p.4
Peripheral Artery Disease (PAD)
What does Peripheral Artery Disease (PAD) refer to?
Atherosclerotic disease of arteries that perfuse the limbs, especially the lower extremities.
p.4
Peripheral Artery Disease (PAD)
What are some methods used to evaluate PAD?
Ankle-brachial index and noninvasive Doppler measurement of blood flow.
p.4
Coronary Artery Disease (CAD)
How many new and recurrent heart attacks occur each year in the U.S.?
Approximately 610,000 new and 325,000 recurrent heart attacks.
p.2
Risk Factors for Atherosclerosis
What are some causes of chronic endothelial injury?
Hypertension, smoking, hyperlipidemia, hyperhomocysteinemia, hemodynamic factors, toxins, viruses, and immune reactions.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What are the laboratory findings for Type IIa familial dyslipoproteinemia?
Triglycerides normal, LDL increased, Cholesterol increased.
p.3
Atherosclerosis Pathophysiology
What can happen to a fibrous plaque that may obstruct blood flow?
The fibrous plaque may calcify, protrude into the vessel lumen, and obstruct blood flow to distal tissues, especially during exercise.
p.3
Atherosclerosis Pathophysiology
What are plaques that have ruptured called?
Plaques that have ruptured are called complicated plaques.
p.3
Clinical Manifestations of Atherosclerosis
What may partial vessel obstruction lead to?
Partial vessel obstruction may lead to transient ischemic events, often associated with exercise or stress.
p.2
Atherosclerosis Pathophysiology
What is the role of monocytes in the progression of atherosclerosis?
They differentiate into macrophages that ingest lipids.
p.3
Atherosclerosis Pathophysiology
What are 'unstable' plaques?
'Unstable' plaques are those prone to rupture even before they affect blood flow and are clinically silent until they rupture.
p.1
Raynaud Phenomenon and Disease
What symptoms often accompany rubor in Raynaud phenomenon?
Throbbing and paresthesias.
p.3
Coronary Artery Disease (CAD)
What is the major cause of myocardial ischemia?
Coronary artery disease (CAD) caused by atherosclerosis is the major cause of myocardial ischemia.
p.2
Atherosclerosis Pathophysiology
What forms the fibrous plaque in atherosclerosis?
Fibroblasts and collagen cap.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
How can HDL remove excess cholesterol from the arterial wall?
HDL can remove excess cholesterol from the arterial wall through several pathways, including mediating the efflux of cholesterol from lipid-laden macrophages (foam cells) through the activation of adenosine triphosphate (ATP)–binding cassette transporter proteins (ABC proteins).
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the laboratory finding for Type I familial dyslipoproteinemia?
Cholesterol normal, Triglycerides increased three times, Chylomicrons increased.
p.3
Clinical Manifestations of Atherosclerosis
What causes the symptoms and signs of atherosclerosis?
Symptoms and signs of atherosclerosis result from inadequate tissue perfusion because of obstruction of the vessels that supply them.
p.1
Raynaud Phenomenon and Disease
What may resolve ischemia in Raynaud phenomenon associated with malignancy?
Surgical removal of the tumor.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the recommended therapy for Type III familial dyslipoproteinemia?
Weight control, Low-carbohydrate, low-saturated-fat, and low-cholesterol diet, Alcohol restriction, Clofibrate, Gemfibrozil, Lovastatin, Nicotinic acid, Estrogens, Intestinal bypass.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the recommended therapy for Type IV familial dyslipoproteinemia?
Weight control, Low-carbohydrate diet, Alcohol restriction, Clofibrate, Nicotinic acid, Intestinal bypass.
p.5
Risk Factors for Atherosclerosis
What is the impact of obesity on CAD in the United States?
The majority of individuals with known CAD have the growing epidemic of obesity in the United States.
p.1
Raynaud Phenomenon and Disease
How do attacks of Raynaud phenomenon typically present?
Attacks tend to be bilateral and usually begin at the tips of the digits and progress to the proximal phalanges.
p.1
Raynaud Phenomenon and Disease
What happens to skin color after a Raynaud phenomenon attack?
Skin color returns to normal.
p.1
Raynaud Phenomenon and Disease
What does treatment for Raynaud phenomenon consist of?
Removing the stimulus or treating the primary disease process.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What are the clinical features of Type III familial dyslipoproteinemia?
Premature vascular disease, Xanthomas of tendons and bony prominences, Uncommon onset: adulthood.
p.3
Clinical Manifestations of Atherosclerosis
What symptoms might occur due to obstructed blood flow caused by a fibrous plaque?
