18

Question 1

main underlying cause of cardiovacular disease

Answer 1

atherosclerosis

Question 2

what is atherosclerosis

Answer 2

disease in which laques build up in the walls of the arteries

Question 3

what dictates the progression of atheroschlerosis

Answer 3

enviroment, diet, and genetics

Question 4

disease of aging

Answer 4

atheroschlerosis
it is multifactorial:
-lipid disorder
-inflammatory disorder
-hypotensive disorder

Question 5

what happens in atheroschlerosis

Answer 5

excess deposition of lipids (TGs and cholesterol) into macrophages within arterial walls
sites of lipid deposition can calcify leading to harderining of the blockage
-the calcified cap can break away and lead to total blockage of smaller vessels

Question 6

how do plaques form step by step

Answer 6

-monocyte attracted to oxidized lipoproteins that aggregate and stick to extracellular matrix
-monocyte differentiates into macrophage
-foam cell (macrophage) ingests lipoprotein
-free cholesterol accumulates in membranes and droplets
-cholesterol rich plaques form

Question 7

multifactorial CVD features

Answer 7

very high LDL cholesterol correlates with atherosclerosis
-some with normal cholesterol have heart attacks and some with high do not
-low HDL cholesterol negatively associated with heart disease

Question 8

pathogenic forms of LDL

Answer 8

sdLDL

oxLDL

Question 9

sdLDL

Answer 9

formed due to excess hydrolysis of LDL triglycerides. occurs when LDL levels are high
cannot bind to LDL receptor, cannot be readily moved from circulation, susceptible to chemical modifications such as oxidation

Question 10

oxLDL

Answer 10

LDL protein and lipid can be oxidized
dietary antioxidants (vit A, C, E) can prevent oxidation of LDL

Question 11

LDL particle size and CVD

Answer 11

LDL particle size is important is atherosclerosis

small dense LLD are more atherogenic
oxidized LDL is more atherogenic
omega 3 FA reduce amount of sdLDL

Question 12

canadian recomendation for blood lipid levels

Answer 12

routine screening in men over 40 and women over 50
and earlier if have risk facotrs such as smoking, high BP, family history of early CVD, abdominal obesity, chronic inflamatory conditions

Question 13

High LDL

Answer 13

leads to excess lipid deposiiton and promotes atherosclerosis

Question 14

low LDL

Answer 14

reduce lipid depositoin and reduce progression of atherosclerosis

Question 15

high HDL

Answer 15

excess RCT and reduce progression of atherosclerosis

Question 16

low HDL

Answer 16

less RCT thus excess deposited lipids from LDL are not removd

Question 17

strategies to lower LDL and prevent atherosclerosis

Answer 17

formation of mevalonate from acetyl coA
statins which inhibit HMG CoA reductase to lower cholesterol snthesis
bile acid binding resins
drugs to lower LDL

Question 18

a common target of choleserol lowering drugs

Answer 18

HMG CoA reductase which is the rate limiting step in cholesterol synth

Question 19

resemble mevalonate

Answer 19

statins
this resemblance leads to competitive inhibitors of HMG CoA reductase

Question 20

first statin found

Answer 20

lovastatin found in fungi
lowers serum cholesterol

Question 21

statins benifits

Answer 21

improve circulation, stabilize plaques by removed cholesterol rom them and reduce vascular inflamation

Question 22

bile acid/ salt binding resins, what do they do

Answer 22

lower LDL by removing cholesterol from the liver in the form of bil eacids and salts to prevent the cholesterol from being packaged into VLDL
increasing the rate of RCT

Question 23

examples of bile acid/ salt binding resins

Answer 23

cholestyramine and colestipol

Question 24

what drugs lower LDL

Answer 24

fibrates and LDL receptor degradation inhibitors

Question 25

fibrates

Answer 25

lower LDL by reducing liver triglyceride synthesis anad increasing fat oxidation (reduce VLDL)

Question 26

examples of fibrates

Answer 26

fenofibrate, gemfibrozil

Question 27

LDL receptor degradation inhibitors

Answer 27

injectable treatment of antibodies that inhibit LDL recptor degradation via PCSK9

Question 28

example of LDL receptor degradation inhibitors

Answer 28

alirocumab
avolocumab

Question 29

medications that lower LDL effectivenes

Answer 29

not more than 60% of the general population

Question 30

increase activity of CETP

Answer 30

increases LDL levels

Question 31

CETP inhibitor

Answer 31

torcetrapib was desgined to raise levels of HDL
but lots unexpetedly died bc it raise blood pressure in some and inc mortality after 2 yrs in 15k ppl

Question 32

dugs that raise HDL

Answer 32

to date, all drgus tested that riase HDL have provided no benifit or inc of detrimental outcomes
-raise BP/ hypertension
-inc death from cardiovascular disease

Question 33

HDL functionality

Answer 33

how efficicently HDL can remove cholesterol from extra hepatic tissues
some pop have high HLD but not effetcive and some that teh oposite

Question 34

lowering dietary cholesterol intake and CVD

Answer 34

minor impact on blood cholesterol for most

Question 35

diet and CVD

Answer 35

inc HDL activity for scavenging cholesterol (omega 3 FA and cholesterol efflux)
-down regulatino of cholesterol synthesis (polyunsaturated FA)
-polyunsaturated FA inhbit CETP activity and raise HDL
-fibre inc bile acid and cholesterol excretion