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FS HN 461 > CVD > Flashcards

CVD Flashcards

1
Q

What diseases are included within CVD

A
  • coronary heart disease
  • coronary artery disease
  • Htn
  • Cerebrovascular disease
  • congenital heart defects
  • peripheral vascular disease
  • congestive heart failure
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2
Q

What is mortality vs. morbidity?

A

Mortality: death rate
Morbidity: incidence of disease

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3
Q

What factors can damage the arterial walls

A
  • hypercholesterolemia
  • oxidized LDL
  • Htn
  • Cigarette smoking
  • DM
  • obesity
  • homocysteine
  • high SFA diet
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4
Q

What is atherosclerosis vs. arteriosclerosis?

A

Atherosclerosis: form of arteriosclerosis
- development of fatty streaks in arteries which develops into
fibrous plaque, ultimately dec BF
Arteriosclerosis: thickening, loss of elasticity and calcification of
arterial walls, ultimately dec BF

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5
Q

What factors influence LDL

A
  • aging
  • genetics
  • diet (SFA)
  • dec estrogen (menopause)
  • DM nephrotic syndrome
  • obstructive liver disease
  • obesity (inc VLDL and dec HDL)
  • some Htn/steroid meds
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6
Q

What are the only carrier of dietary lipids in the blood?

A

Chylomicrons

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7
Q

What is familial heterozygous hypercholesterolemia?

A
  • Cause: dec or defective LDL receptors (pts have 1/2 normal
    expression of LDL receptor)
  • common: 1/500
  • inc TC, inc LDL normal VLDL
  • premature CHD (men: 30-40, women: 40-50)
    Treatment: Step I or ATP III
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8
Q

What is familial homozygous hypercholesterolemia?

A
  • pt receives defective LDL receptors from both parents
  • LDL levels 4x greater than normal
  • develop early CHD and MI, usually in childhood
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9
Q

What is familial combined hyperlipidemia?

A
  • cause: hepatic overproduction of apo B-100, therefore VLDL
  • inc TC, LDL, TG, VLDL
    Treatment: Step 1 or ATP III (wt reduction)
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10
Q

What is familial dyslipidemia?

A

AKA type III
Cause: defective clearance of VLDL remnants
uncommon (1/5000)
inc TC and TG
Treatment: Step 1 or ATP III (wt reduction)

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11
Q

What is familial hypertriglyceridemia?

A

AKA Type IV

  • very common
  • excessive VLDL synthesis
  • inc TG and VLDL
  • Cause: dec LPL activity
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12
Q

What is familial Lipoprotein Lipase Deficiency?

A
  • rare condition
  • LPL activity reduced in all tissues
  • no increased risk of CHD
  • often develops pancreatitis unless strict avoidance of dietary fat
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13
Q

How do statins help manage CVD?

A
  • HMG-CoA reductase
  • Lovastatin, pravastatin, lipitor
  • dec LDL (18-55%), dec TG (7-30%), inc HDL (5-15%)
  • consequences: myopathy, increased liver transaminase activity
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14
Q

How do Bile acid sequestrants (resins) help manage CVD?

A
  • dec LDL (15-30%), inc HDL (3-5%), no change in TG
  • Cholestryamine, colestipol, colesevelam
  • nutritional consequences: dec Ca absorption, fat, and fat soluble vitamins
  • Side effects: N/V, belching, dyspepsia, pain, constipation
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15
Q

How does Nicotinic acid help manage CVD?

A
  • most effective med at increasing HDL
  • decreases FFA mobilization, therefore dec VLDL
  • dec LDL (5-25%), dec TG (20-50%), inc HDL (15-35%)
  • nutrition becomes component of allopathic medicine
  • side effects: flushing, hyperglycemia, gout, hyperuricemia, dyspepsia/peptic ulcer, liver toxicity
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16
Q

How do Fibrates help manage CVD?

A
  • increase PPAR alpha activity: a tx factor that regulates tx of genes for apolipoprotein A-1 and LPL
  • Gemfibrozil, fenofibrate
  • generally used to lower TG, not LDL
  • dec LDL (5-20%), inc HDL (10-35%), dec TG (20-50%)
  • side effects: GI symptoms, gallstones, myopathy
17
Q

What are the major risk factors for CVD?

A
  • HTN (>140 mg/dL)
  • low HDL ( 45; women > 55 or premature menopause w/o ERT
  • family hx of premature CHD- 1st degree relative
    premature: men < 55, women < 65
  • obesity (BMI > 30)
  • TC >240 mg/dL OR TC > 200 mg/dL & HDL < 40 OR 2 or more
    risk factors
18
Q

How does SFA intake relate to CVD?

A
  • inc TC levels because inc LDL
  • inc HDL when substitute CHO or other fatty acids
  • sources of SFA: animal fats, coconut, palm oil
  • most hypercholesterolemic to least
    -myristic acid (14:0)>palmitic acid (16:0)>lauric acid (12:0)>
    stearic (18:0, neutral)
    ** palmitic is most prevalent (60% of all SFA consumed)
  • for every 1% inc in energy intake from SFA, inc TC by 2.7 mg/dL
19
Q

How do MUFAs affect CVD?

A
  • substitute MUFA for SFA: dec TC, LDL, and TG
  • if total fat kcal <30%, MUFA will dec HDL
  • oleic acid is most prevalent
  • sources: canola, olive, peanut, rice, hazelnut, avocado
20
Q

How do PUFAs affect CVD?

A
  • replace CHO with linoleic acid: dec LDL and inc HDL
  • replace SFA with PUFA in LF diet: dec LDL and HDL
  • large quantities of linoleic acid inc LDL oxidation
  • sources of omega 6: veg oils: corn, safflower, sunflower, soybean
  • sources of omega 3: fish oils, walnuts, EB eggs
    • dec TG (25-30%)
    • inc LDL (5-10%)
    • inc clotting times and dec BP
21
Q

What are the therapeutic lifestyle changes in LDL lowering therapy?

A
  • TLC Diet
    • red intake of chol-raising nutrients: SFA and dietary chol
    • other LDL-lowering options
      • plant stanols/sterols
      • viscous (soluble) fiber
      • soy
  • increased PA
  • wt reduction
22
Q

What are the main components of the TLC diet recommended by the NCEP ATP III? concerning: CHO, protein, total fat, SFA, PUFA, MUFA, cholesterol, fiber, plant stanols/sterols, soy

A 
CHO: 50-60% of kcals
Protein: 15% of total kcal
Total fat: 25-35% of total kcal
SFA: <200 mg/day
fiber: 20-30 g/day
plant stanols/sterols: 3-4 g/d
soy: use to replace high SFA animal foods (25 g/d)
23
Q

What are the fiber recommendations for CVD? For soluble and insoluble fiber?

A

Fiber: 20-30 g/da-y

  • Soluble: 10-25 g/d
    • uses chol to replace bile acid pool
    • bacteria in colon ferment CHO to SCFA –> dec cholesterol synthesis
  • Insoluble: no effect on TC concentrations
24
Q

What are the levels of claims of fiber? What is the daily reference value used for food labels?

A
  • High fiber: 5 g or more per serving
  • Good source of fiber: 2.5-4.9 g per serving
  • more or added fiber: >2.5 g/serving than reference food
  • Food label:
    - daily reference value:
    - 25 g/2000 kcal
    - 30 g/2500 kcal
    - 20% daily value/serving
25
Q

What is Benecol? How much is needed to see an effect?

A
  • plant stanol esters

- need 1.5-2.4 g/day for 2-3 wks to see 7-10% dec in LDL

FS HN 461 (6 decks)

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