Exam 4: MNT for CVD atherosclerosis Flashcards
Explain the process of atherosclerosis
- Endothelial Injury and Dysfunction
Atherosclerosis begins with damage to the endothelial cells, which line the inside of the arteries. The damage can be caused by various factors such as:
High levels of LDL cholesterol (which is considered “bad” cholesterol).
High blood pressure.
Smoking and diabetes.
Oxidative stress.
This damage triggers an inflammatory response (release of inflammatory cytokines) that makes the endothelial cells more permeable and prone to plaque formation. - Lipid Accumulation and Foam Cell Formation
After endothelial injury, LDL cholesterol particles penetrate the artery wall and become oxidized.
The oxidized LDL triggers the attraction of monocytes (a type of white blood cell), which move into the artery wall.
The monocytes differentiate into macrophages, which attempt to clear the oxidized LDL by engulfing it. However, when they ingest the oxidized LDL, they transform into foam cells.
Foam cells accumulate, forming fatty streaks, which are the early stages of atherosclerotic plaque. - Plaque Formation
Smooth muscle cells from the artery wall migrate to the fatty streak and begin to secrete extracellular matrix materials, including collagen, elastin, and proteoglycans.
Over time, this material forms a fibrous cap over the fatty streak, creating a fibrous plaque.
The plaque can continue to grow as more foam cells and smooth muscle cells accumulate, and calcium can deposit in the plaque, making it harder and less flexible. - Plaque Rupture and Thrombosis
Some plaques become unstable, meaning the fibrous cap becomes thin and more prone to rupture.
When an unstable plaque ruptures, it exposes its contents (such as oxidized LDL) to the bloodstream. This triggers the blood clotting cascade and the formation of a thrombus (blood clot).
The thrombus can block the artery entirely, leading to conditions such as myocardial infarction (heart attack) or stroke if the blockage occurs in the coronary or cerebral arteries. - Clinical Outcomes
As atherosclerosis progresses, it can lead to a reduction in blood flow, resulting in:
Angina (chest pain due to reduced blood flow to the heart).
Heart attack (myocardial infarction).
Stroke if plaque forms in the arteries supplying the brain.
Peripheral artery disease in the legs, causing pain and tissue damage due to poor circulation.
Recognize clinical manifestations of atherothrombotic disease
- ischemic stroke (no O2/blood to brain)
- transient ischemic attack (temporary lack blood flow, loss conscoiuness)
- myocardial infarction (heart attack)
- angina pectoris (stable, unstable) (chest pain)
- sudden death
- intermittent claudication
- critical limb ischemia, gangrene, necrosis
Identify risk factors for atherosclerosis
- smoking
- obesity (abdominal or high WC
- hypertension (resistance to blood flow and damage to arterial wall)
- elevated LDL cholesterol (oxidation of fatty streaks)
- genes
- high saturated fat/cholesterol diet
- elevated serum triglycerides (injury to arterial wall)
- inactivity
- diabetes (sugar damage arterial wall)
- stress (damage to arterial wall)
- decreased HDL cholesterol (remove LDL)
- aging (damage arterial wall)
- hyperhomocysteinemia (inflammation to wall)
- endothelial dysfunction (not synthesis of nitric oxide, ability to dilate)
normal blood pressure is
<120/<80 mm Hg
elevated: systolic is between _______ and _______ or diastolic is between _______
systolic between 120–
129 mm Hg
diastolic <80
mm Hg
hypertension stage 1 is systolic between ____ and ____
139 mm Hg or diastolic between
_____ and _____ mm Hg
systolic between 130–
139 mm Hg or diastolic between
80-89 mm Hg
hypertension stage 2 is systolic______
or diastolic ______
systolic ≥140 mm Hg
or diastolic ≥90 mm Hg
Patient with hypertension is at an increased risk for
Heart failure
MI
Stroke
Renal disease
UL for sodium
2,300mg
EPA/DHA
omega 3 fatty acids
food is good source of omega-3 if it contains at least ___________ per serving
Must contain at least 0.8 g
EPA/DHA per serving
Dietary Guidelines for seafood
▪ 8 oz seafood/week
▪ ~250 mg/d (DHA/EPA)
EPA/DHA Health Claim
Ability to reduce the risk of
hypertension and coronary
artery disease, as well as lower
blood pressure
ACC/AHA Recommendations
Reduce calories from saturated fat to 5-6% of kcal: dietary guidelines say no more than 10%
* Reduce consumption of trans fat
* Decreasing dietary cholesterol not necessary
* Consume no more than 2,400 mg of sodium/day, no more than 1tsp of salt per day
