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HUNT 243 > Lecture 21 - Cardiovascular Disease > Flashcards

Lecture 21 - Cardiovascular Disease Flashcards

1
Q

what is cardiovascular disease (CVD)

A

general term for all diseases of heart and blood vessels

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2
Q

what is coronary heart disease (CHD) - what is it also referred to as

A

also referred to as coronary artery disease (CAD) or Ischemic heart disease (IHD)

damage that occurs when blood vessels carrying blood to heart become narrow and blocked

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3
Q

what is cerebrovascular disease (stroke)

A

damage to arteries to the brain

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4
Q

what is peripheral vascular disease

A

narrowing of the arteries other than those supply the heart or brain

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5
Q

what is hypertension

A

high blood pressure

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6
Q

what is atherosclerosis

A

characterised by plaques along inner walls of arteries

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7
Q

why are rates of death from heart disease decreasing

A
  • better control of major risk factors
  • better evidence based treatments
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8
Q

what are the major risk factors that are in better control leading to decreasing rates of death from heart disease

A
  • cholesterol
  • systolic blood pressure
  • smoking prevalence
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9
Q

what evidenced based treatments that are better leading to decreased heart disease deaths

A

diagnostic and therapeutic procedures

e.g phramacological treatment of hypertension, hypertension screening, bypass surgery, access to healthcare

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10
Q

what is the leading cause of death globally

A

coronary heart disease

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11
Q

what is the CVD mortality in maori compared to non maori

A

much higher in maori than non maori

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12
Q

compare the deaths from CVD in men in women

A

higher in men, but CVD is still the leading cause of death in women worldwide

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13
Q

1 in how many women die of heart disease or stroke compared to die of breast cancer

A

1 in 2 women will die of heart disease or stroke

1 in 25 women will die with breast cancer

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14
Q

age specific risk of CVD is lower in what gender

A

apparently lower in women, it is estimated presentation in women is on average 7 to 15 years later compared to men

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15
Q

what are some examples of irritants to blood vessels that can lead to the process of atherosclerosis and what do these do

A

high levels of LDL cholesterol, high blood pressure or toxins from smoking damages the blood vessel allows things to get in, once they are in the wall they start to be oxidised

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16
Q

as irritants enter blood vessels, what happens to them and what is sent in the process of atherosclerosis and what happens to them (what do they form)

A

they are oxidised, monocytes are sent

these monocytes will gobble up the cholesterol, they die because they are full of so much cholesterol and become what we call foam cells

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17
Q

in the process of atherosclerosis, what happens when dead macrophages accumulate, and what does this lead to

A

sends a message to the immune system and this will send more recruitment, so there is an ongoing process that causes increased inflammation and a build up of fatty tissue

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18
Q

in the process of atherosclerosis, build up of dead macrophages leads to increased inflammation and build up fatty tissue what happens after this

A

the next layer of the blood vessel, the smooth muscle layer will try to build around it to stop the blood vessel being exposed, this reduces the blood flow through the vessel, increasing blood pressure

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19
Q

along with growing around the inflammation what else will the smooth muscle do in the process of atherosclerosis

A

deposit some calcium to harden it, which is called a fibrous cap

making the blood vessel not as fluid as it was, again increasing blood pressure

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20
Q

what happens if all the inflammation covered in the blood vessel ruptures

A

all this inflammation and mess will enter the blood vessel

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21
Q

LDL cholesterol is an

A

irritant to start the atherosclerosis process

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22
Q

chylomicrons are full of

A

triglycerides

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23
Q

what is the function of chylomicrons

A

transport dietary lipids from intestine to peripheral tissues

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24
Q

what is the function of VLDL

A

transports lipids from liver to peripheral tissues

25
Q

what is the function of intermediate density lipoprotein

A

precursor of LDL

26
Q

what is the function of LDL

A

transports cholesterol to peripheral tissues and liver

27
Q

what is the function of lipoprotein a (Lpa)

A

associated with CHD risk, similar to LDL

28
Q

what is the function of HDL

A

removes cholesterol from tissues and transfers it to the liver or other lipoproteins

