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FNH 477 > Cardiovascular Disease > Flashcards

Cardiovascular Disease Flashcards

1
Q

Describe the burden of CVD in Canada.

A
  • Heart disease and stroke costs the Canadian economy around $25 billion every year in physician services, hospital costs, lost wages and decreased productivity.
  • Since 1952, the cardiovascular death rate in Canada has declined by more than 75%.

Data from the Heart and Stroke Report 2022.

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2
Q

Define: Cardiovascular disease.

A

Diseases and injuries of the heart and blood vessels (in the heart, brain and throughout the body)

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3
Q

Define: atherosclerosis

A

Build up of plaque in arteries, narrowing of arteries and limiting blood flow

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4
Q

Define: coronary heart disease

A

Build up of plaque in coronary arteries, which may lead to a heart attack

Atherosclerosis in coronary arteries = CHD

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5
Q

Define: myocardial infarction

A

Heart attack = loss of blood flow to the heart

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6
Q

Define stroke.

A

Loss of blood flow to the brain

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7
Q

Define: thrombosis

A

Formation of blood clot inside a vessel

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8
Q

Describe the progression of atherosclerosis.

A
  • LDL transport cholesterol to cells.
  • If LDL is not taken up by cells it keeps circulating in the blood.
  • The longer LDL circulates in the blood, the more likely it will be oxidized, then:
    • Uptake by macrophage
    • Foam cell formation
    • Fatty plaques
    • Atherosclerosis
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9
Q

Describe the key steps in the development of atherosclerosis.

A
  • Arterial endothelial cell injury
  • Entry of LDL cholesterol (which will be oxidized given enough time) and phagocytic cells
  • Phagocytes engorge LDL forming foam cells
  • Formation of fatty plaques; narrowing of blood vessels; can lead to myocardial infarction or rupture (thrombus)
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10
Q

What are 4 unmodifiable risk factors for CHD?

A
  • Age
  • Gender (male > female)
  • Family history
  • Ethnicity
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11
Q

What are modifiable risk factors for CHD? [9]

A
  • High blood cholesterol
  • High blood pressure
  • Diabetes
  • Overweight/obesity
  • Excessive alcohol use
  • Physical inactivity
  • Smoking
  • Stress
  • Poor diet
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12
Q

Describe the classic diet-heart hypothesis.

A
  • Dietary characteristics like high saturated fat, high cholesterol, and low PUFA lead to:
    • Elevated serum cholesterol levels
    • Atheromatous plaque
    • Coronary arteries narrow
    • Myocardial infarction
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13
Q

Describe how serum cholesterol is measured.

A
  • Lipid profile
  • Blood test in FASTING state that reports:
    • Total cholesterol
    • LDL cholesterol
    • HDL cholesterol
    • Triacylglycerols
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14
Q

What component of a lipid profile appears to be most predictive of CHD risk?

A
  • The ratio of total cholesterol: HDL cholesterol
  • Or the ratio of LDL: HDL
  • Or apoB: apoA
  • Looking at ratios is of greater validity and significance in clinical diagnostic than measuring total cholesterol only.

Recall: the main apolipoproteins of LDL = apoB; and the main apolipoproteins of HDL = apoA

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15
Q

Dietary cholesterol seems to have a major influence on serum cholesterol.
True or False?

A

False.
Dietary cholesterol does not seem to have a major influence on serum cholesterol.

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16
Q

Dietary cholesterol does not seem to have a major influence on serum cholesterol.
True or False?

A

True.

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17
Q

Describe how plant sterols affect cholesterol levels.

A
  • Cholesterol absorption is decreased by intake of plant sterols.
  • Plant sterols and plant stanols lower cholesterol absorption by displacing cholesterol in the mixed micelles.
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18
Q

Dietary fat does seem to modify serum cholesterol.
True or False?

A

True.
Replacing saturated fats or CHO with MUFA or PUFA decreases total cholesterol to HDL cholesterol ratio.

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19
Q

Dietary fat does not seem to modify serum cholesterol.
True or False?

A

False.
Replacing saturated fats or CHO with MUFA or PUFA decreases total cholesterol to HDL cholesterol ratio.

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20
Q

What are the current recommendations regarding dietary fat?