* Eat appropriate calories for weight loss or maintenance
* Follow diet therapy for other diseases (e.g., diabetes)
* Emphasize fruit, vegetables, legumes, whole grains, fish, poultry, nuts, vegetable oils, low-fat dairy
* Antioxidant-rich foods, not supplements
* Limit intake of red meat
* Limit intake of sweets, especially sugar-sweetened beverages
* Limit added sugars to 25 g (6 tsp) per day for women, 37.5 g (9 tsp) per day for men
* Achieve though DASH diet or USDA MyPlate food pattern
* Moderate-to-vigorous intensity aerobic exercise 40 minutes 3-4 x/week
oilier fish has more ______ than lean fish
omega 3
NCEP
national education cholesterol program
Therapeutic Lifestyle Change (TLC) Dietary
Pattern recommends total fat
25-35%
less fat means ppl eat more refined CHO which can elevate triglycerides
Therapeutic Lifestyle Change (TLC) Dietary
Pattern recommends saturated fat
<7% of kcals
Therapeutic Lifestyle Change (TLC) Dietary
Pattern recommends trans fat
zero
Therapeutic Lifestyle Change (TLC) Dietary
Pattern recommends PUFA fat
up to 10% kcals
Therapeutic Lifestyle Change (TLC) Dietary
Pattern recommends MUFA fat
up to 20% kcals
Therapeutic Lifestyle Change (TLC) Dietary
Pattern recommends CHO
50-60% of kcal
Therapeutic Lifestyle Change (TLC) Dietary
Pattern recommends Fiber
25-30 g/d
Therapeutic Lifestyle Change (TLC) Dietary
Pattern recommends soluble fiber
at least 10g/d
Therapeutic Lifestyle Change (TLC) Dietary
Pattern recommends plant sterols )lower LDL)
2/gd
Therapeutic Lifestyle Change (TLC) Dietary
Pattern recommends cholesterol
<200mg/d
omega-3 sources
- fish
- flax
- hemp
- walnuts
PUFA omega-6 sources
- corn
- soy
- seed oils
PUFA omega-3 are _________ while PUFA omega-6 are ______
anti-inflammatory and pro-inflammatory
following a mediterrenena diet, a patient will most likely meet whihc guidelines?
Therapeutic Lifestyle Change (TLC) Dietary
Pattern
What is Cardiovascular disease?
disease of the heart and or blood vessels
Cardiovascular disease includes:
Coronary heart disease
atherosclerosis
hypertension
Peripheral Vascular Disease
Heart Failure
What is Coronary heart disease?
disease of the coronary arteries
the narrowing or blockage of the coronary arteries, which supply oxygen-rich blood to the heart muscle. This condition is primarily caused by atherosclerosis, the buildup of plaque (a fatty, cholesterol-rich substance) in the walls of arteries.
What is Atherosclerosis?
heartening of arteries
a condition characterized by the progressive buildup of plaque within the walls of arteries. Plaque consists of cholesterol, fatty substances, cellular waste, calcium, and fibrin. This buildup leads to the narrowing and stiffening of arteries, impairing blood flow and oxygen delivery to tissues.
What is Hypertension?
High blood pressure
is persistently high arterial blood pressure.
What is Peripheral vascular disease?
condition where blood flow to peripheral tissues—such as the limbs—is impaired, primarily due to atherosclerosis
What is heart failure?
occurs when the heart’s ability to pump blood efficiently is compromised. This leads to an inadequate supply of blood and oxygen to meet the body’s needs, causing symptoms and complications. HF is often the end result of various cardiovascular conditions, including long-standing hypertension, coronary artery disease, and valvular heart disease
Blood vessels are composed of __________ layers
3
What are the 3 layers of the blood vessels?
outer layer
middle layer
inner lining
The outer layer of the blood vessels is made up of __________ tissue
connective
The middle layer of the blood vessels is made up of __________ tissue
smooth muscle
The inner linning of the blood vessels is made up of __________ tissue
endothelial cells
The outer layer of the blood vessels is made up of connective tissue that helps with _______ and ________
dilation and constriction
What is nitric oxide?
potent vasodilator
is a soluble gas synthesized continuously from the amino acid L-arginine in endothelial cells; acts as vasodilator causing decreased blood pressure and increase blood flow.
Atherogenesis is the start of atheroclerosis, what is atherogenesis?
- begins with an injury to the arterial wall such as cholesterol and other risk factors
- when injury occurs, inflammatory cytokines are released
- oxidation of LDL-c (most harrmful)
Following atherogenesis, fatty streaks may form in the accumulation of plaque process of atherosclerosis, what are fatty streaks?
