coronary heart disease and hypertension

Question 1

indicate the correlation between the different lipoprotein levels and CHD

Answer 1

1. total cholesterol
   
   1. optimal<180…240<high></high>
   </high>
2. LDL cholesterol
   
   1. optimal<100…190<very></very>
   </very>
3. HDL
   
   1. ​risk<40…60<optimal></optimal>
      
      1. ​too low is dangerous. the higher the better
4. total cholesterol / HDL ratio
   
   1. optimal<3.5:1…5:1<high>
      <li>you want the smallest number for total cholesterol</li>
      </high>
      
      • triglycerides
5. optimal<150…500<very>
   </very>

notice that you want all of them to be low EXCEPT for HDL. HDL should be above 60.

Question 2

what dietary restrictions would you suggest to CHD patient?

Answer 2

lower fat and cholesterol intake

Question 3

what are the dietary guidlines from the AHA for foods that help with CHD?`

Answer 3

1. mediterranean type diet
2. sodium
   
   1. decrease
3. fluids
   
   1. decrease
4. dietary supplements
   
   1. increase
5. alcohol
   
   1. decrease
6. softer foods
   
   1. ​increase to avoid excessive effort after eating
7. timing of food, better to have many little meals instead of a few large ones

all of these work to decrease the stress load on the heart

Question 4

What are the types of lipoproteins(5)? what do they carry/do?

Answer 4

1. chylomicrons
   
   1. carry dietary triglyceride to muscle and adipose
2. VLDLs
   
   1. carry mainly endogenous triglycerides, cholesterols, and fat soluble vitamins to the peripheral tissues
3. IDL
   
   1. after VLDLs deposit triglycerides and acquire cholesterol from HDL
      
      1. HD->IDL
4. LDLs
   
   1. carry 2/3 of total plasma cholesterol from liver to body tissues
      
      1. ​VLDL->IDL->LDL
5. HDL
   
   1. carry cholesterol from periphery to liver
   2. protects against cardiovascular disease
      
      1. ​acts as scavanger
   3. NOT FOUND IN FOOD
   4. INCREASES WITH PHYSICAL ACTIVITY

Question 5

what are the stages, causes, and treatments of hypertension?

Answer 5

1. cause
   
   1. history, obesity, smoking, age, alcohol, sodium stress, ethnicity (older african american women)
2. hypertension damages to endothelium of blood vessels
3. types
   
   1. prehypertension
      
      1. treatable with
         
         1. weight loss, diet change, exercise, habit change
   2. stage 1 hypertension
      
      1. diet therapy and drugs
   3. stage 2 hypertension
      
      1. diet and vigorous therapies

Question 6

what is the major cause of CHD?

Answer 6

atherosclerosis

1. fatty, fibrous plaques develop into fatty streaks on the inside lining of major blood vessels
2. thes plaques are largely composed of cholesterol
   
   1. oxidized LDL particles
3. the plaques cause the narrowing of the interior part of the blood vessel
   
   1. if narrowing continues or a blood clot developes, the blood flow is cut off, causing necrosis

Question 7

describe the mechanism of chylomicron processing and the important enzymatic process contributing to disease progression

Answer 7

chylomicrons are mad in the intestinal endothelium->sent into lymph->make way into blood circulation

• on capillary surface (in the blood) of adipose and uscle cells is LIPOPROTEIN LIPASE
  
  • lipoprotein lipase is acrivated by ApoC2, and digests the triglycerides of the chylomicrons to fatty acids and glycerol
• Fatty acids are stored in adipose and oxidized in the muscle
• chylomicron remnants and glycerol are taken up by the liver via reticular mediated endocytosis

Question 8

What is taken up by macrophages and what do they generate?

Answer 8

MO can take up LDL, acting as “scavengers” and may play a role in atherosclerosis

Question 9

What does excess VLDL or chylomicrons lead to?

Answer 9

eruptive xanthomas.

a genetic component is required

Question 10

what does an increase in LDL lead to?

Answer 10

tendinous xanthomas

found on the back of the hand, achilles and patella

Question 11

what is seen in extermely high triglyceride levels?

Answer 11

lipemia retinalis

cream colored blood vessels in the fundus

Question 12

determine the total cholesterol /HDL level and risk of heart disase

Total cholersterol:200

HDL:50

Answer 12

1. the ratio of HDL is one of the most important factos in preventing cardiovascular disease
2. calculation
   
   1. 200:50 ->4:1
      
      1. near optimal

Question 13

what are the cholesterol types that cause CHD?

Answer 13

LDL and VLDL

Question 14

what arethe foods to be avoided for CHD and hypertension?

Answer 14

1. salts and fats should be avoided
2. less meat
3. smaller portions
4. softer foods
5. variety of vegetables

Question 15

1. what are the nonmodifiable factors associated with CHD?

Answer 15

1. age
2. gender
3. family history
4. race

Question 16

what are the primary underlying disease processes of cardiovascular disease are

Answer 16

1. atherosclerosis
2. hypertension

Question 17

common symptoms of coronary heart incident include

Answer 17

1. aangina pectoris, chest pain radiating down arm
2. shortness of breath
3. cold sweat
4. sudden dizziness

Question 18

Very high TG leads to….and disease…

very high cholesterol leads to….

