Answer part a) - Risk factors for ASCVD and lifestyle modifications
List the major risk factors for ASCVD and lifestyle modifications to reduce cholesterol levels (4 marks)
This is a straightforward question worth four marks. For completeness I have put down a comprehensive answer but in the exam you probably would not need to put down as much detail as I have. At the bottom there is also some information on the pathogenesis of atherosclerosis.
Major risk factors for ASCVD:
Metabolic:
- Dyslipidemia - raised levels of LDL-C and low levels of HDL-C
- Hypertension (BP >140/90 or on antihypertensive medication)
- Diabetes mellitis
- Obesity
Behavioural
- Smoking
- Alcohol abuse
- Lack of exercise / sedentary lifestyle
- Unhealthy diet high in salt and saturated fat/cholesterol
Other
- Advancing age
- Gender - Risk is lower in women until they reach menopause after which the risk is the same as in men.
- Kidney disease
- Family history of atherosclerotic cardiovascular disease in a 1st degree relative (i.e., parent, sibling) prior to age 55 (males) or 65 (females)
- Women with premature menopause
- Emotional stress
- Poverty and low education status
Lifestyle modifications
Exercise - recommendation is at least 30 minutes a day of walking or equivalent, 5 days a week.
Diet - balanced diet low in oil, salt and sugar, with at least five portions of fruit and vegetables a day.
Aim to lose weight if overweight.
Stopping smoking and alcohol in those who smoke or consume too much alcohol.
Make sure patients with diabetes mellitus and hypertension are under medical supervision and being receiving appropriate treatment. The same lifestyle modifications can also significantly improve DM and HT.
Regular health check ups which include monitoring of blood pressure and blood sugar in individuals with increased risk (e.g. age, familial history, race).
Non-modifiable risk factors are age, gender, genetics and menopause.
CPD: Pathogenesis of atherosclerosis - Response to injury theory
Formation of atherosclerotic plaque is initiated by injury to the inner lining of the arteries, which is why plaques are usually found on arteries which need to withstand high pressure such as the aorta, and also why hypertension is one of the main risk factors.
Damage to the lining causes the accumulation of LDL-C and macrophages beneath the lining, which harden and form fatty atherosclerotic plaque. Over time the size of the plaque will grow and cause partial occlusion of the artery. If the plaque breaks through the surface lining this will cause bleeding and the additional formation of a thrombus could lead to total occlusion.
Atherosclerosis in turn is also a major risk factor for hypertension, due to progressive hardening and loss of elasticity of the arteries over time.
References