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FNN 301 > Week 10 - Cardiovascular Disease > Flashcards

Week 10 - Cardiovascular Disease Flashcards

1
Q

What is CVD?

A

a group of disorders involving the heart

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2
Q

What are 5 common forms of CVD?

A
  1. coronary artery disease - the most common
  2. hypertension
  3. ischemic heart disease
  4. peripheral vascular disease
  5. heart failure
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3
Q

1 in _____ Canadian adults age 20+ live with diagnosed heart disease

A

1 in 12

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4
Q

how many canadian adults age 20+ live with heart disease in Canada?

A

2.4 million

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5
Q

every hour ___ Canadian adults age 20+ with diagnosed heart disease die

A

12

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6
Q

the death rate is ____x higher among adults age 20+ with diagnosed heart disease vs. those without

A

3x higher

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7
Q

the death rate is ____ x higher among adults age 20+ who had a heart atack vs those without

A

4x higher

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8
Q

the death rate is ___x higher among adults age 40+ with diagnosed heart failure vs those without

A

6x

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9
Q

who is more likely to get heart disease, men or women?

A

men are 2x more likely to get heart disease

men get diagnosed 10 years younger than women (at 55, instead of 65

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10
Q

the death rate from heart disease has DECREASED by

A

23%

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11
Q

CVD has the ______ highest death rate in Canada

A

2nd highest, behind cancer

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12
Q

What are the 3 main roles of the cardiovascular system?

What are 5 other things it does?

A
  1. regulates blood flow to tissue
  2. delivers oxygenated blood and nutrients
  3. retrieves waste products

a. thermoregulation
b. hormone transport
c. maintenance of fluid volume
d. pH regulation
e. gas exchange

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13
Q

what are the 3 layers of the heart?

A
  1. epicardium - outside
  2. myocardium
  3. endocardium - inside
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14
Q

which side of the heart is oxygenated? deoxygenated?

A

right side = deoxygenated (goes to the pulmonary system for oxygenation)
left side = oxygenated

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15
Q

which layer of the heart is the thickest?
why is it the thickest?

A

the myocardium (the thickest)

because it is responsible for contraction of the heart

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16
Q

what are the 3 types of muscle int he body?

A
  1. skeletal
  2. smooth - involuntary
  3. cardiac
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17
Q

the repeated contraction and relaxation of the heart is called ________

A

cardiac cycle

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18
Q

the force exerted by the blood on the walls during CONTRACTION of the ventricle is called

A

systole

120

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19
Q

the force exerted by the blood on the walls during RELAXATION of the ventricle is called

A

diastole

80

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20
Q

the volume of blood ejected with each contraction is called

A

stroke volume

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21
Q

______ is the resistance against which the ventricles must contract to eject blood into systemic circulation

A

mean arterial pressure (MAP)

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22
Q

in blood pressure regulation, the degree of resistance depends on which 3 things:

A
  1. radii of arterioles - this is most important! slight reduction in radius leads to great resistance
  2. length of the vessel - vasoconstriction occurs in cold temp, exercise, pain stress, plaque
  3. blood viscosity - increased blood viscosity can be caused by dehydration, increased rbc
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23
Q

what are some things that may cause a change in the blood viscosity or cause vasoconstriction

A

cold temp, exercise, pain, stress, plaque

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24
Q

the interface between blood and the vessel wall is called the

A

endothelium

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25
Q

damage to _______ attracts proinflammatory factors, platelets, and while blood cells (macrophages)

A

the endothelial layer

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26
Q

white blood cells engulf the oxidized LDL particles, forming

A

foam cells

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27
Q

why is the endotheliel layer important?

A

it regulates bd, produces vasodilators like nitric oxide, it produces inflammatory markers

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28
Q

the ____ produces substances that promote blood flow and regulate muscle tone

A

the endothelium

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29
Q

what happen when the endothlial layer gets damaged?

A

it attracts proimflammatory factors, platelets, and white blood cells (macrophages)

the platelets secrete substances that increase vasoconstriction

the macrophages also engulf the oxidized LDL particles, forming foam cells.

these foam cells contribute to the formation of placque

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30
Q

coronary artery disease is caused by:

A

atherosclerosis

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31
Q

what is coronary artery disease?

