Exam 3 - cardiovascular disease Flashcards
What falls under cardiovascular disease?
- coronary heart disease
- atherosclerosis
- hypertension
- peripheral vascular disease
- heart failure
What is atherosclerotic cardiovascular disease (ASCVD)?
- narrowing of vessels by the buildup of planque starting from an injury to the endothelial cells that line the vessels
- Poor endothelial cells causes heart disease, foam cells damage, stemming from oxidized cholesterol
- plaque known as atherosclerosis can rupture causing a blood clot that blocks blood flow
What is the technical term for a heart attack?
Myocardial Infarction
What is a temporary ischemic stroke (TIA)?
true stroke
What is angina?
chest pain
What is intermitent claudication?
peripheral vascular disease
- could cause dead limbs, necrosis, gangrene
What lipoproteins are associated with being atherogenic?
Apo B100, LDL-C
- half of the people with atherosclerosis have normal lipid levels
- small density lipoproteins are much more atherogenic
What lipoprotein is positively associated with HDL?
Apo A1
What are the risk factors for CVD?
- inflammatory markers
- blood lipids (thought half have normal levels and still presiposed for CVD)
- lifestyle factors: smoking, poor diet, physical inactivity, alcohol, insufficient sleep, stress
- Age: men > 45, women > 55
- gender: men higher likelihood, although women are more likely to die due to not knowing they are having a heart attack
- genetics: gamily members with heart evens put you at elevated risk
- presence of other diseases: diabetes, HTN, low HCL, glucose intolerance, obesity
What are the inflammatory markers for CVD?
- fibrinogen
- C-reactive protein (CRP not a good screening tool)
- homocysteine - high levels associated with heart disease
- Lp-PLA2 - produced by macrophages and foam cells, true marker for atherosclerosis
What are some preventative measures for ASCVD?
- children older than 2 emphasize activity to maintain IBW
- Adults: total cholesterol < 170 mg/dl, HDL > 50, examine lifestyle and overall health before advising patients and dosing
- healthy lifestyle is the backbone of CVD prevention and treatment
ACC/AHA diet recommendations for ASCVD
- Maintain or reach target weight
- Reduce calories from saturated fat (5-6%)
- Eliminate consumption of trans fat
- Limit sweets, SSB and red meat
- Follow diet therapy for other diseases
- Emphasize fruit, vegetables, legumes, whole grains, fish (fatty fish 2 x week) or omega 3 (inhibits Apo B100 synthesis), nuts, nut oils, low-fat dairy
- Antioxidant rich diet
- 25-30 grams soluble fiber/day
- Plenty of stanols and sterols
- Dietary cholesterol is no longer restricted
- DASH diet great, vegan benefits and MedDiet fit recs.
- Include exercise too!
What is the pharmacologic management for ASCVD?
- diet to minimize need for drug therapy
- normally a mixture of medications
- bile acid sequestrants
- nicotinic acid - therapeutic dose causes flushing
- HMG CoA reductase inhibitors (statins)
- fibric acid derivatives
- probucol (decrease Tryglyceride synthesis)
What are statins, when are they used, how do they work?
- Inhibit HMG CoA Reductase (rate limiting step of making cholesterol in the body)
- ACC/AHA Recommend for: LDL cholesterol ≥ 190mg/dL or those with Diabetes, age 40–75 with LDL-C 70–190mg/dl; or in those with a 10-year risk of developing heart attack or stroke of
- 7.5% or more
- Side effects: Need for supplement of CoQ 10
- Subset of humans 5-10% will have serious side effects from statins, must taper on or off the drug
What are the medical interventions for ASCVD?
- Percutaneous coronary intervention (PCI) – stent
- Coronary artery bypass graft (CABG) - open heart surgery
