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Cardiovascular > Cardiovascular Risk Factors 1 + 2 > Flashcards

Cardiovascular Risk Factors 1 + 2 Flashcards

1
Q

Most common cause of premature (<75 yr) death?

A

Coronary heart disease (CHD)

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2
Q

Atherosclerosis?

A

Progressive disease characterized by buildup of plaque within the arteries

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3
Q

Composition of plaque?

A

Fatty substances, cholesterol, cellular waste, calcium, and fibrin

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4
Q

What 2 things can lead to blockage of artery with regards to atherosclerosis? What can this result in?

A
  • bleeding into the plaque
  • formation of clot on surface of the plaque
  • heart attack or stroke
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5
Q

At what stage does angina develop from atherosclerosis? At what stage does MI, stroke and leg ischaemia develop from atehroscleorosis?

A
  • Development of fibrous and atherosclerotic plaque

* Plaque rupture/fissure and thrombosis

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6
Q

What is atherothrombosis? How does this process occur?

A
  • Formation of an acute thrombus in a vessel affected by atherosclerosis
  • Atherosclerotic plaque becomes unstable and ruptures, exposing components like collagen and von Willebrand factor allowing platelets to adhere to damaged area and form thrombus
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7
Q

Risk factors for cardiovascular disease? (11)

A
  • Family history and ethnicity
  • High BP
  • Diabetes
  • Heart disease
  • Smoking
  • Obesity
  • Oral contraception and HRT
  • Previous strokes and TIAs
  • Excessive alcohol consumption
  • Inactivity
  • Age
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8
Q

What are modifiable risk factors for CVD? (9) Non-modifiable? (4)

A

Modifiable

  • Smoking
  • Dyslipidaemia
  • Raised BP
  • Diabetes mellitus
  • Obesity
  • Diet
  • Thrombogenic factors
  • Lack of exercise
  • Excess alcohol consumption
Non-modifiable
* Personal history 
of CHD
* Family history 
of CHD
* Age 
* Gender
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9
Q

Relationship between BP and CVD?

A

Greater the blood pressure the greater the risk

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10
Q

What lipoproteins are implicated in atherosclerosis development? (3)

A
  • LDL (most atherogenic)
  • IDL
  • VLDL

(not chylomicrons or HDL)

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11
Q

Relationship between LDL and CVD risk? What factors is LDL modified by? (4)

A

10% increase in LDL results in 20% increase
in CHD risk

  • low HDL cholesterol
  • smoking
  • hypertension
  • diabetes
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12
Q

What is absolute risk of disease? Relative risk?

A
  • Absolute risk - risk of developing the disease over a time period
  • Relative risk- comparison of risk in two different groups of people
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13
Q

Are triglycerides as atherogenic as LDL? Normal triglyceride levels? High triglyceride levels?

A
  • No, associated with increased risk CHD but not as much as LDL
  • Normal - 2.3mmol/l
  • High - 11.3mmol/l
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14
Q

What does hypertriglyceridaemia due to chylomicrons and large forms of VLDL result in?

A

Pancreatitis but not CHD as chylomicrons and VLDL too large to enter arterial wall

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15
Q

When will HDL cholesterol increase risk of CHD? What lowers HDL cholesterol? (4)

A

When low level (<1 mmol/l)

  • High levels of triglyceride
  • Smoking
  • Obesity
  • Physical inactivity
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16
Q

What transports triglyceride from gut to the liver? From liver to the rest of the body?

A
  • Chylomicrons

* VLDL (most transformed into LDL via IDL and bound to LDL receptor)

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17
Q

What is the exogenous pathway of lipid metabolism?

A

Transport and utilisation of dietary fats via chylomicrons

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18
Q

Is cholesterol a modifiable risk factor?What are the benefits of reducing cholesterol?

A

Total cholesterol is a modifiable risk factor

10% reduction in total cholesterol results in

  • 15% reduction in CHD mortality
  • 11% reduction in total mortality
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19
Q

What is the primary target to lower cholesterol and thus CVD risk?

A

LDL-C

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20
Q

What is the relationship between serum total cholesterol and death rate from CHD?

A

Increased serum total cholesterol, increased death rate from CHD
(however, difference in mortality between different countries at given serum total cholesterol suggests other factors like diet also play a role)

21
Q

What is primary prevention in CHD? Secondary prevention?

A
  • Crucial opportunity to reduce the burden of CHD

* Following MI, etc, to prevent it from happening again

22
Q

Relationship between 10% reduction in total cholesterol and age?

A

Risk of coronary heart disease lowers less as we age - decrease in absolute risk, but increase in relative risk?
(i.e. falls by 50% at age 40 but only 20% at age 70)

23
Q

What is the main effect of statins? Other actions? (5)

A
  • Reduction of total cholesterol and LDL cholesterol
  • improvement of endothelial dysfunction
  • increased nitric oxide bioavailability
  • antioxidant properties
  • inhibition of inflammatory responses
  • stabilisation of atherosclerotic plaques
24
Q

Mechanism of statins?