A

a progressive thickening of blood vessels due to an accumulation of placque + loss of elasticity

chronic sodium will reduce elasticity as well

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32
Q

what is placque made out of?

A

fatty deposits, fibrous connective tissue, and smooth muscle cells

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33
Q

coronary artery disease may lead to the following 3 things:

A
  1. myocardial infarction (blood flow blocked to heart)
  2. stroke (blood flow blocked to brain)
  3. peripheral arterial disease (blood flow blocked to legs)
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34
Q

what are the 5 stages of atherosclerosis?

A
  1. normal blood vessels
  2. build up of fatty streaks
  3. blood vessel with placque
  4. advanced atherosclerosis
  5. complete block of artery
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35
Q

which 14 factors contribute to atherosclerosis?

A
  1. smoking
  2. obesity
  3. hypertension
  4. elevated LDL cholesterol
  5. genes
  6. high saturated fat
  7. high serum trigs
  8. inactivity
  9. diabetes
  10. stress
  11. decreased hdl
  12. aging
  13. hyperhomocysteinemia
  14. endothelial dysfunction
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36
Q

what are the steps to atherosclerosis?

A
  1. accumulation of plaque
  2. produce less nitric oxide
  3. macrophages eat oxidized LDL cholesterol
  4. fatty streaks and foam cells form
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37
Q

what are 5 clinical signs of atherosclerosis?

A
  1. high serum total cholesterol
  2. high LDL cholesterol
  3. low HDL cholesterol
  4. high trigs
  5. high c-reactive protein
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38
Q

how do we do a nutrition assessment for atherosclerosis / CAD?

A
  1. do BMI evaluation
  2. check waist circumference and WHR
  3. do dietary assessment, looking at
    - Saturated fats
    - trans fatty acids
    - omega 3s
    - fibre
    - sodium
    - alcohol
    - refined carbs
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39
Q

what are 8 uncontrollable risk factors of CAD?

A
  1. 40+
  2. postmenopausal
  3. 30+ with diabetes for 15yrs
  4. family history of early cardiovascular disease in immediate family
  5. family history of cholesterol
  6. CKD
  7. abdominal aortic aneurysm
  8. atherosclerosis
  9. being male
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40
Q

what are 8 modifiable risk factors of CAD?

A
  1. smoking
  2. diabetes
  3. abnormal blood fat (high LDL, low HDL, dyslipedmia)
  4. low HDL
  5. high BP
  6. inflammatory diseases
  7. HIV infection
  8. chronic obstructive pulmonary disease
  9. high BP during pregnancy, BMI > 30
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41
Q

what is an aneurism?

A

an air bubble in the vessel

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42
Q

we use this to determine someones risk for CVD

A

framingham risk score calculator

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43
Q

How does the framingham risk score factor work to determine risk for CVD?

A

Step 1: check point system for age, HDL, total cholesterol, and BP, smoker

Step 2: using total points from step 2, determine 10 year CVD risk factor

Step 3: determine the heart age

Step 4: determine if patient is low, moderate or high risk

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44
Q

____ transport lipids

A

lipoproteins

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45
Q

what are lipoproteins? what do they consist of?

A

they are transport lipids. they transport fat

they consist of lipid interior + protein shell (apolipoprotein). fatty core and protein shell

they protein to fat ratio in the lipoproteins indicates risk of developing athersoclerosis AND dictates function

they are a group of soluble proteins that combine with and transport fat or other lipids in the blood plasma

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46
Q

what are apolipoproteins?

A

they are the part of lipoproteins. they give structural integrity and ensure that the receptors can recognize the particles.

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47
Q

what part of lipoproteins determines the risk of developing athersoclerosis?

A

the protein to fat ratio

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48
Q

What has the most apolipoprotein?

A

HDL

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49
Q

what has the most trigs?

A

chylomicrons > VLDL > LDL > HDL

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50
Q

what has the least lipids

A

hdl

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51
Q

which is the smallest

A

HDL

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52
Q

hat has the biggest density

A

HDL

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53
Q

Why is HDL good?

A

because they are involved in reverse cholesterol transport - they remove cholesterol from tissue and return it to the liver

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54
Q

Why is LDL bad?