29
Q

what is the function of albumin

A

transports free fatty acids from adipose tissue to peripheral tissues

30
Q

low density lipoprotein cholesterol is associated with what risk of

A

increased risk of CVD

31
Q

Apo B containing lipoproteins are associated with what risk of

A

increased risk of CVD

32
Q

high density lipoprotein cholesterol is associated with what

A

unsure, it wasn’t found that increasing this reduced risk

33
Q

Lpa is associated with increased risk of what

A

increased risk of CVD

34
Q

triglycerides is associated with increased risk of what

A

increased risk of CVD

35
Q

why is it important to keep cholesterol levels low when you are young

A

its like smoking in your 20s isnt going to give you heart disease in your 30s, its about the long term effects that is important

36
Q

what types of saturated fat increase our LDL cholesterol

A
  • lauric acid : main fatty acid in coconut
  • myristic : high in some dairy products
  • palmitic acid : found in palm oil
37
Q

what saturated fat has a neutral affect on our LDL cholesterol

A

steric acid seems to have a neutral affect : main fat found in dark chocolate

38
Q

what monounsaturated fat reduces our LDL cholesterol

A

Oleic

39
Q

what monounsaturated fat increases our LDL cholesterol

A

elaidic (trans)

40
Q

what type of fats really reduce our cholesterol

A

polyunsaturated fats

41
Q

how does omega 3 reduce our cholesterol, what is it found in

A

reducing triglycerides like VLDL

found in things like fatty fish

42
Q

what does omega 6 reduce

A

reduce LDL

43
Q

what did the keys equation look at

A

how much would our blood cholesterol change if we changed the amount of polyunsaturated fat, saturated fat and dietary cholesterol in our diets

44
Q

for a given amount of saturated fat, it will raise our blood cholesterol levels …… as much as given polyunsaturated fat would decrease it

A

raise it twice as much

45
Q

what is the keys equation

A

change in cholesterol = 2.74 x change in sat fat - 1.13 x change in polyunsat fat

46
Q

what fat is highest in saturated fat

A

coconut oil

47
Q

what oils are high in monounsaturated fats

A

olive, canola, peanut oil

48
Q

what oils are high in polyunsaturated fats

A

safflower, flaxseed, walnut, sunflower oil

49
Q

a meta analysis found that reducing saturated fat intake had a what reduction in CVD risk

A

17% reduction in CVD risk

50
Q

what was found from the meta analysis if the reduction in saturated fat was replaced with polyunsaturated fat

A

27% reduction

51
Q

what was found in the meta analysis if reduction in saturated fat was replaced with carbohydrates or protein

A

not statistically significant

52
Q

in studies that achieved at least a 0.2 mmol/L reduction of total cholesterol, events of CVD reduced by

A

26%

53
Q

the reduction in CVD events was related to the degree of reduction in

A

serum total cholesterol

54
Q

how does saturated fat increase cholesterol

A
  • decrease LDL receptor activity
  • suppress ACAT (rate limiting enzyme of cholesterol esterification) : resulting in greater proportion remaining in the regulatory pool
55
Q

how does N-6 polyunsaturated fat decrease cholesterol

A

increase LDL receptor activity

increase CYP7 (rate limiting enzyme in converting cholesterol to bile acids)

56
Q

what did the early studies of cholesterol do and what did they find (BUT and SO)

A

fed large amounts of cholesterol to rabbits

this induced atherosclerosis

BUT …. rabbits are herbivores, who are hypersensitive to cholesterol and were fed large amounts of cholesterol

SO …. useful between the link of blood cholesterol and atherosclerosis but not useful for dietary cholesterol

57
Q

why do some people say that seed oils are toxic and are going to kill us, why are these claims not true

A

they say they will be oxidised and cause problems in the body……. but in the body vitamin E is often associated with it which helps prevent oxidation

they say this fat is converted to longer chain fatty acids called aracadonic acid, which is associated with pro-inflammatory effects ………. but it is also associated with some anti inflammatory effects

58
Q

what is not true about the claims saying we shouldnt have too much omega 6

A

its not about having too much omega 6 its about not having enough omega 3

59
Q

what are the omega 3 recommendations from the American Heart Association

A

1.0 g/day of EPA + DHA to reduce risk of death from coronary heart disease in a secondary prevention setting

at least 2 serves of (preferably oily) fish per week (500mg of EPA + DHA) in a primary prevention setting

HUNT 243 (30 decks)

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