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strokes\tand\t\ntransient\tischemic\tattacks\n(TIAs)\n;\tand\tin\tthe\tperipheral\tcirculation\tit\tcauses\tintermittent\tclaudication,\tlimb\t\nischemia\n(inadequate\tblood\tsupply),\tand\tgangrene\t(\nFig.\t32.4\n).\tThus\tatherosclerosis\tis\tthe\tunderlying\tcause\tof\nmany\tforms\tof\tCVD.
|
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] |
FIG.\t32.4\nMajor\tclinical\tmanifestations\tof\tatherothrombotic\tdisease.\n\tSource:\t(From\tViles-Gonzalez\tJF,\tet\tal:\nAtherothrombosis:\ta\twidespread\tdisease\twith\tunpredictable\tand\tlife-threatening\tconsequences,\t\nEur\tHeart\tJ\n\t25:1197,\t2004.)\nDyslipidemia\n\trefers\tto\ta\tblood\tlipid\tprofile\tthat\tincreases\tthe\trisk\tof\tdeveloping\tatherosclerosis.
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] |
Three\timportant\tbiochemical\tmeasurements\tin\tASCVD\tinclude\tlipoproteins,\n\ttotal\tcholesterol,\tand\ntriglycerides.\tCholesterol\tis\tdelivered\tinto\tcell\twalls\tby\t\nlow-density\tlipoprotein\t(LDL)\n,\tespecially\nsmaller\tparticles.\tTo\tattract\tand\tstimulate\tthe\tmacrophages,\tthe\tcholesterol\tmust\tbe\treleased\tfrom
|
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] |
the\tLDL\tparticles\tand\toxidized,\ta\tkey\tstep\tin\tthe\tongoing\tinflammatory\tprocess.\tAdditionally,\nmacrophages\tmust\tmove\texcess\tcholesterol\tquickly\tinto\t\nhigh-density\tlipoprotein\t(HDL)\n\tparticles\nto\tavoid\tbecoming\tfoam\tcells\tand\tdying.\tThe\ttypical\tdyslipidemic\tcondition\tis\tone\tin\twhich\tLDL\nlevels\tare\televated\t(hyperlipidemia)\tand\tHDL\tlevels\tare\tlow.
|
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] |
levels\tare\televated\t(hyperlipidemia)\tand\tHDL\tlevels\tare\tlow.\nLipoproteins\nLipids\tare\tnot\twater\tsoluble,\tso\tthey\tare\tcarried\tin\tthe\tblood\tbound\tto\tprotein.\tThese\tcomplex\nparticles,\tcalled\t\nlipoproteins\n\tthat\tare\tmanufactured\tin\tthe\tliver,\tvary\tin\tcomposition,\tsize,\tand\ndensity.\tLipoproteins\n\tmeasured\tin\tclinical\tpractice—chylomicrons,
|
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0.06658242642879486,
0.12844343483448029,
0.10274060070514679,
-0.019166497513651848
] |
density.\tLipoproteins\n\tmeasured\tin\tclinical\tpractice—chylomicrons,\t\nvery-low-density\tlipoprotein\n(VLDL),\tlow-density\tlipoproteins\t(LDL)\n,\tand\t\nhigh-density\tlipoproteins\t(HDL)\n—consist\tof\nvarying\tamounts\tof\ttriglyceride,\tcholesterol,\tphospholipid,\tand\tprotein.\tEach\tclass\tof\tlipoprotein
|
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0.03389690816402435
] |
actually\trepresents\ta\tcontinuum\tof\tparticles.\tThe\tratio\tof\tprotein\tto\tfat\tdetermines\tthe\tdensity;\tthus\nparticles\twith\thigher\tlevels\tof\tprotein\n\tare\tthe\tmost\tdense\t(e.g.,\tHDLs\thave\tmore\tprotein\tthan\tLDLs).\nThe\tphysiologic\trole\tof\tlipoprotein\tincludes\ttransporting\tlipid\tto\tcells\tfor\tenergy,\tstorage,\tor\tuse\tas
|
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] |
substrate\tfor\tsynthesis\tof\tother\tcompounds\tsuch\tas\tprostaglandins,\tthromboxanes,\tand\tleukotrienes.\nThe\tlargest\tparticles,\t\nchylomicrons\n,\ttransport\tdietary\tfat\tand\tcholesterol\tfrom\tthe\tsmall\tintestine\nto\tthe\tliver\tand\tperiphery.\tOnce\n\tin\tthe\tbloodstream,\tthe\ttriglycerides\twithin\tthe\tchylomicrons\tare
|
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-0.00978309940546751,
0.029452532529830933,
0.0937088280916214,
0.20295307040214539,
0.0041604237630963326
] |
in\tthe\tbloodstream,\tthe\ttriglycerides\twithin\tthe\tchylomicrons\tare\nhydrolyzed\tby\tlipoprotein\tlipase\t(LPL),\tlocated\ton\tthe\tendothelial\tcell\tsurface\tin\tmuscle\tand\tadipose\ntissue.\t\nApolipoproteins\n\tcarry\tlipids\tin\tthe\tblood\tand\talso\tcontrol\tthe\tmetabolism\tof\tthe\tlipoprotein
|
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0.006663917098194361,
0.11698503792285919,
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0.005591871682554483
] |
molecule.\tApo\tC-II,\tone\tof\tthe\tapolipoproteins,\tis\ta\tcofactor\tfor\tLPL.\tWhen\tapproximately\t90%\tof\tthe\ntriglyceride\tis\thydrolyzed,\n\tthe\tparticle\tis\treleased\tback\tinto\tthe\tblood\tas\ta\tremnant.\tThe\tliver\nmetabolizes\tthese\tchylomicron\tremnants,\tbut\tsome\tdeliver\tcholesterol\tto\tthe\tarterial\twall\tand\tthus
|
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] |
are\tconsidered\tatherogenic.\tConsumption\tof\thigh-fat\tmeals\tproduces\tmore\tchylomicrons\tand\nremnants.\tPlasma\tstudies\tare\tdone\twhen\tfasting;\tchylomicrons\tare\tnormally\tabsent.\nVLDL\tparticles\tare\tsynthesized\tin\tthe\tliver\tto\ttransport\n\tendogenous\ttriglyceride\tand\tcholesterol.
