue
____________, a peptide that influences expression of endothelial cells, protecting against CVD is decreased in obesity.
Adiponectin
Name the cardioprotective peptide that influences expression of endothelial cells, protects against CVD and increases insulin sensitivity.
Adiponectin
List 2 ways in which obesity contributes to CVD risk
Excess adipose tissue perpetuates inflammation
Lowers levels of adiponectin (CVD protective peptide)
Contributes to insulin resistance
High leptin levels drive vasoconstriction and increased blood pressure.
Obesity is associated with high levels of __________, which causes sodium retention, vasoconstriction and increased blood pressure.
Leptin
Why is insulin resistance a risk factor for CVD?
Generates chronic hyperglycaemia, leading to oxidative stress, inflammation and cellular damage.
Contributes to the lipid triad (high TGs, low HDL, small dense LDLs) and dyslipidaemia.
Slows blood glucose clearance, increasing the risk of glycosylation reactions and production of AGEs (advanced glycation end products)
__________ + endothelial damage leads to atherosclerotic plaque formation.
Dyslipidaemia
What is glycation?
The addition of a glucose molecule to a lipid or protein
____________ = the addition of a glucose molecule to a lipid or protein.
Glycation
What are Advanced Glycation End Products (AGEs)?
Harmful compounds formed when protein or lipids become glycated after exposure to glucose.
How do advanced glycation end products (AGES) exert their effects?
- Bind to RAGE cell receptors, increasing inflammatory cytokines and ROS.
- Increase extracellular matrix synthesis, trapping endothelial LDL and cross-binding it with collagen (creating vascular stiffening)
On which cells would you find RAGE receptors?
Endothelial cells
Vascular smooth muscle cells
Immune cells
Advanced glycation end products (AGEs) increase with advancing age. True or false?
True
List 3 dietary/lifestyle factors that can contribute to the overall AGEs pool.
High refined carbohydrates
Processed foods
Processed meats
Dairy
High heat cooking - grilling, roasting, searing, frying
Smoking
Sedentary lifestyle
Which vitamin seems to ameliorate AGE-mediated complications?
Vitamin D
How does chronic stress contribute to endothelial dysfunction and CVD risk?
Activates SNS and HPA-axis, ultimately increasing inflammatory cytokines, heart rate and blood pressure, increasing arterial inflammation.
How does periodontal disease contribute to CVD?
Increases systemic inflammation, which impairs vasodilation. Promotes endothelial dysfunction.
Deficiency of which mineral increases atherosclerosis risk?
Zinc
__________’s produced by the gut microbiota, decrease the risk of metabolic endotoxemia (a key risk factor for CVD and insulin resistance) by maintaining intestinal barrier integrity.
SCFA’s
How do SCFAs reduce serum lipids?
By inhibiting cholesterol synthesis
By redirecting lipids to the liver
The gut microbiota play a role in cholesterol regulation by altering bile acids that influence systemic cholesterol levels. True or false?
True
Foods rich in ________ may induce low-grade metabolic acidosis, a risk factor for IR and CVD.
Protein
List 3 CVD risk marker tests
- Cardiac risk tools, i.e, QRISK
- Cardiac troponin (released into the blood when heart muscle is damaged)
- Lipid profile (TC:HDL >6 = higher CVD risk)
- Lp-PLA2
- hsCRP
- MPO
A TC:HDL ratio of > ___ is a higher risk for CVD
6
What is the normal level of total cholesterol?
<5 mmol/L
What is a normal level of non-HDL cholesterol?
<4 mmol/L
What is a normal level of LDL cholesterol?
<3 mmol/L
What is a normal level of HDL cholesterol?
> 1 mmol/L (men)
1.2 mmol/L (women)
LDL and HDL particle size (LDL-P and HDL-P) correlate with carotid atherosclerosis and are more closely associated with obesity, diabetes and IR than LDL-C and HDL-C. True or false?
True
LDL and HDL particle size is important. True or false?
