Nutrition and cardiometabolic disease HNH-32106
Summary lectures/slides 2021
Week 1
Lecture 1 Types of cardiometabolic disease
CVD = cardiovascular disease
CHD = coronary heart disease
CMD = cardiometabolic disease
CMD = insulin resistance, inflammation, dyslipidemia, hypertension, vascular dysfunction
Changes in the burden of disease are related to incidence, mortality, cure, population ageing
etc.
CVD = CHD + stroke + peripheral artery disease (PAD)
Thrombosis
- A thrombosis: blood clot inside a blood vessel or cavity
- An embolus: blood clot that moves through the blood stream until it ends up in a
narrowed vessel and blocks the circulation
Acute coronary syndrome (ACS):
ACS comprises three diseases that involve the coronary arteries:
- ST elevation myocardial infarction = STEMI
- Non-ST elevation myocardial infarction = NSTEMI
- Unstable angina pectoris = AP
STEMI / ST-elevation myocardial infarction: caused by a sudden complete
(100%) blockage of a heart (/coronary) artery
NON-STEMI: usually caused by several narrowed arteries but the artery is
not completely blocked
Heart failure: often occurs after myocardial infarction (MI)
Ejection fraction: EF = (SV/EDV)*100
SV = stroke volume (amount of blood pumped from left ventricle per beat)
EDV = end-diastolic volume
-> decompensation cordis: ‘insufficient heart’ -> congestive heart failure (CHF)
Left ventricular failure: fluids build up in the lungs due to congestion of the veins in the lungs
(dyspnoea)
Right ventricular failure: fluid accumulates in the body, especially, in the legs and abdominal
organs (e.g. liver)
Peripheral arterial disease (PAD)
Intermittent claudication: muscle pain (ache, cramp, fatigue) caused by ischemia, mostly in
the calf muscle, which occurs during exercise and is relieved by a short period of rest.
‘’window-shoppers disease’’ or ‘’smoker’s leg’’
Diagnosis: PAD if ankle or branchial blood pressure index (ABI) 0.9
,Thrombo embolism
Arterial (thrombo) embolism
- artery in the leg or else where
- when it ends up in coronary artery: myocardial infarction
- can also start in carotid artery or in the heart due to arterial fibrillation -> travels to
the brain -> ischemic stroke
Venous (thrombo) embolism, VTE
- arises in systemic vein -> travels to the lung -> pulmonary embolism (e.g. after deep
venous thrombosis = DVT)
Cerebrovascular disease (stroke)
- blocked brain artery -> ischemic stroke
- thrombus from elsewhere -> embolic stroke
- ruptured brain vessel -> hemorrhagic stroke
TIA (‘’mini-stroke’’) symptoms < 24 hours
Diabetes
3 main types:
-> type 1 diabetes
-> type 2 diabetes
-> gestational diabetes
GDM = gestational diabetes
- high blood glucose (hyperglycemia) during pregnancy
- starts between 24 and 28 weeks of gestation, disappears after baby is born
- complications during pregnancy (e.g. hypertension), obstructed labor
- babies are bigger in size
- GDM woman: higher risk of T2D
Lecture 2 risk factors for cardiometabolic disease
Risk factors classification
Age is a risk factor for any disease -> chronic disease
Non-modifiable risk factors: age, gender, genetics, (ethnic background)
Modifiable risk factors: behavior, obesity, smoking, alcohol
Endogenous factors (biological / intrinsic Exogenous factors
factors)
Age, sex, genetic factors, blood lipids, blood Smoking, diet, physical activity, alcohol use,
pressure, body composition, diabetes stress, sleep quality, apnea, other lifestyle
mellitus, chronic inflammation and environmental factors.
CV risk factors not only affect heart and blood vessels, but also kidney, brain and eye.
, Cardiometabolic disease process
Develops slowly over time due to long-term exposures
Healthy Early changes Preclinical Screening Clinical phase
phase
Able to adapt Small Elevated risk e.g. oral glucose Disease event:
abnormalities: factors: insulin tolerance test with
do not yet resistance, low- or heart scan hospitalization
affect the grade can for and specialist
functioning of inflammation, calcification in care
the body and changes to coronary
arterial wall. arteries
High blood
pressure and
cholesterol.
Loss of kidney
function.
Pathways in cardiometabolic disease
- Inflammation
- Endothelial dysfunction
Hazard =
Risk = hazard * prevalence of exposure
Differences in CVD prevalence between men and woman
- Different complaints
- Clinical trials studies on males
o Treatment not yet tailored for females -> not optimal -> increase risk of
dying / loss of years
Direct & indirect effects:
Direct: smoking -> effect
Indirect: smoking -> blood pressure, blood cholesterol, blood glucose, BMI -> effect
Raised blood pressure= number one risk factor for mortality worldwide CVD
- = silent killer: no complaints
Hypertension: systolic blood pressure 140 mm Hg or diastolic blood pressure 90 mm Hg
or use of antihypertensive medication.