|
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0.02864968031644821
] |
endogenous\ttriglyceride\tand\tcholesterol.\nTriglyceride\taccounts\tfor\t60%\tof\tthe\tVLDL\tparticle.\tThe\tlarge,\tbuoyant\tVLDL\tparticle\tis\tbelieved\tto\nbe\tnonatherogenic.\tVegetarian\tand\tlow-fat\tdiets\tincrease\tthe\tformation\tof\tlarge\tVLDL\tparticles.\nSmaller\tVLDL\tparticles\t(i.e.,\tremnants)\tare\tformed\tfrom\ttriglyceride\thydrolysis\tby\tLPL.\tNormally
|
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these\tremnants,\tcalled\t\nintermediate-density\tlipoproteins\t(IDLs)\n,\tare\tatherogenic\tand\tare\ttaken\nup\tby\treceptors\ton\tthe\tliver\tor\tconverted\tto\tLDLs.\tSome\tof\tthe\tsmaller\tLDL\tparticles\tstay\tin\tthe\nblood,\tare\toxidized,\tand\tare\tthen\ttaken\tinto\tthe\tarterial\twall.\tClinically,\ta\ttotal\ttriglyceride\tlevel\tis\ta
|
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] |
measurement\tof\tthe\ttriglycerides\tcarried\ton\tthe\tVLDL\tand\tthe\tIDL\tremnants.\nLDL\tis\tthe\tprimary\tcholesterol\tcarrier\tin\tblood,\tformed\tby\tthe\tbreakdown\tof\tVLDL.\tHigh\n\tLDL\ncholesterol\tis\tassociated\tspecifically\twith\tatherosclerosis\t(\nStone\tet\tal,\t2014\n).\tA\trecent\tchange\tin
|
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] |
Stone\tet\tal,\t2014\n).\tA\trecent\tchange\tin\nrecommendations\tfrom\tAmerican\tCollege\tof\tCardiology\t(ACC)/American\tHeart\tAssociation\t(AHA)\nwas\tto\tdrop\tthe\tactual\tserum\tLDL\tASCVD\tprevention\ttarget.\tLDL\tlevels\tare\tused\tfor\tdosing\nmedication\tbut\tare\totherwise\tonly\tconsidered\tpart\tof\ta\tbigger\tpicture\tof\trisk\tand\tshould\tnot\tbe\nassessed\tin\tisolation.
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] |
assessed\tin\tisolation.\n\tAfter\tLDL\tformation,\t60%\tis\ttaken\tup\tby\tLDL\treceptors\ton\tthe\tliver,\tadrenals,\nand\tother\ttissues.\tThe\tremainder\tis\tmetabolized\tvia\tnonreceptor\tpathways.\tThe\tnumber\tand\tactivity\nof\tthese\tLDL\treceptors\tare\tmajor\tdeterminants\tof\tthe\tLDL\tlevel\tin\tthe\tblood.\tApolipoprotein\tB\tis\tthe
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] |
structural\tprotein\tfor\tall\tof\tthe\tatherogenic\tlipoproteins\t(VLDL,\tIDL,\tLDL)\tand\tmodulates\tthe\ntransport\tof\tlipids\tfrom\n\tthe\tgut\tand\tliver\tto\tthe\ttissues.\tThe\ttwo\tforms,\tapo\tB\tand\tapoB-100,\tare\nsynthesized\tin\tthe\tliver.\tApoB-100\tconstitutes\t95%\tof\tthe\tapolipoproteins\tin\tLDL.\tApoB-48\tis
|
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metabolic\trole\tas\ta\treservoir\tof\tthe\tapolipoproteins\tthat\n\tdirect\tlipid\tmetabolism.\tApo\tA-I,\tthe\tmain\napolipoprotein\tin\tHDL,\tis\tan\tantiinflammatory,\tantioxidant\tprotein\tthat\talso\thelps\tto\tremove\ncholesterol\tfrom\tthe\tarterial\twall\tto\tthe\tliver\tfor\texcretion\tor\trepackaging.\tThis\tprocess\tprevents\tthe
|
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build-up\tand\toxidation\tof\tcholesterol\tin\tthe\tarteries.\tEvaluation\tof\tapo\tA-I\tor\tthe\tratio\tof\tapo\tB\tto\tapo\nA-I\thas\tbeen\tproposed\tto\tassess\trisk\tand\tdetermine\n\ttreatment\t(\nNavab\tet\tal,\t2011\n).\tThe\tlower\tthe\nratio,\tthe\tlower\tthe\tASCVD\trisk.\tBoth\tapo\tC\tand\tapo\tE\ton\tHDL\tare\ttransferred\tto\tchylomicrons.\tApo
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-4.045251245088366e-8,
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0.08564309775829315,
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0.12112272530794144,
0.055526286363601685,
0.001675190171226859,
0.0656559094786644,
-0.0017790760612115264,
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0.06545957922935486,
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-0.045925043523311615,
0.1141643226146698,
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-0.0036038022954016924,
-0.046086590737104416,
0.07639547437429428,
0.08890648931264877,
-0.04435828700661659,
0.00004754749534185976,
0.07896768301725388,
-0.0075175827369093895,
-0.06948263198137283,
-0.03419297933578491,
0.08190029859542847,
0.014339365065097809,
-0.029429377987980843,
-0.08076479285955429,
-0.003995600622147322,
0.031047463417053223,
0.018020248040556908,
-0.021786872297525406,
0.00645929342135787,
0.049566201865673065,
0.04407184198498726,
0.09617123752832413,
0.020899146795272827
] |
HDL\tlevels\tand\trisk\tof\ncardiovascular\tevents.\tAnd\tgenerally\ta\thigh\tHDL\tlevel\tis\tconsidered\theart-protective.\tHowever\tthere\nis\trecent\tevidence\tthat\tvery\thigh\tlevels\tof\tHDL\tcholesterol\t(greater\tthan\t97)\tare\tactually\ta\trisk\nfactor\t(\nMadsen\tet\tal,\t2017\n).\nTotal\tcholesterol
|
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0.07342380285263062,
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0.017224140465259552,
0.06247454881668091,
0.02319410815834999,
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0.06628954410552979,
0.11019525676965714,
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0.08053552359342575,
0.022760512307286263,
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0.03678963705897331,
0.038189977407455444,
0.06227405369281769,
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-0.011966739781200886,
-0.007284924853593111,
0.021631574258208275,
0.0797225683927536,
-0.003654209431260824,
-0.03871876373887062,
-0.02158496156334877,
0.17912884056568146,
-0.019458070397377014,
-0.040767036378383636,
0.02034393884241581,
0.10124575346708298,
0.04315996542572975,
-0.0988273024559021,
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0.09064791351556778,
0.044520214200019836,
-0.07848994433879852,
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0.06941595673561096,
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0.010300259105861187,
0.06190172955393791,
0.024790722876787186,
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0.018562912940979004,
0.12158206105232239,
0.051587771624326706,
0.11044494807720184,
0.055356841534376144
] |
factor\t(\nMadsen\tet\tal,\t2017\n).\nTotal\tcholesterol\nA\ttotal\tcholesterol\tmeasurement\tcaptures\tcholesterol\tcontained\tin\tall\tlipoprotein\tfractions:\t60%\tto\n70%\tis\tcarried\ton\tLDL,\t20%\n\tto\t30%\ton\tHDL,\tand\t10%\tto\t15%\ton\tVLDL.\nTriglycerides\nThe\ttriglyceride-rich\tlipoproteins\tinclude\tchylomicrons,\tVLDLs,\tand\tany\tremnants\tor\tintermediary
|
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0.027872508391737938,
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0.08961376547813416,
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0.010317937470972538,
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products\tformed\tin\tmetabolism.\tOf\tthese\ttriglyceride-rich\tlipoproteins,\tchylomicrons\tand\tVLDL\nremnants\tare\tknown\tto\tbe\tatherogenic\tbecause\tthey\tactivate\tplatelets,\tthe\tcoagulation\tcascade,\tand\nclot\tformation.\tAll\tcontain\tthe\tapo\tB\tlipoprotein.\n\tFasting\ttriglyceride\tlevels\tare\tclassified\tas\tnormal
|
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0.013525431975722313,
0.08793503046035767,
0.0038959451485425234,
-0.11182299256324768,
-0.008623919449746609,
0.07991767674684525,
-0.004694818053394556,
-0.03304261341691017,
-0.08765857666730881,
0.026801416650414467,
0.02026074379682541,
-0.0070763141848146915,
0.034059882164001465,
-0.06337440758943558,
0.0336497463285923,
0.08614137768745422,
0.1538901925086975,
-0.018244080245494843
] |
Fasting\ttriglyceride\tlevels\tare\tclassified\tas\tnormal\n(<150\tmg/dL),\tborderline\thigh\t(150\tto\t199\tmg/dL),\thigh\t(200\tto\t499\tmg/dL),\tand\tvery\thigh\t(<500\nmg/dL)\t(\nStone\tet\tal,\t2014\n).\nPatients\twith\tfamilial\tdyslipidemias\thave\thigh\ttriglyceride\tlevels\t(\nhypertriglyceridemia\n).