True
List 3 key nutrients to support CV health
Vitamin C - up regulates nitric oxide, down regulates NADPH oxidase
(500 - 1000mg, 3 x day)
Vitamin E - decreases oxidation of LDL-C and deposition in arterial walls, promotes healthy blood viscosity
(400 - 800 iu/day)
Vitamin D - Modulates nitric oxide synthesis, lowers BP
(600 - 1000iu/day)
Omega-3 - Improves lipid profiles. EPA stabilises cell membranes. DHA supports membrane fluidity.
(3-6g/day)
Magnesium (glycerinate/taurate) - Modulates neuronal excitation and myocardial contraction. Helps stabilise heart rhythm.
(500 - 800mg/day)
Co-enzyme Q10 - Protects against endothelial dysfunction, reduces LDL oxidation, increases superoxide dismutase activity, supports mitochondrial health and ATP production
(60 - 300 mg/day)
List 2 herbs to support CV health
- Hawthorn - vasodilator, antioxidant, anti-inflammatory, strengthens and improvs vascular elasticity, lowers blood pressure.
(1,000 - 5,000mg) - Garlic - Antihypertensive, lowers homocysteine, decreases arterial stiffness, reduces LDL and LDL oxidation, enhances glutathione and SOD
(2-5g fresh bulb daily)
Regular physical activity and exercise significantly reduces CVD risk, true or false?
True
List 2 ways in which regular exercise decreases CVD risk.
- Leads to a more favourable lipid profile
- Improves insulin sensitivity & signalling
- Activates eNOS, increasing nitric oxide synthesis
- Promotes reduced resting blood pressure
List 5 ways to natural support CVD
- Plant-based / Mediterranean style diet
- Key nutrients (Vit C, E, D, omega-3, Mg, Co-Q10)
- Herbs (Hawthorn, garlic)
- Regular exercise
- Reduce stress
Many CVD drugs can add to a nutrient-depleted status, true or false?
True
List 2 common CVD drugs and state which nutrients they deplete.
Statins - deplete Co-Q10
Cholestyramine - depletes fat soluble vitamins
Loop/thiazide diuretics - deplete K, Ca, zinc, B1
ACE inhibitors - deplete zinc
Beta-blockers - deplete Co-Q10 and melatonin
In the UK, hypertension is currently defined as ______/______ or higher.
140/90
List 3 signs/symptoms of hypertension
Fatigue
Headache
Dizziness
Visual disturbances
Often asymptomatic
Hypertension can decrease life expectancy by ____ years
5 years
Hypertension can be ____________ (95%), secondary or malignant.
Essential / primary (no specific underlying medical cause)
What causes secondary hypertension (5% of HTN cases)?
Kidney, adrenal, thyroid diseases, or diabetes
Which type of hypertension is a medical emergency?
Malignant hypertension
Malignant hypertension = _____/______
180/120
Why is malignant hypertension a medical emergency
Risk of organ damage
Why is melatonin deficiency a risk factor for CVD?
It is a potent antioxidant with anti-hypertensive properties. It protects against coronary heart disease.
Why are SCFAs, produced by the gut microbiota, so important in CVD?
- They decrease the risk of metabolic endotoxaemia (a key risk factor for CVD and IR)
- They reduce serum lipids by inhibiting cholesterol synthesis, or redirecting lipids to the liver.
Alterations in the gut microbiota can lead to an increase in harmful __________ such as TMAO (associated with endothelial dysfunction and increased CVD risk)
Harmful metabolites
What are High PRAL foods?
Foods rich in protein
(PRAL = potential renal acid load)
How do trans fats add to CVD risk?
-Promote dyslipidemia
- increase inflammation
- Contribute to endothelial dysfunction
- Encourage visceral adiposity
- Increase risk of IR
_____________ acid increases expression of the receptor involved in the uptake of oxidised LDLs and is a major driver of atherosclerosis and CVD.
Palmitic acid
List 3 causes / risk factors for hypertension
Possible genetic link if parents are hypertensive
Obesity (especially increased abdominal adiposity)
Excess alcohol
Stress
Nutritional deficiencies
High table salt intake
Inactivity
Smoking
Medical drugs
Raised uric acid
Why does obesity increase hypertension and ultimately, CVD risk?