Symptoms such as angina or intermittent claudication may occur.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What are the clinical features of Type I familial dyslipoproteinemia?
Abdominal pain, Hepatosplenomegaly, Skin and retinal lipid deposits, Usual onset: childhood.
p.3
Clinical Manifestations of Atherosclerosis
What may result from increasing obstruction with superimposed thrombosis?
Increasing obstruction with superimposed thrombosis may result in tissue infarction.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What are the laboratory findings for Type III familial dyslipoproteinemia?
IDL or chylomicron remnants increased, Cholesterol increased, Triglycerides increased.
p.3
Evaluation and Treatment of Atherosclerosis
What laboratory tests are included in the evaluation of atherosclerosis?
Laboratory tests include measurement of lipids, blood glucose, and high sensitivity CRP (hs-CRP).
p.1
Atherosclerosis Pathophysiology
What is atherosclerosis?
A form of arteriosclerosis in which thickening and hardening of the vessel are caused by the accumulation of lipid-laden macrophages within the arterial wall, leading to the formation of a plaque.
p.1
Atherosclerosis Pathophysiology
What type of disease is atherosclerosis?
An inflammatory disease that develops and proceeds in the presence of elevated plasma cholesterol levels.
p.1
Atherosclerosis Pathophysiology
What initiates atherosclerosis?
Injury to the endothelial cells that line artery walls.
p.1
Risk Factors for Atherosclerosis
What recent evidence indicates a greater risk for atherosclerotic disease?
Individuals with a defect in the production of precursor endothelial cells in the bone marrow.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What lipoproteins are produced by the liver?
The liver produces several lipoproteins that vary in density and function, including VLDLs, LDLs, and HDLs.
p.2
Atherosclerosis Pathophysiology
What is a complicated lesion in atherosclerosis characterized by?
Thrombus deposition and thinning collagen cap.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What has the discovery of HDL's role in cholesterol efflux led to?
The discovery has resulted in the initiation of a whole new area of pharmacologic investigation into optimizing HDL function.
p.3
Atherosclerosis Pathophysiology
What happens once a plaque ruptures?
Exposure of underlying tissue results in platelet adhesion, initiation of the clotting cascade, and rapid thrombus formation that may suddenly occlude the affected vessel.
p.3
Clinical Manifestations of Atherosclerosis
What can happen to any part of the body when its blood supply is compromised by atherosclerotic lesions?
Any part of the body may become ischemic when its blood supply is compromised by atherosclerotic lesions.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What are the laboratory findings for Type IV familial dyslipoproteinemia?
Glucose intolerance, Hyperuricemia, Cholesterol normal or increased, VLDL increased, Triglycerides increased.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What are the laboratory findings for Type V familial dyslipoproteinemia?
Glucose intolerance, Hyperuricemia, Chylomicrons increased, VLDL increased, LDL increased, Cholesterol increased, Triglycerides increased three times.
p.5
Risk Factors for Atherosclerosis
How can modification of risk factors reduce the risk for CAD?
If individuals receive appropriate preventive care, modification of these factors can significantly reduce the risk for CAD.
p.1
Atherosclerosis Pathophysiology
What are the pathologic stages of atherosclerotic lesion progression?
Endothelial injury and dysfunction, fatty streak, fibrotic plaque, and complicated lesion.
p.1
Atherosclerosis Pathophysiology
What do injured endothelial cells become in atherosclerosis?
Inflamed and unable to make normal amounts of antithrombotic and vasodilating cytokines.
p.1
Atherosclerosis Pathophysiology
What do macrophages release that contribute to oxidative stress in atherosclerosis?
Enzymes and toxic oxygen radicals.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What is the role of LDL in the body?
LDL is responsible for the delivery of cholesterol to the tissues.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What are the three subtypes of HDL that cholesterol progresses through?
As HDL cholesterol is transported, it progresses through three subtypes of HDL: pre-β HDL, HDL3, and HDL2.
p.3
Evaluation and Treatment of Atherosclerosis
What agents are used to prevent complications of atherosclerotic disease?
Aspirin or other antithrombotic agents are used to prevent complications of atherosclerotic disease.
p.3
Evaluation and Treatment of Atherosclerosis
What is essential in evaluating individuals for the presence of atherosclerosis?
A complete health history, including risk factors and symptoms of ischemia, is essential.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the recommended therapy for Type V familial dyslipoproteinemia?
