A4M STANDARD EXAMS ANSWERS AND
QUESTIONS SET A+
✔✔red yeast rice - ✔✔Monascus purpureus
fermented product of rice that contains monocolins which inhibit cholesterol synthesis
via HMG CoA reductase
can cause reduction in coQ10
✔✔plant sterols - ✔✔2 to 2.5 grams/day
can interfere with absorption of lipid soluble compounds such as fat soluble vitamins, vit
DEK and alpha carotene
✔✔what is preferred type of soy? - ✔✔fermented soy
✔✔green tea extract and green tea (EGCG) - ✔✔interferes with micellar solubilization of
cholesterol in the GI tract and reduces absorption
500 to 1000 mg/day
✔✔omega 3 fatty acids - ✔✔DHA more effective in lowering TG, increases LDL and
HDL size
EPA doesn't increase LDL like DHA
EPA and DHA at a 3:2 ratio
krill oil is not recommended
✔✔flax - ✔✔14 to 40 grams of flax seed per day
25 grams of chia seeds per day
chia seeds are richest botanical source of ALA
✔✔monounsaturated fats - ✔✔olives, olive oil and nuts
one of the most potent agents to reduce oxLDL
3-4 tablespoons of EVOO a day
,✔✔sesame - ✔✔40 grams per day
✔✔tocotrienols - ✔✔unsaturated forms of vitamin E
use 200 mg gamma and delta at night, suppress HMG CoA reductase activity
✔✔pantethine - ✔✔derivative of pantothenic acid
300 mg TID or 450 mg BID with or without food
✔✔guggulipids - ✔✔resins from mukluk myrrh tree
no humans studies, not recommended at this time
✔✔garlic - ✔✔used age garlic 600 mg BID
good in conjunction with B vitamins, folate, arginine and statins
✔✔resveratrol - ✔✔use with NAC 1000 mg BID
trans resveratrol 250 mg per day
✔✔curcumin - ✔✔phenolic compound in turmeric and curry
induces changes in the expression of genes involved with cholesterol synthesis
✔✔pomegranate - ✔✔antioxidant
8 oz of juice or 1-2 cups of seeds
✔✔vitamin C - ✔✔lowers LDL and TG
no effect on HDL
at least 500 mg/day
✔✔lycopene - ✔✔acyclic carotenoid with highest concentration in tomatoes
✔✔wogonin and flavonoids - ✔✔a type of flavonoid that enhances reverse cholesterol
transport
✔✔probiotics - ✔✔60 to 100 billion organisms per day
✔✔berberine HCL - ✔✔alkaloid present in roots, rhizomes and stem barks of selected
plants
500 mg qd to BID
more effective and fewer adverse effects compared to ezetimibe
✔✔hs-CRP (high sensitivity C-reactive protein) - ✔✔a risk marker and risk factor for
hypertension and CVD
inhibits nitric oxide and eNOS
down regulates AT2R, which normally counterbalances AT1R
, Angiotensin Ⅱ (A-Ⅱ) upregulates many of the cytokines, especially IL-6, CAMs and
chemokines by activating nuclear factor Kappa B (NF- κb) leading to vasoconstriction.
These events, along with the increases in oxidative stress and endothelin-1, elevate BP
✔✔Angiotensin Ⅱ (A-Ⅱ) - ✔✔activates immune cells (T cells, macrophages and
dendritic cells)and promotes cell infiltration into target organs
IL-17 produced by T cells may play a pivotal role in the genesis of hypertension caused
by Angiotensin Ⅱ.
Hypertensive patients have significantly higher TLR 4 mRNA in monocytes compared to
normal. A-Ⅱ activates the TLR expression leading to inflammation and activation of the
innate immune system. When TLR 4 is activated there is
downstream macrophage activation, migration, increase metalloproteinase 9, vascular
remodeling, collagen accumulation in the artery, LVH and cardiac fibrosis.
