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hypertriglyceridemia\nintermediate-density\tlipoprotein\t(IDL)\nischemia\nleft\tventricular\thypertrophy\t(LVH)\nlipoprotein\nlow-density\tlipoprotein\t(LDL)\nMediterranean\tdiet\t(MeD) | [
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metabolic\tsyndrome\nmyocardial\tinfarction\t(MI)\nnitric\toxide\t(NO)\nplaque\nprehypertension\nrenin-angiotensin\n\tsystem\t(RAS)\nsecondary\thypertension\nstatins\nstroke\nsyncope\nsystolic\tblood\tpressure\t(SBP)\nthrombus\ntrans\tfatty\tacids\ntransient\tischemic\tattack\t(TIA)\ntrimethylamine-N-oxide\t(TMAO)\nvery-low-density\tlipoprotein\t(VLDL)\nxanthoma | [
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very-low-density\tlipoprotein\t(VLDL)\nxanthoma\nCardiovascular\tdisease\t(CVD)\n\tis\ta\tgroup\tof\tinterrelated\tdiseases\tthat\tincludes\tatherosclerosis,\nhypertension,\tischemic\theart\tdisease,\tperipheral\tvascular\tdisease,\n\tand\theart\tfailure\t(HF).\tThese\ndiseases\tare\tinterrelated\tand\toften\tcoexist.\tAn\testimated\t84,000,000\tadult\tAmericans\t(one\tin\tthree) | [
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have\tone\tor\tmore\ttypes\tof\tCVD\t(\nBox\t32.1\n).\nBOX\t32.1\nTypes\tand\tIncidence\tof\tCardiovascular\tDisease\tin\tthe\tUnited\nStates\nHypertension:\t75,000,000\nCoronary\theart\tdisease:\t25,155,000\nMyocardial\tinfarction:\t790,000\nHeart\tfailure:\t6,500,000\nStroke:\t7,950,000 | [
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Heart\tfailure:\t6,500,000\nStroke:\t7,950,000\nBecause\tof\tcomorbidities,\tit\tis\tnot\tpossible\tto\tadd\tthese\tnumbers\ttogether\tto\treach\ta\ttotal\t(American\nHeart\tAssociation\t[AHA],\t2010;\t\nhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408160/\n;\nhttps://www.cdc.gov/heartdisease/heart_attack.htm\n). | [
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about\tevery\tminute\tsomeone\twill\tdie\tof\tone.\tOn\taverage,\tsomeone\tin\tthe\tUnited\tStates\tsuffers\ta\nstroke\tevery\t40\tseconds\t(\nAmerican\tHeart\tAssociation\t[AHA],\t2015\n).\tThe\tlifetime\trisk\tfor\tCVD\tin\nAmerican\tmen\tis\ttwo\tin\tthree\tand\tfor\twomen\tis\tone\tin\ttwo\t(\nAHA,\t2015\n).\tWorldwide,\n\t18\tmillion\ndeaths\tper\tyear\tare\tattributed\tto\tCVD\t(\nYusuf\tet\tal,\t2014\n). | [
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deaths\tper\tyear\tare\tattributed\tto\tCVD\t(\nYusuf\tet\tal,\t2014\n).\nAtherosclerotic\tcardiovascular\tdisease\t(ASCVD)\n\tinvolves\tthe\tnarrowing\tof\tsmall\tblood\tvessels\nthat\toxygenate\tthe\theart\tmuscle\tby\tthe\tbuild-up\tof\t\nplaque\n\t(the\tlesion\tin\tthe\tblood\tvessels).\tThe | [
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thereafter,\twhite\tmen\thave\tthe\thighest\trates.\tBlack\nwomen\thave\thigher\trates\tthan\twhite\twomen\tat\tall\tages.\tAmong\twhites\tolder\tthan\tage\t18,\t12.1%\nhave\tCVD.\tIn\tthe\tsame\tage\tgroup,\t10.2%\tof\tblacks\thave\theart\tdisease,\tand\tin\tHispanics\tthe\nincidence\tis\t8.1%.\tThe\tincidence\tin\tadult\tNative\tAmericans\tis\t12.1%,\tin\tNative\tHawaiians\tor\tother | [