|
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0.027027375996112823,
0.02523920312523842,
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0.030692603439092636
] |
hypertriglyceridemia\n).\nTriglycerides\tin\tthe\tvery\thigh\trange\tplace\tthe\tpatient\tat\trisk\tfor\tpancreatitis.\tTriglyceride\nmeasurements\tare\tnow\tconsidered\talong\n\twith\tglucose\tintolerance,\thypertension,\tlow\tHDL\ncholesterol,\tand\thigh\tLDL\tcholesterol\tas\tpart\tof\tthe\t\nmetabolic\tsyndrome\n.\nGenetic\thyperlipidemias
|
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] |
metabolic\tsyndrome\n.\nGenetic\thyperlipidemias\nThe\tstudy\tand\tidentification\tof\tthe\tgenes\tresponsible\tfor\tthe\tfamilial\tforms\tof\thyperlipidemia\thave\nprovided\tinsight\tinto\tthe\troles\tof\tenzymes,\tapolipoproteins,\tand\treceptors\ton\tcells\tinvolved\tin\tlipid\nmetabolism.\tSeveral\tforms\tof\thyperlipidemia\n\thave\tstrong\tgenetic\tcomponents\tand\tare\tdescribed\nhere.
|
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] |
have\tstrong\tgenetic\tcomponents\tand\tare\tdescribed\nhere.\nFamilial\thypercholesterolemia\nFamilial\thypercholesterolemia\t(FH)\n\tis\ta\tgenetic\tdisorder\tcharacterized\tby\televated\tLDL\ncholesterol\tand\tpremature\tCVD,\twith\ta\tprevalence\tof\tapproximately\tone\tin\t200\tto\t500\tfor\nheterozygotes\tin\tNorth\tAmerica\tand\tEurope\t(\nBrautbar,\t2015\n).
|
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] |
heterozygotes\tin\tNorth\tAmerica\tand\tEurope\t(\nBrautbar,\t2015\n).\nIn\tFH\televated\tcholesterol\tis\talready\tpresent\tat\tbirth\tand\tresults\tin\tearly\n\tatherosclerotic\tdisease.\nThe\toptimal\tage\trange\tfor\tscreening\tis\tbetween\t2\tand\t10\tyears.\tCurrently,\tit\tis\tconsidered
|
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] |
unreasonable\tto\tstart\ta\trestricted\tdiet\tbefore\tage\t2,\tand\tthere\tare\tno\tsafety\tdata\ton\tthe\tuse\tof\nstatins\tbefore\tage\t8\tto\t10\t(\nNordestgaard\tet\tal,\t2013\n).\tMen\twith\tFH\tseem\tto\tdevelop\tCVD\tbefore\nwomen.\tHypertension,\tsmoking,\tdiabetes,\tand\thigh\ttriglycerides\tand\tlow\tHDL\tcholesterol\tare\n\tall\nwell-established\tadditional\trisk\tfactors\tin\tFH.
|
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] |
all\nwell-established\tadditional\trisk\tfactors\tin\tFH.\nThe\tFamilial\tHypercholesterolemia\tFoundation\trecently\tconvened\ta\tpanel\tof\tinternational\texperts\nto\t“assess\tthe\tutility\tof\tgenetic\ttesting.”\tThe\trationale\twas\t(1)\tfacilitation\tof\tdefinitive\tdiagnosis;\t(2)
|
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0.04438018053770065,
0.09275927394628525,
0.021513622254133224,
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-0.04319703206419945,
0.09597986936569214,
0.10828108340501785,
0.1243673712015152,
-0.015325338579714298
] |
testing\ta\tstandard\tof\tcare\tfor\tpatients\twith\tdefinite\tor\tprobable\tFH,\tas\twell\tas\tfor\ttheir\tat-risk\nrelatives.\tThey\trecommended\ttesting\tfor\tthe\tgenes\tencoding\tthe\tlow-density\tlipoprotein\treceptor\n(LDLR),\tapolipoprotein\tB,\tand\tproprotein\tconvertase\n\tsubtilisin/kexin\t9\t(PCSK9)\t(\nSturm\tet\tal,\t2018\n).