A

involved in the atherosclerosis process. is part of placque.

get eating by macrophages (white blood cells) and get oxidized and initiate inflammation

elevated LDL is PRIMARY risk factor, whereas HDL and trigs are secondary risk factors

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55
Q

what are the LDL targets for high risk people for whom treatment has begun?

A

< 2 mmol/L OR

> 50% reduction of LDL OR

< 2.6 mmol/L reduction of non-HDL OR

> 50% reduction for people with LDL > 5

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56
Q

What are diagnostic tests for atherosclerosis?

A
  1. blood tests (now they check for Apo A and apo B, which is more precise than LDL and HDL)
  2. ankle/brachial index - compares blood pressure in ankle with blood pressure in arm to see how well blood is flowing
  3. physical exam
  4. urine test
  5. doppler ultrasound
  6. ECG
  7. exercise stress test
  8. angiography
  9. heart MRI
  10. nuclear image tests
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57
Q

what are nutrition therapy recommendations for atherosclerosis?

A
  1. reduce energy intake to lose weight and adopt healthy diet (health behaviour modifications remain the cornerstone of chronic disease prevention)

Studies suggest consuming healthy diet, regular physical activity, limit alcohol, stop smoking

they primarily recommend a meditteranean dietary pattern, which has evidence of CV outcomes from systematic reviews

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58
Q

what are some diets they recommend for atherosclerosis?

A
  1. mediterranean
  2. portfolio
  3. DASH
  4. high in nuts (> 30 g/day)
  5. high in legumes (> 4 servings/week)
  6. high in olive oil (>60 ml/day)
  7. > 5 servings fruits and veg
  8. > 30 g fibre, > 3 servings whole grains
  9. low glycemic foods
  10. vegetarian diet
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59
Q

Which diet is more effective for CVD - meditteranean diet or vegetarian diet?

A

mediterannean

Medi diet decreases CV events by 30%

Vegetarian diet decreases CV mortality by 10%

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60
Q

what is the effect of Meditteranean diet on health outcomes?

A

decreases major CV events by 30%

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61
Q

what is the effect of the dash diet on CVD outcomes?

A
  1. decreases 10 yr Framingham risk by 20%
  2. reduced LDL by 3%
  3. decreases BP in 2 weeks with or without sodium reduction
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62
Q

what is the effect of the vegetarian diet on CVD outcomes?

A

decreases CV mortality by 10%

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63
Q

what is the effect of the portfolio diet on CVD outcomes?

A

decreases 10 yr Framingham risk score by 11%

reduces LDL by 8-14%

64
Q

what is the effect of low GI diets on CVD outcomes?

A

decreased CHD and CVD by 10-12%

65
Q

which diets are best for CVD?

A

mediterranean and dash

66
Q

name 5+ characteristics of the mediteranean diet?

A
  1. low in saturated fat
  2. very low in trans fat
  3. high unsaturated fat
  4. high starch and fibre
  5. high phytochemicals

+ wine

eat fish 2x per week

bottom of pyramid is activity, then fruits, veggies, whole grains, olive oil, then fish, then poultry and eggs, then meat and sweets

67
Q

what are the 4 main types of dietary fats?

A
  1. monounsaturated fats
  2. polyunsaturated fats
  3. saturated fats
  4. trans fats
68
Q

what are the adverse CV effects of saturated fat?

A
  1. they reduce HDL
  2. they reduce vascular function
  3. they increase LDL
  4. they increase trigs
  5. they increase teratogenic effects in fetus
  6. they increase inflammation
69
Q

what are the 2 types of trans fats?

A

added trans fats

naturally occuring trans fats (in dairy, meat) - these dont case problems

70
Q

for CVD, AVOID intake of trans fats

A
71
Q

what are the main food sources of trans fats?

A
  1. processed foods
  2. hydrogenated oils
  3. bakery products
  4. icing
  5. coffee whitener
  6. vegetable shortening
  7. hard margarine
72
Q

how many grams of trans fats are ok?

A

if serving has < 0.5 g of trans fats, thats ok

73
Q

_____ results from the HYDROGENATION of PUFAS

A

trans fats

74
Q

most sources of ____ are made with partially hydrogenated vegetable oil

A

trans fat

75
Q

the WHO recommends ______ total energy comes from trans fats

A

< 1%

76
Q

which foods ahve the most trans fats

A

commercial baked goods!

