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Clinical Exercise Physiology > Risk Factors for Atherosclerosis > Flashcards

Risk Factors for Atherosclerosis Flashcards

1
Q

What does it mean for something to a positive risk factor?

A
  • it increases the likeliness of something occurring
  • adding to the probablity
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2
Q

What are 6 modifiable positive risk factors?

A
  1. dyslipidemia
  2. hypertension
  3. diabetes
  4. physical inactivity
  5. obesity
  6. smoking
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3
Q

What does it mean for something negative risk factor?

A
  • it decreases the likeliness of something occuring
  • subtracts from the probability
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4
Q

What is an example of a modifiable negative risk factor?

A

high HDL >60mg/dl (protective)

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5
Q

What are 4 non-modifiable risk factors?

A
  1. older age
  2. gender
  3. race
  4. family history of CAD
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6
Q

Non-modifiable risk factor

Older age

A
  • male > 45
  • female > 55
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7
Q

Non-modifiable risk factor

Gender

A

male

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8
Q

Non-modifiable risk factor

Race

A

african american, hispanic

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9
Q

Non-modifiable risk factor

Family History of CAD

A
  • father or brother with CAD < 55
  • mother or sister with CAD < 65
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10
Q

Modifiable Risk Factors

Dyslipidemia: Total Cholesterol

A

greater than 240 mg/dl
(high risk)

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11
Q

Modifiable Risk Factors

Dyslipidemia: LDL

A

greater than 160 mg/dl
(high risk)

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12
Q

Modifiable Risk Factors

Dyslipidemia: HDL

A

less than 40 mg/dl
(high risk)

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13
Q

Describe th MRFIT Trial.

A
  • multicenter trial of CVD risk factor reduction in middle-aged men (35-57)
  • no CVD at baseline
  • measured age, smoking status, blood pressure and serum cholesterol
  • followed for 6 years
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14
Q

MRFIT Trial

How many deaths out of 7840 were due to CVD?

A

2626

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15
Q

MRFIT Trial

Less than 20th percentile = baseline risk (less than 181 mg/dl)

A
  • reference group
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16
Q

MRFIT Trial

Greater than 20th percentile (182 - 202 mg/dl)

A

associtaed with 30% increased risk of CVD death

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17
Q

MRFIT Trial

Greater than or equal to 80th percentile (greater/equal 246 mg/dl)

A

associated with 340% increase in CVD death

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18
Q

MRFIT Trial

Greater than or equal to 90th percentile (greater/equal 264 mg/dl)

A

associated with 400% increase in CVD death rate

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19
Q

Define relative risk

A

the risk of a certian event happening in one group versus another

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20
Q

Put relative risk into a sentence.

A

The risk of developing a disease after an exposure vs. the risk of developing a disease in absence of the exposure.

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21
Q

Treatment of dyslipidemia

A

HMG-CoA Reductase Inhibitors
“statins”

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22
Q

HMG-CoA Reductase Inhibitors

Mechanism of action: blocks the conversion of HMG-CoA to ?? in ?? pathway.

A
  • melavonic acid
  • cholesterol biosynthesis
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23
Q

HMG-CoA Reductase Inhibitors

Reduction of… (3)

A
  1. Total cholesterol
  2. LDL
  3. triglycerides
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24
Q

HMG-CoA Reductase Inhibitors

Increases in…

A

HDL

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25
Q

HMG-CoA Reductase Inhibitors

On average, treatment results in ??% reduction in ??, ??, and ??.

A
  • 20-33%
  • MI, stroke, and CV death
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26
Q

HMG-CoA Reductase Inhibitors

Key Point?

