Summary Class notes - Nutrition and Cardiometabolic Diseases

Course
- Nutrition and Cardiometabolic Diseases
- Marianne Geleijnse
- 2020 - 2021
- Wageningen University (Wageningen University, Wageningen)
- Voeding en Gezondheid
388 Flashcards & Notes
1 Students
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Summary - Class notes - Nutrition and Cardiometabolic Diseases

  • 1603666800 Introduction & Cardiometabolic Diseases

  • CVD =
    Cardiovascular disease =

    CHD + stroke + peripheral artery disease (PAD) + ...
  • Which 5 thinks can you find in all the 4 diseases? (stroke, coronary heart disease, diabetes type 2 and chronic kidney disease)
    • Insulin resistance 
    • Inflammation 
    • Dyslipidemia 
    • Hypertension 
    • Vascular dysfunction 
  • Cancer causes more deaths than CVD in the Netherlands (CVD is second)
  • Is mortality a good indicator for the burden of disease?
    No, only partly.

    But mortality is the best data that is available when comparing countries.

    Changes in the burden of disease are related to incidence, mortality, cure, population ageing etc. 
  • How does the artherothrombotic process looks like?
    See the image  

    1. normal 
    2. Fatty streak 
    3. Fibrous plaque 
    4. Complicated lesion 
  • A thrombus =
    Blood clot inside a blood vessel or cavity of the heart
  • An embolus =
    Blood clot that moves through the blood stream until it ends up in a narrowed vessel and blocks the circulation
  • Myocardial infarction =
    Zie de afbeelding 

    doordat er geen bloed door kan sterven er cellen af.....?
  • Acute coronary syndrome (ACS) comprises three diseases that involve the coronary arteries:
    • STEMI = ST elevation myocardial infarction 
      • caused by a sudden complete (100%) blockage of a heart artery (coronary artery)
    • NSTEMI = Non-ST elevation myocardial infarction 
      • usually caused by a severely narrowed artery but the artery is not completely blocked 
    • AP = Unstable angina pectoris 
  • How do the ECG (or EKG) pictures of STEMI, NSTEMI (ST depression) and NSTEMI (T inversion) look like
    See the image
  • Heart failure often occurs after myocardial infarction
  • How is the Ejection Fraction, EF, calculated
    EF = (SV/EDV) * 100 


    SV = stroke volume (amount of blood pumped from left ventricle per beat)
    EDV = end-diastolic volume 

    Healthy heart = 60% or more 
    Heart failure = 40% or less 
  • Heart failure also decompensation cords, 'insufficient heart', congestive heart failure (CHF)
  • There are two types of ventricular failure, namelijk
    Left ventricular failure 
    • Fluid builds up in the lungs due to congestion of the veins in the lungs (dyspnoea)

    Right ventricular failure 
    • Fluid accumulates in the body, esp. In the legs and abdominal organs (e.g. liver)
  • What is Peripheral Artery (or Arterial) disease?
    (PAD)

    Vernauwing in de been aderen

    intermittent claudication: Muscle pain (ache, cramp, fatigue) caused by schema, mostly in the calf muscle, which occurs during exercise and is relieved by a short period of rest. - "window-shoppers disease' or 'smoker's legs'
  • How can you diagnose PAD?
    You have PAD is ankle/brachial blood pressure index (ABI) <= 0.9 
  • What can you tell about arterial (thrombo) embolism?
    • Artery in the leg or elsewhere 
    • When it ends up in coronary artery: myocardial infarction 
    • Can also starting in carotid artery or in the heart due to arterial fibrillation --> travels to the brain --> ischemic stroke 
  • What can you tell about venous (thrombosis) embolism, VTE?
    Arises in systemic vein --> travels to the lung --> pulmonary embolism (e.g. After deep venous thrombosis = DVT)
  • Name the 4 types of strokes (cerebrovascular disease)
    • Ischemic stroke
      • blocked brain artery
    • Embolic stroke
      • Thrombus from elsewhere
    • Hemorrhagic stroke
      • Ruptured brain vessel


    • TIA
      • mini-stroke
      • symptoms <24 hours
  • This are two pictures of a CT scan for stroke diagnosis. 
    What tells picture 1 you and what tells picture 2

