Lecture 56

Question 1

What are major cardiovascular risk factors?

Answer 1

1) Hypertension
2) Age (>55 years for men, >65 years for women)
3) Diabetes mellitus
4) Elevated LDL-C or total cholesterol or low HDL-C
5) Chronic kidney disease: GFR < 55 years, woman 30kg/m2)
6) Family history of premature cardiovascular disease (men <65 years)
7) Microalbuminuria
8) Obesity* (body mass index ≥ 30 kg/m2)
9) Physical inactivity
10) Tobacco usage, particularly cigarettes (Decreases HDL)

Question 2

Which cardiovascular risk factors are causative?

Answer 2

1) Tobacco use
2) Elevated LDL
3) Low HDL
4) High Blood Pressure
5) Diabetes

Question 3

Which cardiovascular risk factors are nonmodifiable?

Answer 3

1) Age
2) Sex
3) Family history of premature CHD

Question 4

Which cardiovascular risk factors are predisposing?

Answer 4

1) Obesity
2) Physical inactivity
3) Atherogenic diet

Question 5

_____ (Elevated/Decreased) Serum Cholesterol is (Highly/Lowly) Correlated with (Increased/Decreased) CHD Risk

Answer 5

Elevated; Highly; Increased

Question 6

What level should triglyceride levels be maintained under?

Answer 6

<150mg/dL

Question 7

What are shortcomings of the Framingham risk score?

Answer 7

1) It is based mostly on a caucasian population (Massachusetts)
2) It does not include known RF family hx & obesity
3) There is overestimation in elderly
4) There is underestimation in young (missed identifying high risk)

Question 8

What are bodily signs of dyslipidemia in type 2 diabetes?

Answer 8

1) Elevated triglyceride levels
2) Reduced HDL-C
3) No Difference or some elevation in levels of LDL-C
4) Small, dense LDL-C become elevated & are the most atherogenic

Question 9

What risk do patients with established CHD (Coronary heart disease) have for encountering MI (Myocardial infarction)?

Answer 9

Patients with established CHD have a risk for recurrent MI and CHD death that exceeds 20% per 10 years

Question 10

What are CHD risk equivalents?

Answer 10

1) Multiple risk factors (>20% 10-year CHD risk)
2) Type 2 diabetes mellitus
3) Peripheral arterial disease
4) Abdominal aortic aneurysm
5) Carotid artery disease

Question 11

What is the metabolic syndrome?

Answer 11

1) Constellation inter-related risk factors of metabolic origin
2) Clue is distinctive body-type with increased abdominal circumference
3) 35% of overall population
4) Increase with age
5) Nearly equal by gender

Question 12

What can be deceptive about weight when correlated to cardiac problems?

Answer 12

Depending on where adipose tissue builds up in the body can have a dramatic impact on the heart. For instance, two people can weight the same, but one can have adipose storage in the legs, while the other has adipose storage in the belly. The belly adipose storage would cause more problems for the heart (metabolic syndrome)

Question 13

What is diagnostic criteria for metabolic syndrome?

Answer 13

The presence of at least 3 of the following criteria is diagnostic of metabolic syndrome:

1) Waist circumference (>88cm (W); >102 cm (M))
2) Triglycerides (=>150mg/dL)
3) HDL Cholesterol (130/85mmHg)
5) Fasting Glucose (=>100 mg/dL)

Question 14

How can one manage metabolic syndrome?

Answer 14

1) Various studies demonstrate 2-3 fold increase risk of CV death
2) Lifstyle management reduce 7-10% weight reduction over 1 year (Exercise 30-60 minutes 5x week)
3) Pharmacologically manage risk factors

Question 15

Describe the atherosclerosis timeline as endothelial dysfunction increases:

Answer 15

1) Foam cells
2) Fatty streak
3) Intermediate lesion
4) Atheroma
5) Fibrous plaque
6) Complicated lesion/rupture

Question 16

What is the function of HMG-CoA Reductase Inhibitors (Statins)?
They have cardiovascular therapeutic benefits:

Answer 16

1) Lower LDL-C
2) Lower TG
3) Raise HDL-C
4) Reduce major coronary events, CHD deaths, need for coronary procedures, stroke, & total mortality

Question 17

What are potential mechanisms for event reduction by statins?

Answer 17

1) Lipid Lowering
a. Much lower LDLs
b. Lower Triglycerides
c. High HDLs
2) Potential nonlipid effects
a. Higher endothelial function
b. Lower inflammation
c. Lower Coagulation/increase fibrinolysis

Question 18

What conclusions can be made about CV risk factors?

Answer 18

1) CV risk factors probably promote atherosclerosis by increased oxidative stress & inflammation in the vascular wall
2) Intensified CV risk prevention should be directed towards poorly controlled systolic BP & the epidemics of obesity, the metabolic syndrome & diabetes
3) Clinical trials continue to affirm the value of reducing LDL cholesterol with statin-class agents in a wide range of high-risk patients, including those with normal cholesterol & those with acute coronary syndromes