CVD
abnormal condition characterized by disorders of the heart and blood vessels
Common causes of CVD
- HTN
- Coronary Heart Dz
- Stroke
- CHF
- Smoking
Atherosclerosis
- from the greek: athere “fatty mush”, skleros “hard”
- process begins as soft fatty deposits and hardens with age
- Hardening of the Arteries
- Can occur in any artery but prefer the coronary arteries
- focal deposits of cholesterol, lipids, cellular wastes, calcium, and other substances within the intimal wall of an artery
Most common form of atherosclerosis
Arteriosclerosis
Build up is referred as…
Plaque
Endothelial injury Theory
- Hyperlipidemia (nondenuding)
- HTN (Denuding)
- Chemical irritants (infections)
- Factor release into sub-endothelium (CRP)
- Smooth muscle cells move into intima
- initiates synthesis of collage, elastic fiber protein, and proteoglycans
- platelets and clotting factors accumulate (clot under the fibrous cap of the plaque)
Stage 1 Atherosclerosis
Fatty Streak Formation (Reversible)
-collateral circulation formation
Stage 2 Atherosclerosis
Raised Fibrous Plaque
- Progressive changes (age 30 and cont’d to increase)
- Chronic endothelial injury (HTN, elevated cholesterol, heredity, carbon monoxide, immune rxns, toxic substances)
Stage 3 Atherosclerosis
Complicated Lesion
-Rigidity and hardening (“Atheromas”)
Formed Plaque
- Hemorrhage into the plaque
- Thrombus formation on the plaque’s surface
- Total occlusion
Once plaque is formed…
- MI
- Stroke
Unmodifiable Risk Factors
- Age
- Gender
- Genetic predisposition
- Ethnicity
Modifiable Risk Factors
- Elevated Serum Lipids & Cholesterol
- HTN
- Smoking
- Physical inactivity
- Obesity
- DM
- Stress/Behavior Patterns
- Elevated Cholesterol
Lipid Synthesis
- To utilize lipids: must become water soluble, done by combining with proteins
- Provide the vehicles for fat mobilization and transport
Lipoproteins
HDL’s: High density lipoproteins
LDL’s: Low Density lipoproteins
VDL’s: very low density lipoproteins
HDL’s
“Healthy” or Good
- contain more protein by weight and less lipid
- carry lipids away from arteries
- increase with physical exercise
- decreased with age and hx of CAD
– >60 mg/dl = Negative risk
– 45-59 mg/dl = Average risk
– 36-44 mg/dl = Moderate risk
–
VLDL’s
- “LETHAL” or BAD
- Contain more triglycerides
- Lead to LDL’s
- Elevation may increase the risk of premature atherosclerosis with other risk factors (DM, HTN, Smoking)
Triglycerides
Made up of Fatty Acids :
– Saturated
– Unsaturated
LDL’s
“LETHAL” or BAD
Contain more cholesterol
Have an affinity for arterial walls
Decreased level desirable
160 mg/dl = High risk
> 190 mg/dl = Very high risk
How do we get cholesterol?
- Liver manufactures
- Specifically food from ANIMALS
(egg yolds/poultry, meat, fish, seafood, whole-milk dairy products)
Foods that do not contain cholesterol
- fruits
- veges
- grains
- nuts and seeds
- Typically the body makes all the cholesterol it needs
- We do NOT need to consume it
Saturated Fats
major reason for elevating blood cholesterol
-trans fats also do this
- AHA:
- daily cholesterol intake = less than 300mg
Primary Prevention
patient education
- reduce intakes of saturated fat and cholesterol
- increase physical activity
- control weight
- smoking cessation
- decrease stress or alter behavior patterns
- evaluate dietary patterns
Goals of Medication Therapy
- increase lipoprotein removal
- restrict lipoprotein production
- decrease cholesterol absorption