A
  • 1/2 of all myocardial infarctions ocur in individuals with normal cholesterol levels
  • certain values don’t confirm heart disease
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27
Q

Treatment of Dyslipidemia

Primary Prevention Trials

A

no history of CAD when started on statin drug

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28
Q

Treatment of Dyslipidemia

Secondary prevention trials

A

previous MI and high TC and LDL when started on statin drug

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29
Q

Describe the CARE Trial (1998)

A
  • secondary prevention trial
  • patients with normal baseline total cholesterol and LDL
  • started on statin after myocardial infarction
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30
Q

CARE Trial

LDL results

A

lowered about 32%

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31
Q

CARE Trial

HDL results

A

increased about 5%

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32
Q

CARE Trial

Overall results

A

reduced nonfatal or fatal MI by 24%

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33
Q

CARE Trial

CARE conclusion

A

statin therapy reduced risk of MI and death in CAD patients with normal TC and LDL

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34
Q

Possible mechanisms of Statin reduction function

Limits ?? production of ?? cholesterol.

A
  • liver
  • LDL
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35
Q

Possible mechanisms of Statin reduction function

Increases ?? of ?? from blood.

A
  • clearance
  • LDL
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36
Q

Possible mechanisms of Statin reduction function

Stabilizes athersclerotic plaque by either:
- ??
- ??

A
  • reducing lipid core of plaque
  • reducing proteases (MMPs) that degrade fibrous cap
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37
Q

Possible mechanisms of Statin reduction function

Increases endothelial function:
- increases ?? and ?? production
- decreases ?? production = prevents degradation of ??

A
  • eNOS and NO
  • ROS and NO
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38
Q

MRFIT

Hypertension: Optimal BP

A

less than 120 / less than 80

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39
Q

MRFIT

Hypertension: normal but not optimal

A

120-129 / 80-84

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40
Q

MRFIT

Hypertension: High Normal

A

130-139 / 85-89

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41
Q

MRFIT

Hypertension: Stage 1 HTN

A

140-159 / 90-99

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42
Q

MRFIT

Hypertension: Stage 2/3 HTN

A

greater than 160 / 100

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43
Q

MRFIT

HTN Goal?

A

To compare relationships of systolic BP, diastolic BP, and pulse pressure (PP) separately and jointly with CVD mortality

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44
Q

MRFIT HTN/CAD Results

In men age 35-44 (young), CVD risk was greatest for those with…

A

both systolic HTN and diastolic HTN; compared to one alone

45
Q

MRFIT HTN/CAD Results

In men 45-57 (middle-aged), CVD risk was greatest for men with either:
- ??
- ??

A
  • systolic HTN and diastolic HTN
  • systolic HTN and DBP less than 80 (highest risk group)
45
Q

MRFIT HTN/CAD Results

Conclusion?

A

Systolic HTN and low diastolic BP were highest risk in middle aged adults; with systolic/diastolic HTN being the next highest risk

46
Q

Framingham Heart Study: Temporal change in BP over time

  1. Mean, systolic and diastolic BP….
A

increase slowly until mid-life (age 50-60).

47
Q

Framingham Heart Study: Temporal change in BP over time

2.Only systolic BP continually…

A

increases in a linear fashion after mid-life.

48
Q

Framingham Heart Study: Temporal change in BP over time

3.Diastolic BP ?? at mid-life and begins…

A
  • plateaus

to decline thereafter.

49
Q

Framingham Heart Study: Temporal change in BP over time

4.Mean BP ?? at mid-life and remains…

A

thru lifespan.

50
Q

Framingham Heart Study: Temporal change in BP over time

5.Pulse Pressure …..

A

increases exponentially beyond mid-life.

51
Q

Framingham Heart Study: Take home points

Adults less than 50 yrs of age, ?? is the strongest predictor of CVD risk.

A

diastolic BP

52
Q

Framingham Heart Study: Take home points

?? and ?? were the strongest predictors of CVD in adults over 60 yrs.

A

Systolic BP and PP
(PP was superior)

53
Q

Framingham Heart Study: Take home points

?? becomes inversely related with CVD risk over the age of 60.

A

Diastolic BP

54
Q

New High BP Guidelines

HTN Stage 1

A

130-139 / 80-89

55
Q

New High BP Guidelines

HTN Stage 2

A

greater than 140 / greater than 90

56
Q

HTN Treatment

If the risk is less than 10%….

