Cardiovascular Disease Case Study

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EPIDEMIOLOGY
Cardiovascular disease remains the leading cause of death in many industrialized nations including the United States.1,2 Consequently, obesity is a major health concern due to its involvement in the development of many chronic diseases including cardiovascular disease, diabetes, cancer, and premature death.3 Worldwide approximately 937 million persons were overweight and 396 million obese in 2005.3 Moreover, in 2009 a shocking 68% of American adults were overweight or obese.3 As a result of the increasing obesity numbers, there are approximately 325,000 deaths annually in the United States due to obesity, and it accounts for about 5.5% of healthcare costs.4
Interestingly, current epidemiologic data shows that the percentage of
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ETIOLOGY
Endothelial dysfunction precedes atherosclerotic CAD and is characterized by impaired vasodilation, increased adhesion molecules, and increased thrombosis risk.8 This occurs when there is a lack of response of certain chemical messengers produced by the endothelium to acetylcholine; the most notable change is a diminished nitric oxide vasodilatory response.5 As a powerful vasodilator and inhibitor of platelet adhesion, nitric oxide has the important function of protecting the endothelium.5,8
Following endothelial dysfunction is atherosclerosis: a combination of cholesterol accumulation, inflammation, and cellular proliferation.8 Atherosclerosis can be caused by obesity and the resultant harmful changes in plasma lipids and lipoproteins.8, 9 These changes include increases in triglycerides and total low-density lipoprotein (LDL) cholesterol as well as decreases in high-density lipoprotein (HDL) cholesterol.9
In addition, chronic insulin resistance likely contributes to CAD.2 Persistent intake of extreme amounts of carbohydrates may lead to hyperinsulinemia, insulin resistance, and eventual CAD.2 Besides insulin resistance’s high association with dyslipidemia, it also promotes endothelial inflammation and thrombosis.2 Emerging risk factors and biomarkers of insulin resistance include C-reactive protein (CRP) and tumor necrosis factor-α
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2,7,12,13,14

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