AACVPR Cardiac Rehab Resource Manual Chapter 3 Quiz (100% Correct Answers)

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long term epidemiological study of CHD risk Farmingham Heart Study study supports the notion that RFs are important by showing that more than ninety percent of attributable risk can be accounted... for in modifiable risk factors Farmingham Heart Study Secondary prevention study showing 34% reduction of event reduction through fish oil or 1,500mg omega-3 DART Study Secondary prevention study showing a 72% event reduction with a Mediterranean type diet Lyon Heart Study Secondary prevention study showing a 60% event reduction through exercise, stress reduction, low fat diet and weight loss Lifestyle Heart Trial Name 6 risk factors for coronary heart disease that have been proven to lower risk Smoking, hypertension, LDL cholesterol, High-fat diet, Left ventricular hypertrophy, and thrombogenic risk factors What risk factor interacts with other risk factors to affect plaque stability, endothelial function, and thrombogenesis. This risk factor amplifies others. smoking Name the Adult Treatment Panel III Goals for patients with CHD for Cholesterol, LDL, HDL, Triglycerides, Non-HDL Cholesterol Cholesterol <200 LDL <70 HDL > 40 Triglycerides <150 Non-HDL Cholesterol <130 Standard _______ produce mild to moderate effects in lipid alteration but potentiates the effects of pharmacological therapy dietary intervention What is the MUFA dietary recommendations MUFA: 15% of calories PUFA: 10% total calories SAFA: <8% total calories MUFA = monounsaturated PUFA = polyunsaturated fatty acids SAFA = saturated fatty acids Eating what can reduce your chance for recurrent cardiac events by 32% two fatty fish meals What type of lipid lowering drug has an interaction with grapefruit juice? Statins What LCL decreasing and HDL increasing drug is contraindicated for someone with Triglycerides >500 because it may increase Triglycerides Bile Acid Sequestrants Statins may cause GI discomfort, myopathy, elevate hepatic transaminase. Statin + anticoagulant may increase prothrombin time, may deplete _________ Coenzyme Q What is associated with dyslipidemia, metabolic dysfunction, and insulin resistance and deficiency, all which predispose individuals to atherogenesis Hyperglycemia Metabolic syndrome is the present of three of more of what conditions? Abdominal obesity: waist circumference greater than 102 cm or 40 inches in men and greater than 88 cm or 35 inches in women Glucose: fasting glucose greater than or equal to 150 mgdl or 6.1 mmolL BP: 130/85 mmHg or more High Triglycerides: greater than or equal to 150 mhdl or 1.70 mmolL Low HDL: less than 40 in men or less than 50 in women What is the weekly calorie expenditure needed to sustain weight loss 2,000 Kcal/week Study by Diabetes Prevention showed that _______ was nearly twice as effective as Metformin in preventing the onset of diabetes Lifestyle changes Classification of Adult BP Normal <120 <80 Prehypertension 120-139 80-89 Stage 1 hypertension 140-159 90-99 Stage 2 hypertension >160 >100 What is the difference in treatment for adults with prehypertension versus adults with stage 1? Prehypertension = lifestyle modifications Stage 1 = oral antihypertension drugs and lifestyle modifications What diet has been shown to improve BP as well as blood lipids? Dietary Approaches to Stop Hypertension or DASH How many extra calories do you need to burn each week to improve VO2Max in CHD patient as well as provide a cardioprotective effect and potentially reverse CHD 1,250 to 2,000 Kcal CHD patients need lifestyle physical activity and exercise each week. How many hours per week of the above combination are needed? Four to six hours per week ______ intensity and higher duration are more effective in changing lipoprotein concentrations Higher Exercise has positive effects on ______ in both larger conduit and smaller resistance arteries endothelial dysfunction AACVPR recommends what kind of home program? Walking with a pedometer Explain how family history of CHD effects an individual? A first degree relative with CHD will increase the risk by 1.7 to 12.9. Family history is considered having a first degree relative male or female less than 55 years with a history of CHD. True or False Lifestyle and environmental factors exert a much greater influence on the risk of atherosclerosis than genetics. True Multiple genotypes may have relatively small effects by themselves, but when high risk lifestyles are superimposed they account for the majority of atherosclerotic events Name the markers of thrombogenesis that have been shown to be predictors of CHD related events: elevated plasma levels of fibrinogen, factor VII, plasminogen activator inhibitor, and increased platelet aggregation What medications decrease risk of thrombogenesis? ASA and anticoagulants Standard practice for post-MI and CABG patients are low dose ASA or 325 mg ASA True or False AHA recommends that hormone replacement therapy should be used in women with heart disease? False Estrogen is known to decrease the atherogenic lipoprotein Lp(a), however it is not recommend due to a large study that showed risks Name interventions to improve endothelial dysfunction: -LDL lowering with pheresis -LDL lowering by statins and other -LDL lowering by low fat diet -ACE inhibitors and ACE II receptor blockers -L arginine -Moderate alcohol intake -thermal therapy -purple grape juice -iron chelation -tea -high monounsaturated fat diet -Low fat, high complex carbohydrate diet -Folic acid -smoking cessation -antioxidant therapy -aerobic exercise training -weight loss Name the marker of low grade systemic inflammation that has been shown to predict both first and recurrent CHD events High sensitive C-reactive protein (hs CRP) ASA, statins, and weight loss and physical activity haven been shown to lower hs CRP Elevated Homocysteine is associated with endothelial dysfunction, increased arterial wall thickness, arterial wall stiffening, and procoagulant activity. A major cause of hyperhomocysteinemia is what vitamin deficiencies? Folic acid and B vitamins How do you optimize secondary prevention? -Stratification of patients at entry for risk of disease progression -Assessment of readiness to improve each risk factor -Individually targeted therapy according to needs and readiness -Aggressive follow-up until treatment targets are acheived What is associated with a higher risk ratio for CHD in Caucasian women? Lipoprotein Lp(a). Lipoprotein accumulates in atherosclerotic lesions and appears to interact with hyperhomocysteinemia to promote a procoagulant state and thrombosis Estrogen and niacin are the only agents that have been shown to effectively lower Lp(a) What type of dyslipidemia is genetically linked? Pattern B Dyslipidemia Small, dense LDL pattern B appears to be the most common lipid disorder found in CHD patients Physical training, weight loss, low fat diet, nicotinic acid and fibric acid derivatives are effective in improving LDL pattern B trait True or False 80% of patients who develop CHD have similar serum cholesterol levels as those who do not develop CHD True Specific risk factor recommendations for secondary prevention Obesity Isocaloric diet if BMI <25 Hypocaloric diet if BMI >25 Specific risk factor recommendations for secondary prevention Smoking Complete cessation Specific risk factor recommendations for secondary prevention Exercise Weekly caloric expenditure greater than or equal to 2,000 Kcal Resistance training 2-3 days per week Specific risk factor recommendations for secondary prevention Hypertension BP<120/80 Sodium intake less than 1,500 mg a day Specific risk factor recommendations for secondary prevention Diet Fat = 15-25% of total calories SAFA <5% MUFA = 5-12% PUFA= 5-10% (omega-3s) Cholesterol<150 Include functional foods Specific risk factor recommendations for secondary prevention Stress Acquire some kind of stress management skill and practice 5-7 days a week Therapy and counseling as indicated and required Remain socially connected, avoid isolation Control anger, hostility [Show More]

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