Weight control, Low-carbohydrate and low-fat diet, Clofibrate, Lovastatin, Nicotinic acid, Progesterone, Intestinal bypass.
p.1
Atherosclerosis Pathophysiology
What roles do innate and adaptive immunity play in atherosclerosis?
They play a role in the development and progression of atherosclerotic lesions.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the function of Clofibrate in treating dyslipoproteinemias?
Clofibrate decreases the release of free fatty acids from adipose tissue, decreases hepatic secretion of VLDL, and increases catabolism of VLDL.
p.1
Atherosclerosis Pathophysiology
How do macrophages adhere to injured endothelium in atherosclerosis?
By way of adhesion molecules such as vascular cell adhesion molecule-1 (VCAM-1).
p.1
Atherosclerosis Pathophysiology
What do lipid-laden foam cells form in atherosclerosis?
A lesion called a fatty streak.
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
Is raising overall levels of HDL adequate to prevent cardiovascular disease?
No, studies have suggested it is not adequate
p.3
Atherosclerosis Pathophysiology
What do fatty streaks produce once formed?
Fatty streaks produce more toxic oxygen radicals and cause immunologic and inflammatory changes.
p.3
Atherosclerosis Pathophysiology
What mediates the formation of a fibrous plaque over a fatty streak?
The process is mediated by many inflammatory cytokines, including growth factors like TGF-β.
p.3
Atherosclerosis Pathophysiology
What causes plaque rupture?
Plaque rupture occurs because of the inflammatory activation of proteinases, apoptosis of cells within the plaque, and bleeding within the lesion.
p.1
Raynaud Phenomenon and Disease
What can frequent, prolonged attacks of Raynaud phenomenon cause?
Interference with cellular metabolism, causing the skin of the fingertips to thicken and the nails to become brittle.
p.3
Clinical Manifestations of Atherosclerosis
What is the major cause of stroke?
Atherosclerotic obstruction of the vessels supplying the brain is the major cause of stroke.
p.5
Risk Factors for Atherosclerosis
What are the nonmodifiable conventional risk factors for CAD?
Nonmodifiable conventional risk factors for CAD include advanced age, male gender or women after menopause, and family history.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What happens when low-density lipoprotein (LDL) enters the arterial intima?
In hypercholesterolemia, the influx of LDL exceeds the eliminating capacity and an extracellular pool of LDL is formed.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the function of Cholestyramine in treating dyslipoproteinemias?
Cholestyramine is an anion exchange resin that binds bile acids and enhances cholesterol excretion.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What happens to macrophages in the presence of oxidized LDL?
Macrophages up-regulate and internalize oxidized LDL and transform into foam cells.
p.1
Risk Factors for Atherosclerosis
What are some nontraditional cardiovascular risk factors for endothelial injury?
Elevated C-reactive protein (CRP), increased serum fibrinogen, infection, and periodontal disease.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What happens to triglycerides in chylomicrons?
Some of the triglyceride may be removed and either stored by adipose tissue or used by muscle as an energy source.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What is a strong indicator of coronary risk?
An increased serum concentration of LDL is a strong indicator of coronary risk.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What does the term LDL describe?
The term LDL describes several types of LDL molecules.
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
What continues to be explored in research regarding HDL?
The best approach to increasing HDL3
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
Are niacin and fibrates correlated with an improvement in cardiovascular risk in individuals without documented coronary disease?
No, they are not correlated
p.7
Risk Factors for Atherosclerosis
What is hypertension responsible for in terms of cardiovascular disease risk?
A two- to threefold increased risk of atherosclerotic cardiovascular disease including MI
p.7
Risk Factors for Atherosclerosis
What effects do insulin resistance, hyperinsulinemia, and hyperglycemia have on the cardiovascular system?
Endothelial damage, thickening of the vessel wall, increased inflammation and leukocyte adhesion, increased thrombosis, glycation of vascular proteins, and decreased production of endothelial-derived vasodilators such as nitric oxide
p.1
Raynaud Phenomenon and Disease
What are the clinical manifestations of vasospastic attacks in Raynaud phenomenon or disease?
Changes in skin color and sensation caused by ischemia.
p.1
Raynaud Phenomenon and Disease
What follows as vasospasm ends in Raynaud phenomenon?
Rubor follows as the capillaries become engorged with oxygenated blood.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the recommended therapy for Type IIa familial dyslipoproteinemia?
