chd Flashcards
Cardiovascular disease
a very broad term that encompasses many different diseases of the heart and blood vessels.
-We will focus on: • Atherosclerosis • Hypertension • Coronary Heart Disease (CHD) • Metabolic Syndrome • Congestive Heart Failure
Coronary Heart Disease (CHD)
The major underlying cause of CHD
can result in
–Also called coronary artery disease (CAD) or ischemic heart disease (IHD).
- Definition: Heart disease resulting from a lack of adequate blood flow in the blood vessels serving the heart or myocardium (coronary arteries).
- The major underlying cause of CHD is atherosclerosis: Structural and compositional changes in the innermost or intimal layer of the arteries producing impaired blood flow.
Atherosclerosis in the coronary arteries can result in:
- angina
- myocardial infarction: Ischemia in the coronary arteries resulting in necrosis, tissue damage, and sometimes sudden death.
Atherosclerosis in the cerebral arteries can result in stroke.
Major risk factors for CHD (Risk is additive)
(Nonmodifiable)
modifiable
(Nonmodifiable) - increasing age - male sex - family history of CHD, especially premature CHD (younger than 60 yr of age) - diabetes mellitus - (Modifiable) - tobacco smoke - high blood pressure (hypertension) - dyslipidemia: e.g. total serum cholesterol and LDL-C; HDL-C - physical inactivity - overweight and obesity - prediabetes (Remember this term from our diabetes classification)
Hypertension
CATEGORY
High Normal systolic: 130-139 +/or diastolic 85-89
Hypertension systolic > 140 +/or diastolic > 90
Hypertension
CATEGORY
High Normal systolic: 130-139 +/or diastolic 85-89
Hypertension systolic > 140 +/or diastolic > 90
Physician will use a lower cutoff if patients present with multiple risk factors e.g. diabetes
Systolic: BP during contraction
Diastolic: BP during relaxation
•What are myocardial infarction (heart attack) warning signs that should prompt a person to CALL 9-1-1 ? (Heart and Stroke)
- Chest discomfort (uncomfortable chest pressure, squeezing, fullness or pain, burning or heaviness)
- Discomfort in other areas of the upper body (neck, jaw, shoulder, arms, back)
- Shortness of breath
- Sweating
- Nausea
- Light headedness
What are signs of stroke that should prompt a person to CALL 9-1-1? (Heart and Stroke)? FAST
Face: is it drooping?
Arms: can you raise both?
Speech: is it slurred or jumbled
Time: call 911 right away
TREATMENT AND PREVENTION OF CHD
- Medical procedures e.g. angioplasty, stents, bypass surgery - in Lab
- Drug therapy
- Nutritional and other lifestyle
I. DRUG CLASSES OF LIPID ALTERING MEDICATIONS
- statins
- ) PCSK9 Inhibitor
3) Fibrates - Bile Acid Resins (sequestrants)
5) Cholesterol absorption inhibitors
6) Nicotinic acid
II. DRUG CLASSES OF ANTIHYPERTENIVE AGENTS
-there are many different agents that decrease BP by different mechanisms, and more than one agent is often used.
1) Thiazide diuretics
2) -Adrenergic blockers
3) Angiotensin-converting enzyme (ACE) inhibitors
4) Angiotensin II Receptor Blockers
5) Ca channel blockers
1) Statins
- ***This is the major category of lipid-lowering drugs used.
- Major examples are: rosuvastatin, atorvastatin (newer one), pravastatin, simvastatin, lovastatin, fluvastatin
- Block HMG-CoA reductase, the rate-limiting step in de novo cholesterol synthesis.
- This is the major category of drugs used for LDL-C lowering (~90% of the market) …but note that they can have some weak effects on HDL-C and TG as well.
- Remember that the grapefruit-drug interaction is significant for some of the statins (lovastatin, simvastatin, atorvastatin).
2) PCSK9 Inhibitor
- New class of drug recently approved by Health Canada. (hugey expensive and not covered)
- alirocumab and evolocumab
- Monoclonal antibodies that inactivate proprotein convertase subtilisin–kexin type 9 (PCSK9)—This causes decreased LDL-receptor degradation, increased recirculation of the receptor to the surface of hepatocytes, and consequent lowering of LDL cholesterol levels in the bloodstream.
- They have an even greater effect on LDL-C lowering than statins.
- injected, expensive.
3) Fibrates
- Major examples are: bezafibrate, gemfibrozil, fenofibrate
- These drugs are peroxisome proliferator-activated receptor (PPAR) ligands.
- They are the major drugs used for treating elevated triglycerides, although there can also be effects on LDL-C and HDL-C too.
4) Bile Acid Resins
4) Bile Acid Resins (sequestrants) RARELY USED ANY MORE because of fat malabsorption symptom
e. g cholestyramine
- this drug binds bile acids, which are then excreted in the GIT (instead of returning to the liver via enterohepatic circulation) increases demand by liver for cholesterol (to make more bile acids) upregulation to increase transcription of LDL receptor gene to bring in more cholesterol plasma LDL-C decreases.
-Intended use is to decrease LDL-C, but these drugs are little used any more due to the severe GI side effects. Also, they are formulated as a powder that has to be made into a (rather disgusting) drink.
5) Cholesterol absorption inhibitors
5) Cholesterol absorption inhibitors never used on its own
e. g. ezetimibe
- Better tolerated than cholestyramine.
- On its own has weak effects on serum LDL-C lowering—more likely to be used in combination with statins.
