Risk Factors of Atherosclerosis + CHD Flashcards Preview

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Flashcards in Risk Factors of Atherosclerosis + CHD Deck (25):
1

Non-modifiable risk factors

Age
Gender
Family History- cardiac events before 55 (male relative) or 65 (female relative)

2

What is the most important risk factor?

Age!

3

Why are males more likely to have atheroslcerosis?

-Estrogen is protective on blood vessel endothelium
-Men lack estrogen, are more likely to smoke and to have abdominal fat (vs. hip fat)

**after menopause, women's rate of MI catches up to men

4

Variables that family history can affect

Dyslipidemia (high LDL, low HDL, high lipoprotein A)
Diabetes
Hypertension

5

Modifiable Risk Factors

Diet
Exercise
High LDL
Low HDL
Smoking
Stress
Hypertension
Abdominal obesity
Inflammation

6

What is the most important thing to prevent the progression to T2DM?

Exercise!!

7

Factors that damage the epithelium

Aging
Smoking
Stress
High blood pressure
High blood sugar
High lipoprotein A
Inflammation
Low HDL

8

Where does evidence for risk factors come from?
-strengths of the study

INTERHEART study (2004)
- all continents, all races, all ages, both genders

9

Define CHD risk equivalent
-risk factors that are CHD risk equivalents

A patient with CHD risk equivalent has the same risk as someone who is diagnosed with CHD.

Risk factors
- non-cornoary atherosclerosis (e.g. carotid bruit, aortic aneurysm, peripheral artery disease)
-diabetes
-chronic kidney disease

10

-The most important risk factors according to INTERHEART

-Protective factors

1) Elevated LDL:HDL
2) Smoking
3) Psychosocial (e.g. depression, stress)
4) Diabetes
5) Hypertension
6) Abdominal obesity

1) Daily consumption of fruits + veg
2) Regular physical activity
3) Regular alcohol consumption

11

Effect of diet on CHD risk

- calorie excess, harmful fats, low fruits/vg, low fiber, processed food all bad

- fruit and veg consumption independently protective

12

Effect of exercise on CHD risk

- reduces BP
- reduced LDL, increased HDL
- slows progression to T2DM

***don't have to lose weight for it to help

13

Definition of dyslipedemia
-how common is inherited dyslipedemia?

-high LDL, low HDL, high triglycerides or some combination of these
-1/40 people have inherited dyslipidemia

14

What does HDL do?

-Removes cholesterol from artery wall
-Reduces inflammation

15

The effect of smoking on CAD risk

-Chemicals from smoke damage endothelium
-immediately on smoking there is vasoconstriction, reduced organ flow
-risk is reduced soon after quitting

16

The effect of diabetes on CAD risk

- diabetics tend to have higher triglycerides, lower HDL, small dense (harmful) LDL, and high glucose

17

The effect of abdominal obesity

- the extra fat contains more inflammatory cytokines

18

Biomarkers for CHD risk

- lipoprotein a
- CRP

19

Primary prevention targets

-Diet
-Exercise
-Dyslipedemia
-Smoking
-Hypertension
-Stress

20

Primary prevention with diet includes...

-public education and policy
-dietary assessment
-eating frequently (no skipping meals!)
-More fruit and veg, more fiber, more fish, more chicken, more complex carbs
-less red meat, less processed food, less simple carbs, less harmful fats

21

Primary prevention with exercise includes...

- Feasible exercise goals
-Frequent exercise

22

Primary prevention of dyslipedemia...

- Dietary (decrease calories, lower saturated/trans fat, more fiber, fewer simple carbs, plant sterols)

- Treatments: statins and others....

23

Primary prevention with smoking reduction includes...

- education, public policy (e.g. taxes), bans, warnings

- keep bringing it up with patient

-can do cold turkey or assisted

24

Primary prevention of hypertension...

-weight loss
-Exercise
-reduction of salt in diet
-medicate

25

Primary prevention with stress...

encourage stress management: psychotherapy, exercise, meditation etc..