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LIFESCI 3AA3 > TOPIC FOUR: CVD IN WOMEN > Flashcards

TOPIC FOUR: CVD IN WOMEN Flashcards

1
Q

_/3 women over 65 are affected by CVD

A

1

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2
Q

How much later do women develop symptoms of CVD compared to men

A

10-15 years later

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3
Q

How many women report discussion CV health with their doctor

A

1/3

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4
Q

What is the cause for the most deaths in Canada for women

A

Heart disease and stroke

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5
Q

How is the prevalence of HTN related to men and women and age

A

At younger ages, the prevalence of HTN is slightly lower in women than men

For women age 65+ is when there is a switch to the prevalence being higher in women than men - maybe has to do with menopause

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6
Q

How is the prevalence of heart failure related to men and women and age

A

Heart failure is more common among men than women ages 60-79, but 80+, there is a big shift to it being more common in women than men

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7
Q

Which is more important in men and women as a cute for heart failure

Ischemic heart disease/HTN

What is it likely to cause

What is LV diastolic dysfunction

A

HTN is more important cause in women, while ischemic heart disease is more important in men

HTN likely to cause LV diastolic dysfunction (impaired relaxation)

  • Left ventricular diastolic dysfunction – inability for the left ventricle to relax, cant fully fill and pump properly to the body
  • Worse outcomes for women with HF (i.e., depression)
  • More women experience depression with HF compared to men
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8
Q

Do women often recognize heart attacks?

A

There are a lot of unnoticed heart attacks by women!

20,30,40%

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9
Q

Facts

Women are ___ likely to receive preventative treatment than men

A

Less

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10
Q

Facts

When treatment is prescribed, to women treatment is ___ aggressive

A

Less

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11
Q

Facts

Women ___ likely to participate in cardiac rehab

A

Less

Lack of referrals for women for M.Ds

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12
Q

Facts

Women are ___ less likely to be enrolled in CR

A

36%

Enrollment in cardiac rehab is favouring men

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13
Q

Traditional risk factors for CVD

A 
Diabetes
Smoking
Obesity and overweight 
Physical inactivity 
Hypertension
Dyslopidemia
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14
Q

Non traditional risk factors for CVD

A

Preterm delivery
Hypertension disorders of pregnancy
Gestational Diabetes
Autoimmune disease (lupus)
Breast cancer treatment (radiation might alter the heart because of its location close to the breast being treated) - can lead to hypertrophy and remodelling
Depression - can cause chronic inflammation which may link to heart disease. There is also an increase in hypothalamus pituitary axis which is acted when we have fight or flight response - activated in chronic stress state as well

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15
Q

Impact of gestational diabetes on CVD

A

Women with gestational diabetes are at a higher risk of CVD events

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16
Q

What is preeclampsia and how is it related to HTN

A

Preeclampsia is pregnancy induced hypertension

Women with pre-eclampsia are 4X more likely to take HTN mediation later on in life and 3X more likely to take medication for dyslinpidemia

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17
Q

What are steroid hormones

A

Hormones derived from cholesterol (ex. estrogen and testosterone) that are lipid soluble

18
Q

How to steroid hormones entre cells

A

Pass from the blood to the cytoplasm of the cell (right through, lips soluble so does not need to go through a channel)

19
Q

What happens when a steroid hormone is inside the cell

A

binds to a receptor within the cell forming a hormone receptor complex

The hormone receptor complex enters the nucleus and changes genetic transcription (change in enzymes, receptors and functions of ion channels)

20
Q

What is aromatase

A

An enzyme that converts testosterone to estrogen

21
Q

Do cardiomyocytes express aromatase

A

yes

22
Q

How does aromatase related to CVD

A

Aromatase deficiency seems to accelerate atherosclerosis

23
Q

Do cardiomyocytes have estrogen receptors?

A

Yes

Estrogen (alpha receptors) might play the most dominant role in cardiovascular health

24
Q

Do both men and women experience increase in testosterone during puberty

A

Yes

25
Q

What drops off quickly at menopause

A

Estrogen

26
Q

What is adrogenopause

A

Drop in testosterone experienced by men

27
Q

Are there estrogen receptors on endothelial cells

A

Yes - line the blood vessel

28
Q

How does estrogen, endothelial cells and menopause relate

A

With menopause there is a drop in estrogen which has an impact on the ability for the blood vessel to dilate (flow mediated dilation)

When you increase BP, there should be an increase in dilation of blood vessels

However with menopause the response to increase BP is less (FMD is less)

This shows that there is a loss of endothelial function in response to loss of estrogen

29
Q

What are three mechanism by which estrogen impact endothelial cells

A

Estrogen impacts vasoactive substances

Estrogen decreases inflammation

Estrogen protects endothelial cells

30
Q

How does estrogen impact vasoactive substances

A

Involved in increase NO and prostacyclin, decrease endothelin-1

  • If estrogen is lost, then NO and prostacyclin’s (vasodilators) are also lost
  • Endothelin 1 is a vasoconstrictor
31
Q

How does estrogen decrease inflammation

A

Decrease proinflammatory cytokines

Inflammatory cells play a role in starting atherosclerosis and the snowball effect

32
Q

How does estrogen protect endothelial cells

A

Increases vascular endothelial growth factor (VEGF) which is involved in repair to the endothelial cells (keeps the junctions tight so things cannot slip through)

Linked to decrease in endothelial apoptosis

33
Q

Are there estrogen receptors on smooth muscle cells

A

Yes

34
Q

Do men or women have fewer estrogen receptors on SMC

A

Men

If estrogen is plentiful in women, then there might be an upregulation of the receptors in women

35
Q

How is estrogen related to SMC

A

Estrogen prevents blood vessel remodelling

Estrogen promotes vasodilation

36
Q

How does estrogen precent blood vessel remodelling

A

Decreased proliferation of SMC to intima

Keeps the SMC where they are supposed to be (media)

37
Q

How desolations estrogen promote vasodilation

A

K flux out of the cell which can lead to relaxation

Keeps Ca sequestered in the sarcoplasmic reticulum

38
Q

What are the role of natriuretic peptides

A

Involved in vasodilation

Natural diuretic hormone (decreases BP through loss of water, inhibiting SNS and RAAS)

39
Q

What are examples of natriuretic peptides

A

ANP and BNP

40
Q

How is ANP/BNP related to women and estrogen

Where are they secreted from

A

In menstruating women, estrogen stimulates secretion of ANP and BNP

ANP and BNP are natriuretic peptides secreted from the heart

Prior to menopause, heart mass is greater for women than men (not due to bad remodelling, just natural)

Might lead to more ANP and BNP secreted from the heart

Recall the heart is also an endocrine organ

LIFESCI 3AA3 (6 decks)

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