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+ Topic 1.4, Reducing the risk of CVD + Risk Factors of CVD High blood pressure Obesity High blood cholesterol Smoking Genetic inheritance Inactivity High stress High alcohol consumption High salt intake Low antioxidant intake + Ways to reduce the risk Reduce blood pressure Stop smoking Reduce salt intake Lower cholesterol level, mainly LDL-C Reducing intake of fat and saturated fat Increase physical activity Get to a point where waist to hip ratio is under 0.85/0.9, or BMI is 20-25 Alcohol in moderation + Blood Pressure Use pages 49 and 50 in the textbook to complete activity 1.25a in the handout packet Type of How does it reduce BP? drug ACE inhibitors Angiotensin converting enzyme inhibitors Reduce conversion of inactive angiotensin I to angiotensin II Angiotensin II causes vasoconstriction Less angiotensin II = less vasoconstriction = reduced BP Inactive Angiotensin I ACE inhibitor Angiotensin II vasoconstriction Raised b.p. Possible side effects? Cough Dizziness Abnormal heart beats Reduced kidney function Additional information Reduces risk of kidney failure for patients with kidney disease. Some patients intolerant: need alternative, which affects receptors. Block the Ca+2 ion channels in the muscle cells lining the arteries Ca cannot enter cells and muscles cannot contract Vessels do not constrict = lower BP Calcium channel blockers Headaches Dizziness Swollen ankles (fluid build-up) Abnormal heart rhythms Constipation Flushing of skin Not given to people who have had a heart attack: can make symptoms of heart failure worse or fatal Diuretic increase the amount of urine produced (opposite effect to ADH: tubules become less permeable to H2O, less is reabsorbed, more lost in urine) decrease in blood volume = reduced BP Diuretics dizziness nausea cramps + Blood Cholesterol Read pages 50 and 51 and answer Q1.34 and Q1.35. Which drug is used as a treatment? How do statins work? They inhibit an enzyme which produces LDL-C. Are the drugs effective and how do we know? Statins Yes, large sample size, 14 trials. Are there any risks? Yes, statins might cause other problems such as intestinal and respiratory cancers. + British Heart Foundation Gap Fill Fill in the gaps and then we will read through it together. + Diet Use the textbook to complete activity 1.25b Reduced cholesterol intake High levels of cholesterol lead to more build up of plaque and therefore higher risk of CVD Reduced salt intake High levels of salt in the blood cause the kidneys to retain water. This increases volume of blood which raises BP. High BP increases risk of atherosclerosis Energy balance If calorie intake exceeds expenditure then weight is gained. BMI over 25 is a risk factor for CHD: BP + cholesterol level are often higher High in polyunsaturated fatty acids Increase the activity of LDL receptor sites thus lowering level of LDLs in the blood and decreases the risk of atherosclerosis Low in saturated fatty acids LDL cholesterol is composed of cholesterol, proteins, and fatty acids from saturated fats. Lower levels of saturated fats therefore decreases levels of LDL-C 5 portions of fruit + vegetables per day High in antioxidants which reduce the risk of CVD. Radicals react with LDL cholesterol and make it more likely to be taken up into foam cells forming plaques. Antioxidants lower the amount of radicals Also contain non-starch polysaccharides Regular consumption of oily fish Regular consumption of omega 3 fatty acids found in fish such as salmon, mackerel, trout etc has been shown to reduce the risk of CVD (seen in Japan and Greenland) Increase amount of non-starch polysaccharides Also known as soluble fibre. Has been found to bind with cholesterol in the digestive system, reducing the amount absorbed. Found in fruit, veggies, beans, and grains Include sterols and stanols Naturally produced substances found in plants. Compete with cholesterol for absorption, therefore reducing the amount absorbed. Artificially added to certain foods, like margarines. + Anticoagulants and platelet inhibitory drugs What do these drugs so? Give examples and describe how each work: Aspirin Prevents platelets sticking together forming platelet plug. Clopidogrel: prevents platelets from sticking together forming platelet plug Warfarin: anticoagulant, affects production of clotting factors. Are there any risks? Platelet inhibitory drugs or anticoagulants reduce blood clotting. These drugs involve a risk of bleeding. This has to be considered in relation to risk of CVD. Q 1.36 and 1.37