|
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] |
subtilisin/kexin\t9\t(PCSK9)\t(\nSturm\tet\tal,\t2018\n).\nTreatment\twith\tstatin\tdrugs\timproves\tarterial\tfunction\tand\tstructure\t(\nMasoura\tet\tal,\t2011\n).\nUltrasound\tof\tthe\tAchilles\ttendon\tfor\t\nxanthomas\n\t(cholesterol\tdeposits\tfrom\tLDL)\tcorrectly\tidentifies\nthe\tmajority\tof\tFH\tpatients\t(\nHarada,\t2017\n).\nPolygenic\tfamilial\thypercholesterolemia
|
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] |
Harada,\t2017\n).\nPolygenic\tfamilial\thypercholesterolemia\nPolygenic\tFH\tis\tthe\tresult\tof\tmultiple\tgene\tdefects.\tThe\t\nAPOE-4\n\tallele\n\tis\tcommon\tin\tthis\tform.\tThe\ndiagnosis\tis\tbased\ton\ttwo\tor\tmore\tfamily\tmembers\thaving\tLDL\tcholesterol\tlevels\tabove\tthe\t90th\npercentile\twithout\tany\ttendon\txanthomas.\tUsually\tthese\tpatients\thave\tlower\tLDL\tcholesterol\tlevels
|
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] |
than\tpatients\twith\tthe\tnonpolygenic\tform,\tbut\tthey\tremain\tat\thigh\trisk\tfor\tpremature\tdisease.\tThe\ntreatment\tis\tlifestyle\tchange\tin\tconjunction\twith\tcholesterol-lowering\tdrugs.\nFamilial\tcombined\thyperlipidemia\nFamilial\tcombined\thyperlipidemia\t(FCHL)\n\tis\tthe\tmost\tprevalent\tprimary\tdyslipidemia,\tbut\tits
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is\tthe\tmost\tprevalent\tprimary\tdyslipidemia,\tbut\tits\nprecise\tdefinition\tis\tcontroversial.\tFCHL\tis\tcharacterized\tby\tfluctuations\tin\tserum\tlipid\nconcentrations\tand\tmay\tpresent\tas\tmixed\thyperlipidemia,\tisolated\thypercholesterolemia,\nhypertriglyceridemia,\tor\tas\ta\tnormal\tserum\tlipid\tprofile\tin\tcombination\twith\tabnormally\televated
|
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] |
levels\tof\tapolipoprotein\tB.\t(\nBello-Chavolla\tet\tal,\t2018\n).\tSeveral\tlipoprotein\tpatterns\tmay\tbe\tseen\tin\npatients\twith\tFCHL.\tThese\tpatients\tcan\thave\t(1)\televated\tLDL\tlevels\twith\tnormal\ttriglyceride\tlevels
|
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] |
(type\tIIa),\t(2)\televated\tLDL\tlevels\twith\televated\ttriglyceride\tlevels\t(type\tIIb),\tor\t(3)\televated\tVLDL\nlevels\t(type\tIV).\tOften\tthese\tpatients\thave\tthe\tsmall,\tdense\tLDL\tassociated\twith\tASCVD.\nConsequently\n\tall\tforms\tof\tFCHL\tcause\tpremature\tdisease;\tapproximately\t15%\tof\tpatients\twho\thave
|
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] |
an\tMI\tbefore\tthe\tage\tof\t60\thave\tFCHL.\tThe\tdefect\tin\tFCHL\tis\thepatic\toverproduction\tof\tapo\tB-100\n(VLDL)\tor\ta\tdefect\tin\tthe\tgene\tthat\tproduces\thepatic\tlipase,\tthe\tliver\tenzyme\tinvolved\tin\ttriglyceride\nremoval\tfrom\tthe\tbloodstream.\tPatients\twith\tFCHL\tusually\thave\tother\trisk\tfactors\tsuch\tas\tobesity,\nhypertension,
|
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0.11990834027528763,
0.14297287166118622,
0.14965954422950745,
-0.02283221296966076
] |
hypertension,\n\tdiabetes,\tor\tmetabolic\tsyndrome.\tIf\tlifestyle\tmeasures\tare\tineffective,\ttreatment\nincludes\tmedication.\tPatients\twith\televated\ttriglyceride\tlevels\talso\tneed\tto\tavoid\talcohol.\nFamilial\tdysbetalipoproteinemia\nFamilial\tdysbetalipoproteinemia\n\t(type\tIII\thyperlipoproteinemia)\tis\trelatively\tuncommon.
|
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0.07709841430187225,
0.12552620470523834,
0.02681962214410305,
0.010213836096227169
] |
(type\tIII\thyperlipoproteinemia)\tis\trelatively\tuncommon.\nCatabolism\tof\tVLDL\tand\tchylomicron\tremnants\tis\tdelayed\tbecause\t\nAPOE-2\n\treplaces\t\nAPOE-3\n\tand\nAPOE-4.\n\tFor\tdysbetalipoproteinemia\tto\tbe\tseen,\tother\trisk\tfactors\tsuch\tas\tolder\tage,\thypothyroidism,\nobesity,\tdiabetes,\tor\tother\tdyslipidemias\tsuch\tas\tFCHL\tmust\tbe\tpresent.\tTotal\tcholesterol\tlevels
|
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] |
range\tfrom\t300\tto\t600\tmg/dL,\tand\ttriglyceride\tlevels\trange\tfrom\t400\tto\t800\tmg/dL.\tThis\tcondition\ncreates\tincreased\trisk\tof\tpremature\tASCVD\tand\tperipheral\tvascular\tdisease.\tDiagnosis\tis\tbased\ton\ndetermining\tthe\n\tisoforms\tof\t\nAPOE.\n\tTreatment\tinvolves\tweight\treduction,\tcontrol\tof\thyperglycemia
|
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] |
APOE.\n\tTreatment\tinvolves\tweight\treduction,\tcontrol\tof\thyperglycemia\nand\tdiabetes,\tand\tdietary\trestriction\tof\tsaturated\tfat\tand\tcholesterol.\tIf\tthe\tdietary\tregimen\tis\tnot\neffective,\tdrug\ttherapy\tis\trecommended.\nMedical\tdiagnosis\nNoninvasive\ttests\tsuch\tas\telectrocardiograms,\ttreadmill\tstress\ttests,\tthallium\tscans,\tand
|
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echocardiography\tare\tused\tinitially\tto\testablish\ta\tcardiovascular\n\tdiagnosis.\tA\tmore\tdefinitive,\ninvasive\ttest\tis\t\nangiography\n\t(\ncardiac\tcatheterization\n),\tin\twhich\ta\tdye\tis\tinjected\tinto\tthe\tarteries,\nand\tradiographic\timages\tof\tthe\theart\tare\tobtained.\tMost\tnarrowing\tand\tblockages\tfrom
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atherosclerosis\tare\treadily\tapparent\ton\tangiograms;\thowever,\tneither\tsmaller\tlesions\tnor\tlesions\tthat\nhave\tundergone\tremodeling\tare\tvisible.\nMagnetic\tresonance\timaging\t(MRI)\tscans\n\tshow\tthe\tsmaller\tlesions\tand\tcan\tbe\tused\tto\tfollow\natherosclerosis\tprogression\tor\tregression\tafter\ttreatments.\tTo\tpredict\tMI\tor\tstroke,\tmeasuring\tthe
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more\tlikely\tto\thave\ta\tfuture\tcoronary\tevent\tthan\tthose\twith\ta\tnegative\tscan.\nApproximately\ttwo\tthirds\tof\tcases\tof\tacute\tcoronary\tsyndromes\t(unstable\tangina\tand\tacute\tMI)\nhappen\tin\tarteries\tthat\tare\tminimally\tor\tmildly\tobstructed.\tThis\tillustrates\tthe\trole\tof\tthrombosis\tin\nclinical\tevents.\tIn\tthe\tischemia\tof\tan\tinfarction,
|
