Cardiovascular System Treatment

Question 1

When does development of atherosclerosis occur typically?

Answer 1

Development often starts in childhood and develops slowly and silently over many years
Clinical symptoms occur decades later (50’s 60’s)

Question 2

When do clinical symptoms occur in atherosclerosis?

Answer 2

No clinical symptoms until blood flow to organs is inadequate due to plaque rupture and occlusive thrombus formation
Sudden catastrophic event that can’t be predicted

Question 3

How can CVD be prevented?

Answer 3

strategies to prevent CVD are focused on LDL and include:
- Monitoring blood lipid profile to identify individuals at risk from CVD
- Lifestyle changes to lower LDL levels
- Pharmaceuticals to lower LDL levels

Question 4

What is a CVD screening?

Answer 4

CV Health Screening
Routinely done for over 40’s
Questionnaire about lifestyle and family history of CVD
Blood test: Lipid profile monitoring
Used to assess risk of CVD

Question 5

What are elevated levels of LDL in children associated with?

Answer 5

Genetic predisposition (inherited)
Family history informs risk of CVD

Question 6

What is Familial hypercholesterolemia?

Answer 6

Gene mutations which affect production or function of LDL receptors
Impaired hepatic clearance of circulating LDL = higher LDL circulating
Accelerates atherosclerosis

Question 7

What is the blood lipid profile used to monitor?

Answer 7

predict CVD risk by monitoring
- Total cholesterol
- HDL- cholesterol
- Triglycerides
Good and bad cholesterol quantified
Good = HDL (rather protective)
Bad = LDL (artherogenic)

Question 8

How does the results from blood lipid profile inform of CVD?

Answer 8

High levels of LDL and low levels of HDL
are major risk factors for CVD
These levels inform whether prevention is required

Question 9

What is Dyslipidaemia?

Answer 9

Imbalance of lipids: abnormal levels of

Question 10

How is artherosclerosis treated?

Answer 10

Surgery- Visualize blocked coronary arteries (angiogram)
Dye injected into coronary arteries via a catheter to image x ray

Question 11

What lifestyle factors contribute to CVD?

Answer 11

Smoking
High blood pressure
Obesity
Diabetes
Lifestyle changes recommended to reduce risk of CVD

Question 12

How is diet important to both risk and prevention of CVD?

Answer 12

Fats are vital for normal function
Fat in diet often referred to as ‘good’ and ‘bad’
Quantity and quality of these important to health
Influences the levels of HDL and LDL

Question 13

What are the good and bad dietary fats?

Answer 13

Unsaturated fatty acids (good)
Saturated and trans fatty acids (bad)
Raise LDL (cholesterol) blood levels
Lipids more vulnerable to oxidation

Question 14

What is the Lyon Diet Heart Study?

Answer 14

French subjects adopted a Mediterranean or Western diet
More bread, root and green vegetables less meat and butter
Health monitored for 5 years
Subjects had a 50-70% lower risk of recurrent heart disease

Question 15

What food can reduce CVD risk?

Answer 15

Fish consumption however some contaminants in fish may increase risk of other diseases
Omega 3 fatty acids in fish may confer protection from CVD
Fish derived fatty acids can improve morbidity and mortality in at risk patients

Question 16

How were fish oils studied as potential dietary pharmaceuticals to decrease risk of CVD?

Answer 16

Patients given fish oil capsules or placebo
Deaths associated with CVD decreased with fish oils
Change in diet/delivery of fish oils as pharmaceuticals could be used to prevent CVD

Question 17

What are the LDL lowering drugs?

Answer 17

Statins are a group of pharmaceuticals that lower LDL levels in blood
Used for treatment of hypercholesterolemia
Examples: lovastatin, pravastatin, simvastatin
Targets the liver

Question 18

How do statins?

Answer 18

Targets the liver and specifically hepatocyte cells
Inhibits HMG-CoA reductase which is responsible for cholesterol biosynthesis in the liver
This causes an increase of expression of LDL receptors on hepatocytes
Increases uptake of LDL by liver

Question 19

What are the other effects of statins?

Answer 19

Inhibition of LDL oxidation
Inhibition of scavenger receptor expression on macrophages
Reduce foam cell formation
Improves endothelial function
Anti- inflammatory effects
Improve plaque stability

Question 20

What is the crucial step in artherogenesis?

Answer 20

Transformation of LDL to oxLDL
In response to oxidation hypothesis

Question 21

How can antioxidants be used to treat artherosclerosis?

Answer 21

Antioxidants prevent the oxidation of substances
An inverse correlation between dietary intake/plasma levels of antioxidant vitamins and incidence of CVD
Increase of antioxidants = decrease in CVD

Question 22

What is an example of antioxidant in clinical trial?

Answer 22

Vitamin E will inhibit oxidation of LDL to prevent artherosclerosis

Question 23

What are some other preventive treatments of arthersclerosis?

Answer 23

• Lowering blood clot formation via Anticoagulants e.g. aspirin
• Surgery- ‘widen’ affected arteries e.g. coronary arteries

Question 24

What are the novel approaches to diagnose and treat artherosclerosis?

Answer 24

Use of natural or synthetic forms of HDL
HDL is artheroprotective
Use HDL/LDL as delivery agents for therapeutics or diagnostics

Gene Therapy e.g. to replace defective LDL receptors in FH