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Week 7 Astrup article, CVD Risk Factors and Pathogenesis of Atherosclerosis Aims:
- To continue discussions of the Astrup article
- To build on the previous weeks 9 case studies in terms of the additional risk factors for CVD/pancreatitis.
- To describe the Pathogenesis of Atherosclerosis (or Pancreatitis) for the 9 cases and Treatment. Method:
- View the lectures from weeks 6 and 7 (Week 6 Parts A: CVD Facts, B Risk Factors for CVD and C: Risk Factor Cases Studies and week 7 Part A Pathogenesis of Atherosclerosis, Part B Treatment - Drugs & Surgery and Part C Treatment - Primary & Secondary Prevention)
- View the Lipid Animations as there is more information than the lectures (normal carbohydrate metabolism, diabetes, hypertension, smoking, familial hypercholesterolaemia) and Pathogenesis of Atherosclerosis (Moodle).
- Finish reading the article by Astrup et al. (pages 849-857) “Saturated Fats and Health: A reassessment and Proposal for Food Based Recommendations”, so you are able to answer the questions.
- Read the article by Koehler et al “Bloodletting to treat severe hypertriglyceridemia” as this will help with Case 7.
- Answer the following questions in the spaces provided
- Don’t forget to answer the questions at the very end of this practical/tutorial. Use the risk calculator provided to answer the last question. Reminder of the 9 cases studies – complete the table below re: sdLDL and risk of CVD or pancreatitis (if applicable) Case Name TC (mmol/L) TG (mmol/L) HDL-C (mmol/L) LDL-C (mmol/L) Sample appearance Type Presence of small dense LDL (Yes/No) Risk of CVD (Yes/No) 1 Robert Smith 17.8 1.5 1.0 15.7 clear IIa homozyg ous 2 Cathy Potts 6.7 0.7 2.5 3.6 clear N/A 3 Ben Shorts 9.2 1.5 1.0 7.3 clear IIa heterozy gous 4 Melinda Best 5.7 3.7 1.0 2.9 cloudy III 5 Greg Morrison 28.0 80.0 0.9 3.4 Creamy V 6 Steve Cain 5.2 20 0.9 3.2 Creamy (top layer) I 7 Peter Summers 37 203 0.8 3.9 Creamy throughout I 8 Mike Hughes 4.8 1.0 0.5 3.8 clear N/A 9 Emily Wills 5.2 3.6 0.8 2.6 cloudy N/A No (^) yes?
If you have any questions, don’t forget to attend the zoom meeting held during the Monday 8.30-10.30am lecture time (except weeks 4, 6 and 8 the zoom will be held after the quiz, i.e. 9.30-10.30am), or post your queries on the Moodle forum, or email me bmeyer@uow.edu.au but I prefer you to utilize the zoom meeting and the Moodle forum in the first instance. Table showing which group will lead the discussion on which case in week 5 and week 7 Case 1 Week 5 group number explaining the case Week 7 group number explaining the case 1 9 1 2 8 2 3 7 5 4 6 4 5 5 8 6 4 6 7 3 7 8 2 9 9 1 3 Group 1 : From the article by Astrup et al. “Saturated Fats and Health: A reassessment and Proposal for Food Based Recommendations” (hint page 849): Explain why a person with insulin resistance has a higher propensity to convert carbohydrate to fat. What is a good biomarker for this phenotype?
highest
risk due^ to^ homozygous
= no risk^ for^ CVD
-^4 highest^ = increase risk^ of 75th (^) highest
CUD
risk
Does this person require treatment and if so, what do you recommend and why (explain how the treatment will work)? Hint: treatment think of lifestyle changes, diet, drugs etc
- Liver transplant
- plasma exchange → blood is separated from^
red blood^ cells^
and
Group 2 : From the article by Astrup et al. “Saturated Fats and Health: A reassessment and Proposal for Food Based Recommendations” (hint page 849): Do low carbohydrate diets increase or decrease the rates of whole body fat oxidation? And therefore explain why a higher dietary saturated fat intake is associated with lower circulating saturated fats in the context of a low carbohydrate diet. Case 2: Cathy Potts: Reminder of plasma lipid levels Case Name (^) (mmolTC/L) (mmol^ TG/L) (^ HDL-Cmmol/L) (mmol^ LDL-C/L) appearance^ Sample^ Type^ Presence of small dense LDL (Yes/No) Risk of CVD (Yes/No) 2 Cathy Potts 6.7 0.7 2.5 3.6 clear N/A Age 42, smoker, non-drinker of alcohol, BMI = 24, W/H ratio = 0.75, normal blood pressure (110mmHg SBP, 72mmHg DBP), no other medical abnormalities, no history of diabetes or coronary heart disease in the family. Don’t forget to include their plasma lipids levels as risk factors if applicable.