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clinical\tevents.\tIn\tthe\tischemia\tof\tan\tinfarction,\n\tthe\tmyocardium\tor\tother\ttissue\tis\tdeprived\tof\toxygen\nand\tnourishment.\tWhether\tthe\theart\tis\table\tto\tcontinue\tbeating\tdepends\ton\tthe\textent\tof\tthe\nmusculature\tinvolved,\tthe\tpresence\tof\tcollateral\tcirculation,\tand\tthe\toxygen\trequirement.\nPrevention\tand\tmanagement\tof\trisk\tfactors
|
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Prevention\tand\tmanagement\tof\trisk\tfactors\nThe\tidentification\tof\trisk\tfactors\tfor\tASCVD\tand\tstroke\thas\tbeen\ta\tlandmark\tachievement.\tThe\nprimary\tprevention\tof\n\tthese\tdisorders\tinvolves\tthe\tassessment\tand\tmanagement\tof\tthe\trisk\tfactors\tin\nthe\tasymptomatic\tperson.\tPersons\twith\tmultiple\trisk\tfactors\tare\tthe\ttarget\tpopulation,\tespecially
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those\twith\tmodifiable\tfactors\t(\nBox\t32.2\n).\nBOX\t32.2\nCardiovascular\tDisease\tRisk\tFactors\nMajor\trisk\tfactors\nHypertension\nAge\t(older\tthan\t45\tyears\tfor\tmen,\t55\tyears\tfor\twomen)\nDiabetes\tmellitus\nEstimated\tglomerular\n\tfiltration\trate\t<60\tmL/min\nMicroalbuminuria\nFamily\thistory\tof\tpremature\tcardiovascular\tdisease\t(men\t<55\tyears\tof\tage,\tor\twomen\t<65
|
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] |
years\tof\tage)\nModifiable\tcardiovascular\trisk\tfactors\nLipoprotein\tprofile\nLow-density\tlipoprotein\t(LDL)\tcholesterol,\televated\nTotal\ttriglycerides,\televated\nElevated\ttrimethylamine\tN-oxide\t(TMAO)\nHigh-density\tlipoprotein\t(HDL)\tcholesterol,\tlow\nInflammatory\n\tmarkers\nFibrinogen\nC-reactive\tprotein
|
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Lifestyle\trisk\tfactors\nTobacco\tuse,\tparticularly\tcigarettes\nPhysical\tinactivity\nPoor\tdiet\nStress\nInsufficient\tsleep\nExcessive\talcohol\tconsumption\nRelated\tconditions\nHypertension\nObesity\t(body\tmass\tindex\t>30)\nMetabolic\tsyndrome\t(including\treduced\tHDL,\televated\ttriglycerides,\tabdominal\tobesity)\nModified\tfrom\tNational\tInstitutes\tof\tHealth,
|
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] |
Modified\tfrom\tNational\tInstitutes\tof\tHealth,\n\tNational\tHeart,\tLung,\tand\tBlood\tInstitute,\tNational\tHigh\nBlood\tPressure\tEducation\tProgram:\tThe\tseventh\treport\tof\tthe\tJoint\tNational\tCommittee\ton\tprevention,\ndetection,\tevaluation,\tand\ttreatment\tof\thigh\tblood\tpressure,\tNIH\tPublication\tNo.\t04-5230,\tAugust\t2004.
|
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] |
Risk\tfactor\treduction\thas\tbeen\tshown\tto\treduce\tCVD\tin\tpersons\tof\tall\tages.\tMany\tcoronary\tevents\ncould\tbe\tprevented\twith\tadoption\n\tof\ta\thealthy\tlifestyle\t(eating\ta\theart-healthy\tdiet,\texercising\nregularly,\tmanaging\tweight,\tand\tnot\tusing\ttobacco)\tand\tadherence\tto\tlipid\tand\thypertension\tdrug\ntherapy\t(\nStone\tet\tal,\t2014
|
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therapy\t(\nStone\tet\tal,\t2014\n).\tThe\tFramingham\tHeart\tStudy,\tconducted\tover\tseveral\tdecades,\thas\nprovided\ta\tplethora\tof\tuseful\tinformation\tto\tresearchers\t(see\t\nFocus\tOn\n:\tFramingham\tHeart\tStudy\n).\n\t\nFOCUS\tON\nFramingham\tHeart\tStudy\nThe\tFramingham\tHeart\tStudy\t(FHS)\thas\tconducted\tseminal\tresearch\tdefining\tcardiovascular
|
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] |
disease\t(CVD)\trisk\tfactors\tand\tfundamentally\tshaping\tpublic\thealth\tguidelines\tfor\tCVD\tprevention\nover\tthe\tpast\tfive\tdecades.\tThe\tsuccess\tof\tthe\toriginal\tcohort,\tinitiated\tin\t1948,\tpaved\tthe\tway\tfor\nfurther\tepidemiologic\tresearch\tin\tpreventive\tcardiology.\nSince\t1948\tvarious\n\tleading\tinvestigators\t(Dr.\tJoseph\tMountain,\tDr.\tThomas\tDawber,\tDr.\tWilliam
|
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] |
Kannel,\tand\tDr.\tWilliam\tCastelli)\thave\tbeen\tstudying\tthe\tpopulation\tof\tFramingham,\nMassachusetts,\tto\tdetermine\tthe\tprevalence\tand\tincidence\tof\tCVD\tand\tfactors\trelated\tto\tits\ndevelopment.\tThis\tis\tthe\tlargest\tepidemiologic\tstudy\tof\tCVD\tin\tthe\tworld.\tInitial\tstudy\nparticipants\t(\nn\n\t=\t5209)\twere\thealthy\tadults\tbetween\t30\tand
|
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] |
participants\t(\nn\n\t=\t5209)\twere\thealthy\tadults\tbetween\t30\tand\n\t62\tyears\tof\tage.\tBecause\tof\tthe\npredominance\tof\twhite\tindividuals\tof\tEuropean\tdescent\tin\tthe\tthree\toriginal\tgenerations\tof\tFHS\nparticipants,\tthe\tFHS\tenrolled\tthe\tOMNI1\tand\tOMNI2\tcohorts\tin\t1994\tand\t2003,\trespectively,
|
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] |
aimed\tto\treflect\tthe\tcurrent\tgreater\tracial\tand\tethnic\tdiversity\tof\tthe\ttown\tof\tFramingham.\nThe\tstudy\tcontinues\ttoday,\tlooking\tat\tthe\tchildren\tand\tgrandchildren\tof\tthe\toriginal\n\tcohort.\nThrough\tthis\tcohort\tstudy,\tthe\tconcept\tof\trisk\tfactors\tand\tthus\tprevention\twas\tborn.\tModifiable
|
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] |
intolerance,\n\tand\tleft-ventricular\thypertrophy\t(\nOpie\tet\tal,\t2006\n).\tAll\tFHS\tcohorts\thave\tbeen\nexamined\tapproximately\tevery\t2\tto\t4\tyears\tsince\tthe\tinitiation\tof\tthe\tstudy.\nIn\taddition\tto\tthe\tcontributions\ttoward\tunderstanding\tCVD\trisk\tfactors,\tthe\tFHS\thas\talso\tbeen
|
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] |
instrumental\tin\testablishing\tthe\tepidemiology\tof\tspecific\tCVD\tsubtypes.\tThe\tFHS\tdemonstrated\nmuch\tof\tthe\tcharacteristics\tand\tprognosis\tsurrounding\n\tmyocardial\tinfarction\t(MI),\tincluding\tits\nfrequent\tpresentation\tas\tsudden\tcardiac\tdeath,\tand\tthe\thigh\tmortality\tassociated\twith\tfirst\tMI,
|
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] |
particularly\tin\twomen.\tHeart\tfailure\thas\tbeen\tand\tis\ta\tgrowing\tepidemic.\tThe\tFHS\twas\tone\tof\tthe\nfirst\tto\tdescribe\tthe\tincidence,\tprevalence,\tand\tgrim\tnatural\thistory\tof\theart\tfailure\tand\talso\nidentified\thypertension,\tvalvular\theart\tdisease,\tand\tcoronary\tdisease\n\tas\tkey\tetiologies\tfor\theart\nfailure\t(\nTsao\tand\tVasan,\t2015\n).
