11:17 - Nutrition and Cardiovascular Disease and Stroke

11:17 - Nutrition and Cardiovascular Disease and Stroke -...

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Cardiovascular Disease and Stroke Reading: Gropper 4 th ed, Ch 6, pp. 144-151, 166-167 Gropper 5 th ed, Ch 5, pp. 149–157, 176–177
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2 Objectives for today: Atherogenic process Role of inflammation Role of dietary lipids in cardiovascular disease and stroke
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3 Definitions Atherosclerosis Characterized by thickening of vessels and plaques laden with fatty macrophages=inflammatory process Leading cause of CAD and cerebrovascular disease Arteriosclerosis Thickening of the blood vessel walls, resulting in loss of elasticity and narrowed lumen, presence of plaque Both changes increase resistance and blood pressure (hypertension), which increases the work load on the heart Coronary artery disease (CAD) Heart disease caused by narrowing of blood vessels that supply blood to the heart
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4 Clinical Manifestations of Atherosclerosis Cardiovascular disease (CVD) Includes CAD, congenital heart disease, arrhythmias, congestive heart failure Cerebrovascular disease Includes stroke (~80% ischemic, 20% hemorrhagic), and transient ischemic attack (TIA) Peripheral vascular disease Includes carotid artery disease and intermittent claudication (“limping”; intermittent cramping pain)
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5 (From Harkreader H. Fundamentals. Philadelphia: W.B. Saunders, 2000) Natural progression of atherosclerosis
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6 Major risk factors for CVD Adverse blood cholesterol High blood pressure (hypertension) Smoking Diabetes
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7 Risk factors for CVD Diet related Adverse blood cholesterol, high blood pressure (hypertension), diabetes, obesity, alcohol consumption Other risk factors smoking, stress, physical inactivity age, sex, race, family history
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8 Table 6-3, p. 140 Composition of lipoproteins
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9 Table 6-4, p. 141
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10 Lipids and lipoproteins HDL (“Good cholesterol”) Produced by liver Removes cholesterol from peripheral cells for transport to the liver apoE lipoprotein binds to LDL receptor on peripheral cells apoA-1 lipoprotein stimulates LCAT (lecithin:cholesterol acyltransferase) Converts cholesterol to cholesterol esters, which are transported to liver, converted to bile salt, and excreted from body
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11 What makes HDL “good”? Reverse cholesterol transport by HDL Transport of cholesterol esters from periphery to liver Reduces amount of cholesterol deposited in vascular endothelium Reduces risk of fatty plaque formation
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12 Lipids and lipoproteins VLDL (“Bad cholesterol”) Produced by liver Rapidly reduced to LDL by lipoprotein lipase Major cholesterol carrier to peripheral tissues apoB-100 = ligand for LDL receptor (apoB, E receptor) LDL binds to LDL receptor and is taken up by peripheral cells includes vascular endothelium In normal individuals, deleterious effects of LDL are opposed by HDL High HDL:LDL ratio decreases risk of CVD
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LDL receptor (coated pit) Cholesteryl Linoleate Protein LDL LDL binding Lysosome
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11:17 - Nutrition and Cardiovascular Disease and Stroke -...

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