A
  • Minimize intakes of saturated and trans fats
  • AMDR: n-6 PUFA 5-10%
  • AMDR: n-3 PUFA 0.6-1.2%
  • No recommendations for MUFA
  • AMDR: fat 20-35%
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21
Q

Elevated serum cholesterol is a risk factor for CHD.
True or False?

A

True.

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22
Q

Elevated serum cholesterol is not a risk factor for CHD.
True or False?

A

False.
Elevated serum cholesterol is a risk factor for CHD.

23
Q

Dietary fat composition appears to influence serum cholesterol.
True or False?

A

True.

24
Q

Dietary fat composition does not appear to influence serum cholesterol.
True or False?

A

False.
It does appear to influence serum cholesterol.

25
Q

Do dietary fatty acids influence risk for CHD?

A
  • Findings from observational studies and experimental trials are mixed.
26
Q

Why is evidence regarding dietary fat and CHD risk conflicting?

A
  • Epidemiological studies are difficult to interpret.
  • What replaces saturated fat is important
27
Q

Why are epidemiological studies difficult to interpret?

A
  • Difficult to separate effects of nutrients from dietary patterns or lifestyle factors
  • Studies may be done on secondary prevention
  • Difficulties in conducting “good” observational and experimental nutrition studies
28
Q

Based on the forest-plot, replacing SFA with CHO leads to statistically significant slight increase in risk of CHD in cohort studies.
True or False?

A

True.
The CI of the pooled analysis of 11 cohorts does not include 1

29
Q

Based on the forest-plot, replacing SFA with MUFA leads to statistically significant increase in risk of CHD in cohort studies.
True or False?

A

False.
The CI of the pooled analysis of 11 cohorts includes 1.

30
Q

Based on the forest-plot, replacing SFA with PUFA leads to statistically significant decrease in risk of CHD in cohort studies.
True or False?

A

True.
The CI of the pooled analysis of 11 cohorts does not include 1.

31
Q

What is the latest evidence about dietary fat and CVD risk?

A
  • Lowered intake of dietary saturated fat and replacement with polyunsaturated vegetable oil reduced CVD by ≈30% (RCTs)
  • Benefits from lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat (prospective cohort studies)
  • NO benefits: replacement of saturated fat with mostly refined carbohydrates and sugars (clinical trials)
32
Q

Why might the ‘diet-heart’ hypothesis be too simplistic?

A
  • Most inter-individual variation in serum cholesterol is NOT related to dietary fat/cholesterol intake.
  • Factors other than blood cholesterol are important in the etiology of CHD
33
Q

List dietary factors that may influence CVD.

A
  • Saturated fats/PUFA/n-3 fatty acids
  • Glycemic index
  • Whole grains/fiber
  • Anti-oxidants
  • Phytochemicals
  • Vitamin D
  • Magnesium
  • Alcohol
  • B vitamins (folate, B6, B12, etc)
  • And more…
34
Q

Describe omega-3 fatty acids and their role in CVD risk, as well as possible mechanisms [4].

A
  • Hypothesis generated from observation of lower rates of CHD in populations with very high intake of fish such as Greenland and Japan
  • Possible mechanisms:
    • Effects on blood lipids (TAG lowering)
    • Anti-arrythmic effects
    • Anti (less)-inflammatory effects
    • Anti-thrombotic effects
35
Q

Describe the role fiber may play in CVD risk.

A
  • May reduce serum cholesterol by binding to bile acids in the gut
    • Major pathway of cholesterol excretion in the body
  • May also improve glycemic control, insulin resistance and weight control
  • Whole grains: source of fiber, phytochemicals, magnesium, etc.
36
Q

Describe the role anti-oxidants may play in CVD risk.

A
  • Hypothesis that anti-oxidants may protect the arterial wall and prevent LDL oxidation
  • Note: Oxidation of LDL particles is an important step in the progression of atherosclerosis.

E.g., tocopherols, ascorbic acid, beta-carotene, selenium

37
Q

Describe the role phytochemicals play in CVD risk.

A
  • Have anti-oxidant properties
  • Stilbenoids (e.g., resveratrol from grapes and pterostilbene from blueberries) modify gene expression through epigenetic mechanisms which may explain their anti-oxidant and anti-inflammatory properties

E.g., Flavonoids, stilbenoids, and others.

