Vascular Ageing & CVD Risk Prediction Flashcards
(26 cards)
vascular aging
deterioration of vascular structure and function over time, leading to arterial stiffness
good indicator of CVD risk as encompasses the cumulating effect of all CVD risk factors over time
arterial stiffness
loss of elasticity in arterial walls
structural changes of artery
thickened arterial walls, decreased elastin, calcification, increased intimal layer of thickness
functional changes of artery
endothelial dysfunction, increased pulse wave velocity, impaired vasodilation, increased vascular resistance
assessment of arterial stiffness
pulse wave velocity, flow mediated dilatation
pulse wave velocity (PWV)
structural measure
speed at which a ventricular contraction (pressure wave) moves through the artery
increases with age
stiff arteries PWV
less elasticity and can’t expand as blood passes. Therefore the artery pushes back against the blood and the wave moves faster
= faster PWV
flow mediated dilatation (FMD)
functional measure of the change in the diameter of the brachial artery in response to a blood flow stimulus
stimulus created by releasing an arm cuff that is inflated to supra-systolic BP level
less dilation of arteries with age
healthy artery FMD
responsive to changes in blood flow and will dilate and relax accordingly
less elasticity of the artery = less responsive
age associated vascular changes
vascular structural remodelling (increase vascular intimal thickness
increase vascular stiffness), functional changes (altered regulation of vascular tone, reduced physical activity)
increase vascular thickness
matrix production by vascular smooth muscle cell, possible deviation of intimal cells from other sources
promotes development of atherosclerosis
increase vascular stiffness
elastin fragmentation (= systolic hypertension)
increase elastase activity (= left ventricular wall thickening)
increase collagen production of vascular smooth muscle cells and increase cross linking of collagen (= stroke, atherosclerosis)
altered growth factor regulation and tissue repair mechanisms (= left ventricular hypertrophy)
altered regulation of muscle tone
decrease nitric oxide production = vascular stiffening, hypertension, early atherosclerosis
reduced physical activity
learned lifestyle = exaggerated age changes of vascular structure and function
fratility = negative impact on atherosclerosis, hypertension and heart failure
CV modifiable risk factors
behaviour, psychosocial factors, diet and lifestyle
smoking, weight gain, physical inactivity, stress, SES and social inequalities, maternal-fetal nutrition, type of CHO, fat saturation, alcohol, salt intake, nutraceuticals
CV unmodifiable risk factors
genetics, ethnicity, ageing, sex, birth order
anatomy and physiology
screening
process of identifying apparently healthy people who may be at increased risk of a disease or condition
offered information, further tests, appropriate treatment to reduce their risk and any complication arising from a disease/condition
primary prevention CVD
aims to prevent the development of CVD in high risk individuals
secondary prevention of CVD
aims to prevent further events in those patients with established CVD
assess CVD risks
CVD risk assessment tools
identify high-risk people for primary prevention, usually based on groups of people with untreated levels of BP and cholesterol
can under-estimate risk in people with family history of CVD and certain high risk ethnic groups
Framingham Heart Study
collected data on BP, diabetic status, smoking and causes of death - used to define risk factors of CVD
ongoing study
under estimates risk in certain ethnicities
QRISK2-2013
computer generated risk assessment tool that estimates 10 year risk
includes BMI, family history, age, ethnicity, areas of deprivation, personal clincial information
CVD high risk groups
all adults over 40, any adult with strong family history of early CVD or first degree relative with hereditary cholesterol disorder
high risk assessment score
20% or more = 20% chance of developing CVD within next 10 years
medication to lower cholesterol and/or BP, lifestyle advice (healthy eating, smoking cessation, physical activity, safe alcohol limits)