A

start with healthy lifestyle recommendations and reasses in 3-6 months

57
Q

HTN Treatment

If risk is greater than 10% or the patient hase known CVD, diabetes mellitus, or chronic kidney disease…

A

recommended lifestyle changes and BP-lowering medication

58
Q

New HTN BP Guidelines

Non-Pharmacological treatment options

A
  • healthy diet
  • weight loss
  • sodium (reduce intake)
  • PA (add aerobic exercises)
  • PA (add dynamic resistance training)
  • alcohol (reduce intake)
59
Q

Diabetes Mellitus

ADA Definition
(at least 1 of 3)

A
  1. fasting blood glucose: >126 mg/dl
  2. oral glucose tolerance test: glucose >200 2 hrs after 75g
  3. HbA > 6.4%
60
Q

Diabetes mellitus

ADA Prediabetes

A
  1. FBG: 100 - 126
  2. OGTT: 140 - 199 2 hrs after 75g
  3. HbA = 5.7 - 6.4%
61
Q

Diabetes Mellitus

Type 1

A

insulin-dependent
- pancreatic beta-cells fail to produce insulin
- exogenous insulin required

62
Q

Diabetes Mellitus

Type 2

A

non-insulin dependent
- Insulin resistance: tissues (muscle, fat, liver) do not respond (less sensitive) to insulin’s effects to lower glucose
- results in over production of insulin

63
Q

Diabetes and CAD risk

KEY POINT?

A

in general, adults with diabetes are 2-4 times increased risk of developing CAD and stroke

64
Q

Diabetes and CAD risk

incidence of 1st MI

A

5.5 - 6x higher rate of 1st MI for diabetics

65
Q

Diabetes and CAD risk

incidence of 2nd MI

A

about 2.5 higher rate of 2nd MI in diabetics

66
Q

MRFIT PA

Describe MRFIT PA.

A

1st US study to document decreased risk of CAD, CAD death, and all-cause death with increased PA
- no CAD, but several risk factors at baseline
- based on self-reported amount of leisure-time physical activity (LTPA) by questionnaire

67
Q

MRFIT PA

1 = low LTPA

A
  • avg 15 min/day
  • 73 kcal/day
68
Q

MRFIT PA

2 = moderate LTPA

A
  • avg 47 min/day
  • 223 kcal/day
69
Q

MRFIT PA

3 = high LTPA

A
  • 133 min/day
  • 638 kcal/day
70
Q

MRFIT PA

In regards to group 2 and group 3….

A

there is no statistical difference between the two

71
Q

MRFIT PA Results

Moderate and high LTPA were associated with:
- ??
- ??

A
  • 63% less fatal CAD deaths
  • 70% less all-cause deaths

compared to low LTPA

72
Q

MRFIT PA

Conclusions:
1. LTPA has a ?? to CAD and overall mortality in high-risk men
2. ?? was just as good as ?? in reducing CHD (MI), CHD death, and all-cause death.

A
  1. modest inverse relation
  2. Moderate LTPA, high intensity LTPA
73
Q

Obesity using BMI

Overweight BMI?

A

25 - 29.9

74
Q

Obesity using BMI

Obese I BMI?
Obesity class?

A
  • 30 - 34.0
  • class I
75
Q

Obesity using BMI

Obese II BMI?
Obesity class?

A
  • 35 - 39.9
  • class II
76
Q

Obesity using BMI

Morbidly Obese BMI?
Obesity class?

A
  • greater than 40
  • class III
77
Q

Obesity using BMI

How is BMI calculated?

A

BMI = weight / height

78
Q

Obesity and CVD mortality

results?

A
  • death rates increased throughout the range of increasing BMI from 24.9
  • risk of CVD death increased rapidly with BMIs greater than 30
  • low BMI (less than 18.5) predictive of increased CVD and all cause death
79
Q

Obesity/Physical Fitness and CAD death

Fit or Fat key point??

A

“Lean and unfit” has double the risk compared to “high fit and obese”

  • PA is more important than BMI
80
Q

Obesity/Physical Fitness and CAD death

Fit or Fat Conclusions:
Low fitness…

A

was an independent predictor of CAD death and all-cause death in all BMI groups.

