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Cardiovascular Disease - Any disease that affects the cardiovascular system:
Cardiac muscle
•

Coronary Heart Disease/ Coronary Artery Disease

•

Myocardial Infarction

•

Valvular Heart Disease etc
...


Fatty deposits - Atherosclerosis - ↓ Lipids
Clotting - Thrombosis - ↓ Clotting
Idiopathic & Renal - Hypertension - Vasodilation
Blocked blood flow to heart (Angina) - Myocardial Infarction - reduce cardiac work, treat atheroma
and thrombosis (Vasodilators)
Myocardial damage ion imbalance - Heart failure - Increases contractility, Vasodilation
Hypertension, Muscle Damage - Arrhythmia - Antidysrhythmic agents direct on heart

Atherosclerosis
Build-up of plaque inside any artery, including those of the heart, brain, arms, legs, pelvis, and
kidneys
Plaque composed of:
Fat, Cholesterol, Calcium, Other blood-borne substances
Over time, these plaque deposits harden and narrow the arteries, Results in limited flow of oxygenrich blood to organs and other parts of the body

Thrombosis
Thrombosis is the formation of a blood clot within a blood vessel, results in partial or complete
blockage of the vessel
Clots are not necessarily static and can travel through the circulatory system, causing; Heart attack in
the heart, Stroke in the brain, Pulmonary embolism in the lungs
Thromboses are classified according to where they occur:
Venous: Superficial Vein (SVT), Deep Vein (DVT), Renal Vein (RVT) or Arterial (atherothrombosis)

Myocardial Infarction
Acute MI is myocardial necrosis
Blockage of one of the heart’s three coronary arteries that perfuse the heart with oxygenated blood
→ death of heart tissue
Outcomes following MI:
Heart failure, Arrhythmias, Cardiac arrest
MI can be triggered by:
Atherosclerosis, Thrombosis, Plaque rupture

Heart Failure (HF) or Congestive Heart Failure (CHF)
Symptoms include:
– Dyspnoea (shortness of breath)
– Peripheral oedema affecting mainly the feet and legs (can also include stomach and lumbar region)
– Fatigue
– Asthenia (weakness and/or lack of energy)
Common causes of heart failure include:
– MI
– Hypertension
– Cardiomyopathy (heart muscle disease characterised by enlargement, thickening or rigidity of the
tissue

Arrhythmias
Arrhythmias and conduction disorders result from abnormalities in the generation and/or
conduction of cardiac electrical impulses
Types of arrhythmias:
•

Atrial fibrillation: Irregular or fast heart rhythm

•

Tachycardias (fast heart rhythms) where the heart beats faster than 90 beats per minute,
include:
•

Supraventricular tachycardia (SVT),

•

Sinus tachycardia (ST)

•

Ventricular tachycardia (VT)

•

Bradycardias (slow, abnormal heart rhythms) where the heart beats at 60 beats

per minute or below, include heart block
•

Atrial flutter is a very fast, irregular heart rhythm

•

Tachybrady syndrome (or sick sinus syndrome) is periods of very fast or slow heart

beats
•

Ventricular fibrillation (VF) is an abnormal, fast heart rhythm that is so fast a pulse

cannot be identified

Cardiovascular Disease (CVD) Overview
• Brought about by deficits in blood circulation
• Results from:
– Vascular narrowing
– Increased vascular resistance
– Vascular obstruction
– Fluid excess and / or loss
– Death of tissue and / or organ failure

Pathophysiology
• Peripheral vascular disease – Atherosclerosis
• Hypertension
• Thrombosis and other clotting disorders
• Embolism
• Infarction
• Oedema
• Myocardial infarction
• Mild chronic inflammatory conditions
• Plaque builds up on the insides of arteries
• Plaque is made up mainly of fat, oxidized cholesterol, smooth muscle cells, calcium, leukocytes
• Over time, plaque hardens and narrows arteries

Atherogenic Dyslipidemia

• Elevated blood levels of:
– Triglycerides (TG)
– Low-density lipoprotein
– Very low density lipoprotein
• Low levels of High-density lipoprotein cholesterol (HDL-C)

Coronary Heart Disease (CHD)
• Failure of coronary circulation to supply adequate circulation to cardiac muscle and surrounding
tissue
...
Peripheral Artery Occlusive Disease (PAOD)
2
...
One-way valves help
with pumping action and prevent blood from flowing backward
...
This weakness tends to
be associated with certain factors, including increasing age, a family history of varicose veins, high
pressure inside veins due to overweight or pregnancy, or poor diet
• When the walls of the veins are weak, they lose their normal elasticity
...

• Blood is then able to flow backward through the valves, filling the vein and stretching it even more
...


Inflammation
• A complex orchestration of pro-inflammatory and anti-inflammatory events
• Important for:
– Leukocyte recruitment
– Vascular permeability changes
– Wound healing
– Many other functions

Mild chronic inflammation: A common pathway in…
• Obesity
• Cardiovascular disease
• Type 2 diabetes
• Cancer
• Neurodegenerative disease

• Respiratory disease
• Arthritic conditions
• Autoimmune disease
• Many others

Risk Factors in CVD
1
...
Gender: M > F
3
...
High cholesterol
5
...
)
6
...
Hypertension
8
...
Diabetes

Physiological Risk Factors
1
...
Blood cholesterol
a) High LDL (Low-density lipoprotein ) = high risk > 3
...
1 mmol/L
3
...
Diabetes (endothelial damage, increased HbA1c - glycated haemoglobin)
5
...
Gender
7
...
” De Koning et al
...
g
...

–Eicosanoids derived from ω-3 →
• Less potent pro-inflammatory & some are anti-inflammatory
–Eicosanoids derived from ω-6 →
• Potent pro-inflammatory & thrombogenic

Sources of Trans Fats
1
...
Hydrogenation / partial hydrogenation: Trans fats formed during reduction of naturally occurring
unsaturated fat
3
...
5 g / serving can be listed on Nutrition Facts panel as 0 g trans fat
– (Allows for up to 0
...
4 g trans fat and believe they have consumed 0 g

How to Assess Amount of Trans Fat
A
...
5 g
B
...
Portion size
– Look for the portion size on the Nutrition Facts panel and be honest about how much you
eat
– Be aware that if you eat more than the nominal portion size, you may be accumulating significant
trans fat, even if it says 0 g trans fat

Anti-inflammatory Diet
•
•
•
•
•
•
•

Fibres
Low glycaemic load
Good ratio ω-6/ω-3
‘Rainbow’ of fruit & veg
Vitamins & minerals & anti-oxidants
Low saturated fat intake, absent trans fat
Portion sizes / proportions / frequency

Anti-inflammatory Lifestyle
•
•
•
•
•
•
•
•

Diet
Exercise
Weight loss
Quit smoking
Don’t skip meals
Stress management
Psychological background
Socialization (friends & family & hobbies)

American Heart Association Recommendations (mirrors the anti-inflammatory diet & lifestyle)
• Healthy individuals should take two servings of fish (salmon, sardines, tuna, mackerel, trout)
weekly along with flaxseed, canola, olive and hemp seed oil
• Patients with CHD should consume higher doses, 1 g/d of EPA + DHA, which may require fish oil
supplementation
• Eating fish as little as once a week reduces the risk of sudden death in men
• Eating fish twice a week reduces CHD risk in women
• Utilize complex carbohydrates, higher in fibre and lower in glycemic load to reduce risk of CHD



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