It activates the RAAS (renin angiotensin aldosterone system), causing vasoconstriction and water retention.
Why does excess alcohol increase risk of hypertension?
- It decreases the baroreceptor reflex (ability to respond to BP changes) by interacting with receptors in the brain stem.
- Increases heart rate and blood pressure
- Stimulates the endothelium to release vasoconstrictors
- Activates the RAAS
How does stress increase hypertension risk?
It increases SNS activity, causing vasoconstriction.
High cortisol increases the potent vasodilator endothelin-1
Activates the RAAS.
High cortisol increases the potent vasodilator _____________-1
Endothelin-1
Micronutrient deficiencies increase the risk of hypertension, especially ___________ and ___________.
- Magnesium (is a vasodilator)
- Potassium (increases urinary excretion of sodium, decreases blood volume)
Why is inactivity a risk factor for hypertension?
It’s associated with higher heart rate and greater force on the arteries.
Why is smoking a risk factor for hypertension?
Damages the endothelium
Nicotine constricts blood vessels
Increases heart rate
Give an example of a medical drug that can increase blood pressure, increasing risk of hypertension.
NSAIDs
Corticosteroids
Decongestants
Why is raised uric acid a risk factor for hypertension?
It stimulates the RAGE pathway, increasing NF-Kb and disrupting eNOS activity.
It exacerbates endothelial insulin resistance
Lowers nitric oxide levels
Raised uric acid is a risk factor for hypertension. But why might uric acid be raised?
Hyperinsulinemia
Gout
High intake of purine foods
Why might focusing on reducing uric acid levels reduce the risk of CVD?
Because it reduces the risk of hypertension.
A natural approach to hypertension includes increasing the _________/ sodium ratio to >3:1
Potassium
Why might you want to increase dietary potassium in hypertension cases?
Potassium assists in sodium regulation/excretion, reducing blood pressure & volume.
How does potassium contribute to lowering hypertension risk?
Increases sodium excretion (naturesis)
Encourages vasodilation
Reduces sensitivity to angiotensin II
Lowers SNS activity
Decreases oxidative stress in the vascular wall
In hypertension you should reduce sodium intake to <1.5 g/day. True or false?
True
When should you avoid potassium supplements and take care with dietary potassium intake?
In renal disease
Alongside ACE inhibitors
Alongside potassium-sparing diuretics
Which diet is often used in patients with hypertension?
DASH diet
(Dietary Approaches to Stop Hypertension)
What foods are eaten on the DASH diet?
Fresh fruits and vegetables, legumes, nuts, seeds, whole grains, fish, lean meat, low-fat dairy, limited fat & salt. Sodium is restricted.
Which potent antioxidant and neurotransmitter is reduced by beta-blockers?
Melatonin
List 3 natural ACE inhibitors (reduce vasoconstriction)
Sprulina
Mushrooms
Spinach
Hemp seeds
Walnuts
Why is it important to optimise sleep in hypertension?
Melatonin is associated with anti-hypertensive effects (through GABA stimulation, angiotensin-II inhibition and increases in NO)
Why are optimum vitamin D levels important in hypertension?
Vit D deficiency increases vasoconstriction and sodium/water retention.
Vit D decreases pro-inflammatory cytokines, increases nitric oxide, endothelial function and arterial elasticity, decreases hs-CRP.
The lower the levels of vitamin D, the greater the risk of hypertension. True or false?
True
Magnesium deficiency is associated with hypertension. True or false?
True.
What dose of magnesium glycerinate/taurate might you use for hypertension?
500 - 800 mg/day
What dose of L-arginine might you use for hypertension?
1-2g, three times daily
Why is L-arginine a useful supplement in hypertension?
It is the principle substrate for vascular nitric oxide synthesis.
Modulates the RAAS, ACE inhibitor
Hypertensive patients often display high arginase. What is this and why is it a problem?
