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32 Cards in this Set
- Front
- Back
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What is metabolic syndrome?
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Combination of 5 risk factors that lead to CAD, peripheral vasculature disease, stroke, and diabetes
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What are the 5 risks of Metabolic Syndrome?
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Abdominal obesity
Triglycerides levels above 150mg/dl Low HDL cholesterol Elevated blood pressure (>130/85) Elevated blood glucose levels (>100mg/dl) |
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why was Ivan Applebod diagnosed with Metabolic Syndrome?
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He has all 5 of the risks, and must have only 3 to be diagnosed
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Why did Ann Jeina have a heart attack?
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She has familial hypercholesterimia type IIA – high LDL, low HDL, high overall cholesterol levels
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what is her doctor trying to do to prevent her from having another heart attack?
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He has placed her on the TLC (step I) diet and prescribed cholestyramin and pravastatin
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which hyperlipoproteinemia was Ann Jeina diagnosed with?
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It is a metabolic problem associated with elevated levels of specific lipoproteins in the plasma
type 2A: defect in LDL-receptor increases levels of LDL in blood |
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What are the three causes for primary hypercholesterolemia type IIA?
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Familial hypercholesterimia
Family defective ApoB100 Polygenic Heypercholesterima |
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Familial hypercholesterimia
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increased levels of LDL due to decreased LDL receptor (1:500) dominant inheritance
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Family defective ApoB100
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increased LDL due to decreased ApoB100 binding to LDLR (1:100) co-dominant inheritance
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Polygenic Heypercholesterima
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increased cholesterol which is common
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What is atherosclerosis?
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accumulation of plaques on the inside of artery walls
decreased lumen size and elasticity |
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what are the risk factors for atherosclerosis?
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Decreased HDL
Tobacco use Obesity Poor diet Sedentary lifestyle Stress Diabetes High blood pressure Alcohol use |
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why is chronic infection emerging as a very important risk factor for atherosclerosis?
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increased numbers of monocytes in circulation
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When did the age-adjusted death rate for heart disease peak in the U.S.?
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Peaked in 1950 at 587 (per 100,000)
1900 was 265 1997 was 479 |
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Why do plaques form in artery walls?
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The altered forms of LDL (Derivatization and Oxidation) cannot be recognized by LDL receptors so must be uptaken by macrophages
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what specific lipoproteins are responsible for this plaque formation?
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Lp(a) is LDL that has been reacted with a protein that converts plasminogen to plasmin so blood clots can be removed and cannot be recognized by LDL receptor
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Why is the HDL level the single most important factor in determining who will have a heart attack?
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Because HDL removes the cholesterol from the macrophages that cause plaques
As HDL levels decrease, then the risk of CHD increase |
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Why do about 25% of current Americans have a heart attack even though they have a completely normal lipid profile?
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not all of the LDL and HDL subspecies are measured in a lipid profile
to identify more people at risk they must all be measured |
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What are the 6 discrete stages of pathology that occur during plaque development?
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Foam cells
Fatty Streak Extracellular fatty streak Lipd Core Atheroclerotic plaque lipid core embedded in fibrosis Complicated atherosclerotic plaque (rupture, thrombosis, hemorrhage) |
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What percentage of young (12 to 14) American males have plaques in their arteries that have reached the pathological stage where blood clots can be formed?
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8% have Type III
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Why do plaques rupture and cause blood clot formation?
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Inflammation is a critical step in plaque rupture
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What are the surgical treatments for heart disease?
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Percutaneous transluminal coronary angioplasty (PTCA)
Stent placement CABG – Bypass surgery Heart transplants |
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What are the medical (drug) treatments for heart disease?
Statins |
Anti-thrombotic
Anit-inflammatory Immunomodulatory Anti-oxidant Vascular cytoprotection Angiogenesis Plaque stability |
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What are the medical (drug) treatments for heart disease?
Fungal metabolites: Lovastatin, Simvastatin, Provastatin |
Short half lives (except atorvastatin) but effective with once daily administration
Higher efficacy if given at night Major side effects are hepatits and myositis |
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What are the medical (drug) treatments for heart disease?
Lipid Lowering: Fibrates |
Greatly decrease VLDL (TG), decrease LDL, and increase HDL
Side effects of GI intolerance and increase in gallstones |
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What are the medical (drug) treatments for heart disease?
Lipid Lowering Agents: Anion Exchange Resins |
Secondary effect on cholesterol synthesis to increase VLDL and hyper TG – limits use
Used with statins Can cause nausea, constipation and have a bitter taste |
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What are the medical (drug) treatments for heart disease?
Therapies to alter Cholesterol Absorption |
Plant sterols and sterols decrease absorption by displacing cholesterol from micelles
derived from diet (margarine) or supplements and decreases LDL Partial ileal bypass surgery |
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What are the medical (drug) treatments for heart disease?
Lipid Lowering Agents : Nicotinic Acid (Niacin or Niaspan) |
Decrease hepatic VLDL
Increase VLDL clearance Lowers lipoproteins VLDL, IDL, LDL by 30% Lowers lipoproteins VLDL, IDL, LDL by 30% |
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Why do fish oil supplements stabilize plaques just a well as the statins drugs do?
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They decrease inflammation and platelet aggregation
They increase endothelial function after 8 months of supplementation |
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What dietary factor carries the greatest risk for heart disease development?
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Saturated and trans fat increase the risk
For every 2% increase in trans fat, there is a 93% increase in CAD |
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Why is going on a low fat diet useless for preventing heart disease or for loosing weight?
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carbohydrates are substituted for fat
population is sensitive to carbohydrates due to insulin resistance There is a reduced intake of good fats as well and increased calorie intake |
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What is the best kind of diet to be on to prevent heart disease?
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The Mediterranean diet fits most people
It is nutrient dense, high in antioxidants, omega 3 fats, fruits and vegetables, and low in GI carbs, sugar, and saturated hydrogenated fats |