Low-saturated-fat and low-cholesterol diet, Cholestyramine, Colestipol, Lovastatin, Nicotinic acid, Neomycin, Intestinal bypass.
p.5
Risk Factors for Atherosclerosis
How has new information about conventional risk factors impacted CAD?
New information about conventional risk factors has markedly improved the prevention and management of CAD.
p.5
Risk Factors for Atherosclerosis
How do aging and menopause contribute to CAD?
Aging and menopause are associated with increased exposure to risk factors and poor endothelial healing.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What enhances the formation of an extracellular pool of LDL?
The formation is enhanced by the association of LDL with the extracellular matrix.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the function of Colestipol in treating dyslipoproteinemias?
Colestipol has the same function as cholestyramine.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What does macrophage uptake of oxidized LDL lead to?
It leads to the presentation of fragments of oxidized LDL to antigen-specific T cells.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
How can cholesterol be obtained by the body?
Cholesterol can be obtained from dietary fat intake, and most body cells can also manufacture cholesterol.
p.1
Atherosclerosis Pathophysiology
What inflammatory cytokines are released in atherosclerosis?
Tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), interleukin-1 (IL-1), toxic oxygen radicals, CRP, and heat shock proteins.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What percentage of the U.S. population has some form of dyslipidemia?
Nearly half of the U.S. population has some form of dyslipidemia, especially among white and Asian populations.
p.5
Atherosclerosis Pathophysiology
What are key steps in the pathogenesis of atherosclerosis?
LDL oxidation, migration into the vessel wall, and phagocytosis by macrophages are key steps in the pathogenesis of atherosclerosis.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What is a strong indicator of coronary risk related to HDL?
Low levels of HDL cholesterol are a strong indicator of coronary risk.
p.7
Controversies in Cardiovascular Disease Prevention
What remains controversial in the primary prevention of cardiovascular disease?
Pharmacologic modulation of lipid levels
p.7
Controversies in Cardiovascular Disease Prevention
How have the other two CETP inhibitors, dalcetrapib and anacetrapib, performed in clinical trials?
They have been well tolerated in phase I and II clinical trials and do not adversely affect blood pressure and aldosterone
p.2
Atherosclerosis Pathophysiology
What is the significance of a lipid pool in atherosclerosis?
It indicates lipid accumulation within the arterial wall.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What other roles does HDL play besides removing cholesterol?
HDL also participates in endothelial repair and decreases thrombosis.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What are the laboratory findings for Type IIb familial dyslipoproteinemia?
LDL, VLDL increased, Cholesterol increased, Triglycerides increased.
p.1
Raynaud Phenomenon and Disease
What is the treatment for Raynaud disease?
Prevention or alleviation of vasospasm itself, avoiding stimuli that trigger attacks, and stopping cigarette smoking.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What are the clinical features of Type IV familial dyslipoproteinemia?
Premature vascular disease, Skin lipid deposits, Obesity, Hepatomegaly, Common onset: adulthood.
p.5
Risk Factors for Atherosclerosis
What are the major modifiable conventional risks for CAD?
Major modifiable conventional risks for CAD include dyslipidemia, hypertension, cigarette smoking, diabetes and insulin resistance, obesity, sedentary lifestyle, and an atherogenic diet.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What do monocytes differentiate into within the arterial intima?
Monocytes differentiate into macrophages.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
Why are lipids required by most cells?
Lipids (cholesterol in particular) are required by most cells for the manufacture and repair of plasma membranes.
p.1
Atherosclerosis Pathophysiology
What growth factors are released in atherosclerosis?
Angiotensin II, fibroblast growth factor, TGF-β, and platelet-derived growth factor.
p.1
Atherosclerosis Pathophysiology
What does oxidized LDL increase in atherosclerosis?
Endothelial adhesion molecule expression, which recruits more monocyte/macrophages.
p.7
Risk Factors for Atherosclerosis
What is cigarette smoking associated with in terms of lipoproteins?
An increase in LDL and a decrease in HDL
p.7
Controversies in Cardiovascular Disease Prevention
What did a recent large study exploring the role of statins in primary prevention find?
Statin therapy lowered LDL and C-reactive protein, reduced overall cardiovascular risk by 39%, and reduced overall mortality by 17%, but increased the risk for diabetes by 28% among individuals with risk factors for diabetes at baseline
p.2
Atherosclerosis Pathophysiology
What happens to the collagen cap in a complicated lesion of atherosclerosis?
It becomes thin and may fissure.
p.3
Atherosclerosis Pathophysiology
What results from the progressive damage to the vessel wall caused by fatty streaks?
