CVD - Exam 2 Flashcards
_____ buildup of fatty plaques in the walls of arteries that causes those arteries to narrow. What can it cause?
atherosclerosis
decreases blood flow to an area
can cause rupture/blood clot
What are risk factors for atherosclerosis?
Diabetes Mellitus
Hyperlipidemia/Hypercholesterolemia
Hypertension
Obesity
Smoking
Physical inactivity
Poor diet
____ is the #1 cause of mortality in the United States! What is it due to ?
CVD
western diet (increased intake of fats, red meats and carbs, minimal fruits and veggies)
When do you need to start lifestyle changes based on their LDL levels
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
What is the general recommendation for fat intake? What percentage of total calories?
“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
Dietary fats mainly contribute to atherosclerosis by increasing _____. Saturated fatty acids equals greater increase in ____.
serum lipids
bad cholesterol (LDL)
____ is often found to be the case before a cardiac stressor event
Acute ingestion of meal high in fatty acids
Where are common places to find saturated fats?
Flesh of domestic mammals raised for consumption
Dairy products
Several vegetable oils (coconut, palm, palm kernel)
ACC and AHA recommend to replace saturated fats with ______. Which kind of saturated fats is worse for you, meats or dairy?
MUFAs/PUFAs
saturated fats from meats are WORSE for you
Where do adult males get the majority of their saturated fats from? children? adult women?
males: red meat
children: milk
adult women: dairy and processed foods
Give 2 examples of PUFAs. Can we synthesize them on our own?
Omega-3
Omega-6
no, need to be consumed
Give some examples of where omega 3 can be found? omega 6? What is the native ration? modern diet ratio?
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
What kind of pt should take PUFA supplementation?
pt who already have heart disease
Give some examples of MUFAs. What do they promote?
olive or canola oils, peanuts, tree nuts, avocados
promote reductions in LDL and elevations in HDL
____ are generally regarded as healthy fats and may be promoted as part of an overall heart-healthy diet
MUFAs
What are 2 major approaches to prevent heart disease and limit worsening of existing heart disease
Limiting overall dietary fats (low-fat diet)
Liberalizing intake of MUFAs and omega-3 PUFAs
What type of fats are in eggs? What is the recommendation?
high in cholesterol but low in fat - controversial!!
Optimal Dietary Fat Intake - may lower ____ by up to 20% and _____ by up to 30%
LDL
total cholesterol
____ diet is NOT recommended for CVD. _____ need to be reduced.
keto diet
Refined carbohydrates and grains and added sugars
What kind of protein is preferred?
plant protein is preferred when compared to animal based proteins
_____ reduce oxidative stress, which reduces cell damage. Inhibits ____ oxidation and protects _____ from degradation. What does it lead to?
Antioxidants
LDL oxidation
nitric oxide
slows/inhibits atherosclerotic disease process
What are some examples of antioxidants?
vitamin E, vitamin C, carotenoids, flavonoids
????? (3 things) - not shown to be helpful to prevent ASCVD or improve disease course
Vitamin E, Beta-Carotene, and Vitamin C supplementation
_____ found in dark chocolate/cocoa, tea, red wine, grape juice are associated with improved overall cardiac health
Bioflavonoids
when consumed in moderation
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
B6 (pyridoxine), B12 (cobalamin), and B9 (folate)
homocysteine
folate levels contribute to elevated homocysteine
Describe the link between B vitamins and cardiac benefit.
Cardiac benefit of B-vitamin supplementation is uncertain! thought to NOT cause harm but unsure if it is actually helpful
_____ ubiquitous in plant-based foods; functions in mitochondria to help with ATP synthesis. What heart conditions specifically does it help with?
Coenzyme Q10 (CoQ10)
**heart failure
post MI
angina
ASCVD
What is the function of Coenzyme Q10 (CoQ10)?
functions in mitochondria to help with ATP synthesis
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?
resveratrol
red wine if you are going to drink something, chose red wine
**____ and ____ are the nuts of choice for cardiac pts
**walnuts-first choice
almonds- second choice
_____ may lower BP somewhat, but not associated with lower CVD morbidity and mortality
Garlic
_____ can help reduce cholesterol levels. Similar MOA to statins, but questionable potency
Red Yeast Rice
_____ lower levels associated with higher CVD risk. Increasing dietary intake preferred to adding a supplement. Whole grains, green leafy vegetables, nuts, legumes
magnesium
______ help reduce cholesterol by interfering with absorption; may be of greater benefit when combined with statin
ex: Whole grain cereals, bran, peanuts
Plant Stanols/Sterols
HTN is especially prevalent in US - ____ of adults
29-45%
Association between higher BMI and HTN especially prevalent in ____
Black patients
Up to 50% of nonobese patients who have HTN may also be _____. ____ is associated with lower BP readings
insulin resistant!
modest weight loss
What are the 4 general considerations for a pt with HTN?
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
What is the focus of the DASH diet?
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!!!
____ 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
calcium
garlic
what 4 additional things have found to be associated with lower blood pressure?
magnesium
fiber
cocoa
potassium
What 3 things are associated with an increase in blood pressure? What is the major one?
**sodium
alcohol
caffeine
Name some helpful way to reduce sodium in cardiac pts
Salt-substitutes - use calcium or potassium salts
educate about nutritional food labels
be mindful of processed and commercially prepared foods