A

HMG-CoA reductase inhibitors

25
Q

What are physical manifestations of high cholesterol?

A
  • Xanthelasma
  • Tendon Xanthomas
  • Tuberous xanthomas
  • Eruptive xanthomas
26
Q

What are xanthelasmas, tendon xanthomas, tuberous xanthomas and eruptive xanthomas? What are they indicative of?

A
  • Xanthomas of the eyelids (hyperlipidaemia)
  • Xanthomas on extensor tendons of fingers, patella, elbows, Achilles tendon (hypercholesterolaemia)
  • Xanthomas in dermis and subcutaneous tissue of extensor surfaces of large joints, hands, buttocks, heels, flexures (familial or acquired hypertriglyceridaemias and biliary cirrhosis)
  • Small reddish-yellow papules on buttocks, posterior thighs, body folds (abrupt increase in serum triglyceride levels)
27
Q

Some diseases attributable to hypertension? (6)

A
  • Heart failure
  • MI
  • Cerebral haemorrhage
  • Stroke
  • Left ventricular hypertrophy
  • Coronary heart disease
28
Q

Types of hypertension?

A
  • Primary (essential) hypertension - 90% of cases (majority), no known cause
  • Secondary - underlying cause
29
Q

What increases prevalence of hypertension?

A

Increasing age

30
Q

What are the effects of hypertension treatment?

A

Reduces

  • Ischaemic Heart Disease
  • Stroke
  • Mortality
31
Q

What are lifestyle modifications to reduce hypertension?

A
  • Lose weight, if overweight
  • Limit alcohol intake
  • Increase physical activity
  • Reduce salt intake
  • Stop smoking
  • Limit intake of foods rich in fats and cholesterol
32
Q

Why is hypertension a complicated risk factor of CVD? Examples? (6)

A

Most hypertensives have other CV risk factors

  • Dyslipidaemia
  • Diabetes
  • Age
  • Male
  • Smoking
  • Family history
33
Q

What is the first line treatment for young patents with hypertension? Older?

A
  • Young - start with ACE-I or ARBS

* Older - start with Ca++ channel blocker

34
Q

What is the most effective way to treat hypertension?

A

Combination therapies (different types of drug used rather than using increased dose of one drug)

35
Q

Why is diabetes one of the main risk factors for atherosclerosis? (3)

A
  • Increases hypercoaguability of blood (Virchow’s triad)
  • Increased LDL levels and decreased HDL
  • Increased endothelial damage due to oxidative stress
36
Q

What is the ticking clock hypothesis for diabetes?

A

Must be diagnosed quickly

  • Microvascular changes occur at onset of hyperglycaemia
  • Macrovascular changes occur before diagnosis of hyperglycaemia
37
Q

What is the probability of death in patients with diabetes with prior MI?

A

50% survival after 8 years

38
Q

What is the main cornerstone of obesity treatment?

A

Diet

  • Micronutrients, antioxidants, omega 3 and 6, polyunsaturates and monounsaturates
  • Calorie intake to normalise weight
  • Plus or minus exercise program
39
Q

What conditions are people with obesity at risk of? (5)

A
  • Stroke
  • Angina
  • MI
  • Hypetension
  • Type 2 diabetes
40
Q

What are the characteristics of metabolic syndrome?

A

To achieve diagnosis, must have 3or ore of these characteristics

  • Abdominal obesity (waist circumference >40 in males and >35 in females)
  • Triglycerides (>1.7mmol/l)
  • HDL-C (<1 mmol/l in men and 1.3 mmol/l in women)
  • Blood pressure (130/85 mm Hg)
  • Fasting glucose (>5.6 mmol/l)
41
Q

Can inflammatory markers predict future coronary events?

A

Some debate over whether high sensitivity CRP test can e reflective of increased CVD risk (increased levels of CRP indicate inflammation)

42
Q

What are socio-economic differences in CVD?

A

Premature deaths from CHD greater for manual workers than non manual (58% higher)

43
Q

Relationship between ischaemic heart disease and deprivation?

A

IHD mortality increases as deprivation increases

44
Q

What are ethnic differences in CVD? (2)

A
  • South Asians living in the UK have a higher death rate for CHD
  • Black Caribbean & black Africans much lower CHD death rate than average
  • BUT much higher risk in stroke
45
Q

What is ASSIGN score used for?

A

Estimate the risk of CVD

46
Q

What are levels of risk associated with smoking, hypertension and hypercholesterolaemia?

A
  • Risk multiplies as a combination of these factors (16 fold increase in risk)
47
Q

What are treatments for ischaemia in CVD? (2) Examples?

A
  • Anti-anginal medications (calcium blockers, nitrates, beta blockers)
  • Revascularisation (angioplasty, CABG)
48
Q

What are the treatments for antherothrombosis in CVD?

A
  • Aspirin
  • Statin
  • Beta Blocker
  • ACE Inhibitor
  • Exercise
  • Smoking Cessation

Cardiovascular (28 decks)

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