INP final - CVD Flashcards
Flashcards for the second half of the INP course. This set will cover CVD
What does cardiovascular disease (CVD) entail?
- Coronary artery disease: Inadequate blood flow through coronary arteries leading to angina/infarction
- Ischemic stroke: Thrombus blocks blood flow to part of brain
- Hemorrhagic stroke: Rupture of blood vessel to brain
- Heart failure & arrhythmias: Problems with pumping of heart and beating of heart (too slow-bradycardia; too fast-tachycardia)
Summarize the evolution of an atherosclerotic lesion/plaque.
- inflammation
- thickening of blood vessels
- accumulated/excess deposition of LDL-C, fat, Ca, cellular waste, and fibrin on arterial walls
- lumen of arteries becomes narrower
- over time rupture of the vessel wall has the plaque detaches or bursts
What are the key things that play a role in buildup?
LDL-C: High levels in circulation form basis for LDL deposits in intima
HDL-C: Reverse cholesterol transport, anti-inflammatory, inhibits LDL oxidation & prevents cell oxidative stress & platelet activation
Triglycerides: Enhance cholesterol accumulation & inflammatory response; destabilize plaque & enhance thrombus formation, clotting, coagulation
Macrophages/inflammatory cells: Attracted to intima by LDL particles, form foam cells; Inflammation leads to lesions
What are statins?
medication that lowers LDL-C and TGs; they may slightly increase HDL-C as well
HMG CoA reductase inhibitors = prevent cholesterol synthesis in the liver
What are some benefits of using statins for preventive care?
- Low-to-moderate dose statins
- Moderate reduction in probability of CVD events and mortality in adults with one or more CVD risk factors and calculated CVD event risk of 10% or more
- Small reduction in probability of CVD events and mortality in adults with one or more CVD risk factors and calculated CVD event risk of 7.5-10%
What are some risks of using statins for preventive care?
- Mixed evidence of association with T2D – small increased risk with high-dose statins
- Sparse evidence for cognitive harm – no effect on AD or dementia incidence
- Potential increased risk of cataracts
- No evidence of increased risk of cancer
- No evidence of causative role in occurrence of myalgia, although commonly reported adverse effect
What are the genetic risk factors for CVD?
- Familial hypercholesterolemia
- Very high LDL-C and TC
- Places one at risk of heart disease at young age
- Clinical signs: xanthomas, xanthelasmas, corneal arcus
- Other genetic causes: PCSK9 mutation, familial defective apoB, Tangier disease
What are the lifestyle risk factors for CVD?
- Overweight/obesity
- Poor dietary habits (low in fruits, veggies, healthy fats)
- Low physical activity (sedentary)
- Poor sleep (duration, quality, timing)
- High stress
- Excessive alcohol consumption
- Smoking
What preventative measures, primordial or early in life, can be taken to avoid CVD?
- Maintain a healthy diet
- Low saturated fat, low salt
- Exercise (at least 2.5 h/wk)
- Reduce sedentary behavior (limit TV to 7 h/wk)
- Low alcohol consumption
- Maintain normal BMI
- Not smoking
What primary preventative measures can be taken to avoid CVD?
- Achieve a healthy diet that is high in fiber, F&V and low in salt, SFA, simple sugars
- Low alcohol intake
- Meet physical activity guidelines
- Reduce body weight
- Quit smoking
- Diabetes prevention & treatment: glucose control
- Reduce blood pressure/treat hypertension
- Achieve/maintain optimal lipid profile: statin treatment
What secondary preventative measures can be taken to avoid CVD?
Prevents recurring events.
Generally pharmacological interventions:
Aspirin, statins, BP lowering medications, beta-blockers, and ACE-I (all of which reduce blood pressure); aspirin is no longer recommended for CVD.
What are life’s simple 7?
- Healthy weight
- Healthy diet
- Physical activity
- Not smoking
- Normal blood pressure
- Normal blood glucose
- Low LDL-C
What are the key recommendations from the AHA Diet and Lifestyle Recommendations to reduce the risk of CVD?
