SSEH3301 Study Guide - Final Guide: Reverse Cholesterol Transport, High-Density Lipoprotein, Low-Density Lipoprotein
20 Jun 2018
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Chapter 3: Health Risk Factor Modification
Risk Factor
→ A factor which has shown a strong epidemiological association with incidence of CVD
→ A factor which pathophysiological mechanism can be postulated to explain epidemiological
association to CVD
1. Modifiable → Age, Gender, Family History
2. Non-modifiable → High blood lipids, smoking, hypertension, obesity, diabetes, physical
inactivity, nutrition, stress/behaviour, syndrome X
With RISK FACTOR MODIFICATION → A decrease in extent of atherosclerosis occurs within a
year of appropriate changes of lfestyle
1. Age → older people are at higher risk (associated with BP, weight, PA)
2. Gender → men are at higher risk
3. Family history → 1st order relative with premature manifestation of CVD → 30%
increase risk, however, genetic predisposition does not mean you will develop the
disease
4. Blood lipids (cholesterol) → Compound produced in your body or food you ingest,
function is to transport of fat in bloodstream, too much cause problem
TOTAL CHOLESTEROL = LDL Cholesterol (Bad) + HDL Cholesterol + VLDL
Cholesterol)
Triglycerides
→ LDL increase risk of CVD, high LDL increase chance and degree of oxidation,
increase plaque formation and development.
→ HDL decrease risk of CVD, reverse cholesterol transport, decrease monocyte
adhesion, maintains endothelial function
BLOOD Lipid Profile →
- Total cholesterol < 5.2 mmol/L
- LDL cholesterol < 3.4 mmol/L
- HDL cholesterol > 1.0 mmol/L
- Total cholesterol: HDL < 3.5 mmol/L
- Trigylcerides < 1.7mmol/L
Modification
→ Exercise (aerobic, increase HDL)
→ Diet (decrease fat intake, increase fibre, small alcohol intake, increase soy protein
→ Drug Therapy (lipid lowering medication if cholesterol remains high)
Type of Fats in Diet
→ Saturated Fats (animal fats, coconut oil, increase LDL)
→ Monounsaturated Fats (olive, canola oil, decrease LDL, increase or maintain HDL)
→ Polyunsaturated Fats (corn and peanut oil, increase omega 3, decrease risk of CAD)
→ Trans-Fatty Acids (processed, fried, baked food, increase LDL, decrease HDL)
→ 5g of trans fat can increase risk of CVD by 25%
5. Smoking
Linear relationship between no of cigarettes smoked and extent of atherosclerosis.
Smoking increase risk x2.
→ How smoking increase risk of CVD
1. Increase myocardial oxygen demand
2. Increase endothelial damage (increase platelet aggregation and clotting,
vasoconstriction, permeability)
3. Destabilizes plaque and increase LDL oxidation
4. Effect on blood lipids
→ How to modify / tips for quitting
End habit to decrease risk of CVD
Help a friend quit
Counselling
Pharmacologic treatment
Start exercising
Financial incentive
6. Hypertension
→ Blood pressure (BP) force exerted by blood against artery walls
→ High BP → Hypertension (Systolic > 140mmHg, Diastolic > 90mmHg)
→ Grade 1(S 140-159, D 90-99), Grade 2 (S 160-170, D 100-109), Grade 3 (S>180,
D>110)
→ Over 30% of Australian >25 yo have hypertension
→ Every 20mmHg increase in systolic or 10 mmHg in diastolic BP → Double risk of CVD
→ How does hypertension increase risk of CVD
a. Direct injury to endothelium
b. Increase myocardial oxygen deman
c. Increase likelihood of plaque rupture
d. Can cause aneurysm (abnormal swelling or bulge in blood vessel) or
haemorrhage
→ Decrease BP
a. Aerobic Exercise
i. Weight loss and stress management
b. Diet
i. Sodium intake <2400mg/day (look for foods with <120mg/100g on label,
never add salt, avoid food with visible salt, decrease processed food)
ii. Alcohol consumption (<2 standard drinks per day, <4 drinks on a single
occasion, increase no alcohol free days per week, use smaller glass)
c. Stress Management and Drug Therapy (If BP is >160/100 mmHg)
Document Summary
A factor which has shown a strong epidemiological association with incidence of cvd. A factor which pathophysiological mechanism can be postulated to explain epidemiological association to cvd inactivity, nutrition, stress/behaviour, syndrome x: modifiable age, gender, family history, non-modifiable high blood lipids, smoking, hypertension, obesity, diabetes, physical. Total cholesterol = ldl cholesterol (bad) + hdl cholesterol + vldl. Ldl increase risk of cvd, high ldl increase chance and degree of oxidation, increase plaque formation and development. Hdl decrease risk of cvd, reverse cholesterol transport, decrease monocyte adhesion, maintains endothelial function. Diet (decrease fat intake, increase fibre, small alcohol intake, increase soy protein. Drug therapy (lipid lowering medication if cholesterol remains high) Saturated fats (animal fats, coconut oil, increase ldl) Monounsaturated fats (olive, canola oil, decrease ldl, increase or maintain hdl) Polyunsaturated fats (corn and peanut oil, increase omega 3, decrease risk of cad) Trans-fatty acids (processed, fried, baked food, increase ldl, decrease hdl)
