Lecture 31

Question 1

Balanced diet

Answer 1

Decrease plaque buildup, decrease cholesterol and inflammation

Question 2

Exercise

Answer 2

Strengthens vasculature to resist plaque buildup, increasing cardiac efficiency, weight maintenance

Question 2

Lifestyle changes

Answer 2

Removes sources of accelerated plaque build-up, risk factor decrease, decrease cardiac decline due to injury.

Question 3

Preventative measures

Answer 3

Recommended at early phase but effective at all phases

Question 4

Pharmacological interventions

Answer 4

Mostly used during intermediate stages of atheroscleorsis. Timing and drug type depends on patient profile.

Question 5

Indirect pharmacological interventions

Answer 5

Antihypertensives. Decreases systemic resistance/BP to preserve endothelial integrity and function.

Question 6

Direct pharmacological interventions effects

Answer 6

Lipid lowering, decreasing LDLs to decrease rate of plaque formation.

Question 7

Cholesterol and lipoproteins

Answer 7

Lipoproteins composed of triglycerides, cholesterol, phospholipids and apolipoproteins.

Question 7

Statins

Answer 7

Most common. Decrease liver cholesterol production by inhibiting HMG-CoA reductase which facilitates cholesterol production. Liver then works to clear LDL from circulation

Question 8

PCSK-9 inhibitors

Answer 8

Inhibits PCSK9 which works to regulate amount of LDL receptors on surface of liver cells. PCSK9 removes LDL receptors on cell surface, decrease LDL brought back to liver. Increase LDL receptors=decrease substrates for LDL production.

Question 9

Ezetimibe

Answer 9

Inhibits gut cholesterol absorption (intestines). Decrease circulating cholesterol = increase LDL clearance.

Question 10

Fibrates

Answer 10

Works through lipoprotein lipase (acts on PPAR-alpha gene) to increase triglyceride break down = decrease circulating triglycerides = decrease substrates for LDL production.

Question 11

Intervention devices

Answer 11

Used in late stages where occlusions of vessels ~80%. Surgical endovascular.

Question 12

Surgical interventions

Answer 12

Bypass grafting bypasses blood around a blockage in arterial vessels. Synthetic BV or graft redirects blood around blockage. Cann occur anywhere in the body. Requires general anaesthesia (invasive), long recovery time, complex blockages (long and/or diffuse lesions), patient vessels not always available but synthetic grafts have high failure rate.

Question 13

Endovascular interventions

Answer 13

Less invasive. Small cut near groin where catheter system inserted. guide wire navigates to blockage which is seen through contrast. Balloon inflates to push blockage to the side. When vessel patency is compromised, stent left behind while balloon removed. Local anaesthesia, short recovery period, simple blockages ONLY. But, can cause collateral vessel damage that triggers injury response.