|
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] |
as\tkey\tetiologies\tfor\theart\nfailure\t(\nTsao\tand\tVasan,\t2015\n).\nMilestones\tof\tthe\tframingham\theart\tstudy\n1960\tCigarette\tsmoking\tfound\tto\tincrease\tthe\trisk\tof\theart\tdisease.\n1961\tCholesterol\tlevel,\tblood\tpressure,\tand\telectrocardiogram\tabnormalities\tfound\tto\tincrease\nthe\trisk\tof\theart\tdisease.
|
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] |
the\trisk\tof\theart\tdisease.\n1967\tPhysical\tactivity\tfound\tto\treduce\tthe\trisk\tof\theart\tdisease,\tand\tobesity\tfound\tto\tincrease\nthe\n\trisk\tof\theart\tdisease.\n1970\tHigh\tblood\tpressure\tfound\tto\tincrease\tthe\trisk\tof\tstroke.\n1976\tMenopause\tfound\tto\tincrease\tthe\trisk\tof\theart\tdisease.\n1978\tPsychosocial\tfactors\tfound\tto\taffect\theart\tdisease.
|
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1978\tPsychosocial\tfactors\tfound\tto\taffect\theart\tdisease.\n1988\tHigh\tlevels\tof\thigh-density\tlipoprotein\tcholesterol\tfound\tto\treduce\trisk\tof\tdeath.\n1994\tEnlarged\tleft\tventricle\t(one\tof\ttwo\tlower\tchambers\tof\tthe\theart)\tfound\tto\tincrease\tthe\nrisk\tof\n\tstroke.\n1994\tOMNI1\tincluded\tchanging\tracial\tand\tethnic\tdiversity.
|
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] |
stroke.\n1994\tOMNI1\tincluded\tchanging\tracial\tand\tethnic\tdiversity.\n1996\tProgression\tfrom\thypertension\tto\theart\tfailure\tdescribed.
|
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2003\tOMNI2\tincluded\tchanging\tracial\tand\tethnic\tdiversity.\n2006\tGenetic\tResearch\tStudy\tbegins\tto\tidentify\tgenes\tunderlying\tCVDs\tin\t9000\tparticipants\nfrom\tthree\tgenerations.\n2008\tDiscovery\tand\tpublication\tof\tfour\trisk\tfactors\tthat\traise\tprobability\tof\tdeveloping\nprecursor
|
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] |
precursor\n\tof\theart\tfailure;\tnew\t30-year\trisk\testimates\tdeveloped\tfor\tserious\tcardiac\tevents.\n2009\tResearchers\tfind\tparental\tdementia\tmay\tbe\tlinked\tto\tpoor\tmemory\tin\tmiddle-aged\nadults.\n2011\tBlood\tlipids\tand\tthe\tincidence\tof\tatrial\tfibrillation:\tThe\tmultiethnic\tstudy\tof\natherosclerosis\tand\tthe\tFHS.
|
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] |
atherosclerosis\tand\tthe\tFHS.\nIn\t1971\tthe\toffspring\tstudy\twas\tbegun\tto\tmeasure\tthe\tinfluence\tof\theredity\tand\tenvironment\non\tthe\toffspring\n\tof\tthe\toriginal\tcohort.\tThe\tyounger\tgroup\tappears\tto\tbe\tmore\thealth\nconscious\tbecause\tthey\thave\tlower\trates\tof\tsmoking,\tlower\tblood\tpressures,\tand\tlower
|
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] |
cholesterol\tlevels\tthan\ttheir\tparents\tat\tthe\tsame\tage.\tThe\tGeneration\tIII\tCohort\tStudy\tof\tthe\ngrandchildren\tis\tpresently\tunderway.\nData\tfrom\tFramingham\tHeart\tStudy:\t\nA\ttimeline\tof\tmilestones\tfrom\tthe\tFramingham\theart\tstudy\n\t(website).\nhttp://www.framingham.com/heart/timeline.htm\n,\t2015.
|
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] |
(website).\nhttp://www.framingham.com/heart/timeline.htm\n,\t2015.\nIn\tthe\tmedical\tmodel,\tprimary\tprevention\tof\tASCVD\tand\tstroke\tinvolves\taltering\tsimilar\trisk\nfactors\ttoward\ta\thealthy\tpatient\tprofile.\tFor\tischemic\tstroke,\tatherosclerosis\tis\tthe\tunderlying\ndisease.\tTherefore\toptimal\tlipid\tlevels,\tas\tdetermined\tby\tthe\tNational\tCholesterol\tEducation
|
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] |
Program\t(NCEP)\tfor\thypercholesterolemia,\tare\talso\tthe\ttarget\tlevels\tto\tprevent\tstroke.\nAlthough\tthe\tNational\n\tHeart,\tLung,\tand\tBlood\tInstitute\tcreated\tthe\tNCEP,\tthe\tAHA\thas\tendorsed\nit.\tThe\tAHA\tsuggests\tthat\tprimary\tprevention\tof\tCVD\tshould\tbegin\tin\tchildren\tolder\tthan\tage\t2\n(\nGidding\tet\tal,\t2009
|
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(\nGidding\tet\tal,\t2009\n).\tDietary\trecommendations\tfor\tchildren\tare\ta\tbit\tmore\tliberal\tthan\tthose\tfor\nadults.\tActivity\tis\temphasized\tin\tmaintaining\tideal\tbody\tweight.\tEarly\tscreening\tfor\tdyslipidemia\tis\nrecommended\tfor\tchildren\twith\ta\n\tfamily\thistory\tof\thypercholesterolemia\tor\tASCVD.