    And why is this important to know?
    1. Bleeding (white area)
    2. Infarction (dark area) 


    The treatment is different 
    1.  something for bloodclotting or surgery 
    2. aspirin -> om het bloed te verdunnen om zo de bloedprop te verminderen
  • Types of CVD
    • Coronary heart disease
    • Congenital heart disease
    • Stroke
    • Heart infections 
    • Peripheral artery disease 
    • Damage to veins 

    Note: not all forms of CVD are sensitive to diet 
  • Silent diabetes

    Globally, almost half of T2D cases is unaware
    in NL ± 10% unaware
  • What are the diabetes complications?
    1 in 3 diabetic patients dies from kidney failure 

    • Cerebrovascular disease
    • eye damage
    • peripheral neuropathy 
    • coronary heart disease 
    • diabetic nephropathy (kidney damage)
    • iets met de enkels 
    • en iets in de been aders 
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Measure artherosclerosis
  • Intima-media thickness
  • Peripheral arterial disease (angel-arm BP index)
  • Aortic clarification 
  • Coronary artery calcification (CAC)
Measure arterial stiffness
  • Pulse wave velocity 
  • Pulse wave analysis, augmentation index 
Measure endothelial function
  • Flow mediated dilation (FMD)
  • Biochemical markers in blood 
Measure blood pressure
  • Office systolic and diastolic BP
  • 24h-ambulatory BP
  • Home BP
When do you use platelet (=bloedplaatjes) inhibition and give a example
  • Arterial disease --> platelet inhibition
  • Venous disease --> no platelet inhibition, anticoagulation
  • Arterial disease --> high 'shear stress' --> vulnerable plaque rupture --> platelet activation --> thrombus/embolus formation --> ischemia/infarction


  • Different platelet inhibitors: aspirine, dypiridamol, clopidogrel, ticagrelor etc.
  • Most en most robust evidence for aspirine in atherosclerotic disease in general
  • Others for more narrow indications (stents etc)
Wat valt er onder acute plaque rupture and chronic obstruction (CV events are a manifestation of atherosclerotic disease)BrainHeartLegsAorta
Brain
Acute plaque rupture
  • Ischaemic stroke
  • Transient ischaemic attack (TIA)
Chronic obstruction
  • Hemodynamic cerebral
  • Hypoperfusion


Heart
Acute plaque rupture
  • Myocardial infarction
  • Sudden death
Chronic obstruction
  • Angina pectoris


Legs
Acute plaque rupture
  • Acute limb ischemia
Chronic obstruction
  • Intermittent claudication
  • Critical limb ischaemia / gangrene /necrosis


Aorta
Aortic aneurysm formation 
  • Acute rupture
  • Finding by accident or screening
What are probiotics and what are prebiotics
Probiotics are microorganisms

Prebiotics are substrates that are selectively utilised by host microorganisms conferring a health benefit
A medicine for AF
Role of Heat Shick Proteins (HSPs) in AF:
  • HSPs bind to contractile proteins to make them more stable 


The more HSPs the less structural damage GGA (drug) induces HSP expression 
  • it can prevent AF induced cardiomyocyte damage 
  • protect against AF induced structural damage 
  • protects against contractile dysfunction drosophila 


it takes 10 years to invent a new medicine 
  • let food be the medicine (vit C, B3, E, antioxidants)
What is the treatment strategy for hypertension
Choose first antihypertensie drug according to patient characteristics
  • Age >55/6o yrs or blacks: diuretic/calcium antafonist
  • Age <55/60 yrs: ACE-i or ARB
  • Proteinuria or other renal disease: ACE-i or ARB
  • MI, LVH, heart failure: ACE-i or ARB, beta blocker
  • Heart failure: diuretic


If not at target: combine ACE-i/ARB, diuretic and Ca-antagonist
What is the mechanism of action of statins and ezetimibe
Statins 
  • inhibition of cholesterol synthesis in the liver
    • Increase in LDL receptors 
    • More LDL clearance

Ezetimibe
  • Inhibition of Nieman Pick protein 
    • inhibition of enteral cholesterol (re-) absorption