CVD - Exam 2

Question 1

_____ buildup of fatty plaques in the walls of arteries that causes those arteries to narrow. What can it cause?

Answer 1

atherosclerosis

decreases blood flow to an area

can cause rupture/blood clot

Question 2

What are risk factors for atherosclerosis?

Answer 2

Diabetes Mellitus
Hyperlipidemia/Hypercholesterolemia
Hypertension
Obesity
Smoking
Physical inactivity
Poor diet

Question 3

____ is the #1 cause of mortality in the United States! What is it due to ?

Answer 3

CVD

western diet (increased intake of fats, red meats and carbs, minimal fruits and veggies)

Question 4

When do you need to start lifestyle changes based on their LDL levels

Answer 4

If LDL is ≥ 190…start lifestyle changes +/- meds
If 10-year risk is >20%… start if LDL is ≥ 100 mg/dL
If 10-year risk is ≤ 20%…
And 2+ risk factors for CAD, start if LDL is ≥ 130 mg/dL
And 0 or 1 risk factor for CAD, start if LDL is ≥ 160 mg/dL

Question 5

What is the general recommendation for fat intake? What percentage of total calories?

Answer 5

“Saturated fatty acid, trans fatty acid, and cholesterol consumption should be as low as possible while still getting adequate nutrition

20-35% of total calories

Saturated fats - 7% or less of calories in pts with CVD risk

Question 6

Dietary fats mainly contribute to atherosclerosis by increasing _____. Saturated fatty acids equals greater increase in ____.

Answer 6

serum lipids

bad cholesterol (LDL)

Question 7

____ is often found to be the case before a cardiac stressor event

Answer 7

Acute ingestion of meal high in fatty acids

Question 8

Where are common places to find saturated fats?

Answer 8

Flesh of domestic mammals raised for consumption
Dairy products
Several vegetable oils (coconut, palm, palm kernel)

Question 9

ACC and AHA recommend to replace saturated fats with ______. Which kind of saturated fats is worse for you, meats or dairy?

Answer 9

MUFAs/PUFAs

saturated fats from meats are WORSE for you

Question 10

Where do adult males get the majority of their saturated fats from? children? adult women?

Answer 10

males: red meat

children: milk

adult women: dairy and processed foods

Question 11

Give 2 examples of PUFAs. Can we synthesize them on our own?

Answer 11

Omega-3

Omega-6

no, need to be consumed

Question 12

Give some examples of where omega 3 can be found? omega 6? What is the native ration? modern diet ratio?

Answer 12

Omega-3: found in flaxseed oil, linseed oil, marine oils (seafood), canola oil

Omega-6: found in soybeans, safflower oil, sunflower seeds/oil, and corn

native: 1:4

modern: 1:20

Question 13

What kind of pt should take PUFA supplementation?

Answer 13

pt who already have heart disease

Question 14

Give some examples of MUFAs. What do they promote?

Answer 14

olive or canola oils, peanuts, tree nuts, avocados

promote reductions in LDL and elevations in HDL

Question 15

____ are generally regarded as healthy fats and may be promoted as part of an overall heart-healthy diet

Answer 15

MUFAs

Question 16

What are 2 major approaches to prevent heart disease and limit worsening of existing heart disease

Answer 16

Limiting overall dietary fats (low-fat diet)

Liberalizing intake of MUFAs and omega-3 PUFAs

Question 17

What type of fats are in eggs? What is the recommendation?

Answer 17

high in cholesterol but low in fat - controversial!!

Question 18

Optimal Dietary Fat Intake - may lower ____ by up to 20% and _____ by up to 30%

Answer 18

LDL

total cholesterol

Question 19

____ diet is NOT recommended for CVD. _____ need to be reduced.

Answer 19

keto diet

Refined carbohydrates and grains and added sugars

Question 20

What kind of protein is preferred?

Answer 20

plant protein is preferred when compared to animal based proteins

Question 21

_____ reduce oxidative stress, which reduces cell damage. Inhibits ____ oxidation and protects _____ from degradation. What does it lead to?

Answer 21

Antioxidants

LDL oxidation

nitric oxide

slows/inhibits atherosclerotic disease process

Question 22

What are some examples of antioxidants?