Maintain healthy body weight
Eat an overall healthy dietary pattern
Consume a variety of vegetables & fruits
Choose whole-grains, high-fiber foods, low-fat dairy products, skinless poultry and fish, non-tropical vegetable oils (no palm oil or coconut oil because high in SFA and only contains 15% of the MCFA)
↓ intakes of saturated and trans fat, cholesterol, sodium, red meat, sweets and sugar-containing beverage
Don’t smoke tobacco and avoid 2nd-hand smoke
Describe the effects of fat quantity vs quality on the risk of CVD.
Replacing UFA with simple carbs ↑ CVD risk by ↑ inflammation and oxidative stress which makes the LDL-C particles more atherogenic
Low-fat diets reduce cholesterol but ↑ TGs and quantity of LDL and UFA ↓ cholesterol without ↑ triglycerides compared to SFA
Size of the particle that matters – cholesterol in LARGE LDL-lipoprotein particle has ↓ risk compared to the smaller denser and ↑ presence of LDL-lipoprotein particles
Chain lengths - important to note that SFA are diverse: chain length: short, medium, and long where the short and MC FAs are protective and long chain FAs are adverse
Summarize the health effects and mechanism of action for soluble/insoluble fiber.
- Soluble fiber is fermentable, viscous (fruits, veggies,, legumes) while insoluble fiber is not (grains, nuts)
- ↓ coronary heart disease risk, stroke, hypertension, diabetes, obesity and some GI disorders
- affects total and LDL-C with little effect on HDL-C and TG; effects greater in those with higher baseline LDL-C and T2D
Mechanism of action:
- ↑ bile acid excretions because cholesterol is used to produce bile
- Inhibits hepatic cholesterol synthesis via SCFA production with colonic fermentation of fiber
Summarize the health effects and mechanism of action for soy protein.
- Leads to ↓ in total cholesterol, LDL-C, VLDL-C, TGs, and ↑ in HDL-C
Mechanism of action:
- Up-regulation of LDL-R activity, resulting in ↓ circulating LDL-C and/or prevention of LDL oxidation
- Binding bile acids and preventing their absorption because of an insoluble fraction of soy protein generated during normal digestion
Summarize the health effects and mechanism of action for nuts.
- ↓ the risk of CVD through a dose-dependent response (lowers LDL-C, HDL-C, TG)
- We want a high lys:arg ratio to ↓ cholesterol synthesis?
Mechanism of action:
- Peanuts, for example, contains protein, fat including SFAs, MUFAs, and PUFAs (more MUFAs and PUFAs compared to SFAs)
- May contain other micronutrients Ca, Mg, K, E
Summarize the health effects and mechanism of action for plant sterols.
- Cholesterol ↓ agents (reduces total and LDL-C) that are added to margarine residues
- ↓ heart disease risk by 25%
Mechanism of action:
- Blocks cholesterol absorption from intestinal lumen
- Displaced cholesterol from micelles
- ↑ bile salt excretion
- Hinders cholesterol esterification in intestinal mucosa
- May modify activity of hepatic acetyl CaA carboxylase and cholesterol 7-α-hydroxylase
What is the Portfolio diet? How much of an effect has been seen with this diet?
What is it? Combination of cholesterol-lowering foods in the diet to achieve maximum reduction in cholesterol concentration by diet alone (ie: plant sterols, viscous fiber, soy protein, almonds)
What are the effects? Decreased changes in LDL-C with the portfolio diet was similar to that of statins
What is a health claim?
Something that that characterizes a relationship between a food, a food component, or dietary ingredient, or dietary supplement and risk of a disease or health related condition (is not disease prevention)
What is an authorized health claim?
Calcium, vitamin D, osteoporosis; Dietary fat and cancer; Folic acid and neural tube defects
Example: X grams of [one of the four foods that reduces cholesterol or from the portfolio diet like soy protein] a day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease (no disease prevention]. A serving of [name of food, we identified the food component] supplies x grams of soy protein. This amount of grams is necessary per day to have this effect.
What is a structure function claim?
Reflect the known role of nutrient in body functions
Example: Role of Ca in bone formation vs Role of Ca in the prevention of osteoporosis
What is a qualified health claim?
Differ from regular “health claims” in that they must be accompanied by a disclaimer as to not mislead the consumer.
Do no meet “significant scientific agreement”
suggests but does not prove that having x food as part of a diet low in SFA and cholesterol may reduce the risk of heart disease – “some evidence but no proof” is the disclaimer