Smooth muscle cells proliferate, produce collagen, and migrate over the fatty streak forming a fibrous plaque.
p.1
Raynaud Phenomenon and Disease
What symptoms are caused by vasospasm in Raynaud phenomenon?
Pallor, numbness, and the sensation of cold in the digits.
p.3
Atherosclerosis Pathophysiology
What can result from the sudden occlusion of a vessel due to thrombus formation?
Ischemia and infarction can result from the sudden occlusion of the affected vessel.
p.1
Raynaud Phenomenon and Disease
What are the diagnostic criteria for Raynaud disease?
Characteristic clinical manifestations, absence of necrosis, no detectable underlying cause, normal capillaroscopy findings, normal laboratory tests for inflammation, and negative tests for antinuclear factors.
p.3
Clinical Manifestations of Atherosclerosis
What may indicate that an individual is at risk for other ischemic complications elsewhere?
Disease in one area may indicate that the individual is at risk for other ischemic complications elsewhere.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What are the clinical features of Type V familial dyslipoproteinemia?
Abdominal pain, Hepatosplenomegaly, Skin lipid deposits, Retinal lipid deposits, Onset: childhood.
p.5
Risk Factors for Atherosclerosis
What is the concern regarding particulate matter air pollution and CAD?
Exposure to particulate matter air pollution is associated with an increase in myocardial infarction risk and is a worsening global problem.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the function of Neomycin in treating dyslipoproteinemias?
Neomycin is an experimental medication with a questionable mode of action that decreases LDLs.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the function of Estrogens in treating dyslipoproteinemias?
Estrogens decrease IDL levels in type III disorders and are experimental.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What is the function of HDL in cholesterol transport?
HDL is responsible for 'reverse cholesterol transport,' returning excess cholesterol from the tissues to the liver.
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
What other lipoproteins are associated with increased cardiovascular risk?
Elevated serum VLDL (triglycerides) and increased lipoprotein (a)
p.7
Risk Factors for Atherosclerosis
What positive effects do drugs that block the effects of the SNS and RAAS have?
Many positive effects on the vasculature
p.7
Controversies in Cardiovascular Disease Prevention
What was the adverse risk response to torcetrapib found to be?
Molecule specific and independent of its CETP inhibition effect
p.1
Raynaud Phenomenon and Disease
What can sluggish blood flow resulting in ischemia cause in Raynaud phenomenon?
The skin may appear cyanotic.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What are the clinical features of Type IIa familial dyslipoproteinemia?
Premature vascular disease, Xanthomas of tendons and bony prominences, Common onset: all ages.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the recommended therapy for Type IIb familial dyslipoproteinemia?
Same as IIa; plus carbohydrate restriction, Clofibrate, Gemfibrozil, Lovastatin.
p.3
Evaluation and Treatment of Atherosclerosis
What may physical examination reveal in individuals with atherosclerosis?
Physical examination may reveal arterial bruits and evidence of decreased blood flow to tissues.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the function of Nicotinic acid in treating dyslipoproteinemias?
Nicotinic acid decreases the release of free fatty acids from adipose tissue, increases lipogenesis in the liver, decreases glucagon release, and is most effective for type V disorder.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the function of Gemfibrozil in treating dyslipoproteinemias?
Gemfibrozil is similar to clofibrate but increases HDLs more.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What effects do proinflammatory cytokines have on smooth muscle cells (SMCs)?
They induce NO production and inhibit growth, collagen, and actin expression.
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
What are some drugs being developed to specifically increase HDL?
Recombinant apolipoprotein A-I (ApoA-I) mimetics, thiazolidinediones, and cholesteryl ester transfer protein inhibitors
p.7
Risk Factors for Atherosclerosis
What is diabetes associated with in terms of lipoproteins?
Dyslipidemia due to alteration of hepatic lipoprotein synthesis and increases in triglycerides and LDL oxidation
p.5
Risk Factors for Atherosclerosis
What are the risk factors for CAD?
The risk factors for CAD are the same as those for atherosclerosis and can be categorized as conventional (major) versus nontraditional (novel) and modifiable versus nonmodifiable.
p.1
Raynaud Phenomenon and Disease
What exercises are helpful in the early stages of vasospasm in Raynaud disease?
Exercises that build centrifugal force in the extremities.
p.5
Risk Factors for Atherosclerosis
What role do gene polymorphisms play in CAD?