81
Q

Obesity/Physical Fitness and CAD death

Fit or Fat Conclusions:
High fitness…

A

reduced risk of CAD death and all-cause death compared to low-fitness in each BMI group

82
Q

Obesity/Physical Fitness and CAD death

Fit or Fat Overall Conclusion.

A

better to be fit and fat, than thin and unfit

83
Q

Smoking

How many people in US are estimated to smoke?

A

42.1 million
- 18.1% of all adults 18 and older

84
Q

Smoking

Is smoking more common among men or women?

A

men (20.5%) compared to women (15.8%)

85
Q

Smoking

What is the current population trend?

A

overall decrease in smoking prevalance from 2005 (20.9%) to 2012 (18.1%)

86
Q

Smoking Cessation and MI risk

In adults with no previous CHD, the reduction in cardiac event rate is associated with smoking cessation ranges from…

A

7 to 47 percent

87
Q

Smoking Cessation and MI risk

In adults with no previous CHD, the risks of MI diminish relatively soon after smoking cesstion by…

A

1 year compared with smokers

88
Q

Smoking Cessation and MI risk

In adults with no previous CHD, Relative Risk back to level of never smokers beyond…

A

1 year (2+ years)

89
Q

Smoking

What are the 7 potential mechanisms of by which smoking promotes CVD?

A
  1. enhacned oxidation of lipids - atherosclerosis
  2. decreased HDL-C
  3. increased platelet adhesiveness
  4. excessive stimulation of sympathetic nervous system
  5. increased propensity for thrombosis
  6. increased vasospasm/constriction of coronary arteries
  7. O2 replaced by CO on RBCs - tissue ischemia
90
Q

Framingham Risk Score

What does the framingham risk score NOT predict?

A

stroke of heart failure

91
Q

Framingham Risk Score

What does the framingham risk score predict?

A

estimates 10 year risk of CAD in person without diabetes or existing heart disease

92
Q

Framingham Risk Score

Low risk?

A

10% or less

93
Q

Framingham Risk Score

Moderate risk?

A

10 - 19%

94
Q

Framingham Risk Score

High risk?

A

20% or more

95
Q

Framingham Risk Score

CAD equivalent?

A

diseases that have 10-year high risk of CAD (20% or more)
- diabetes, chronic kidney disease, carotid artery disease

96
Q

Metabolic Syndrome

Define Metabolic Syndrome

A

a clustering of CAD risk factors most notable abdominal obesity, insulin resistance, high BP, increasing the risk of CAD and type 2 diabetes

97
Q

Metabolic Syndrome

How is Metabolic Syndrome diagnosed?

A

3 or more of the following:

  1. glucose intolerance
  2. abdominal obesity
  3. hypertension
  4. high fasting triglycerides
  5. low fasting HDL-C
98
Q

Metabolic Syndrome: possible sign

Glucose intolerance (pre-diabetes)

A

fasting glucose > 100 mg/dl

99
Q

Metabolic Syndrome: possible sign

Abdominal obesity: waist circumference

A
  • men > 40 inches
  • womens > 35 inches
100
Q

Metabolic Syndrome: possible sign

Hypertension

A

greater than 130 / greater than 80 mmHg

101
Q

Metabolic Syndrome: possible sign

High fasting triglycerides

A

greater than 150 mg/dl

102
Q

Metabolic Syndrome: possible sign

low fasting HDL-C

A
  • men < 40 mg/dl
  • women < 50 mg/dl
103
Q

Metabolic Syndrome Prevalence

Total in US

A

23.7%

104
Q

Metabolic Syndrome Prevalance

In regards to age?

A

increases with age
- greater than 45% in age 60+ years

105
Q

Metabolic Syndrome Prevalance

In regards to gender?

A

no difference between men and women

106
Q

Metabolic Syndrome Prevalance

In regards to race?

A

higher in hispanic women

107
Q

Metabolic Syndrome

Does a diagnosis of MetS increase CVD risk compared to each CVD risk factor individually?

A

unclear; could possibly be due to cluster effect

108
Q

Metabolic Syndrome

Does diagnosis of MetS alter course of medical treatment?

A

unclear; not usually

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