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- Physical Activity
- Habitual physical activity associated with
reduced incidence of sudden death
- lowers blood pressure
- lowers triglyceride levels
- raises HDL cholesterol levels
- reduces/maintains body weight & muscle
tissue
- Beneficial effects may be primarily due to
exercise-mediated reduced BP & serum cholesterol levels,
reduced weight {decreased body fat}, better glucose tolerance
and increased fibrinolytic activity.
- Obesity
- Independent risk predictor (Framingham Study) for both sexes
- Increased weight positively & independently correlated with:
- coronary
artery disease
- stroke
- congestive
heart failure
- cardiovascular
deaths
- Obesity is correlated with other risk factors, e.g.
hypertension, hypertriglyceridemia, lack of exercise,
hyperinsulinemia & varies inversely with serum HDL
cholesterol
- Platelets
- May promote coronary vasospasm
- Possibly increased platelet coagulant activity
in patients with coronary artery disease
- Family History
- Familial aggregation of risk factors:
hypercholesterolemia spacer + hypertension + diabetes &
obesity
- Homocystinuria-associate disaster disease
- Genetics may influence:
- extent, time, course, atherosclerosis
severity, & symptoms
- Behavioral
Factors Predisposing to Coronary Vascular Disease (CAD)
- Emotional distress
- Circadian rhythm variations
- "Educational" Level: inverse
relationship between educational level & cardiovascular
disease/death
- Interpretation: relationship between
educational level and ability/willingness to modify behavior
and alter other CAD risk factors
- Stress (type A
personality)
- Type "A"personality consistent with
competitiveness, impatience, ambition
- Possible positive correlation between CAD &
type A personality
- Independent risk factor possibly a strong as
hypertension, serum cholesterol, tobacco use ( smoking)
- Glucose
Intolerance
- Diabetes
mellitus {impaired glucose tolerance}
- Frequency:
20% of the population
- Diabetes:
major risk factor highly correlated with obesity, hypertension,
& lipid abnormalities {Framingham Study}
- Additional adverse effects secondary to:
- platelet dysfunction
- increased erythrocyte adhesion
- Cardiovascular
morbidity/mortality: increased 4-6-fold in patients with type II
diabetes*
- High prevalence: due to many factors including specific
cardiac risk factors {hypertension & hyperlipidemia}
- Characteristics of type II diabetes:
- insulin resistance, hyperinsulinemia, altered
carbohydrate/lipid metabolism (causing hyperglycemia),
increased blood very low density & low-density
lipoproteins & decreased blood high-density
lipoproteins
- Pathophysiology: Type II diabetes:
- Vasculopathy-predisposing factors --
vessel wall lipid deposition, resulting/associated with:
- monocyte infiltration, atrial mural
fibrosis, thrombosis, vascular smooth muscle
filtration
- Treatment
issues:
- Limited efficacy associated with angioplasty &coronary
bypass surgical interventions
- Important to reduce other cardiac risk factors, i.e.
hypertension
- Important to reduce/reverse insulin resistance; improve
metabolic control without worsening hyperinsulinemia
- Pharmacological treatment: biguanides &
thiozolidinediones which sensitize tissues to insulin
- Other treatment: diet & exercise
- Gender
- Decreased atherosclerosis incidence: women
- Males: increased likelihood for myocardial
infarction (10 X)
- Alcohol Use:
- Probable
inverse relationship between alcohol use (moderate) and coronary
vascular disease
- > 2 or more drinks/day: elevated blood pressure
- Heavy drinking: increased mortality, many
etiologies
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