Nutrition and CVS – Atherosclerosis
• Developed countries: ischemic heart disease remains the top cause of death; mortality is
decreasing but morbidity is rising
o Better, well-organized healthcare systems
o Increase in morbidity, see in an increase in heart failure from other diseases because they
suffered from ischemic heart disease
• Developing countries: increase of non-communicable diseases and mortality due to ischemic
heart disease is rising
o Must develop different therapies/ approaches in developed vs developing countries
• Acute myocardial infarction = heart attack
• Ischemic heart disease = damage to the heart’s major blood vessels because it is not receving
enough blood and oxygen
• Narrowing of your coronary arteries = build-up of the atherosclerosis plaque
o Deposit of fat that builds up in arteries → block arteries and blood flow → prevent
cells from receiving oxygen
• Main factors – unhealthy diet, unhealthy lifestyle, smoking, lack of exercise
• Arteriolosclerosis – hardening and loss of elasticity of arterioles or small arteries, most often
associated with hypertension and diabetes mellitus
• Atherosclerosis – the build-up of fats, cholesterol and other substances in the medium and
large artery walls
• Monckeberg’s arteriosclerosis – deposit of calcium medium arteries
o Harmless disorder
o More common in men than women, may be due to hormones
o Pre- vs post-menopause alters the risk in women
Note: sclerosis (hardening), arterio- (of the arteries)
Atherosclerotic plaque
Contains
• Intra- and extracellular cholesterol and phospholipids
• Inflammatory cells
• Smooth muscle cells
• Connective tissue (collagen, elastic fibres)
• Thrombus (blood clot)
• Calcium deposit
Origin
• A slow and complex disease, may begin in childhood
o Clinical symptoms only appear 30 years after it begins
o To limit development = adopt a healthy lifestyle from childhood
• Chronic inflammatory response in wall arteries → leading to accumulation of macrophages in
the wall
• Promoted by low-density lipoproteins → oxidized then brings cholesterol
o Normally have physiological process of removing fat and cholesterol by HDL → becomes
inadequate, resulting in the hardening
, Major lipid molecules
Cholesterol • Main physiological functions: part of plasma membrane,
precursor of bile acids (for fat digestion) and steroid hormones
• Present in each individual cell
Cholesteryl esters • Most prominent form of cholesterol circulating in plasma
• ACAT – enzyme that catalyses the formation of cholesteryl esters
Triglycerides • Non-polar, hydrophobic molecules
• Generation of free fatty acids
o Generation requires lipases
Phospholipids • Sphingomyelin – major component of the cell membrane
• Plays important role in signaling pathways – DAG and FFA
Lipoprotein transport system
• All lipids are hydrophobic, therefore cannot be
transported in aqueous plasma
• The transport system carries hydrophobic molecules
from the site of origin to the site of utilization
• Core – transport triglycerides and cholesteryl ester
• Envelope – phospholipid and cholesterol
• Transport is controlled by the apolipoprotein
o Apo A, B, C and E
o Control the assembly and secretion of the lipoprotein
o Ensure the structural integrity of the lipoprotein
o Control the coactivation/ inhibition of enzymes > control path of different lipids
o Can control the binding/ docking to specific receptors and proteins for cellular uptake of
a lipid component
• Classification function to density in the plasma
o Highest to lowest density = HDL > LDL > IDL > VLDL > Chylomicron
Characteristics of major lipoproteins
• Major lipoproteins have different compositions = different roles
Chylomircons VLDL LDL HDL
Origin Intestines Liver VLDL Liver
Role Dietary fat Transport of fat Transport of Transport of excess
transport from liver → cholesterol from cholesterol from
periphery liver → periphery periphery → liver
Most abundant Triglycerides triglycerides cholesterol Protein,
constituents phospholipids,
cholesterol
• Origin of cholesterol can come from diet but cells can also form cholesterol (synthesis at liver)
• VDLD transport cholesterol and triglycerides that come from liver → send to periphery
o Eventually changes composition and becomes an LDL particle
