coronary heart disease and hypertension Flashcards
indicate the correlation between the different lipoprotein levels and CHD
- total cholesterol
- optimal<180…240<high></high>
- LDL cholesterol
- optimal<100…190<very></very>
-
HDL
-
risk<40…60<optimal></optimal>
- too low is dangerous. the higher the better
-
risk<40…60<optimal></optimal>
- total cholesterol / HDL ratio
- optimal<3.5:1…5:1<high>
<li>you want the smallest number for total cholesterol</li>
</high>- triglycerides
- optimal<3.5:1…5:1<high>
- optimal<150…500<very>
</very>
notice that you want all of them to be low EXCEPT for HDL. HDL should be above 60.
what dietary restrictions would you suggest to CHD patient?
lower fat and cholesterol intake
what are the dietary guidlines from the AHA for foods that help with CHD?`
- mediterranean type diet
- sodium
- decrease
- fluids
- decrease
- dietary supplements
- increase
- alcohol
- decrease
-
softer foods
- increase to avoid excessive effort after eating
- 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
What are the types of lipoproteins(5)? what do they carry/do?
- chylomicrons
- carry dietary triglyceride to muscle and adipose
- VLDLs
- carry mainly endogenous triglycerides, cholesterols, and fat soluble vitamins to the peripheral tissues
- IDL
- after VLDLs deposit triglycerides and acquire cholesterol from HDL
- HD->IDL
- after VLDLs deposit triglycerides and acquire cholesterol from HDL
- LDLs
- carry 2/3 of total plasma cholesterol from liver to body tissues
- VLDL->IDL->LDL
- carry 2/3 of total plasma cholesterol from liver to body tissues
- HDL
- carry cholesterol from periphery to liver
-
protects against cardiovascular disease
- acts as scavanger
- NOT FOUND IN FOOD
- INCREASES WITH PHYSICAL ACTIVITY
what are the stages, causes, and treatments of hypertension?
- cause
- history, obesity, smoking, age, alcohol, sodium stress, ethnicity (older african american women)
- hypertension damages to endothelium of blood vessels
- types
- prehypertension
- treatable with
- weight loss, diet change, exercise, habit change
- treatable with
- stage 1 hypertension
- diet therapy and drugs
- stage 2 hypertension
- diet and vigorous therapies
- prehypertension
what is the major cause of CHD?
atherosclerosis
- fatty, fibrous plaques develop into fatty streaks on the inside lining of major blood vessels
- thes plaques are largely composed of cholesterol
- oxidized LDL particles
- the plaques cause the narrowing of the interior part of the blood vessel
- if narrowing continues or a blood clot developes, the blood flow is cut off, causing necrosis
describe the mechanism of chylomicron processing and the important enzymatic process contributing to disease progression
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
What is taken up by macrophages and what do they generate?
MO can take up LDL, acting as “scavengers” and may play a role in atherosclerosis
What does excess VLDL or chylomicrons lead to?
eruptive xanthomas.
a genetic component is required
what does an increase in LDL lead to?
tendinous xanthomas
found on the back of the hand, achilles and patella
what is seen in extermely high triglyceride levels?
lipemia retinalis
cream colored blood vessels in the fundus
determine the total cholesterol /HDL level and risk of heart disase
Total cholersterol:200
HDL:50
- the ratio of HDL is one of the most important factos in preventing cardiovascular disease
- calculation
- 200:50 ->4:1
- near optimal
- 200:50 ->4:1
what are the cholesterol types that cause CHD?
LDL and VLDL
what arethe foods to be avoided for CHD and hypertension?
- salts and fats should be avoided
- less meat
- smaller portions
- softer foods
- variety of vegetables
- what are the nonmodifiable factors associated with CHD?
- age
- gender
- family history
- race
what are the primary underlying disease processes of cardiovascular disease are
- atherosclerosis
- hypertension
common symptoms of coronary heart incident include
- aangina pectoris, chest pain radiating down arm
- shortness of breath
- cold sweat
- sudden dizziness
Very high TG leads to….and disease…
very high cholesterol leads to….
- hyperlipidemia
- TG from chylomicrons and VLDL lead to acute pancreatitis
- exogenous=chylomicrons
- enodgenous = VLDL
- this is from the liver taking in free fatty acids and sugars, repackaging them as VLDL and sending them to the periphery
- hypercholesteremia
- synthesized from acetyl coa
- from diet high in animal products
what carries 2/3 of total plasma cholesterol from liver to body tissues?
