CV Health Flashcards
What is the role of the glycocalyx (GX) in endothelial health, and how is it vulnerable to damage?
A carbohydrate-rich protective layer covering the ED.
The glycocalyx regulates permeability, controls NO production, and acts as a mechanosensor. It is easily damaged by inflammation, hyperglycaemia, endotoxemia, oxidised lipoproteins, and abnormal blood shear stress.
Function of the Vascular Smooth Muscle Cells? Where do they reside?
In tunica media. Key in vessel contraction and dilation (regulate blood circulation/pressure).
With the ED, VSMCs maintain the integrity and elasticity of blood vessels, limit immune cell infiltration.
Under pathological conditions (e.g., inflam, OS, telomere damage) VSMCs undergo phenotypic modulation, altering cell structure/function (through interaction of the genotype and environment) - changes central to vascular disease, esp atherosclerosis, hypertension.
What is the role of Nitric Oxide in CV health? What nutrients are key for this and why?
Regulates vascular tone, ↓ platelet aggregation and VSMC proliferation, inhibits leukocyte adhesion and inflammatory cytokines, and opposes oxidation of LDLs.
NO diffuses easily from the ED into VSMCs and the bloodstream, exerting its main physiological effects in large vessels.
L-arginine continuously generates by the ED enzyme eNOS (endothelial NO synthase).
Vitamin D regulates NO synthesis by mediating eNOS. Beetroot – for NO.
What are the impact of Oxidative stress on Endothelium and VSMCs?
ED:↑ permeability, inflammatory cytokines and leukocyte adhesion. Reduced vasodilator (NO, prostacyclin) molecules.
Increased risk of thrombosis.
VSMCs (e.g., arteries): Increased inflammatory cytokines and extracellular matrix synthesis. Migration into the tunica intima and proliferation of VSMCs.
What is the role of peroxisome proliferator-activated receptors (PPARs) in cardiovascular health, and how can they be activated naturally?
Peroxisome proliferator-activated receptor (PPARs) Nuclear transcription factors that are control gene expression in various cellular processes, including adipogenesis, lipid and glucose metabolism, cellular proliferation, and apoptosis. They ↓ inflammation and promote ED health.
PPAR-α agonists include green tea, resveratrol (up to 50 mg), dietary inclusion of oregano, thyme and rosemary, naringenin (part of citrus bioflavonoid up to 100mg/day) and omega-3 (up to 3 g).
PPAR-γ ↓ blood glucose, fatty acids and insulin. Natural PPAR-γ agonists include apigenin (in parsley, celery), hesperidin, curcumin, resveratrol, EGCG (polyphenol from green tea).
Outline the functions of the endothelial cells (ED) in the cardiovascular system.
Endothelial cells serve as a semi-permeable barrier, regulate vascular tone, contain enzymes like ACE for blood pressure regulation, contribute to angiogenesis, play a role in hemostasis, and contribute to immune defense.
What are the key functions of nitric oxide (NO) in cardiovascular health, and how is it regulated?
NO regulates vascular tone, inhibits platelet aggregation and VSMC proliferation, and opposes oxidation of LDLs. It is continuously generated by the ED enzyme eNOS, and its synthesis is regulated by vitamin D.
What are the risk factors associated with cardiovascular diseases, including genetic and lifestyle factors?
Family history, genetics (MnSOD, NOS3, MTHFR, ACE gene polymorphisms), ethnicity, gender, dyslipidaemia, hypertension, mitochondrial dysfunction, elevated homocysteine, thyroid hormones, inflammation, and endothelial dysfunction
How does obesity contribute to cardiovascular complications, and what are the associated inflammatory factors?
Obesity leads to increased inflammation, vascular breakdown, and metabolic complications.
Inflammation is linked with elevated endothelin-1 (ET-1), (vasoconstrictor peptide - leading to VSMC fibrosis and increased ROS), decreased adiponectin,
High Leptin - activation of the sympathetic nervous system, sodium retention, vasoconstriction, and high BP
What role does insulin resistance play in cardiovascular health, and how does it contribute to atherosclerosis?
Insulin resistance generates chronic hyperglycaemia, leading to oxidative stress, inflammation, and cellular damage. It contributes to the lipid triad and dyslipidaemia, promoting atherosclerotic plaque formation.
Explain the formation and consequences of advanced glycation end products (AGEs) in cardiovascular health.
AGEs, formed by glycation, bind to receptors like RAGE, inducing inflammation and oxidative stress. AGEs contribute to oxidative stress, vascular endothelial dysfunction, and immune cell dysfunction.
Receptor mediated: bind to RAGE, increased inflammatory cytokines and ROS - activation of NADPH oxidase (enzyme that increases ROS) and NFkB activation.
Non-receptor: increased EC matrix synthesis trapping ED LDLD and cross binding with collagen (vasular stiffening)
How does smoking impact cardiovascular health, and what specific mechanisms contribute to its detrimental effects?
Smoking increases oxidative stress, depletes antioxidants, and overstimulates the sympathetic nervous system. Nicotine, present in smoking, activates the SNS, causing sodium retention, vasoconstriction, and elevated blood pressure.