Answer 22

vitamin E, vitamin C, carotenoids, flavonoids

Question 23

????? (3 things) - not shown to be helpful to prevent ASCVD or improve disease course

Answer 23

Vitamin E, Beta-Carotene, and Vitamin C supplementation

Question 24

_____ found in dark chocolate/cocoa, tea, red wine, grape juice are associated with improved overall cardiac health

Answer 24

Bioflavonoids

when consumed in moderation

Question 25

What 3 things all help in the metabolism of methionine and homocysteine? Elevated _____ levels have been found in up to ⅓ of all patients with coronary artery disease. _____ contributes to this elevation

Answer 25

B6 (pyridoxine), B12 (cobalamin), and B9 (folate)

homocysteine

folate levels contribute to elevated homocysteine

Question 26

Describe the link between B vitamins and cardiac benefit.

Answer 26

Cardiac benefit of B-vitamin supplementation is uncertain! thought to NOT cause harm but unsure if it is actually helpful

Question 27

_____ ubiquitous in plant-based foods; functions in mitochondria to help with ATP synthesis. What heart conditions specifically does it help with?

Answer 27

Coenzyme Q10 (CoQ10)

**heart failure
post MI
angina
ASCVD

Question 28

What is the function of Coenzyme Q10 (CoQ10)?

Answer 28

functions in mitochondria to help with ATP synthesis

Question 29

Health benefits may be primarily due to ____ and other polyphenic compounds found in the skin of grapes. What type of alcohol is preferred in cardiac pts?

Answer 29

resveratrol

red wine if you are going to drink something, chose red wine

Question 30

**____ and ____ are the nuts of choice for cardiac pts

Answer 30

**walnuts-first choice

almonds- second choice

Question 31

_____ may lower BP somewhat, but not associated with lower CVD morbidity and mortality

Answer 31

Garlic

Question 32

_____ can help reduce cholesterol levels. Similar MOA to statins, but questionable potency

Answer 32

Red Yeast Rice

Question 33

_____ lower levels associated with higher CVD risk. Increasing dietary intake preferred to adding a supplement. Whole grains, green leafy vegetables, nuts, legumes

Answer 33

magnesium

Question 34

______ help reduce cholesterol by interfering with absorption; may be of greater benefit when combined with statin
ex: Whole grain cereals, bran, peanuts

Answer 34

Plant Stanols/Sterols

Question 35

HTN is especially prevalent in US - ____ of adults

Answer 35

29-45%

Question 36

Association between higher BMI and HTN especially prevalent in ____

Answer 36

Black patients

Question 37

Up to 50% of nonobese patients who have HTN may also be _____. ____ is associated with lower BP readings

Answer 37

insulin resistant!

modest weight loss

Question 38

What are the 4 general considerations for a pt with HTN?

Answer 38

weight reduction, keep a healthy BMI

aerobic exercise: 30min/day 5 days a week

moderation of alcohol intake: less than 2 drinks/day men. less than 1 drink a day for women/elderly

sodium restriction to less than 2300mg/day

Question 39

What is the focus of the DASH diet?

Answer 39

Focuses on whole grains, legumes, vegetables, fruits, low-fat dairy, lean animal protein, nuts/seeds
Has a relatively high carb, but low glycemic index, profile
Limits red meat, processed meat, sweets, saturated fats, sodium

salt under 2300mg/day!!!

Question 40

____ lowered BP in trials by 1-3 mmHg; greater effect in younger pts

____ weak evidence, but may have some positive effect on HTN. Not likely to cause harm, but can cause “thinner blood” especially in patients already on anticoagulant/antiplatelet drugs

Answer 40

calcium

garlic

Question 41

what 4 additional things have found to be associated with lower blood pressure?

Answer 41

magnesium
fiber
cocoa
potassium

Question 42

What 3 things are associated with an increase in blood pressure? What is the major one?

Answer 42

**sodium
alcohol
caffeine

Question 43

Name some helpful way to reduce sodium in cardiac pts

Answer 43

Salt-substitutes - use calcium or potassium salts

educate about nutritional food labels

be mindful of processed and commercially prepared foods