• Developed countries: ischemic heart disease remains the top cause of death; mortality is
decreasing but morbidity is rising
o Better, well-organized healthcare systems
o Increase in morbidity, see in an increase in heart failure from other diseases because they
suffered from ischemic heart disease
• Developing countries: increase of non-communicable diseases and mortality due to ischemic
heart disease is rising
o Must develop different therapies/ approaches in developed vs developing countries
• Acute myocardial infarction = heart attack
• Ischemic heart disease = damage to the heart’s major blood vessels because it is not receving
enough blood and oxygen
• Narrowing of your coronary arteries = build-up of the atherosclerosis plaque
o Deposit of fat that builds up in arteries → block arteries and blood flow → prevent
cells from receiving oxygen
• Main factors – unhealthy diet, unhealthy lifestyle, smoking, lack of exercise
• Arteriolosclerosis – hardening and loss of elasticity of arterioles or small arteries, most often
associated with hypertension and diabetes mellitus
• Atherosclerosis – the build-up of fats, cholesterol and other substances in the medium and
large artery walls
• Monckeberg’s arteriosclerosis – deposit of calcium medium arteries
o Harmless disorder
o More common in men than women, may be due to hormones
o Pre- vs post-menopause alters the risk in women
Note: sclerosis (hardening), arterio- (of the arteries)
Atherosclerotic plaque
Contains
• Intra- and extracellular cholesterol and phospholipids
• Inflammatory cells
• Smooth muscle cells
• Connective tissue (collagen, elastic fibres)
• Thrombus (blood clot)
• Calcium deposit
Origin
• A slow and complex disease, may begin in childhood
o Clinical symptoms only appear 30 years after it begins
o To limit development = adopt a healthy lifestyle from childhood
• Chronic inflammatory response in wall arteries → leading to accumulation of macrophages in
the wall
• Promoted by low-density lipoproteins → oxidized then brings cholesterol
o Normally have physiological process of removing fat and cholesterol by HDL → becomes
inadequate, resulting in the hardening
, Major lipid molecules
Cholesterol • Main physiological functions: part of plasma membrane,
precursor of bile acids (for fat digestion) and steroid hormones
• Present in each individual cell
Cholesteryl esters • Most prominent form of cholesterol circulating in plasma
• ACAT – enzyme that catalyses the formation of cholesteryl esters
Triglycerides • Non-polar, hydrophobic molecules
• Generation of free fatty acids
o Generation requires lipases
Phospholipids • Sphingomyelin – major component of the cell membrane
• Plays important role in signaling pathways – DAG and FFA
Lipoprotein transport system
• All lipids are hydrophobic, therefore cannot be
transported in aqueous plasma
• The transport system carries hydrophobic molecules
from the site of origin to the site of utilization
• Core – transport triglycerides and cholesteryl ester
• Envelope – phospholipid and cholesterol
• Transport is controlled by the apolipoprotein
o Apo A, B, C and E
o Control the assembly and secretion of the lipoprotein
o Ensure the structural integrity of the lipoprotein
o Control the coactivation/ inhibition of enzymes > control path of different lipids
o Can control the binding/ docking to specific receptors and proteins for cellular uptake of
a lipid component
• Classification function to density in the plasma
o Highest to lowest density = HDL > LDL > IDL > VLDL > Chylomicron
Characteristics of major lipoproteins
• Major lipoproteins have different compositions = different roles
Chylomircons VLDL LDL HDL
Origin Intestines Liver VLDL Liver
Role Dietary fat Transport of fat Transport of Transport of excess
transport from liver → cholesterol from cholesterol from
periphery liver → periphery periphery → liver
Most abundant Triglycerides triglycerides cholesterol Protein,
constituents phospholipids,
cholesterol
• Origin of cholesterol can come from diet but cells can also form cholesterol (synthesis at liver)
• VDLD transport cholesterol and triglycerides that come from liver → send to periphery
o Eventually changes composition and becomes an LDL particle
