Vascular disease
7 important questions on Vascular disease
With a metabolic syndrome you need more than 3 out of 5 of ....
- RR: >=130/85 mmHg or medication
- Triglycerides: >=1.7 mmol/L
- HDL-c: <1.0 (man) <1.3 (vrouw)
- Waist circumference: >102cm (man) >88cm (vrouw)
- Glucose: >=6.1 mmol/L
- Inflammation
- Trhombosis
- Hyperglycaemia
- Hypertension
- Dyslipidemia
What are the medical guidelines on physical activity?
- AHA/ACC en ESC guidelines:
- >=5 days/wk >30 min moderate-intensive physical activity
- If possible resistance training 2x/wk
- higher daily activities
- high risk patients: supervised training
What are the favourable vascular effects of physical activity
- Lower risk for premature mortality
- Lower risk for vascular disease
- Lower risk for type 2 diabetes
- Lower weight
- Lower systolic and diastolic blood pressure
- Favorable lipid changes: higher HDL-c, lower TG and LDL-c stays the same
- Lower insulin sensitivity
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What is the treatment of lipoproteins?
- Niacin (HDL-c is raised, but no CVD reduction)
- CETP in hibition
- ApoA infusion
Lowering triglycerides (?)
- Fibrates (no effect op CVD reduction on top of statins), possible in subgroups (diabetics?)
- REDUCE IT study: effect of omega 3 fatty acids
- PROMINENT STUDY
Lowering LDL-c: powerful reduction in vascular events: (!)
- Statins
- Ezetimibe
- PCSK9 inhibitors
What is the mechanism of action of statins and ezetimibe
- 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
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)
What is the treatment strategy for hypertension
- 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
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