Many gene polymorphisms have been associated with CAD and its risk factors.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What do proinflammatory lipids generated by oxidized LDL induce?
They induce endothelial expression of the adhesion molecule; vascular cell adhesion molecule-1 activates complement and stimulates chemokine secretion.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What is the link between CAD and elevated plasma lipoprotein concentrations?
The link between CAD and elevated plasma lipoprotein concentrations is well documented.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What essential substances require cholesterol for their manufacture?
Cholesterol is a necessary component for the manufacture of bile acids and steroid hormones.
p.1
Atherosclerosis Pathophysiology
What happens once endothelial injury has occurred in atherosclerosis?
Endothelial dysfunction and inflammation lead to a series of pathophysiologic events.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What are some secondary causes of dyslipidemia?
Secondary causes of dyslipidemia include systemic disorders such as diabetes, hypothyroidism, pancreatitis, renal nephrosis, and the use of certain medications.
p.1
Atherosclerosis Pathophysiology
What receptors on macrophages enable detection and engulfment of LDL in atherosclerosis?
Toll-like receptors (TLRs) and LDL receptor-related protein (LRP).
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
Which HDL molecule is most protective in preventing atherosclerosis?
The smaller HDL3 molecule
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
What are niacin and fibrates able to do?
Cause modest increases in HDL
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
What has lipoprotein (a) been shown to be an important risk factor for?
Coronary atherosclerosis, especially in women
p.7
Controversies in Cardiovascular Disease Prevention
What have low levels of HDL been strongly correlated with?
Increased cardiovascular risk
p.1
Raynaud Phenomenon and Disease
What is the treatment for Raynaud phenomenon not associated with malignancy?
Amelioration of symptoms with arm exercises and medications such as calcium channel blockers, alpha-blockers, prostaglandin analogs, or endothelin antagonists.
p.1
Raynaud Phenomenon and Disease
What pharmacologic management can be used if attacks of vasospasm become frequent or prolonged in Raynaud disease?
Calcium channel blockers, nitric oxide agonists, alpha-blockers, prostaglandin analogs, and selective serotonin reuptake inhibitors.
p.5
Risk Factors for Atherosclerosis
How is blood type linked to cardiovascular risk?
Blood type is linked to cardiovascular risk, with type O associated with the lowest risk and type AB the highest.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What causes the adhesion and entry of mononuclear leukocytes?
The factors caused by oxidized LDL, such as proinflammatory lipids, cause adhesion and entry of mononuclear leukocytes, particularly monocytes and T lymphocytes.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What does the term lipoprotein refer to?
The term lipoprotein refers to lipids, phospholipids, cholesterol, and triglycerides bound to carrier proteins.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What effects do proinflammatory cytokines have on endothelial cells?
They stimulate the expression of adhesion molecules and procoagulant activity.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What happens to chylomicron remnants?
Chylomicron remnants, composed mainly of cholesterol, are taken up by the liver.
p.1
Atherosclerosis Pathophysiology
What is the effect of oxidized LDL on endothelial cells?
It is toxic to endothelial cells and causes smooth muscle proliferation.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What are apolipoprotein B levels a predictor of?
Apolipoprotein B levels are a very strong predictor of future coronary events.
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
What do experts currently recommend to increase HDL levels?
Exercise, weight loss, fish oil consumption, and moderate alcohol
p.7
Risk Factors for Atherosclerosis
What overactivity is commonly found in hypertension and contributes to the genesis of coronary artery disease?
The overactivity of the SNS and RAAS
p.7
Controversies in Cardiovascular Disease Prevention
What was the result of using the CETP inhibitor torcetrapib?
An increase in cardiovascular risk
p.5
Risk Factors for Atherosclerosis
What insights have nontraditional risk factors provided regarding CAD?
Nontraditional risk factors have provided insight into the pathogenesis of CAD and may lead to more effective interventions.
p.5
Risk Factors for Atherosclerosis
How can family history contribute to CAD?
Family history may contribute to CAD through genetics and shared environmental exposures.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What happens to intimal LDL through the action of free oxygen radicals?
Intimal LDL is oxidized through the action of free oxygen radicals formed by enzymatic or nonenzymatic reactions.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the function of Lovastatin in treating dyslipoproteinemias?
Lovastatin is a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor that decreases cholesterol synthesis in the liver.
p.1
Risk Factors for Atherosclerosis
What are possible causes of endothelial injury in atherosclerosis?