|
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family\thistory\tof\thypercholesterolemia\tor\tASCVD.\nFor\tadults,\ta\ttotal\tcholesterol\tlevel\tof\t170\tmg/dL\tor\tless\tis\tnow\tconsidered\toptimal,\tincluding\tan\nHDL\tof\tat\tleast\t50\tmg/dL.\tThe\tnew\t2013\tguidelines\tno\tlonger\trely\tstrictly\ton\tcholesterol\tlevels\tfor\nadvising\tpatients\tor\tdosing\tmedications.\tInstead\tthe\tpatient’s\toverall\thealth\tis\tevaluated\tfor
|
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treatment\tdecisions.\tThe\tguidelines\tadvise\tassessing\n\tfactors\tsuch\tas\tage,\tgender,\trace,\twhether\ta\npatient\tsmokes,\tblood\tpressure\tand\twhether\tit\tis\tbeing\ttreated,\twhether\ta\tperson\thas\tdiabetes,\tand\nblood\tcholesterol\tlevels\tin\tdetermining\trisk.\tThey\talso\tsuggest\tthat\thealth\tcare\tproviders\tshould
|
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consider\tother\tfactors,\tincluding\tfamily\thistory.\tOnly\tafter\tthat\tvery\tpersonalized\tassessment\tis\ta\ndecision\tmade\ton\twhat\ttreatment\twould\twork\tbest.\tThe\tASCVD\n\tRisk\tCalculator\tdeveloped\tby\tthe\nACC/AHA\texpert\tpanel\tis\tavailable\tat\tthe\t\nACC.org\n\twebsite.\nInflammatory\tmarkers
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in\nasymptomatic\tindividuals\tor\tthe\textent\tof\tatherosclerosis\tin\tpatients\twith\tsymptoms.\tSeveral\nmarkers\thave\tbeen\tsuggested\t(\nBox\t32.3\n),\tand\tresearch\tcontinues\tto\tlook\tat\tthe\teffects\tof\tdiet\ton\nthese\tbiomarkers.\tPlasma\tlevels\tof\tomega-3\tfatty\tacids\tare\tinversely\tassociated\twith\tthe
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] |
inflammatory\tmarkers\tC-reactive\tprotein\t(hs-CRP),\tinterleukin-6\t(IL-6),\tfibrinogen,\tand\nhomocysteine\t(\nKalogeropoulos\tet\tal,\t2010\n).\tAn\tinflammatory\tmarker\tspecific\tto\tvascular\ninflammation\thas\tbecome\tavailable.\tThe\tPLAC™\ttest\tmeasures\tLp-PLA2\t(\nJellinger\tet\tal,\t2012\n).\tLp-
|
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] |
Jellinger\tet\tal,\t2012\n).\tLp-\nPLA2\tlevels\tindicate\tASCVD\trisk\tindependent\tfrom\tother\tmarkers\tand\tprovides\tinformation\ton\tthe\nrelationship\tbetween\tinflammation\tand\tatherosclerosis\t(see\t\nChapters\t5\n\tand\t\n7\n).\nBOX\t32.3\nInflammatory\tMarkers\tfor\tCardiovascular\tRisk\nGenetic\tmarkers:\tangiotensin\n\tII\treceptor\ttype-1\tpolymorphism
|
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0.05777191370725632,
0.06952628493309021,
-0.09340951591730118,
-0.012903210707008839,
0.07254070788621902,
0.010344253852963448,
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0.025032373145222664,
0.062365055084228516,
0.027654562145471573,
0.008832372725009918,
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0.06866469234228134,
0.045011892914772034,
0.1301005482673645,
0.00982437189668417
] |
Genetic\tmarkers:\tangiotensin\n\tII\treceptor\ttype-1\tpolymorphism\nOxidized\tlow-density\tlipoprotein\tcholesterol\nAdhesion\tmolecules\nSelectins\nFree\tfatty\tacids\nCytokines\nInterleukin-1\nInterleukin-6\nTumor\tnecrosis\tfactor-alpha\nAcute-phase\treactants\nFibrinogen\nC-reactive\tprotein\nSerum\tamyloid\tA\nWhite\tblood\tcell\tcount\nErythrocyte\tsedimentation\trate
|
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0.12920118868350983,
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0.08754674345254898,
0.10461755096912384,
0.03550054132938385
] |
Serum\tamyloid\tA\nWhite\tblood\tcell\tcount\nErythrocyte\tsedimentation\trate\nTrimethylamine\tN-oxide\t(TMAO)
|
[
0.012040133588016033,
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] |
Derived\tfrom\tFung\tMM,\tet\tal:\n\tEarly\tinflammatory\tand\tmetabolic\tchanges\tin\tassociation\twith\tAGTR1\npolymorphisms\tin\tprehypertensive\tsubjects,\t\nAm\tJ\tHypertens\n\t24:225,\t2011;\tPearson\tTA,\tet\tal:\tMarkers\tof\ninflammation\tand\tcardiovascular\tdisease:\tapplication\tto\tclinical\tand\tpublic\thealth\tpractice:\ta\tstatement
|
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] |
for\thealthcare\tprofessionals\tfrom\tthe\tCenters\tfor\tDisease\tControl\tand\tPrevention\tand\tthe\tAmerican\tHeart\nAssociation,\t\nCirculation\n\t107:499,\t2003.\nFibrinogen.\nMost\tMIs\tare\tthe\tresult\tof\tan\tintracoronary\tthrombosis.\tProspective\tstudies\thave\tshown\tthat\tplasma
|
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] |
fibrinogen\tis\tan\tindependent\tpredictor\tof\tASCVD\trisk.\tFactors\tassociated\twith\tan\televated\tfibrinogen\nare\tsmoking,\tdiabetes,\thypertension,\tobesity,\tsedentary\tlifestyle,\televated\ttriglycerides,\tand\tgenetic\nfactors.\tMore\tclinical\ttrials\tare\tneeded\tto\tdetermine\twhether\n\tfibrinogen\tis\tinvolved\tin\tatherogenesis
|
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fibrinogen\tis\tinvolved\tin\tatherogenesis\nor\tis\tjust\ta\tmarker\tof\tvascular\tdamage.\tBlood\tthrombogenicity\tincreases\twith\thigh\tLDL\tcholesterol\nand\tin\tdiabetes.\nC-reactive\tprotein.\nC-reactive\tprotein\n\t(hs-CRP)\tis\tsynthesized\tin\tthe\tliver\tas\tthe\tacute-phase\tresponse\tto\tinflammation.\nThe\t\nhs
|
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] |
The\t\nhs\n\trefers\tto\thuman\tserum.\tIn\ta\tnormal\tindividual\twithout\tinfection\tor\tinflammation,\ths-CRP\nlevels\tare\tvery\tlow,\n\tless\tthan\t0.6\tmg/dL.\tBecause\tatherogenesis\tis\tan\tinflammatory\tprocess,\ths-CRP\nhas\tbeen\tshown\tto\tbe\televated\t(>3\tmg/dL)\tin\tpeople\twith\tangina,\tMI,\tstroke,\tand\tperipheral\tvascular
|
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] |
disease;\tthe\televated\tlevels\tare\tindependent\tof\tother\trisk\tfactors\t(see\t\nChapter\t5\n).\tDespite\ta\tlack\tof\nspecificity\tfor\tthe\tcause\tof\tthe\tinflammation,\tdata\tfrom\tmore\tthan\t30\tepidemiologic\tstudies\thave\nshown\tsignificant\tassociation\n\tbetween\televated\tblood\tlevels\tof\ths-CRP\tand\tthe\tprevalence\tof\natherosclerosis\t(\nMorrow\tand\tCrea,\t2014\n).
