Rush University - NSG 533 Module 8 CAD and HTN objectives Study Guide. Latest 2021. Explain the comprehensive risk factor profile (including
... [Show More] dyslipidemia, genetic factors, traditional modifiable
and non-modifiable risk factors, and novel risk factors) for coronary artery disease (CAD).
o Genetic Factors:
Elevated LDL linked to CHD in persons with genetic forms of hypercholesterolemia
Decreased LDL removal related to defective or reduces number of LDL receptors
Familial Hypercholesterolemia (FH) develop significant atherosclerosis early on and
premature CAD in the absence of other risk factors
If left untreated can have heart attack in 30-40s
o Modifiable Risk Factors:
Dyslipidemia
Elevated LDL-C
Low HDL-C
Hypertriglyceridemia
Hyperhomocysteinemia
Smoking
Hypertension
Physical Inactivity
Diabetes Mellitus
Atherogenic Diet
Obesity
o Non-Modifiable Risk Factors:
Family History & Genetic Factors:
Elevated LDL linked to CHD in persons with genetic forms of hypercholesterolemia
Decreased LDL removal related to defective or reduces number of LDL receptors
Familial Hypercholesterolemia (FH) develop significant atherosclerosis early on and
premature CAD in the absence of other risk factors
o If left untreated can have heart attack in 30-40s
Age
Gender: male gender or women after menopause
Blood type: AB highest risk, O lowest risk
o Novel Risk Factors
Elevated lipoprotein (a)
Associated with atherosclerosis and thrombosis
At risk for premature CAD as well as Stroke
Genetically derived particle
Elevated high sensitivity C-reactive protein (hs-CRP)
Inflammatory marker
The serum marker more systemic inflammation, CRP, is now considered a major risk
factor marker for atherosclerosis and vascular disease
Elevated fibrinogen
Inflammatory marker
Elevated LDL particle number
Small, dense LDL
Describe the relationship among lipids/lipoproteins, atherosclerosis, and CAD.
o The link between CAD and elevated lipoproteins is well documents. The term lipoprotein refers to
lipids, phospholipids, cholesterol, and triglycerides bound to carrier proteins
o An increased serum concentration of LDL (low density lipoproteins) is a strong indicator for
coronary risk
LDL is responsible for the delivery of cholesterol to the tissues
LDL oxidation, migration into the vessel wall, and phagocytosis by macrophages are key
steps in the pathogenesis of atherosclerosis.
LDL also plays a role in endothelial injury, inflammation, and immune responses that have
been identified as being important in atherogenesis.
LDL-C measurements allow for detection of small the small dense LDL particles that are the
most atherogenic
Apolipoprotein B levels are a very strong predictor of future coronary events
o Low levels of HDL cholesterol also are a strong indicator of coronary risk
HDL is responsible for “reverse cholesterol transport” which returns excess cholesterol from
the tissues to the liver where it binds to hepatic receptors (including the LDL receptor) and is
process and eliminated as bile or converted to cholesterol-containing steroids.
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 ATP-binding cassette transporter proteins (ABC proteins)
HDL also participates in endothelial repair and decreases thrombosis
HDL3 is the most protective in preventing atherosclerosis
o Other lipoproteins associated with increased cardiovascular risk include elevated serum VLDL
(triglycerides) and increase lipoprotein (a).
Triglycerides are associated with an increased risk for CAD, especially in combination with
other risk factors such as diabetes. Because of this, the measurement of “non HDL
cholesterol” (LDL plus VLDL) is frequently used to assess cardiovascular risk rather than just
LDL or HDL levels alone
Lipoprotein (a) is genetically determined molecular complex between LDL and a serum
glycoprotein called apoproteins (a) that has been shown to be an important risk factor for
coronary atherosclerosis, especially in women
Describe risk levels for CAD associated with serum lipids and lipoproteins (Table 33.3, p. 1075).
o LDL
An increased serum LDL has the greatest association with the development of
atherosclerosis and is a strong indicator of coronary risk
Small and dense LDL have a greater association with atherosclerosis
< 100 is optimal, > 160 is high, >190 is very high
LDL is the real management goal in patients with ASCVD, the higher the individual’s risk the
lower the LDL cholesterol goal is
o HDL
Low levels of HDL are also a strong indicator of coronary risk
< 40 is low, > 60 is high
HDL levels are higher in children and women, and decrease with age
o Triglycerides
Elevated triglycerides are associate with Type II DM, chronic renal failure, drugs
(corticosteroids, hormone replacement), genetic disorders, high alcohol consumption, high
intake of carbs and simple sugars, physical inactivity [Show Less]