38
Q

Why is low vitamin D associated with a higher risk of CHD? [3]

A
  • Decreasing inflammation
  • Endothelial function
  • Reducing vascular stiffness
39
Q

What are possible mechanisms explaining why low vitamin D is associated with higher risk for CHD? [3]

A
  • Vitamin D receptor (VDR) and VDR responsive elements in DNA
  • Regulation of gene expression
  • Epigenetic mechanisms.
40
Q

What are mechanisms for why low magnesium is associated with higher risk for CHD? [3]

A
  • Modulating vascular smooth muscle tone
  • Endothelial cell function
  • Myocardial excitability
41
Q

Describe the role of B-vitamins in CHD risk.

A
  • B vitamins are needed to metabolize homocysteine.
  • Increased homocysteine is a risk factor for CHD
42
Q

Is red wine protective against CHD?

A
  • Possibly in moderation (1-2 drinks/day)
  • Contains: Resveratrol; other polyphenolic compounds (antioxidants); alcohol
  • Excess alcohol is harmful
  • No evidence that ‘non-drinkers’ should drink
43
Q

Why may it be more useful to examine dietary patterns and not nutrients in relation to CVD risk?

A

We eat foods that contain nutrients.
We don’t eat nutrients in isolation.

44
Q

Describe two diets that are associated with reduced CVD risk.

A
  • ‘Prudent diet’: a high intake of vegetables, fruit, legumes, whole grains, fish, and lean meats (poultry)
  • ‘Mediterranean diet’: a high intake of vegetables, fruits, legumes, nuts, olive oil (MUFA), and seafood
45
Q

Describe a diet that is associated with increased CHD risk.

A
  • ‘Western diet’: higher intakes of red and processed meats, sweets, and desserts, high fat dairy, refined grains.
46
Q

What did the PREDIMED study determine about the Mediterranean diet?

A
  • A MD with olive oil or nuts significantly reduced CVD risk compared to a low fat diet
  • This may be because the MD enhances cardioprotective lipid profiles, which improves glucose metabolism and decreases inflammation levels.
47
Q

What are the current dietary recommendations for prevention of heart disease?

A
  • Eat a balanced diet that emphasizes vegetables and fruit, whole grains, and minimizes saturated fat
  • Encourage intake of omega-3 fatty acids (e.g., fish)
48
Q

Describe the Canadian Food Guide 2019.

A
  • The Food Guide continues to encourage Canadians to choose a variety of nutritious foods and beverages while highlighting that healthy eating is more than the foods you eat.
  • Health Canada encourages Canadians to be mindful of their eating habits, to cook more often, to enjoy their food, and to eat meals with others.
  • The new Food Guide recommends the regular intake of vegetables, fruit, whole grains and protein foods, and among protein foods, to consume plant-based more often. The intention is not to reduce total fat in the diet; rather it is to help reduce intakes of saturated fat while encouraging foods that contain mostly unsaturated fat.
49
Q

Does dairy increase CHD risk?

A
  • SF do not all have the same effect; SF from dairy may not increase LDL in a clinically significant way
  • MCFA may lead to better weight management
  • MUFA/PUFA increase HDL and lower total cholesterol (oleic acid)
  • Other ingredients in dairy: calcium, iodine, potassium, bioactive peptides, vitamin D, vitamin A
50
Q

What are the American Heart Association Lifestyle recommendations?

A
  • Use up at least as many calories as you take in
  • Aim for at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity, or an equal combination of both, each week.
51
Q

What are the American Heart Association Diet recommendations?

A
  • Eat a variety of nutritious foods from all food groups
  • Emphasize fruits, vegetables, whole grains, low fat dairy, skinless poultry and fish, nuts and seeds, legumes, non-tropical vegetable oils
  • Limit saturated and trans fat, sodium, red meat, sweets, sugar-sweetened beverages.

Diets that fit this pattern = DASH or MD

52
Q

Which apolipoprotein is associated with HDL?

A

apo A

53
Q

Which apolipoprotein is associated with LDL?

A

apoB

FNH 477 (11 decks)

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