Risk Factors of Atherosclerosis + CHD Flashcards

1
Q

Non-modifiable risk factors

A

Age
Gender
Family History- cardiac events before 55 (male relative) or 65 (female relative)

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2
Q

What is the most important risk factor?

A

Age!

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3
Q

Why are males more likely to have atheroslcerosis?

A
  • Estrogen is protective on blood vessel endothelium
  • Men lack estrogen, are more likely to smoke and to have abdominal fat (vs. hip fat)

**after menopause, women’s rate of MI catches up to men

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4
Q

Variables that family history can affect

A

Dyslipidemia (high LDL, low HDL, high lipoprotein A)
Diabetes
Hypertension

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5
Q

Modifiable Risk Factors

A
Diet
Exercise
High LDL
Low HDL
Smoking
Stress
Hypertension
Abdominal obesity
Inflammation
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6
Q

What is the most important thing to prevent the progression to T2DM?

A

Exercise!!

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7
Q

Factors that damage the epithelium

A
Aging
Smoking
Stress
High blood pressure
High blood sugar
High lipoprotein A
Inflammation
Low HDL
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8
Q

Where does evidence for risk factors come from?

-strengths of the study

A
INTERHEART study (2004)
- all continents, all races, all ages, both genders
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9
Q

Define CHD risk equivalent

-risk factors that are CHD risk equivalents

A

A patient with CHD risk equivalent has the same risk as someone who is diagnosed with CHD.

Risk factors

  • non-cornoary atherosclerosis (e.g. carotid bruit, aortic aneurysm, peripheral artery disease)
  • diabetes
  • chronic kidney disease
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10
Q
  • The most important risk factors according to INTERHEART

- Protective factors

A

1) Elevated LDL:HDL
2) Smoking
3) Psychosocial (e.g. depression, stress)
4) Diabetes
5) Hypertension
6) Abdominal obesity

1) Daily consumption of fruits + veg
2) Regular physical activity
3) Regular alcohol consumption

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11
Q

Effect of diet on CHD risk

A
  • calorie excess, harmful fats, low fruits/vg, low fiber, processed food all bad
  • fruit and veg consumption independently protective
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12
Q

Effect of exercise on CHD risk

A
  • reduces BP
  • reduced LDL, increased HDL
  • slows progression to T2DM

***don’t have to lose weight for it to help

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13
Q

Definition of dyslipedemia

-how common is inherited dyslipedemia?

A
  • high LDL, low HDL, high triglycerides or some combination of these
  • 1/40 people have inherited dyslipidemia
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14
Q

What does HDL do?

A
  • Removes cholesterol from artery wall

- Reduces inflammation

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15
Q

The effect of smoking on CAD risk

A
  • Chemicals from smoke damage endothelium
  • immediately on smoking there is vasoconstriction, reduced organ flow
  • risk is reduced soon after quitting
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16
Q

The effect of diabetes on CAD risk

A
  • diabetics tend to have higher triglycerides, lower HDL, small dense (harmful) LDL, and high glucose
17
Q

The effect of abdominal obesity

A
  • the extra fat contains more inflammatory cytokines
18
Q

Biomarkers for CHD risk

A
  • lipoprotein a

- CRP

19
Q

Primary prevention targets

A
  • Diet
  • Exercise
  • Dyslipedemia
  • Smoking
  • Hypertension
  • Stress
20
Q

Primary prevention with diet includes…

A
  • public education and policy
  • dietary assessment
  • eating frequently (no skipping meals!)
  • More fruit and veg, more fiber, more fish, more chicken, more complex carbs
  • less red meat, less processed food, less simple carbs, less harmful fats
21
Q

Primary prevention with exercise includes…

A
  • Feasible exercise goals

- Frequent exercise

22
Q

Primary prevention of dyslipedemia…

A
  • Dietary (decrease calories, lower saturated/trans fat, more fiber, fewer simple carbs, plant sterols)
  • Treatments: statins and others….
23
Q

Primary prevention with smoking reduction includes…

A
  • education, public policy (e.g. taxes), bans, warnings
  • keep bringing it up with patient
  • can do cold turkey or assisted
24
Q

Primary prevention of hypertension…

A
  • weight loss
  • Exercise
  • reduction of salt in diet
  • medicate
25
Q

Primary prevention with stress…

A

encourage stress management: psychotherapy, exercise, meditation etc..