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IPFC 4 Final > NHPs for CVD > Flashcards

NHPs for CVD Flashcards

1
Q

Which NHPs have CV risk-lowering data from RCTs (2)

A

Omega-3 fatty acids (fish oil)
Multivitamin

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2
Q

Which NHPs do NOT have CV risk-lowering data from RCTs (3)

A

Garlic
Soluble fiber
Plant sterols

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3
Q

What are the main fatty acids in omega 3 (2)

A

EPA (eicosapentaenoic)
DHA (docosahexaenoic)

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4
Q

Which oils have a-linolenic acid (3)

A

Flaxseed oil
Canola oil
Soybean oil

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5
Q

Which fatty acids family have more thrombotic and inflammatory metabolites? Which oil does it contain?

A

Linoleic (corn oil, safflower oil, sunflwoer oil)
and arachidonic
(omega-6 family)

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6
Q

MOA of omega-3 for CV risk lowering (3)

A
  • Reduce triglycerides
  • Antithrombotic effects
  • Mild anti-hypertensive effects
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7
Q

Effects on lipid profile for fish oil (4)
TG
Total cholesterol
HDL
LDL

A

TG: dec
Total cholesterol: no change
HDL: slight inc
LDL: slight inc

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8
Q

What do older vs newer meta-analyses say for benefit of fish oil to reduce CV risk

A

Old: benefit
New: no benefit (even in secondary)
- no statistically significant on hard outcomes, stroke or MI

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9
Q

Which trials have “positive” fish oil studies (3)

A

GISSI-prevenzione (probe)
JELIS
DART

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10
Q

Which trials have “negative” fish oil studies (6)

A

ORIGIN
OMEGA
Alpha-OMEGA
VITAL (no benefit with VIT D as well)
ASCEND
STRENGTH

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11
Q

GISSI trial
Primary/secondary
Statin/no statin

A

All secondary
4% on statin

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12
Q

What could be the cause of no benefit for ORIGIN trial

A

54% on statin

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13
Q

What are cautions to take with fish oil (risks)

A
  • Bleeding with doses greater than 3g/day
  • Increased risk of afib
  • Increased risk of stroke in primary prevention
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14
Q

What can fish oil be used for?

A

High triglycerides
(need to take 3-4g/day)

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15
Q

Is multivitamin beneficial in for prevention of CVD in primary and secondary according to Physicians Health Study II

A

No benefit for primary endpoint

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16
Q

MOA of flaxseed (2)

A

Reduce total cholesterol
Reduce LDL

17
Q

MOA of Krill oil (3)
What does it contain

A

Reduced LDL
Reduced TG
Increased HDL

Contains
- EPA and DHA
- omega-9
- phospholipids
- Vit A & E and other antioxidants

18
Q

Garlic effects (2)
which drug has the most evidence?

A

Cholesterol (some show effect, some don’t)
- Dec total cholesterol
- Dec LDL

Blood-pressure lowering (some show effect, some don’t)
- Lower BP by 8/7 mm HG

Most evidence drug: Kwai

19
Q

Caution with Garlic

A

May have anti platelet activity

20
Q

Which extra evidence does soluble fibre have over garlic?

A

Has observational data in addition to meta-analysis

21
Q

Soluble fiber MOA
Examples?

A

Reduced LDL
Reduced total cholesterol

Ex
- psyllium
- beta-glucan

22
Q

Phytosterols MOA (1)

A

reduce intestinal cholesterol absorption by displacing cholesterol from mixed micelles
- dec LDL

23
Q

Mediterranean diet benefit in PREDIMED

A

Same benefit as statin
- best natural route for decreasing CV disease

24
Q

What does the GISSI-HF say for fish oil capsule reduction in CV events?

A

Reduces death and hospitalization
NNT= 50

25
Q

What is the rational use for coenzyme Q10 (3)
MOA?

A

That coenzyme is deficient in
- hypertension
- HF
- Statin-induced myopathy (muscle pain)

MOA
- causes vasodilation and lowers BP in hypertensive patients

26
Q

What do meta-analysis say for HF patients using Conenzyme Q10?

A

Small improvement in ejection fraction

27
Q

Q-symbio coenzyme q10 in HF limitations? (4)

A
  • Small study (randomization not as effective in small studies)
  • Took longer than expected
  • Lower than expected death rates in both groups
    (GISSI-HF had 1969 deaths, Q-symbio had 60)
  • Results not as consistent with prior research (no plausbility)
28
Q

Is it good to recommend Omega-3 fatty acids and Coenzyme Q10 for HF patients?

A

Yes

29
Q

What is the main use of ginkgo biloba? (2)

A

Memory and concentration

30
Q

MOA of Ginkgo biloba (3)

A
  • Increased blood supply by dilating vessels and reducing blood viscosity
  • MOA of neurotransmitter system
  • Antioxidant effects
31
Q

Benefits of ginkgo biloba?

A

Trend toward benefit in walking distance in PAD

Can reduce events of PVD
- not significant, looked at dementia

32
Q

Cautions of ginkgo biloba

A

inhibits platelet aggregation, inc bleed risk

33
Q
A

IPFC 4 Final (6 decks)

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