- Increases fat oxidation
- makes (^) body rely on^ burning fat
instead of carbs for^ energy
- results (^) in lower circulating fats fa✓ 107 .^ risk
of
CVD
very v56.s)ñˢÉi"ˢ )
event
/ (ob%ot^ asaieraoigood . ↓ w
No yes
Does this person require treatment and if so, what do you recommend and why (explain how the treatment will work)? Hint: treatment think of lifestyle changes, diet, drugs etc
- strongly recommended^ to^ quit smoking
- exercise ( release (^) stress)
- Nicotine Replacement^ therapy . ( NRT)
Food Based Recommendations” (hint page 849): Palmitic acid is the primary fatty acid product of the de novo lipogenesis. What is a good surrogate for the de novo lipogenesis? Why is it a good surrogate? What is this surrogate strongly linked to? Case 3: Ben Shorts: Reminder of plasma lipid levels Case Name TC (mmol/L) TG (mmol/L) HDL-C (mmol/L) LDL-C (mmol/L) Sample appearance Type Presence of small dense LDL (Yes/No) Risk of CVD (Yes/No) 3 Ben Shorts 9.2 1.5 1.0 7.3 clear IIa heterozy gous No Yes Age 55, non-smoker, drinks occasionally, BMI = 2 4 , W/H ratio = 0.9, normal blood pressure (120mmHg SBP, 70mmHg DBP), no other medical abnormalities, no history of diabetes, his grandfather died from heart attack at age 58 and his uncle has just had his first heart attack at age 56. He has xanthelasma – planar xanthoma involving the eyelid(s). (Recall that xanthoma means a tumor composed of lipid-laden foam cells, which are histiocytes containing cytoplasmic lipid material) Picture obtained from Dorland’s Illustrated Medical Dictionary, 30th edition, Saunders © Don’t forget to include their plasma lipids levels as risk factors if applicable. List all the risk factors for Atherosclerosis (or pancreatitis) if applicable
to
fat.
- (^) linked to^ obesity ,^ hypertriglyceridemia
- BMI
- W/ (^) A
ratio
Genetics
Does this person require treatment and if so, what do you recommend and why (explain how the treatment will work)? Hint: treatment think of lifestyle changes, diet, drugs etc
- healthy lifestyle^ →^ diet^
exercise
managing
stress_
Group 4 : From the article by Astrup et al. “Saturated Fats and Health: A reassessment and Proposal for Food Based Recommendations” (hint page 852): Define healthfulness of fats. Explain what this means in your own words.
their introduction
to a^ balanced^
diet.
Does this person require treatment and if so, what do you recommend and why (explain how the treatment will work)? Hint: treatment think of lifestyle changes, diet, drugs etc Progression
earliest sign^
.
Group 8 : From the article by Astrup et al. “Saturated Fats and Health: A reassessment and Proposal for Food Based Recommendations” (hint page 853): Given that cheese and yoghurt intakes are inversely associated with CVD risk, should we consume low fat dairy or full fat dairy? Explain your answer. What are good biomarkers of dairy intakes? Case 5: Greg Morrison: Reminder of plasma lipid levels Case Name (^) (mmolTC/L) (mmol^ TG/L) (mmol^ HDL-C/L) (mmol^ LDL-C/L) appearance^ Sample^ Type^ Presence of small dense LDL (Yes/No) Risk of CVD (Yes/No) 5 Greg Morrison 28.0 80.0 0.9 3.4 Creamy V Age 33, a non-smoker, drinks far too much beer and is overweight - BMI = 30 and W/H ratio = 1.1. Elevated blood pressure (140mmHg SBP, 85 mmHg DBP). His blood glucose levels are 12 mmol/L. He has eruptive xanthoma. He has a Picture obtained from Dorland’s Illustrated Medical Dictionary, Picture obtained from A Handbook of Hyperlipidaemia,
full fat
dairy has an (^) inverse effect with
CVD
No No
Does this person require treatment and if so, what do you recommend and why (explain how the treatment will work)? Hint: treatment think of lifestyle changes, diet, drugs etc Yes (^) , drugs →^ librates,^ Nicotinic^
acid.
Group 6 : From the article by Astrup et al. “Saturated Fats and Health: A reassessment and Proposal for Food Based Recommendations” (hint page 853):
Given their risk factors, in your own words, describe their Pathogenesis of Atherosclerosis (or pancreatitis if applicable). DO NOT just repeat the risk factors.
Does this person require treatment and if so, what do you recommend and why (explain how the treatment will work)? Hint: treatment think of lifestyle changes, diet, drugs etc