77
Q

it is ILLEGAL to add trans fats to products. but products can be listed as 0 g trans fat if they are less then 0.5 g per serving

A
78
Q

________ the intake of saturated fats for CVD disease risk reduction

A

DECREASE

79
Q

what are the adverse CV effects of saturated fat?

A
  1. they reduce HDL
  2. they reduce vascular function
  3. they increase LDL
  4. they increase trigs
  5. they increase inflammation
80
Q

is all saturated fat the same?

A

no. saturated fat is different in meat vs. dairy products. it is more damaging in meat.

in meat, the heme molecule has pro-inflammatory effect on body. and then in dairy, you have addition of calciu, metc

81
Q

which foods have saturated fats?

A

animal products:
- red meat
- chicken with skin
- butter
- cheese
- high fat milk

tropical oils
- coconut oil
- palm oil palm kernel oil

82
Q

replace saturated fats with PUFAs

A
83
Q

what are the positive health and CV effects of PUFAs?

A
  1. decreased mortality
  2. decreased CAD risk
  3. decreased stroke
  4. decreased LDL
  5. decreased trigs
  6. increased HDL
  7. increased vascular function

good for brain development, nerve transmission, skin structure, immune function

84
Q

which oils have MUFAs?

A
  1. olive oil
  2. canola oil - not good
  3. peanut oil
  4. sunflower oil
  5. soybean oil
85
Q

which foods have MUFAs?

A

avocado

peanut butter

almond butter

nuts and seeds

86
Q

What is the saturated fat recommendation for CVD?

A

<9% of total energy

87
Q

Replace saturated fat with _____

A

MUFAS and PUFAS

88
Q

1% increase in saturated fats —> _____ % increase in blood LDL —> _____ % increase in heart diseas2

A

1% increase in saturated fat –> 2% increase in LDL –> 2% increase in heart disease

89
Q

1% decrease in saturated fat –> ___% decrease in LDL –> ____% decrease in heart disease

A

Q
1% decrease in saturated fat –> 2% decrease in LDL –> 2% decrease in heart disease

90
Q

avocado is an example of a ________

A

MUFA

91
Q

Nuts are examples of a ________

A

MUFA

92
Q

Canola oil is an example of ____

A

MUFAS

93
Q

Margarine, mayo, are examples of_______

A

Omega 6 PUFA

94
Q

Fatty fish and flaxseed are examples of

A

Omega 3 PUFA

95
Q

How many grams of fibre per day should be viscous soluble fibre? (oats, barliey, pectin)

A

10-15g (eating more than this won’t help)

96
Q

_____ are similar to cholesterol in structure.

They can lower LDL cholesterol on blood

A

Plant sterols

97
Q

_______ block the absorption of cholesterol from the intestine, to help reduce LDL in blood. They can reduce cholesterol in 3 weeks

A

plant sterols

98
Q

how many plant sterols should I have?

A

2 g / day can reduce cholesterol by 5-15%. There are no additional benefits to taking more

99
Q

Where are plant sterols found?

A

vegetable oils
nuts
seeds
legumes
whole grains
veggies
fruits
SESAME OIL AND SEEDS

(but can’t get 2 g from these foods alone)

100
Q

What are the risks to eating plant sterols?

A

there are no known risks or side effects from eating foods or taking supplements with added plant sterols

101
Q

why do people take plant sterols?

A

to help reduce LDL cholesterol

102
Q

how often should we eat fatty fish to be heart healthy (omega 3)?.

A

2-3 x per week

103
Q

what are plant sources of omega 3 fats?

A

flaxseed
flaxseed oil
canola oil
soybean oil
nuts

104
Q

Are fish oil (omega 3 EPA/DHA) supplements recommended?

A

fish oil supplements are NOT recommended for CVD prevention.

fish oil supplements ARE recommended for CVD management, if people have CAD or are trying to manage high trigs

105
Q

in what 3 scenarios are fish oils recommended?

how much is recommended?

