Clinical Aspects of Cardiovascular Risk Flashcards
What is the most common form of premature death?
CHD
How prevalent is CHD?
No 1 cause of death worldwide No2 cause of death in developing countries
What is atherosclerosis?
A progressive disease characterised by plaque build-up in arteries.
What type of substances can form plaque?
Cholesterol, cellular waste, calcium, fibrin.
What can be the effect of a total/partial block of an artery due to atherosclerosis?
- Bleeding into the plaque - Formation of blood clot in the artery. Can result in a stroke or heart attack
What is the pathophysiology of Atherosclerosis? (7)
Pathogenesis of Atherosclerosis:
- Endothelial damage
- Protective response causes production of cell adhesion molecules (IL-1, TNFa)
- Monocytes and T lymphocytes attach to the endothelial lining,
- Migrate through arterial wall into sub-endothelial space.
- Macrophages take up oxidised LDL-C
- Lipid rich foam cells
- Fatty streak and plaque
What are the effects of oxidised LDL formation?
- Promotes death of endothelial cells and inflammatory response. - Produces thrombotic state by affecting platelets and coagulation factors. - Vasodilatory impairment.
What is athero-thrombosis? hows it caused?
Formation of an acute thrombus in a vessel that has atherosclerosis. -Plaque deposition may rupture, exposing the components of the endothelial such as collagen. - Platelets attach to the endothelium at the damaged site, causing an acute thrombus. - Thrombus formation can occlude the vessel, resulting in ischaemia or tissue injury. Can be fatal/non fatal.
What are some common risk factors for CVD? Mention non mod/ modifiable.
Non Modifiable: • Personal history of CHD • Family history • Age • Gender • Ethnicity Modifiable: • Smoking • Dyslipidaemia • Hypertension • Diabetes • Obesity • Alcohol • Lack of exercise.
What are the major classes of Lipoproteins?
• Chylomicrons • VLDL • Intermediate density lipoprotein • LDL • HDL
Which class of lipoprotein is the most dangerous? What are its risk factors?
LDL- Strongly associated with atherosclerosis and CVD. Modified by other risk factors: • Low HDL • Smoking • hypertension • Diabetes.
What problems are associated with high triglyceride levels?
Risk of CHD events. May have accompanying dyslipidaemias.
What is the effect of HDL on CHD?
Protective effect. Moves excess cholesterol in circulation to the liver for excretion. HDL levels- lowered by smoking, obesity, lack of exercise.
What are the effects of lowering Cholesterol?
Modifiable risk factor Reducing cholesterol levels reduces risk of CVD and total mortality. LDL-C: Main target of intervention in CVD.
What is primary prevention?
Long term reduction in cholesterol of 10% and measuring its benefits. In 40yr old men- 50% less risk of CVD 70yr old men- 20% less risk of CVD.
What is the main effect of statins?
Reduce total cholesterol and LDL cholesterol.
What are some other beneficial effects of statins?
• Improvement of endothelial dysfunction • Increased NO bioavailability • Anti-oxidant properties • Inhibits inflammatory responses • Stabilises atherosclerotic plaques.
What is the drug mechanism of statins?
Statins competitively inhibit HMG-CoA reductase, the rate limiting step in cholesterol synthesis. As a response, liver cells increase LDL receptor expression. More LDL cholesterol is removed rom the plasma and excreted by the liver.
What are some of the clinical manifestations associated with high triglyceride levls levels?
Xanthomas: 1. Xanthelasma- Xanthoma in the eyelids. Swelled up areas around eyes. 2. Tendon xanthoma- Extensor tendons of fingers, patella, elbows, achillies tendon. Diffuse infiltration of tendon by lipid. 3. Tuberous xanthomas- Lipid deposits as papules, nodules or plaques at extensor surfaces of large joints, hands etc. Familial or acquired hypertriglyeridaemias. 4. Eruptive xanthomas- Small eruptive reddish yellow papules affecting buttocks, posterior thighs, body folds
Name some common diseases in association with hypertension.
MI, LVH, CVD, Stroke, Aortic aneurysm, heart failure
What are the two types of hypertension?
- Essential: 90%. No underlying cause - Secondary: An underlying cause.
What changes in the arteries are caused by high BP?
- widen arteries, putting strain on the lining. - smooth muscle hypertrophy, narrowing lumen. - Fatty deposition on the endothelium can cause the lumen to get narrower.
Is hypertension a risk factor for CHD?
Yes increased systolic and diastolic BP values increases risk of CHD.
What are the effects of hypertension treatment?
Reduces BP. Other effects: Reduces ischaemic heart disease stroke mortality.
What lifestyle modifications can help with hypertension?
Diet, exercise, stop smoking, lose weight, limit intake of salt and fatty food.
What are the effects of diabetes on CVD?
Increases risk of various diseases like stroke, MI, CHD. Diabetes single risk factor is found to be more dangerous than the combined effects of hypertension, cholesterol and smoking.
What is the main way to cure Obesity?
Controlling diet
What types of food groups are good? (IMP REMEMBER THESE
-Micronutrients - omega 3,6 - antioxidants - polyunsaturates - monounsaturates
What are the diseases caused by obesity?
Chronic conditions like stroke, angina, MI, hypertension, diabetes,
What is the main way to counter obesity?
- Diet - Exercise
What is metabolic syndrome?
A cluster of conditions collectively termed as metabolic syndrome: - High BP - High blood sugar - Abnormal cholesterol/triglyceride levels - Excess body fat around waist.
What is the usefulness of inflammatory markers as a predictor for CHD?
Studies showed that even having a high-normal CRP levels meant that risk of MI was significantly higher. Thus CRP can be used as a direct predictor of CHD.
What major ethnic group are more likely to develop CVD?
South Asians. Black, caribbean, african much lower risk of CVD. greater risk of stroke however.
What does Assign score do?
Uses risk factors, pmh, sh and fh to evaluate the risks of an individual getting CVD in the next ten years.
What is the relevance of CVD risk in a person with multiple risk factors?
The sum of the different risk factors add up to impose a much greater risk than a single factor (even if the single factor is very sever)
What are some common drug Types used to treat ischaemia?
- Ca blocker - B blocker - Nitrates
What are some common drug Types used to treat atherothrombosis?
-aspirin - statin - ACE - exercise - Smoking cessation.