LDL
results from
VLDL->IDL->LDL
What carries the fat soluble vitamins to the periphery?
chylomicrons and a little in VLDL
what lipoprotein protects from cardiovascualr disease? Are they foundi n food?
HDL
not found in food
which lipoproteins carry the most and the least of the following
- cholesterol
- protein
- triglycerides
- phospholipids
- fat soluble vitamins
- cholesterol
- VLDL>LDL>HDL>chylomicrons
- protein
- HDL>LDL>VLDL>chylomicrons
- TG
- chylomicrons>VLDL>LDL>HDL
- phospholipids
- HDL>VLDL>IDL>chylomicrons
- fat soluble vitamins
- chylomicrons> VLDL
where do chylomicrons mature?
in the blood
what are the three fates for LDL?
- endocytosed by receptor mediated processes in the liver
- endocytosed by receptor mediated proecesse in periphery cells
- oxidized and taken up by “scavenger” receptors on macrophages
- this route play a critical roll in atherosclerosis.
what lipoprotein has a special contribution to atherosclerosis?
LDL can be taken up by macrophages and oxidized to form foam cells. the scavenger pathwat plays a role in atherosclerosis.
xanthomas require require what specific components?(name the discussed, their constituents and a specific requirement for all three)
- eruptive xanthomas
- TG >1000, from chylomicrons or VLDL
- lipemia retinalis when TG>2000
- genetic predisposition
- TG >1000, from chylomicrons or VLDL
- tendinous xanthomas
- high LDL
- genetic predisposition
risk factors for CVD
- gender
- age
- family history
- compounding
- blood cholesterol profile
- men > women, until menopause
- risk increases with age
- heredity
- ethnicities
- LDL receptor deficiency is the most common
- familial hypertriglyceridemia
- ethnicities
- T2DM, hypertension, metabolic syndrome
- high TC, high LDLC and low HDL
recomendations for preventative treatment of reducing risk of CVD
TLC
- total energy intake equal enegy expedenture
- exercise to spend 200kcal/day
- total fat< 20-35%kcal/day
- avoid trans fats
- carbohydrates= 50-60%
- increase in carbohydrate
- proteins=15%
- maintain proteins
- total cholesterol < 200mg/day
what can individuals with metabolic syndrome or diabetes do to manipulate their diet?
patients with metabolic syndrome or diabetes can increase their
- increase unsaturated fats IN PLACE OF CARBOHYDRATES
describe the dietary changes in acute cardiovascular disease:MYOCARDIAL INFARCTIONS
- objectitve
- goals
- immediate
- longterm
- objective:
- cardiac rest(analgesics)
- goals
- promote recovery and strength
- lower LDL
- immediate
- energy intake reduced to decrease the load on the heart
- intake of small amounts throughout the day
- patient should eat soft or easily digested foods
- long-term
- adopt mediterranean-type diet
- limited sodium
- light salt when cooking
- no salt when eating
- avoid processed foods
describe dietary changes for patient with heart failue
- objective
- goals
heart failure
-
objective
- CONTROL PULMONARY EDEMA
-
goal
- sodium restriction
- 2g/day
- no salt with meals
- fluid restiction
- 2L/day
- 1.5 L/day for advanced
- texture and timing
- soft foods
- frequent small meals
- nutrtional adequecy
- should ensure diet restirctions do not result in malnutritions
- little to no alcohol
- sodium restriction
describe the management of hypertension
- weight management
- personal plan to address hypertension
- lose excess weight and maintain healthy weight
- sodium control
- limit sodium to 1.5-2.4 g/day
- use the DASH diet
- lower blood pressure through diet ALONE
- lifestyle
- limit alcohol
- stop smoking
- reduce sat fats
- increse aerobic activitty
- meals
- less meatt
- smaller portions
- complex carbs
- whole grain bread and pasta
- more fish
- vegetables
what are three education principles to consider when addressing hypertension
- start early
- prevention begins in childhood, especially with children in high risk families
- focus on high-risk groups
- direct education to people and families with risk of heart disease and hypertension
- use a variety of resources
- national organizations
- community programs
- registered dietitians
- AHA,ADA,NIH,CDC