Arginase breaks down arginine, which is needed for nitric oxide production and subsequent vasodilation.
Vitamin B6 deficiency is associated with hypertension, true or false?
True
What dose of vitamin B6 might you use for hypertension?
100mg, 1-2 x day
Which 3 herbs are traditionally used together for hypertension?
Hawthorn, Yarrow, Lime flower
Which herb is a diuretic, naturally high in potassium and helps support lowering of blood pressure?
Dandelion
What is atherosclerosis?
Narrowing and hardening of large/medium arteries, which reduces blood flow.
__________ dysfunction plays a central role in the formation of fatty streaks, a primary event in atherosclerosis.
Endothelial dysfunction
explain the process of atherosclerosis
- Endothelial dysfunction plays a central role in the formation of fatty streaks.
- Increased endothelial permeability allows entry of LCL-C into the tunica intima.
- LDL becomes ‘trapped’ within the vessel wall and is oxidised to mLDL.
- mLDL recruits leukocytes expressing high levels of inflammatory cytokines, which also trigger cytokine release from the endothelium and VSMC cells.
- Macrophages consume the lipoproteins to form foam cells. Cellular debris also becomes incorporated inflammation drives plaque formation.
- A cap forms over the plaque to wall off the plaque from the blood.
What ultimately starts / begins the process of atherosclerosis?
Endothelial dysfunction
(Disturbance of the protective glycocalyx layer and damage to the endothelial cells)
List 3 risk factors for endothelial dysfunction and ultimately, atherosclerosis.
Inflammation
Increased oxidative stress
Oxidised LDL
Hyperglycaemia
Endotoxaemia
Abnormal shear stress
List 2 factors that drive the inflammatory response in atherosclerosis.
Endothelial dysfunction
Subintimal cholesterol accumulation
Immune cell recruitment
What do ‘inflammasomes’, found in atherosclerosis formation do?
Originally made from monocytes/macrophages, they release inflammatory cytokines, activating IL-6 and stimulating CRP production. This enhances the inflammatory cascade in vessel walls.
Why does ongoing inflammation increase the risk of thrombosis in atherosclerosis?
It thins the fibrous cap on the atheroma, giving rise to instability/rupture and the release of the contents into the blood stream.
Pro-inflammatory cytokines differentiate VSMC into osteoblast-like cells, increasing plaque calcification.
Why is dislipidemia a significant risk factor for atherosclerosis?
Lipids are a fundamental component of atherosclerotic plaques.Trig
Triglycerides are hydrophobic and must combine with lipoproteins to travel in plasma, true or false?
True
Which triglyceride-rich lipoproteins are prone to endothelial accumulation and uptake by foam cells and are strongly linked with endothelial dysfunction and atherosclerosis?
VLDLs and VLDL remnants
Oxidised LDLs
Regular _______ oil consumption reduces LDL-C and oxidised LDLs and improves post-prandial glucose profiles
Olive oil
Oleocanthal and Oleacein are antioxidant and anti-inflammatory polyphenols found in ________ _______
Olive oil
What food contains Monocolin K, an inhibitor of cholesterol synthesis via HMG Co-reductase (having a similar effect to statins)?
Red yeast rice.
How much red yeast rice might you prescribe per day in atherosclerosis?
2.4 - 4.8 g/day
Dietary sources of beta glucans interact with lipids and biliary salts in the bowel, lowering LDL-C and ApoB. List 2 food sources of beta glucans.
Oats
Mushrooms
Seaweed
Barley
Why are SCFA’s, produced by the gut microbiota, important in treating/preventing atherosclerosis?
They decrease cholesterol synthesis and increase bile excretion.
Also modulate immune function
Which foods might you use to lower endothelin-1 levels?
Citrus flavonoids
Quercetin
Epicatechins
Garlic
Olive oil
Blackcurrant
How much beetroot juice per day might you prescribe in atherosclerosis?
200ml day
Why is beetroot useful in atherosclerosis?
Contains inorganic nitrates that convert to nitric acid in the body
Betaine decreases homocysteine by helping re-methylate homocysteine to methionine
Why is green tea useful in atherosclerosis?