A

800-1000 mg EPA/DHA is recommended for:

  1. patients with CAD
  2. those at risk with sudden cardiac death
  3. managing high trigs
106
Q

why is taking fish oil good for CVD management?

A
  1. it prevents sudden cardiac death
  2. prevents blood clots
  3. lowers trigs
107
Q

how much fish oil should i take for cvd management?

A

0.8-1 g EPA/DHA

3 g is overdoing it

if someone is on blood thinners, dont do fish oil

108
Q

is alcohol good for CVD?

A

maybe. moderate alcohol consumption (1-2) drinks per day from ANY SOURCE, including beer, can reduce risk of CVD

but HIGH intakes are associated with high trigs, hypertension, liver damage etc

109
Q

What are 8 good ways to reduce LDL cholesterol in the diet?

A
  1. increase intake of MUFAs (seafood, canola oil, olive oil. Eat 30 g/day of nuts)
  2. Include plant sterols
  3. Add soluble fibre to diet - psyllium, barley, prunes, flaxseed.
  4. Eat more fruits and veggies - 3-4 servings each day, or 5+ servings for extra benefits
  5. include more plant proteins
  6. increase activity level - heart beat raising and resistance training
  7. decrease or eliminate foods that have trans fats
  8. decrease saturated fats
110
Q
A
111
Q

What are 4 good ways to increase HDl cholesterol in the diet?

A
  1. increase activity level
  2. moderate amounts of alcohol
  3. increase intake of omega 3 and MUFAs
  4. eat more fruits and veggies
112
Q

What is hypertension?

A

It is when your blood pressure (aka the force of blood pushing against the walls of your blood vessels) is consistently high

113
Q

_____ is the force at which the blood is pumped out of the heart

A

systolic

114
Q

____ is the pressure in the blood vessels when the heart is at rest

A

diastolic

115
Q

what is considered elevated bp?

A

120-129 / 80

116
Q

what is considered high blood pressure (hypertension stage 1)?

A

130-139 / 80-90

117
Q

what is considered high blood pressure (hypertension stage 2)?

A

140+ / 90+

118
Q

what is considered hypertensive crisis?

A

180+ / 120+

119
Q

what are the 5 categories of blood pressure?

A
  1. normal
  2. elevated
  3. high bp stage 1
  4. high bp stage 2
  5. hypertensive crisis
120
Q

hypertension affects _____ Canadian adults

A

1 in 4 Canadian adults
7.5 million Canadians

121
Q

What is the pathophysiology of hypertension? What is the difference between primary (essential) hypertension and secondary hypertension?

A

primary = idiopathic. influenced by lifestyle factors and inflammatory responses. There is NO CLINICAL REASON for it but lifestyle factors affect it

Secondary = result of another chronic condition like kidney disease

122
Q

in what % of hypertension cases is the cause unknown?

A

90-95%

123
Q

BP is elevated by factors that:

A
  1. increase blood volume
  2. increase heart rate
  3. increase resistance blood flow
124
Q

what are 2 non-modifiable risk factors that affect bp?

A
  1. increasing age
  2. family history - genetics
125
Q

what are 7 modifiable risk factors that influence bp?

A
  1. increased LDL cholesterol
  2. decreased HDL cholesterol
  3. alcohol
  4. diabetes
  5. obesity
  6. physical inactivity
  7. smoking
126
Q

What are 3 dietary approaches to reducing hypertension?

A
  1. DASH diet
  2. restrict sodium
  3. monitor potassium intake
127
Q

how to reduce hypertension?

A
  • reduce weight
  • increase physical activity
  • moderate alcohol consumption
  • DASH diet
  • restrict sodium
  • potassium intake
  • 2 or more drugs
128
Q

What are the 4 classes of drug therapies for hypertension?

A
  1. Diuretics (thiazide)
  2. ACE inhibitors (pril)
  3. angiotensin receptor blockers (sartan)
  4. calcium channel blockers (dipine)
129
Q

this class of hypertension medications decreases blood volume by increasing urinary output

A

diuretics

130
Q

this class of hypertension medications reduces BP by decreasing peripheral vascular resistance

A

ACE inhibitors

131
Q

this class of hypertension medications interferes with renin-angiotensin system without inhibiting bradykinin degradation

A

angiotensin receptor blockers

132
Q

with which hypertension drugs do you have to avoid grapefruit?