Answer 18

1. hyperlipidemia
   
   1. TG from chylomicrons and VLDL lead to acute pancreatitis
   2. exogenous=chylomicrons
   3. enodgenous = VLDL
      
      1. this is from the liver taking in free fatty acids and sugars, repackaging them as VLDL and sending them to the periphery
2. hypercholesteremia
   
   1. synthesized from acetyl coa
   2. from diet high in animal products

Question 19

what carries 2/3 of total plasma cholesterol from liver to body tissues?

Answer 19

LDL

results from

VLDL->IDL->LDL

Question 20

What carries the fat soluble vitamins to the periphery?

Answer 20

chylomicrons and a little in VLDL

Question 21

what lipoprotein protects from cardiovascualr disease? Are they foundi n food?

Answer 21

HDL

not found in food

Question 22

which lipoproteins carry the most and the least of the following

1. cholesterol
2. protein
3. triglycerides
4. phospholipids
5. fat soluble vitamins

Answer 22

1. cholesterol
   
   1. VLDL>LDL>HDL>chylomicrons
2. protein
   
   1. HDL>LDL>VLDL>chylomicrons
3. TG
   
   1. chylomicrons>VLDL>LDL>HDL
4. phospholipids
   
   1. HDL>VLDL>IDL>chylomicrons
5. fat soluble vitamins
   
   1. chylomicrons> VLDL

Question 23

where do chylomicrons mature?

Answer 23

in the blood

Question 24

what are the three fates for LDL?

Answer 24

1. endocytosed by receptor mediated processes in the liver
2. endocytosed by receptor mediated proecesse in periphery cells
3. oxidized and taken up by “scavenger” receptors on macrophages
   
   1. this route play a critical roll in atherosclerosis.

Question 25

what lipoprotein has a special contribution to atherosclerosis?

Answer 25

LDL can be taken up by macrophages and oxidized to form foam cells. the scavenger pathwat plays a role in atherosclerosis.

Question 26

xanthomas require require what specific components?(name the discussed, their constituents and a specific requirement for all three)

Answer 26

1. eruptive xanthomas 1. TG \>1000, from chylomicrons or VLDL 1. lipemia retinalis when TG\>2000 2. genetic predisposition 2. tendinous xanthomas 1. high LDL 2. genetic predisposition

Question 27

risk factors for CVD 1. gender 2. age 3. family history 4. compounding 5. blood cholesterol profile

Answer 27

1. men \> women, until menopause 2. risk increases with age 3. heredity 1. ethnicities 1. ***_LDL receptor deficiency is the most common_*** 2. familial hypertriglyceridemia 4. T2DM, hypertension, metabolic syndrome 5. high TC, high LDLC and low HDL

Question 28

recomendations for preventative treatment of reducing risk of CVD

Answer 28

TLC 1. total energy intake ***_equal_*** enegy expedenture 2. exercise to spend ***_200kcal/day_*** 3. total fat\< ***_20-35%kcal/day_*** 4. avoid trans fats 5. carbohydrates= 50-60% 1. ***_increase in carbohydrate_*** 6. proteins=15% 1. ***_maintain proteins_*** 7. total cholesterol ***_\< 200mg/day_***

Question 29

what can individuals with ***_metabolic syndrome_*** or ***_diabetes d_***o to manipulate their diet?

Answer 29

patients with metabolic syndrome or diabetes can increase their 1. ***_increase unsaturated fats IN PLACE OF CARBOHYDRATES_***

Question 30

describe the dietary changes in ***_acute cardiovascular disease:MYOCARDIAL INFARCTIONS_*** 1. objectitve 2. goals 3. immediate 4. longterm

Answer 30

1. objective: 1. ***_cardiac rest(analgesics)_*** 2. goals 1. promote recovery and strength 2. lower LDL 3. immediate 1. energy intake reduced to decrease the load on the heart 2. intake of small amounts throughout the day 3. patient should eat soft or easily digested foods 4. long-term 1. adopt mediterranean-type diet 2. limited sodium 1. light salt when cooking 2. no salt when eating 3. avoid processed foods

Question 31

describe dietary changes for patient with ***_heart failue_*** 1. objective 2. goals

Answer 31

heart failure 1. ***_objective_*** 1. ***_​CONTROL PULMONARY EDEMA_*** 2. ***_​_***goal 1. sodium restriction 1. 2g/day 2. no salt with meals 2. fluid restiction 1. 2L/day 2. 1.5 L/day for advanced 3. texture and timing 1. soft foods 2. frequent small meals 4. nutrtional adequecy 1. should ensure diet restirctions do not result in malnutritions 5. little to no alcohol

Question 32

describe the management of hypertension

Answer 32

1. weight management 1. personal plan to address hypertension 2. lose excess weight and maintain healthy weight 2. sodium control 1. limit sodium to 1.5-2.4 g/day 2. use the DASH diet 1. lower blood pressure through diet ALONE 3. lifestyle 1. limit alcohol 2. stop smoking 3. reduce sat fats 4. increse aerobic activitty 4. meals 1. less meatt 2. smaller portions 3. complex carbs 4. whole grain bread and pasta 5. more fish 6. vegetables

Question 33

what are three education principles to consider when addressing hypertension

Answer 33

1. start early 1. prevention begins in childhood, especially with children in high risk families 2. focus on high-risk groups 1. direct education to people and families with risk of heart disease and hypertension 3. use a variety of resources 1. national organizations 2. community programs 3. registered dietitians 4. AHA,ADA,NIH,CDC