It contains L-theanine, which increases nitric oxide production in endothelial cells
It is important to lower homocysteine in atherosclerosis, but why?
To reduce inflammation
Which supplements might you use to reduce homocysteine?
B6, folate, B12 (methyl forms), TMG
Why is it important to reduce fibrinogen levels in atherosclerosis?
High fibrinogen increases blood viscosity, stimulates fibrin formation and increases platelet aggregation.
List 2 things you could recommend to lower fibrinogen levels.
Mediterranean diet
Garlic
Mild-moderate exercise
Why would you want to support liver detoxification in atherosclerosis?
Poor liver function can increase circulation of inflammatory mediators and compromise fatty acid status.
Which fruit supports liver function and is a powerful activator of phase 1 detox without increasing harmful bio activation (antioxidant and hepatoprotective effects) and also enhances phase II detox?
Schisandra fruit/berries
Which amino acid, useful in atherosclerosis, enhances the bioavailability of both arginine and nitric oxide?
L-citrulline
Which nutrients might you use in atherosclerosis?
B5, B3, omega 3
Pomegranate, pycogenol, lycopene, citrus fruit, glob artichoke
Which vitamin reduces “bad” cholesterol and increases HDL?
B5 (pantothenic acid)
Which vegetable reduces serum LDL, TC and TG’s, regulates lipid metabolism, increases bile production, is anti-oxidant and hepatoprotective?
Globe artichoke
In what Cardiovascular conditions would you avoid recommending sauna?
Unstable angina
Recent MI
Hypertension
Diet aside, what other modalities might you recommend to support atherosclerosis?
Sauna (if not contraindicated)
Dry skin brushing
Contrast hydrotherapy
Tai Chi, yoga, acupuncture
What is ischaemic heart disease?
An imbalance between myocardial oxygen supply and demand, associated with inadequate supply via the coronary arteries.
Ischaemic heart disease is commonly caused by ______________
Atherosclerosis
List 2 ischaemic heart disease syndromes
Angina
Myocardial infarction
What is angina?
Chest pain caused by insufficient supply of oxygenated blood supply to the myocardium by the coronary arteries.
What are the 2 types of angina?
- Stable angina - predictable, transient pain during exertion or emotional stress. Symptoms resolve once oxygen balance is restored.
- Unstable angina - unpredictable, occurs at rest. May be a precursor to acute MI.
List 3 signs/symptoms of stable angina.
- Constricting chest pain (can radiate to the neck, left shoulder, arm, jaw), worsened by exertion, relieved by rest
- Shortness of breath
- Sweating
- Nausea
Family history of premature ischaemic heart disease is a strong risk factor for angina. True or false?
True
List 3 risk factors for angina
Smoking
Vitamin D deficiency
Family history
A deficiency in which vitamin significantly correlates with chronic angina?
Vitamin D
What is a myocardial infarction (MI)?
An acute blockage of a coronary artery, usually due to a thrombus, resulting in death of cardiac tissue.
Why does an MI hurt?
Ischaemic myocardial cells release adenosine and lactate onto nerve endings, causing pain.
Which CVD pathology is divided into 2 categories:
STEMI - full occlusion
NSTEMI - partial occlusion
Myocardial infarction
List 3 risk factors for myocardial infarction.
- Sex (Males are 3 times more likely due to high androgen levels)
- Psychosocial factors (stress, loss of control, sudden major life events)
- Drugs
- Severe hypertension
- Reduced oxygen supply (i.e, severe anaemia)
- Vasculitis syndromes
What are the signs and symptoms of myocardial infarction?
Severe prolonged crushing retrosternal chest pain
Pain radiating to left shoulder/arm/jaw
Sweating
Cool / clammy skin
Feeling of ‘impending doom’
Dyspnoea (laboured breathing)
Syncope (fainting)
Nausea
Vomitting
Weakness
List 2 complications of myocardial infarction.
Arrhythmias
Heart failure
Cardiogenic shock
Death
How is an MI officially diagnosed?