A

angiotension receptor blockers

133
Q

what is one food you need to be careful about with hypertension drugs

A

licorice

134
Q

which interventions have the biggest effect on BP in those with hypertension?

A
  1. DASH diet - reduces systolic BP by 11.4/5.5
  2. diet and waist circumference control - reduces systolic BP by 6/4.8
135
Q

the DASH diet is a pattern that is low in:

the DASH diet emphasizes:

A
  1. saturated fat
  2. cholesterol
  3. total fat
  4. sodium
  5. fruit and veggie consumption
  6. low fat dairy products
  7. whole grains
  8. fish, poultry, nuts
136
Q

if following the dash diet, the greatest benefits are observed with an intake of ______ mg sodium

A

1500 mg/day (but people are now saying that that isnt realistic, and are recommending 2000)

137
Q

What is the sodium recommendation for hyertension?

A

AI = 2000 mg/day
Upper limit = 2300 mg/day
most people = > 3000 mg/day

138
Q

EVERYONE will benefit from a reduction in sodium except hypotensive people.

A
139
Q

Salt is ____ % sodium by weight - and is the major source of sodium

A

40%

140
Q

What contains more sodium - iodized salt, sea salt, kosher salt,?

A

they all are similar

141
Q

What are 5 roles of salt in the body?

A
  1. controls fluid volume
  2. maintains bp
  3. participates in proper nerve and muscle function
  4. helps nutrients enter body cells
  5. too much salt = less flexible blood vessels
142
Q

why do people crave more salt the more they eat it?

A

because the more salt we eat, the bigger goblet cells get, so the more we crave salt

143
Q

which 3 food groups contain the most sodium?

A
  1. bake products
  2. mixed dishes
  3. processed meat
144
Q

what are the main dietary sources of sodium?

A
  1. restaurants/processed foods (77%)
  2. naturally present in foods (12%)
  3. salt shaker (6%)
  4. home cooking (5%)
145
Q

The % of Canadians consuming excess sodium increases with age during childhood, and PEAKS DURING ADOLESCENCE AND EARLY ADULTHOOD, before it starts to decrease at age 30

A
146
Q

at what age does sodium consumption peak?

A

19-30

147
Q

List 5 tips for reducing sodium intake?

A
  1. choose low-sodium or no-sodium options
  2. use fresh poultry/fish rather than canned or smoked
  3. limit cured foods
  4. choose convenience foods that are lower in sodium
  5. rinse canned foods
  6. choose snacks that are lower in sodium
  7. dont add salt to cooking water
  8. flavour with fresh spices
148
Q

What % sodium on label is low? how many mg?

A

5% (or less than 8% of daily value aka < 200 mg(

149
Q

What % sodium on label is moderate?

A

5-20%

150
Q

What % sodium on label is high?

A

20% (or 15% if you want to be conservative)

151
Q

What are the main differences between the old labels and the new labels?

A
  1. serving size stands out more
  2. calories is larger
  3. new % daily value for total sugars
  4. potassium, iron, calcium instead of vitamin a, vitamin c, calcium
  5. New % daily value footnote for sodium
152
Q

whats the AI for sodium? how many tsp?

A

2300 mg/day
1 tsp salt

153
Q

What are some examples of low sodium foods?

A

mealts
poultry
fish
legumes
eggs
nuts
yogurt
cream cheese

154
Q

What are the hypertension recommendations around potassium? What is the minimum? What is the AI?

A

minimum = 3000 mg/day
AI = 4700 mg/day

155
Q

How is one diagnosed with hyperkalemia (high potassium)? What could it be a result of?

A

Potassium concentration above 3.5-5 mmol/L.

Can lead to:
1. CKD
2. patients taking renin-angiotensin aldosterone inhibitors

156
Q

What are the main sources of potassium?

A

POTATOS
BANANAS
LIMA BEANS
CEREAL
YOGURT
MILK

potassium is common in veggies nad dairy, less common in protein and wheat

157
Q

if you are trying to reduce hypertension, how much alcohol should you drink?

A

1 drink per day/women

2 drinks per day/men

FNN 301 (10 decks)

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