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brs y2 > PVD and Atherosclerosis > Flashcards

PVD and Atherosclerosis Flashcards

1
Q

What are modifiable risk factors in atherosclerosis development

A 
Smoking
Lipid intake
BP
Diabetes
Obesity
Sedentary lifestyle
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2
Q

What are non modifiable risk factors in atherosclerosis development

A

Age
Sex
Genetic background

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3
Q

How much do risk factors increase risk of developing atherosclerosis?

A

A lot, the risk also severely increases when multiple risk factors are involved

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4
Q

What layer does atherosclerosis start in?

A

Tunica intima

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5
Q

What are the stages of atherosclerosis progression called?

A 
Coronary artery at lesion prone location
Type 2 lesion
Preatheroma
Atheroma
Fibroatheroma
Complicated lesion
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6
Q

At what stage of atherosclerosis progression do foam cells form?

A

Type II lesion

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7
Q

What is the role of vascular endothelial cells in atherosclerosis

A 
Barrier function (eg to lipoproteins
Leukocyte recruitment
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8
Q

What is the role of monocyte/macrophages in atherosclerosis?

A

Foam cell formation
Cytokine and growth factor release
Major source of free radicals
Metalloproteinases

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9
Q

What is the role of platelets in atherosclerosis?

A

Thrombus generation

Cytokine and growth factor release

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10
Q

What is the role of platelets in vascular smooth muscle cells?

A

Migration and proliferation
Collagen synthesis
Remodelling and fibrous cap formation

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11
Q

What is the role of T lymphocytes in atherosclerosis?

A

Macrophage activation

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12
Q

What are the main inflammatory cells in atherosclerosis?

A

Macrophages

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13
Q

What are macrophages derived from in atherosclerosis?

A

Monocytes

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14
Q

What are the 2 main types of macrophages?

A

Inflammatory

Resident

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15
Q

What do inflammatory macrophages do?

A

They are adapted to kill microorgansims

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16
Q

What so resident macrophages do?

A

They are normally homeostatic and suppress inflammatory activity

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17
Q

What is the role of macrophages in the alveoli?

A

They are for surfactant lipid homeostasis

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18
Q

What is the role of macrophages in the osteoclasts?

A

For calcium and phosphate homeostasis

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19
Q

What is the role of macrophages in the spleen?

A

Iron homeostasis

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20
Q

Where is LDL synthesised?

A

In the liver

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21
Q

What is the role of LDL

A

Transport of cholesterol from the liver to the rest of the body (its bad cholesterol)

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22
Q

What is the role of HDL

A

Reverse cholesterol transport (from the body back to the liver)

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23
Q

What type of LDL is highly inflammatory and toxic

A

Oxidised or modified LDL

24
Q

How is LDL trapped in the subendothelial space?

A

It binds to sticky carbohydrates in the matrix eg proteoglycans

25
Q

What happens to LDL in the subendothelial space?

A

After becoming oxidised it is phagocytosed by macrophages and stimulates chronic inflammation

26
Q

How is familial hypercholesterolaemia inherited?

A

Autosomal

27
Q

What happens in familial hypercholesterolaemia and why?

A

Cholesterol becomes massively elevated due to deficiency of the LDL receptor in the liver

28
Q

What does a deficiency of LDL receptors in the liver cause (eg in FH)?

A

Causes macrophages to accumulate cholesterol

29
Q

What cholesterol level illicits recommendation for statins?

A

Above 5 mmol/L

30
Q

What is cholesterol level in FH?

A

Above 20 mmol/L

31
Q

How does FH present?

A

Xanthomas and early atherosclerosis

32
Q

What is the second LDL receptor in atherosclerotic lesions called?

A

Scavenger receptors

33
Q

What do scavenger receptors do?

A

They mop up chemically modified LDL

34
Q

What do statins inhibit?

A

HMG coA reductase

35
Q

What are the 2 types of scavenger receptors?

A

A and B

36
Q

What do type A scavenger receptors bind to?

A

Oxidised LDL
Gram positive bacteria
Dead cells

37
Q

What do type B scavenger receptors bind to?

A

Oxidised LDL
Malaria parasites
Dead cells

38
Q

How do macrophages oxidise LDLs?

A

They have oxidative enzymes

39
Q

What oxidative enzymes do macrophages contain?

A

NADPH oxidase

Myeloperoxidase

40
Q

How do macrophages in plaques recruit monocytes?

A

They express cytokine mediators

41
Q

What do cytokines do in atherosclerosis?

A

They activate endothelial cell adhesion molecules

42
Q

What do chemokines do in atherosclerosis?

A

They are chemoattractants

to monocytes

43
Q

Describe how inflammation in atherosclerosis is a positive feedback loop?

A

Cytokines and chemokine release increases the release of other cytokines and chemokines, so there is a vicious cycle leading to self perpetuating inflammation

44
Q

For what type of cells do macrophages in plaques display chemo attractants and growth factors?

A

Vascular smooth muscle cells

45
Q

What do vascular smooth muscle cells do once they have been recruited by macrophages in atherosclerosis?

A

They proliferate and deposit extracellular matrix

46
Q

What states are vascular smooth muscle cells normally and then when they become athersclerotic?

A

Normally they are contractile, they then become synthetic

47
Q

What causes the change from contractile to synthetic in vascular smooth muscle cells?

A

PDGF (platelet derived growth factor) and TGF-b (transforming growth factor beta)

48
Q

What does PDGF do?

A

It causes:
VSMC chemotaxis
VSMC survival
VSMC division (mitosis)

49
Q

What does TGF- beta do?

A

Increased collagen synthesis

Matrix deposition

50
Q

What happens to contractile filaments and matrix deposition genes when VSMC switch from contractile to synthetic?

A

Contractile filaments go from high to low in number

Matrix deposition genes go from silent to being upregulated

51
Q

What do proteinases displayed by macrophages in plaques do?

A

They degrade tissue and plaques, eventually this leads to plaque erosion or rupture (can lead to occlusive blood flow and death)

52
Q

What is an example of a proteinase displayed by macrophages in plaques?

A

Metalloproteinases

53
Q

What is the lipid necrotic core?

A

Central death zone where macrophages release tissue factors and toxic lipids

54
Q

What is nuclear factor kappa B?

A

A transcription factor that is a master regulator of inflammation

55
Q

What is nuclear factor kappa B activated by?

A

Scavenger receptors
Toll-like receptors
Cytokine receptors e.g. IL-1

56
Q

What genes does nuclear factor kappa B switch on?

A

Inflammatory genes eg
Matrix metalloproteinases
Inducible nitric oxide synthase
Interleukin-1

brs y2 (85 decks)

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