Cardiovascular disease

Question 1

What is atherosclerosis?

Answer 1

Intima of arterial wall thickened by the development of fibrous material and lipid accumulation

Question 2

What clinical problems does atherosclerosis lead to?

Answer 2

Aorta and coronar arteries –> CHD
Carotid arteries supplying brain –> stroke
Damage to arteries supplying lower limbs

Question 3

How does the endothelium become damaged?

Answer 3

Step 1 of atheroclerosis: 
Mechanical 
- high blood pressure causes damage, especially at branch points
chemical toxins
- cigarette smoke
High plasma lipid levels 
immunological response
- autoimmune responses

Question 4

What are the 7 steps of atherosclerosis?

Answer 4

1. damage to endothelium
2. monocytes to artery role
3. accumulation of lipid
4. cell proliferation
5. cell death
6. calcification
7. thrombosis

Question 5

What proteins triggers monocytes to come to the artery wall?

Answer 5

Monocyte chemotactic protein (MCT)
- produced by endothelial/smooth muscle cells

Vascular Cell Adhesion Molecule 1 (VCAM1)
- attaches monocytes to artery wall

Question 6

Where does the lipid accumulation come from?

Answer 6

LDL in blood, which accumulates as cholesterol ester

Question 7

What cells proliferate during cell proliferation?

Answer 7

Macrophages, which die from being overfilled with cholesterol.

Question 8

Why does calcification occur?

Answer 8

calcium laid down as hydroxyapatite as part of scarring process

Question 9

What is thrombosis?

Answer 9

• Blood clot forms in response to arterial damage
• If lesion ruptures and is exposed to the blood, coagulation occurs –> thrombus
• Insoluble protein in thrombus is fibrin
• Sometimes not life threatening and can incorporate into the plaque as the rupture heals
• However, thrombus can block artery –> thrombosis –> ischaemia –> Can dislodge and travel to block another artery

Question 10

What are the genetic risk factors of CHD?

Answer 10

• being male
• family history of CHD
• family history of hypercholesterolaemia
• ethnic group

Question 11

Genetics accounts for how many premature CHD cases?

Answer 11

50%

Question 12

What other risk factors for CHD?

Answer 12

• obesity
• diabetes
• socioeconomic group
• lack of exercise

Question 13

Name three saturated fats and their sources.

Answer 13

Myristic - milk, coconut oil
Palmitic - milk, dairy, palm oil
Stearic - cocoa butter, lamb

Question 14

Name two monounsaturated fats.

Answer 14

Oleic acid - meat, dairy, olive oil
Elaidic acid (trans) - margarine

Question 15

What does the keys equation tell us about cholesterol?

Answer 15

• Dietary cholesterol –> modest increase
• Sat fat –> large increase
• Polyunsaturated –> decrease
• Monounsaturated –> no effect
• Keys equation doesn’t tell you
  - Effect of individual FAs on plasma cholesterol
  - Effects of fats on LDL and HDL

Question 16

What has contributed to reduced CHD mortality?

Answer 16

• large drop in smoking
• drops in cholesterol, blood pressure, deprivation
• obesity, diabetes, and sedentary lifestyle increases risk
• TOTAL EFFECT: 58% reduction