WBC or macrophages ingest oxidized cholesterol
Following atherogenesis, fatty streaks may form in the accumulation of plaque process of atherosclerosis, when those fatty streak calcify or calcification of fatty streaks it is known as________?
fibrous plaque
What is thrombus in relation to atherosclerosis?
clot/plaque accumulation that blocks or restricts blood flow
American heart Association My Life Check- “life’s simple 7” to reduce CVD risk
- no smoking
- physical activity
- maintain healthy weight
- eat healthy diet
- monitor blood sugar
- monitor blood lipids
- monitor blood pressure
To diagnose atherosclerosis a doctor may order ________ and look at ________
- blood lipid panel
- blood markers of inflammation
what is included in a blood lipid panel
– total cholesterol (<200mg/dL)
– serum triglycerides a measure of fat in bloos (<150mg/dL)
–LDL c (100<130mg/dL<160)
– HDL >50+
Identify risk factors for atherosclerosis, what is included in a blood markers of inflammation
– Hs CRP C-reactive protein (chronic inflammation)
– homocysteine
what procedures might a cardiologist do when diagnosing/treat atherosclerosis?
- electrocardiogram (ECG)
- treadmill stress test
- echocardiogram
- angiography/cardiac catheterization
- angioplasty/percutaneous coronary intervention
- coronary artery bypass graft (CABG)
best method for atherosclerosis procedure to diagnose and treat
- diagnose with angiography/cardiac catheterization
- treat with angioplasty/percutaneous coronary intervention
most severe method for atherosclerosis procedure to diagnose/treat
- coronary artery bypass graft (CABG)
what medication might be prescribed for atherosclerosis?
- lowering LDLc
list the lowering LDL-c medications
- bile acid sequestrants (questran)
- HMG CoA reductase inhibitors (statins)
- dietary supplements (red yeas rice, niacin)
What is Questran?
a lowering LDL-c medication, a type of bile acid sequestrant. Bile acid sequestrants are used to lower LDL-C (low-density lipoprotein cholesterol) by binding to bile acids in the intestines and preventing their reabsorption. This forces the liver to use more cholesterol to produce bile acids, thereby reducing the level of LDL-C in the bloodstream.
what is statins?
Statins (HMG-CoA reductase inhibitors): These are the primary medications used to lower LDL-C by inhibiting the enzyme responsible for cholesterol production in the liver. prevent cholesterol from being made.
list dietary supplements for atherosclerosis
red yeas rice (banned, same active ingredient as statin)
niacin (large dosis above UL)
side effect of statins?
deplete CoQ10, supplement with CoQ10. a powerful antioxidant and mitochondrial function
side effect of lowering LDL c medication
liver damage
T/F all medication of oatherosclerosis to lower TG contain EPA and/or DHA
True. All medications that treat atherosclerosis via lowering TG contain EPA or DHA or combination of both
Medication given to atherosclerosis patient to lower TG?
Vascepa
Lovaza
What is Vascepa?
prescription EPA
What is Lovaza?
prescription EPA and DHA
What are fish oil supplements?
EPA and DHA most powerful
therapeutric dosage for fish oil supplements?
2-4 g/d EPA and DHA (2k-4k ml)
main concern is blood thinning thus hemorrhage
Medication given to atherosclerosis patient to raise HDL- ?
there is no actual medication but typically prescribe Niacin supplements
Is there a medication on the market that raises HDL-c?
no
___________ panel must be ordered when taking lowering LDL-c medications
liver panel
MNT goals for Atherosclerosis
- lower LDL
- lower TG
-increase HDL - exercise and with loss improve all blood lipids
MNT for Atherosclerosis: goal - Lowering LDL… What should you do?
- REPLACING saturated fat with monounsaturated fat
- increase soluble fiber
- avoid trans fat
- plant sterols/stanols
MNT for Atherosclerosis: goal - Lowering TG… What should you do?
- omega 3 fatty acids
- substitute MUFA for saturated fats
- limit alcohol
- limit refined CHO and added sugar
MNT for Atherosclerosis: goal - increase HDL… What should you do?
exercise
food exchanges: ___________ instead of butter
__________ meat instead of dark meat
____________ milk instead of whole milk
olive oil
white
low-fat
saturated fats are found in ?
- butter
- dark meat chicken
- chicken skin
- red meat
- tropical oil i.e coconut oil
- dairy/meat product fats
what are the leaner meats to reccomend?
- sirloin
- tenderlion
- round
limit meats
- ribs
T/F coconut oil does not only raise HDL but also LDL-c
T
still not good oil to use bc raise LDL
HDL little bit compare to butter
MUFA options
olive, canola oil
avocado
nuts
T/F eating more MUFA and PUFA is enough to lower LDL-c
F eat more and replace it with a saturated fat food
how does fiber lower LDL-c?
acts as bile sequester
trans fat will _________ LDL and __________ HDL
raise and lower
foods with trans fat
any with hydrogenated oils, ultra-processed baked goods, shelf-stable items, pie crust, shortening, liquid to solid fat, margerine stick
plant sterols/stanols help lower LDL
plant foods, structurally similar to cholesterol. body wont produce as much. prevent synthesis
Omega 3 fatty acids can be found in what foods?
fish
flax
chia
hemp seed
walnut
________ beverage can raise TG
alcohol
T/F exercise and weight loss improves all blood lipids