- Categorization is mainly for clinicians! Not much value in research
- Systolic blood pressure is more important = upper reading, when heart pumps blood
into body => stronger predictor of CVD
- Diastolic blood pressure when heart is at rest, lower reading
SBP: upper reading, when heart pumps blood into body
DBP: lower reading, when heart is at rest
Summary lectures/slides 2021
Week 1
Lecture 1 Types of cardiometabolic disease
CVD = cardiovascular disease
CHD = coronary heart disease
CMD = cardiometabolic disease
CMD = insulin resistance, inflammation, dyslipidemia, hypertension, vascular dysfunction
Changes in the burden of disease are related to incidence, mortality, cure, population ageing
etc.
CVD = CHD + stroke + peripheral artery disease (PAD)
Thrombosis
- A thrombosis: blood clot inside a blood vessel or cavity
- An embolus: blood clot that moves through the blood stream until it ends up in a
narrowed vessel and blocks the circulation
Acute coronary syndrome (ACS):
ACS comprises three diseases that involve the coronary arteries:
- ST elevation myocardial infarction = STEMI
- Non-ST elevation myocardial infarction = NSTEMI
- Unstable angina pectoris = AP
STEMI / ST-elevation myocardial infarction: caused by a sudden complete
(100%) blockage of a heart (/coronary) artery
NON-STEMI: usually caused by several narrowed arteries but the artery is
not completely blocked
Heart failure: often occurs after myocardial infarction (MI)
Ejection fraction: EF = (SV/EDV)*100
SV = stroke volume (amount of blood pumped from left ventricle per beat)
EDV = end-diastolic volume
-> decompensation cordis: ‘insufficient heart’ -> congestive heart failure (CHF)
Left ventricular failure: fluids build up in the lungs due to congestion of the veins in the lungs
(dyspnoea)
Right ventricular failure: fluid accumulates in the body, especially, in the legs and abdominal
organs (e.g. liver)
Peripheral arterial disease (PAD)
Intermittent claudication: muscle pain (ache, cramp, fatigue) caused by ischemia, mostly in
the calf muscle, which occurs during exercise and is relieved by a short period of rest.
‘’window-shoppers disease’’ or ‘’smoker’s leg’’
Diagnosis: PAD if ankle or branchial blood pressure index (ABI) 0.9
,Thrombo embolism
Arterial (thrombo) embolism
- artery in the leg or else where
- when it ends up in coronary artery: myocardial infarction
- can also start in carotid artery or in the heart due to arterial fibrillation -> travels to
the brain -> ischemic stroke
Venous (thrombo) embolism, VTE
- arises in systemic vein -> travels to the lung -> pulmonary embolism (e.g. after deep
venous thrombosis = DVT)
Cerebrovascular disease (stroke)
- blocked brain artery -> ischemic stroke
- thrombus from elsewhere -> embolic stroke
- ruptured brain vessel -> hemorrhagic stroke
TIA (‘’mini-stroke’’) symptoms < 24 hours
Diabetes
3 main types:
-> type 1 diabetes
-> type 2 diabetes
-> gestational diabetes
GDM = gestational diabetes
- high blood glucose (hyperglycemia) during pregnancy
- starts between 24 and 28 weeks of gestation, disappears after baby is born
- complications during pregnancy (e.g. hypertension), obstructed labor
- babies are bigger in size
- GDM woman: higher risk of T2D
Lecture 2 risk factors for cardiometabolic disease
Risk factors classification
Age is a risk factor for any disease -> chronic disease
Non-modifiable risk factors: age, gender, genetics, (ethnic background)
Modifiable risk factors: behavior, obesity, smoking, alcohol
Endogenous factors (biological / intrinsic Exogenous factors
factors)
Age, sex, genetic factors, blood lipids, blood Smoking, diet, physical activity, alcohol use,
pressure, body composition, diabetes stress, sleep quality, apnea, other lifestyle
mellitus, chronic inflammation and environmental factors.
CV risk factors not only affect heart and blood vessels, but also kidney, brain and eye.
, Cardiometabolic disease process
Develops slowly over time due to long-term exposures
Healthy Early changes Preclinical Screening Clinical phase
phase
Able to adapt Small Elevated risk e.g. oral glucose Disease event:
abnormalities: factors: insulin tolerance test with
do not yet resistance, low- or heart scan hospitalization
affect the grade can for and specialist
functioning of inflammation, calcification in care
the body and changes to coronary
arterial wall. arteries
High blood
pressure and
cholesterol.
Loss of kidney
function.
Pathways in cardiometabolic disease
- Inflammation
- Endothelial dysfunction
Hazard =
Risk = hazard * prevalence of exposure
Differences in CVD prevalence between men and woman
- Different complaints
- Clinical trials studies on males
o Treatment not yet tailored for females -> not optimal -> increase risk of
dying / loss of years
Direct & indirect effects:
Direct: smoking -> effect
Indirect: smoking -> blood pressure, blood cholesterol, blood glucose, BMI -> effect
Raised blood pressure= number one risk factor for mortality worldwide CVD
- = silent killer: no complaints
Hypertension: systolic blood pressure 140 mm Hg or diastolic blood pressure 90 mm Hg
or use of antihypertensive medication.
- Categorization is mainly for clinicians! Not much value in research
- Systolic blood pressure is more important = upper reading, when heart pumps blood
into body => stronger predictor of CVD
- Diastolic blood pressure when heart is at rest, lower reading
SBP: upper reading, when heart pumps blood into body
DBP: lower reading, when heart is at rest