✔✔CD4+ T lymphocytes - ✔✔express AT1R and PPAR gamma receptors, and release
TNF-α, interferon and interleukins within the vascular wall when activated
✔✔Efferent cholinergic anti-inflammatory pathways via the
vagal nerve - ✔✔innervate the spleen, nicotine acetylcholine
receptor subunits and cytokine producing immune cells to influence vasoconstriction
and BP
✔✔aldosterone - ✔✔associated with increased adaptive
immunity and autoimmune responses with CD4+ T cell
activation and Th 17 polarization with increased IL 17,
TGF-β and TNF-α which modulate over 30 inflammatory genes. Increased serum
aldosterone is an independent risk factor for CVD and CHD through
non-hemodynamic effects as well as through increased BP
Blockade of mineralocorticoid receptors in the
heart, brain, blood vessels and immune cells reduces CV risk even with the persistence
of hypertension
✔✔AT1 vs AT2 receptors - ✔✔angiotensin II receptor type 1 & 2
promote AT2, block AT1
stimulation of AT1R increases production of superoxide anion which neutralizes NO and
also forms additional downstream ROS and RNS that increase vascular oxidative stress
the AT2 receptor exerts a protective effect against an overstimulation of AT1 receptors
by counteracting AT1 receptor-mediated actions; e.g., whereas the AT1 receptor
stimulates cell proliferation, the AT2 receptor has an antiproliferative effect and
promotes cell differentiation
QUESTIONS SET A+
✔✔red yeast rice - ✔✔Monascus purpureus
fermented product of rice that contains monocolins which inhibit cholesterol synthesis
via HMG CoA reductase
can cause reduction in coQ10
✔✔plant sterols - ✔✔2 to 2.5 grams/day
can interfere with absorption of lipid soluble compounds such as fat soluble vitamins, vit
DEK and alpha carotene
✔✔what is preferred type of soy? - ✔✔fermented soy
✔✔green tea extract and green tea (EGCG) - ✔✔interferes with micellar solubilization of
cholesterol in the GI tract and reduces absorption
500 to 1000 mg/day
✔✔omega 3 fatty acids - ✔✔DHA more effective in lowering TG, increases LDL and
HDL size
EPA doesn't increase LDL like DHA
EPA and DHA at a 3:2 ratio
krill oil is not recommended
✔✔flax - ✔✔14 to 40 grams of flax seed per day
25 grams of chia seeds per day
chia seeds are richest botanical source of ALA
✔✔monounsaturated fats - ✔✔olives, olive oil and nuts
one of the most potent agents to reduce oxLDL
3-4 tablespoons of EVOO a day
,✔✔sesame - ✔✔40 grams per day
✔✔tocotrienols - ✔✔unsaturated forms of vitamin E
use 200 mg gamma and delta at night, suppress HMG CoA reductase activity
✔✔pantethine - ✔✔derivative of pantothenic acid
300 mg TID or 450 mg BID with or without food
✔✔guggulipids - ✔✔resins from mukluk myrrh tree
no humans studies, not recommended at this time
✔✔garlic - ✔✔used age garlic 600 mg BID
good in conjunction with B vitamins, folate, arginine and statins
✔✔resveratrol - ✔✔use with NAC 1000 mg BID
trans resveratrol 250 mg per day
✔✔curcumin - ✔✔phenolic compound in turmeric and curry
induces changes in the expression of genes involved with cholesterol synthesis
✔✔pomegranate - ✔✔antioxidant
8 oz of juice or 1-2 cups of seeds
✔✔vitamin C - ✔✔lowers LDL and TG
no effect on HDL
at least 500 mg/day
✔✔lycopene - ✔✔acyclic carotenoid with highest concentration in tomatoes
✔✔wogonin and flavonoids - ✔✔a type of flavonoid that enhances reverse cholesterol
transport
✔✔probiotics - ✔✔60 to 100 billion organisms per day
✔✔berberine HCL - ✔✔alkaloid present in roots, rhizomes and stem barks of selected
plants
500 mg qd to BID
more effective and fewer adverse effects compared to ezetimibe
✔✔hs-CRP (high sensitivity C-reactive protein) - ✔✔a risk marker and risk factor for
hypertension and CVD
inhibits nitric oxide and eNOS
down regulates AT2R, which normally counterbalances AT1R
, Angiotensin Ⅱ (A-Ⅱ) upregulates many of the cytokines, especially IL-6, CAMs and
chemokines by activating nuclear factor Kappa B (NF- κb) leading to vasoconstriction.
These events, along with the increases in oxidative stress and endothelin-1, elevate BP
✔✔Angiotensin Ⅱ (A-Ⅱ) - ✔✔activates immune cells (T cells, macrophages and
dendritic cells)and promotes cell infiltration into target organs
IL-17 produced by T cells may play a pivotal role in the genesis of hypertension caused
by Angiotensin Ⅱ.
Hypertensive patients have significantly higher TLR 4 mRNA in monocytes compared to
normal. A-Ⅱ activates the TLR expression leading to inflammation and activation of the
innate immune system. When TLR 4 is activated there is
downstream macrophage activation, migration, increase metalloproteinase 9, vascular
remodeling, collagen accumulation in the artery, LVH and cardiac fibrosis.
✔✔CD4+ T lymphocytes - ✔✔express AT1R and PPAR gamma receptors, and release
TNF-α, interferon and interleukins within the vascular wall when activated
✔✔Efferent cholinergic anti-inflammatory pathways via the
vagal nerve - ✔✔innervate the spleen, nicotine acetylcholine
receptor subunits and cytokine producing immune cells to influence vasoconstriction
and BP
✔✔aldosterone - ✔✔associated with increased adaptive
immunity and autoimmune responses with CD4+ T cell
activation and Th 17 polarization with increased IL 17,
TGF-β and TNF-α which modulate over 30 inflammatory genes. Increased serum
aldosterone is an independent risk factor for CVD and CHD through
non-hemodynamic effects as well as through increased BP
Blockade of mineralocorticoid receptors in the
heart, brain, blood vessels and immune cells reduces CV risk even with the persistence
of hypertension
✔✔AT1 vs AT2 receptors - ✔✔angiotensin II receptor type 1 & 2
promote AT2, block AT1
stimulation of AT1R increases production of superoxide anion which neutralizes NO and
also forms additional downstream ROS and RNS that increase vascular oxidative stress
the AT2 receptor exerts a protective effect against an overstimulation of AT1 receptors
by counteracting AT1 receptor-mediated actions; e.g., whereas the AT1 receptor
stimulates cell proliferation, the AT2 receptor has an antiproliferative effect and
promotes cell differentiation