Common risk factors such as smoking, hypertension, diabetes, increased levels of LDL, decreased levels of HDL, and autoimmunity.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What effects do proinflammatory cytokines have on macrophages?
They activate proteases, endocytosis, nitric oxide (NO), and cytokines.
p.1
Risk Factors for Atherosclerosis
What factors contribute to increased LDL oxidation in atherosclerosis?
Diabetes, smoking, and hypertension, especially with increased levels of angiotensin II.
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
What measurement is frequently used to assess cardiovascular risk rather than just LDL or HDL levels alone?
Non-HDL cholesterol (LDL plus VLDL)
p.7
Risk Factors for Atherosclerosis
What does cigarette smoking contribute to in the vessels?
Vessel inflammation and thrombosis
p.7
Controversies in Cardiovascular Disease Prevention
How do women compare to men in terms of cardiovascular benefit from statins for primary prevention?
Women demonstrate less cardiovascular benefit and have no improvement in mortality
p.3
Evaluation and Treatment of Atherosclerosis
What imaging techniques may be necessary to identify affected vessels in atherosclerosis?
X-ray films, electrocardiography, ultrasonography, nuclear scanning, CT, MRI, and angiography may be necessary.
p.1
Atherosclerosis Pathophysiology
Is atherosclerosis a single disease?
No, it is a pathologic process that can affect vascular systems throughout the body, resulting in ischemic syndromes that can vary widely in their severity and clinical manifestations.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What does the autoimmune reaction induced by oxidized LDL lead to?
It leads to the production of proinflammatory cytokines.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What is the role of chylomicrons in lipid metabolism?
Chylomicrons are required for absorption of fat; they transport exogenous lipid from the intestine to the liver and peripheral cells.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What causes primary or familial dyslipoproteinemias?
Primary or familial dyslipoproteinemias result from genetic defects that cause abnormalities in lipid-metabolizing enzymes and abnormal cellular lipid receptors.
p.7
Risk Factors for Atherosclerosis
What does the release of catecholamines increase?
Heart rate and peripheral vascular constriction
p.7
Controversies in Cardiovascular Disease Prevention
What have some clinical trials and meta-analyses shown about the use of statins, niacin, and other cholesterol-lowering medications?
A reduction in primary cardiovascular events
p.4
Peripheral Artery Disease (PAD)
What are the risk factors for PAD?
The same as those for atherosclerotic disease, especially prevalent in individuals who smoke and those with diabetes.
p.3
Dyslipidemia and Its Impact on Cardiovascular Health
What are some of the proinflammatory cytokines produced in response to oxidized LDL?
Proinflammatory cytokines include interferon-gamma, tumor necrosis factor-alpha, and interleukin-1.
p.6
Dyslipidemia and Its Impact on Cardiovascular Health
What is the function of Progesterone in treating dyslipoproteinemias?
Progesterone decreases plasma triglycerides in type V disorders and is experimental.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What does dyslipidemia refer to?
Dyslipidemia refers to abnormal concentrations of serum lipoproteins.
p.1
Atherosclerosis Pathophysiology
What happens to LDL in the subintima of arterial walls in atherosclerosis?
It is trapped by proteoglycans and becomes oxidized.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
What results in high levels of LDL in the bloodstream?
High dietary intake of cholesterol and fats, often in combination with a genetic predisposition to accumulations of LDL in the serum, results in high levels of LDL in the bloodstream.
p.5
Atherosclerosis Pathophysiology
What role does LDL play in endothelial injury and inflammation?
LDL plays a role in endothelial injury, inflammation, and immune responses important in atherogenesis.
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
What did a study of individuals with a rare genetic trait that increases HDL levels dramatically fail to show?
Any reduced cardiovascular risk in that population
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
What is lipoprotein (a) (Lp[a])?
A genetically determined molecular complex between LDL and a serum glycoprotein called apoprotein (a)
p.7
Risk Factors for Atherosclerosis
How does the risk of CAD change with smoking habits?
The risk increases with heavy smoking and decreases when smoking is stopped
p.7
Controversies in Cardiovascular Disease Prevention
What complicates the ability to weigh the risks and benefits of medication use for primary prevention?
Mixed results from studies
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
How are serum levels of LDL normally controlled?
Serum levels of LDL are normally controlled by hepatic receptors for LDL that bind LDL and limit liver synthesis of this lipoprotein.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
How is excess cholesterol processed in the liver?
Excess cholesterol is processed and eliminated as bile or converted to cholesterol-containing steroids in the liver.
p.7
Risk Factors for Atherosclerosis
What does nicotine stimulate the release of?