|
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] |
atherosclerosis\t(\nMorrow\tand\tCrea,\t2014\n).\nHs-CRP\tlevels\tare\tcategorized\tfor\trisk\tas\tlow\t(<1\tmg/L),\taverage\t(2\tto\t3\tmg/L),\tand\thigh\t(>3\tmg/L)\nafter\tthe\taverage\tof\ttwo\tmeasurements\tare\ttaken\tat\tleast\t2\tweeks\tapart.\tThe\tMediterranean\tdiet\npattern\t(\nAppendix\t23\n)\tis\tmost\teffective\tin\tinhibiting\tinflammation.\tThe\tDietary\tApproaches\tto\tStop
|
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] |
Hypertension\tmodel\t(described\tlater\tin\tthe\tchapter\tand\tin\t\nAppendix\t17\n)\tand\tthe\tplant\tnutrition\nmodel\talso\thave\tproven\tto\tbe\tbeneficial.\tThe\tdata\ton\tlow-fat\tand\tlow-carbohydrate\tdiets\tare\ninconclusive\t(\nLee\tet\tal,\t2014\n;\t\nSmidowicz\tand\tRegula,\t2015\n).\nHomocysteine.\nHomocysteine
|
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] |
;\t\nSmidowicz\tand\tRegula,\t2015\n).\nHomocysteine.\nHomocysteine\n\tis\tan\tamino\tacid\tmetabolite\tof\tmethionine.\tElevated\tcirculating\ttotal\thomocysteine\n(tHcy)\tconcentrations\thave\tbeen\tregarded\n\tas\tan\tindependent\trisk\tfactor\tfor\tCVD.\tHowever,\tseveral\nlarge\tclinical\ttrials\tto\tcorrect\thyperhomocysteinemia\tusing\tB-vitamin\tsupplements\t(particularly\tfolic
|
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] |
acid)\thave\tlargely\tfailed\tto\treduce\tthe\trisk\tof\tCVD\t(\nBaggot\tand\tTamura,\t2015\n).\nAlthough\tsome\tevidence\tsuggests\tthat\thomocysteine\tmay\tpromote\tatherosclerosis,\tno\tcausal\tlink\nhas\tbeen\testablished.\tAnd\tit\tappears\tmore\tlikely\tthat\tincreased\n\thomocysteine\tlevels\tare\tmarkers\nrather\tthan\tcauses\tof\tCVD.\tGiving\tsupplemental\tvitamins\tfolate,\tB\n6\n\tand\tB\n12
|
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] |
6\n\tand\tB\n12\n,\thave\tbeen\tshown\tto\nlower\thomocysteine\tlevels\tin\tsome\tindividuals\tand\tis\tbeing\tinvestigated\tactively\tas\ta\ttreatment\tfor\nCVD\tbut\tas\tof\tnow\tis\tnot\twidely\trecommended.\nTrimethylamine-N-oxide.\nTrimethylamine-N-oxide\t(TMAO)\n\tis\ta\tgut\tmicrobiota-dependent\tmetabolite\tthat\tcontributes\tto\nheart\n\tdisease\t(\nTang\tet\tal,\t2013
|
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heart\n\tdisease\t(\nTang\tet\tal,\t2013\n).\tIt\tis\tproduced\tby\tthe\tliver\tafter\tintestinal\tbacteria\thave\tdigested\nanimal\tprotein.\tTMAO\thas\tbeen\tshown\tto\tpredict\tcardiac\trisk\tin\tindividuals\tnot\tidentified\tby\ntraditional\trisk\tfactors\tand\tblood\ttests.\tThis\tis\tspeculated\tto\tbe\ta\tfactor\tin\tthe\temerging\tevidence
|
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] |
that\ta\tplant-based\tdiet\tis\tcardioprotective\tcompared\twith\tone\tthat\tincludes\tanimal\tsources\t(\nTuso,\n2015\n).\nLifestyle\tguidelines\nLifestyle\tmodification\tremains\tthe\tbackbone\tof\tCVD\tprevention\tand\ttreatment.\tAdhering\tto\ta\theart-\nhealthy\tdiet,\tregular\texercising,\tavoidance\tof\ttobacco\tproducts,\tand\tmaintenance\tof\ta\thealthy\tweight
|
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] |
are\tknown\tlifestyle\tfactors\tthat,\talong\twith\tgenetics,\tdetermine\tCVD\trisk.\tThree\tcritical\tquestions\n(CQs)\twere\taddressed\tin\tthe\t2013\tACC/AHA\tlifestyle\tmodification\tguidelines.\n\tCQ1\tpresents\tevidence\non\tdietary\tpatterns\tand\tmacronutrients\tand\ttheir\teffect\ton\tblood\tpressure\tand\tlipids,\tCQ2\tpresents
|
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0.07434964179992676,
0.02432997338473797,
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0.0058183930814266205,
0.05334028974175453,
0.06508319824934006,
0.011263566091656685,
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0.058767374604940414,
0.08924257010221481,
0.10370910912752151,
-0.036212872713804245
] |
evidence\ton\tthe\teffect\tof\tdietary\tsodium\tand\tpotassium\tintake\ton\tblood\tpressure\tand\tCVD\toutcomes,\nand\tCQ3\tpresents\tthe\tevidence\ton\tthe\teffect\tof\tphysical\tactivity\ton\tlipids\tand\tblood\tpressure.\tThe\nrecommendations\tare\tsummarized\tin\t\nBox\t32.4\n.\nBOX\t32.4\nSummary\tof\tAmerican\tCollege\n\t\nof\tCardiology\t(ACC)/\tAmerican
|
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0.05160137638449669,
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0.07058657705783844,
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0.04401040077209473,
0.05201159417629242,
0.01673884689807892,
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0.1204579770565033,
0.036113545298576355,
0.11637677252292633,
-0.03619777411222458
] |
BOX\t32.4\nSummary\tof\tAmerican\tCollege\n\t\nof\tCardiology\t(ACC)/\tAmerican\nHeart\tAssociation\t(AHA)\tRecommendations\tfor\tLifestyle\nManagement\nDiet\nLDL-C\nAdvise\tadults\twho\twould\tbenefit\tfrom\tLDL-C\tlowering\tto\n1.\t\nConsume\ta\tdietary\tpattern\tthat\temphasizes\tintake\tof\tvegetables,\tfruits,\tand\twhole\tgrains;
|
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