Lecture 39: Diet and Exercise, Role in the Prevention of CV Disease Flashcards
What are the risk factors for MI in men and women?
- obesity
2. physical inactivity
What is the relationship between BMI and CV disease?
Directly proportional
What is Glagov’s coronary remodeling concept?
How lumen stays patent even though there is outpouching of fibrous cap/lipid core
40% stenotic before there is an obstruction in blood flow
What is the Metabolic Syndrome?
A constellation of features that are associated with obesity
- abdominal obesity
- hypertriglyceride
- low HDL
- High BP
- high fasting glucose
What is the genetic susceptibility to metabolic syndrome?
Genetically susceptible as well to HTN, T2DM and CHD
What are the features of the metabolic syndrome?
- insulin resistance
- hyperinsulinemia
- glucose intolerance
- impaired fibrinolysis and endothelial dysfunction
What are the benefits of healthy diet, weight loss and exercise?
Improves lipid profile Decreases insulin resistance Decreased inflammatory markers (CRP) Decreases BP Improves Endothelial Function Decreased metabolic syndrome parameters
How do you lose 1-2 lbs a week?
By eating 500-1000 calories less but doesn’t reduce CV risk if you just eat snickers
Need to reduce calories by eating healthy as well
What is the relationship between fat intake and CV disease progression?
Less fat intake = less CV disease
What are the pros of low-carbohydrate diets?
- diuretic effect for initial weight loss
- palatable
- caloric restriction
What are the cons of low-carb diet?
High protein content (calcium imbalance, renal/hepatic complications
Atherogenic: high saturated fat, cholesterol; ack of fruits, vegetables,, whole grains
What are the effects of low-carb diet on other CVD risk factors?
- may have beneficial effect on glucose levels (especially in diabetics)
- may have short-term defect on insulin sensitivity
- may improve diastolic BP
- further study needed
What are the three types of diets?
- Low-fat, restricted calorie
- Mediterranean, restricted-calorie
- Low-carb, non-restricted calorie
Mediterranean = lowest LDL, and low carb = lowest triglycerides and highest HDL
Are CV health and weight loss mutually inclusive?
No
One does not mean the other
What are the characteristics of the well-fed state?
High levels of insulin
Insulin leads to storage of glucose in fatty acids and glycogen
What are the characteristics of the fasting state?
Glucagon stimulates glucose production and release in liver
What are the key characteristics of trans fats?
Trans bond makes it so that there are more atherosclerotic events
How does epinephrine play a role in fuel metabolism?
Signals impending activity
Acts on muscle, liver and adipose tissue
What is the best diet according to lecturer?
Mediterranean Diet seems to be best
- reduces risk of diabetes and reduces cholesterol - Reduces risk of CV events - weight loss - easy to adhere
What is the dose of physical activity?
The total amount of energy expended (usually expressed in kilojoules or kilocalories)
What is absolute intensity?
Rate of energy expenditure
Expressed in METs
Walking = 4 METs
What is relative intensity?
Percentage of maximal aerobic power that is maintained during exercise, expressed as percentage of VO2 max
Will you burn more calories running 1 mile or walking one mile?
About the same because same amount of work is being done
What is the difference between physical activity and fitness?
The former is the normal shit you do on a day to day basis (walking to car)
Physical fitness = cardiorespiratory fitness and muscle strength
Exercise = subset of physical activity that is planned, structured and purposeful
What is the significance of trans fats?
Behaves atherogenically
What are the conclusions for exercise?
Exercising at 19km/wk at 40-55% of peak VO2 is the bare minimum
More intensity and repetition = more benefits
What are the biological mechanisms for benefits of exercise?
- Antiatherogenic effects
- antithrombotic effects
- endothelial function alteration
- autonomic functional changes
- Anti-ischemic effects
- Antiarrhythmic effects
What were the antiatherogenic effects of exercise?
- Reduction of adiposity in abs and upper body
- reduction of BP
- reduction of TG
- increase in HDL
- Improved insulin sensitivity
What does physical activity do for diabetes mellitus?
Beneficial effects on glucose metabolism and insulin sensitivity
Decreased production of glucose from liver
Muscle cells use more glucose
Reduces obesity
Independent effect on symptom amelioration
What lifestyle change makes the biggest change in CV disease?
Going from not fit to moderately fit made the biggest change
What does physical fitness do for your CV disease chance?
They improve your risk factors for CV (less likely to get CV
What is bottomline for exercise in relation to CV disease?
A. Some is definitely better than none, more is probably better
B. Sedentary and obese have the most to gain by just moving out of the lowest category of daily activity
C. Greater amounts and higher intensity probably provides reduction in clinical disease, effect less clear for mortality
What is the recommendation of the ACSM for physical activity and CV health?
Minimum of 30 minutes of moderate intensity physical activity (continuous or in 10 minute increments) is required on most days of the week to reduce risk of CAD events
This is equivalent to 1.5 miles per day of brisk walking at an energy cost of 150 kcal/day for avg sized person