Catecholamines (epinephrine and norepinephrine)
p.7
Controversies in Cardiovascular Disease Prevention
What is clear from studies about the role of medications in the prevention of cardiovascular disease?
There is still much work needed to fully understand the proper role
p.4
Peripheral Artery Disease (PAD)
What does evaluation for PAD require?
A careful history and physical examination that focuses on looking for evidence of atherosclerotic disease.
p.5
Dyslipidemia and Its Impact on Cardiovascular Health
How does measurement of LDL subfractions help in predicting coronary risk?
Measurement of LDL subfractions allows for better prediction of coronary risk, such as detecting small dense LDL particles that are the most atherogenic.
p.7
Dyslipidemia and Its Impact on Cardiovascular Health
What is still being evaluated about the new drugs aimed at increasing HDL?
Their effectiveness in preventing heart disease and their safety
p.7
Risk Factors for Atherosclerosis
What can aggressive management of diabetes significantly improve?
CAD risk in individuals with diabetes
p.4
Evaluation and Treatment of Atherosclerosis
What are current management strategies for atherosclerosis focused on?
Detecting and treating preclinical lesions with drugs aimed at stabilizing and reversing plaques before they rupture.
p.4
Evaluation and Treatment of Atherosclerosis
What lifestyle changes are recommended for managing atherosclerosis?
Exercise, smoking cessation, and control of hypertension and diabetes when appropriate.
p.4
Peripheral Artery Disease (PAD)
What newer treatment modalities are being explored for PAD?
Autologous stem cell therapies, gene therapy, and angiogenesis.
p.7
Risk Factors for Atherosclerosis
What is the result of increased heart rate and peripheral vascular constriction due to nicotine?
Increased blood pressure, cardiac workload, and oxygen demand
p.7
Controversies in Cardiovascular Disease Prevention
What significant complications are linked to statin use?
Muscle soreness, elevation in liver enzymes, cognitive impairment, and diabetes
p.4
Peripheral Artery Disease (PAD)
What can result from arterial obstruction in PAD?
Lower-extremity ischemia, which can be gradual or acute.
p.4
Evaluation and Treatment of Atherosclerosis
What is the primary goal in managing atherosclerosis once a lesion obstructs blood flow?
To restore adequate blood flow to the affected tissues.
p.4
Evaluation and Treatment of Atherosclerosis
How can LDL cholesterol be reduced in the management of atherosclerosis?
By diet or medications or both.
p.4
Myocardial Ischemia and Acute Coronary Syndromes
What constitutes the often-fatal event known as a heart attack?
Infarction, which is irreversible myocardial injury.
p.4
Peripheral Artery Disease (PAD)
What is PAD a significant predictor of?
Systemic atherosclerotic disease.
p.4
Peripheral Artery Disease (PAD)
What happens if a thrombus forms over the atherosclerotic lesion in PAD?
Perfusion can cease acutely with severe pain, loss of pulses, and skin color changes in the affected extremity.
p.4
Coronary Artery Disease (CAD)
What forms a pathophysiologic continuum that impairs the pumping ability of the heart?
Coronary Artery Disease (CAD), myocardial ischemia, and acute coronary syndromes.
p.4
Peripheral Artery Disease (PAD)
How many Americans are affected by PAD?
Approximately 8 to 12 million Americans.
p.4
Peripheral Artery Disease (PAD)
What may be indicated if acute or refractory symptoms of PAD occur?
Emergent percutaneous or surgical revascularization.
p.4
Evaluation and Treatment of Atherosclerosis
What are the management focuses in situations where the disease process does not require immediate intervention?
Reducing risk factors, removing the initial causes of vessel damage, and preventing lesion progression.
p.4
Peripheral Artery Disease (PAD)
What does treatment for PAD include?
Risk factor reduction, antiplatelet therapy, and management with vasodilators, antiplatelet or antithrombotic medications, cholesterol-lowering medications, and exercise rehabilitation.
p.4
Coronary Artery Disease (CAD)
What is ischemia?
A local state in which the cells are temporarily deprived of blood supply, remaining alive but unable to function normally.
p.4
Peripheral Artery Disease (PAD)
What is intermittent claudication?
Pain with ambulation caused by gradually increasing obstruction to arterial blood flow to the legs.
p.4
Coronary Artery Disease (CAD)
What can CAD diminish until it impairs myocardial metabolism enough to cause ischemia?
The myocardial blood supply.