ECG findings
Which key vitamin would you optimise in ischaemic heart disease?
Vitamin D
Mg deficiency has been shown to produce coronary artery spasms. True or false.
True
List 3 supplements you might use in ischaemic heart disease (angina or MI)
(drug interactions allowing)
L-carnitine
Magnesium
Hawthorn
Co-Q10
L-arginine
Gingko biloba
Define heart failure.
A syndrome in which the heart is impaired as a pump - failing to supply sufficient blood flow.
List 3 signs/symptoms of heart failure.
Breathlessness (on exertion and at rest)
Nocturnal dyspnoea
Fluid retention (ankle oedema, abdominal swelling)
Fatigue
Exercise intolerance
Lightheadedness
Syncope (fainting)
Tachycardia
Cardiac mitochondrial dysfunction is a common feature of heart failure. True or false?
True
List 3 risk factors for heart failure.
Other CV conditions
Insulin resistance
Obesity
Nutrient deficiencies
List 5 nutrients needed for normal cardiac metabolism.
Co-Q10
Vitamin D
B1,2,9,12
Calcium
Iron
Copper
Magnesium
Manganese
Potassium
Selenium
What might a natural approach to heart failure include?
Lower CVD risk factors
Correct nutrient deficiencies
Work to achieve ideal body weight
Smoking cessation (where applicable)
What does the heart use as its main energy source?
Free fatty acids. That’s why l-carnitine is important.
Why is hawthorn often useful in cases of chronic heart failure?
It has a vasodilatory effect on coronary arteries
Potent antioxidant properties
Increases nitric oxide
Why do varicose veins appear in the lower limbs in particular?
The pressure is higher due to gravity
List 3 signs/symptoms of varicose veins
Visible vein dilation
Aching
Burning
Throbbing
Heaviness
Worse for prolonged standing and at the end of the day
What are haemorrhoids?
Dilated veins in the anal canal. Internal or external.
List 2 signs/symptoms of haemorrhoids
Bright red blood with bowel movements
Protruding lesions
Anal itching
List 3 causes/risk factors for haemorrhoids and varicose veins
Increased abdominal pressure
Valve defects
Smoking
Sedentary lifestyle
Lack of dietary connective tissue support - i.e, vit C, low bioflavonoids
Portal hypertension
Increased blood viscosity and stagnation
Abdominal bloating
Structural defects
Why are haemorrhoids more likely in pregnancy, obesity and constipation?
Because of increased abdominal pressure
Why does cigarette smoking contribute to haemorrhoid / varicose vein risk?
It causes hypoxia, which results in endothelial damage, vessel wall inflammation and loss of elasticity
What is portal hypertension and what may cause it?
Increased portal vein pressure
Can be caused by liver cirrhosis and heart failure
List 2 things that may increase blood viscosity
Dehydration
Liver congestion
Sedentary lifestyle
Dilated veins are associated with a decrease in ___________ and elastin content.
Collagen
List 3 things you might include in a natural approach to varicose veins/haemorrhoids.
Anti-inflammatory / CNM Naturopathic diet
Address any obvious root causes
Vitamin-C rich foods
Bioflavonoids (rutin, proanthocyanidins, etc)
Increase fibrinolytic foods - garlic, onion, ginger, cayenne
Bromelain
Optimise liver function
Increase bowel movements to alleviate downward pressure
Raise feet above heart for 20 mins/day
Lymphatic drainage / massage
Reduce body weight
Exercise
Why are bioflavonoids useful in supporting varicose veins/haemorrhoids?
They improve the integrity of ground substance and the vascular system, whilst acting as antioxidants.
Give 3 food sources of bioflavonoids
Buckwheat, grapes, apples, cranberry, blueberry, figs, blackcurrants, capers, asparagus, green tea
Which food has the highest source of rutin (a bioflavonoid)?
Buckwheat
List 2 herbs that are useful for varicose veins/haemorrhoids
Horse Chestnut
Gotu Kola
Butchers Broom
Pycnogenol
Witch Hazel
Yarrow