What is the role of the gut-brain axis in cardiovascular health, and how do alterations in the gut microbiota affect risk factors?
SCFAs from the gut microbiota reduce the risk of metabolic endotoxaemia, maintaining intestinal barrier integrity. Alterations in the gut microbiota can lead to an increase in harmful metabolites like TMAO, associated with endothelial dysfunction and CVD risk.
Describe the dietary considerations and natural approaches to maintaining cardiovascular health.
avoiding high PRAL foods, trans fats, and excessive fructose. Nutrient deficiencies should be addressed (e.g., vitamin C, D, E, CoQ10, Mg), and a natural approach involves stress management, regular exercise, and a balanced diet.
What cardiovascular markers are commonly tested, and what do they indicate about heart health?
cardiac troponin for heart muscle damage
Lipid profile (TC, non-HDL, TG, LDL-C),
Lp-PLA2 (enzymes produced by monocytes, macrophages, T cells, upregulated in atherosclerotic plaques and vasular inflammation
hsCRP
MPO - measures body response to damaged arterial walls.
How do lifestyle factors such as chronic stress and periodontal disease contribute to cardiovascular risk?
Chronic stress activates the sympathetic nervous system and HPA-axis, leading to increased inflammatory cytokines. Periodontal disease increases systemic inflammation, promoting endothelial dysfunction, arterial stiffness, and plaque formation.
Supplements and doses for CV health
Vit C (500-1000mg x 3) - downregular NADPH oxidase, upregulate endothelial NO synthase. reduce platelet aggregation.
Vit E (400-800iu) - endothelium protection. NO synthesis, ↓ ROS and LDL-C oxidation.
Magnesium glycinate/taurate) (500-800mg) - ion transporter regulator. vasular tone regulation.
CoQ10 (60-300mg): endothelial function. ↓ LDL oxidation. ↑ SOD to preserve NO activity. Mitochondrial health and ATP
Vit D (6000-1000iu): No Synthesis _ lower BP
Omega 3 (3-6g): Improve lipid profile. Synthesise regulators of inflammation, vasodilation, platelet aggregation. Membrane fluidity.
Garlic (2-5g fresh)- reduce LDL, ↑ glutathione/SOD
Hawthorn (1000-1500mg)- cardiac tonic. ACE inhibiting
Define hypertension and its impact on life expectancy.
Hypertension is a condition characterized by elevated blood pressure, often asymptomatic. In the UK, it is defined as >140/90 mmHg. Hypertension can decrease life expectancy by up to 5 years.
Differentiate between essential/primary hypertension and secondary hypertension.
Essential/primary hypertension (95%) has no specific underlying medical cause and is often driven by factors like vascular resistance, obesity, stress, smoking, and high salt intake. Secondary hypertension (5%) is due to diseases affecting the kidneys, adrenals, thyroid, or diabetes.
What characterizes malignant hypertension, and why is it considered a medical emergency?
Malignant hypertension is defined by blood pressure readings exceeding 180/120. It poses a significant risk of damaging organs and is considered a medical emergency.
Outline the causes and risk factors associated with hypertension.
genetic factors
obesity (especially abdominal adiposity)
excess alcohol consumption
stress
nutritional deficiencies (especially magnesium and potassium),
high table salt intake,
inactivity
smoking
certain drugs
raised uric acid levels.
How does obesity contribute to hypertension, and what role does the RAAS play in this context?
Obesity activates the RAAS, causing vasoconstriction and water retention. Abdominal adiposity, in particular, stimulates the renin-angiotensin-aldosterone system, contributing to hypertension.
Explain the impact of stress on blood pressure, including its effects on the sympathetic nervous system and cortisol.
Stress activates the sympathetic nervous system, causing vasoconstriction. High cortisol levels increase the vasoconstrictor endothelin-1 (ET-1) and activate the RAAS, contributing to elevated blood pressure.
What nutritional factors play a role in hypertension, and how does salt sensitivity contribute to the condition?
Nutritional factors include deficiencies in magnesium and potassium. Salt-sensitive hypertension occurs in 50% of hypertensive individuals
What is the natural approach to managing hypertension, and how does potassium contribute to its control?
The natural approach involves maintaining a potassium/sodium ratio >3:1 through a diet rich in fresh fruits and vegetables. Potassium encourages vasodilation, reduces sensitivity to angiotensin II, and lowers sympathetic nervous system activity.
How does the DASH Diet contribute to reducing blood pressure in hypertensive individuals?
The DASH Diet, rich in fresh vegetables, fruits, legumes, nuts, seeds, whole grains, fish, lean meat, and low-fat dairy, limits saturated fats and salt, leading to a reduction in systolic and diastolic blood pressure.
What are ACE inhibitory peptides, and how can they contribute to managing hypertension?
ACE inhibitory peptides act as decoys, encouraging ACE to react with peptides and reducing vasoconstriction via angiotensin II. Sources include spirulina, mushrooms, spinach, hemp seeds, walnuts, and bitter melon seeds.
How does optimizing sleep contribute to the management of hypertension, and what is the role of melatonin?
Melatonin, associated with anti-hypertensive effects, stimulates GABA, inhibits angiotensin-II, and increases NO.