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Pacific\tIslanders\tit\tis\t19.7\t%,\tand\tin\tAsians\tit\tis\t5.2%\t(\nAHA,\t2015\n).\tThis\tchapter\tdiscusses\tthe\nincidence,\tpathophysiologic\tfindings,\tprevention,\tand\ttreatment\tof\teach\tof\tthe\tCVDs.\nAtherosclerosis\tand\tcoronary\theart\tdisease\nAnatomy\tand\tphysiology\nBlood\tvessels\tare\tcomposed\tof\tthree\tlayers.\tThe\touter\tlayer\tis\tmainly\tconnective\ttissue\tthat\tgives | [
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key\trole\tin\tvasodilation\t(\nTousoulis\tet\tal,\t2012\n).\tDecreased\tNO\tis\ta\tfactor\tin\tthe\tendothelial\tcell\ndysfunction\tthat\tdisrupts\tvascular\tbalance\tand\tcan\tresult\tin\tvasoconstriction,\tplatelet\tactivation,\nleukocyte\tadherence,\tand\tvascular\tinflammation.\nPathophysiology | [
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leukocyte\tadherence,\tand\tvascular\tinflammation.\nPathophysiology\nASCVD\tinvolves\tthe\taccumulation\tof\tplaque\twithin\tthe\twalls\tof\tthe\tarteries.\tIt\tstarts\twith\tinjury\tto\nthe\tendothelial\tcells\twith\tan\tassociated\tinflammatory\tresponse\tinvolving\tphagocytes\n\tand\tmonocytes.\nOnce\tin\tthe\ttissue,\tmonocytes\tevolve\tinto\ta\tspecialized\ttype\tof\tmacrophage\tcalled\ta | [
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narrowing\tcaused\n\tby\tthe\tplaque.\tThis\t“remodeling”\tof\tthe\tshape\tand\tsize\tof\tthe\tblood\tvessel\tmay\nresult\tin\tan\taneurysm.\tAtheromas\tcan\trupture\tor\tbreak\toff,\tforming\ta\t\nthrombus\n\t(blood\tclot),\twhere\nthey\tattract\tblood\tplatelets\tand\tactivate\tthe\tclotting\tsystem\tin\tthe\tbody.\tThis\tresponse\tcan\tresult\tin\ta\nblockage\tand\trestricted\tblood\tflow. | [
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blockage\tand\trestricted\tblood\tflow.\nOnly\thigh-risk\tor\tvulnerable\tplaque\tforms\tthrombi.\tVulnerable\tplaques\tare\tlesions\n\twith\ta\tthin\nfibrous\tcap,\tfew\tsmooth\tmuscle\tcells,\tmany\tmacrophages\t(inflammatory\tcells),\tand\ta\tlarge\tlipid\tcore\n(\nFig.\t32.2\n).\tArterial\tchanges\tbegin\tin\tinfancy\tand\tprogress\tasymptomatically\tthroughout\tadulthood\n(\nFig.\t32.3\n). | [
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] |
FIG.\t32.2\nNatural\tprogression\tof\tatherosclerosis.\n\tSource:\t(From\tHarkreader\tH:\t\nFundamentals\tof\tnursing:\tcaring\tand\nclinical\tjudgment,\n\tPhiladelphia,\t2007,\tSaunders.)\nFIG.\t32.3\nPlaque\tthat\tcan\tbe\tsurgically\tremoved\tfrom\tthe\tcoronary\tartery.\n\tSource:\t(Photographs\tcourtesy\tRonald\tD.\nGregory\tand\tJohn\tRiley,\tMD.) | [
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Source:\t(Photographs\tcourtesy\tRonald\tD.\nGregory\tand\tJohn\tRiley,\tMD.)\nThe\tclinical\toutcome\tof\timpaired\tarterial\tfunction\tarising\tfrom\tatherosclerosis\tdepends\ton\tthe\nlocation\tof\tthe\timpairment.\tIn\tthe\tcoronary\tarteries\tatherosclerosis\tcan\tcause\t\nangina\n\t(chest\tpain),\nMI,\tand\tsudden\tdeath;\tin\tthe\tcerebral\tarteries\tit\tcauses\n\tstrokes\tand | [
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strokes\tand\t\ntransient\tischemic\tattacks\n(TIAs)\n;\tand\tin\tthe\tperipheral\tcirculation\tit\tcauses\tintermittent\tclaudication,\tlimb\t\nischemia\n(inadequate\tblood\tsupply),\tand\tgangrene\t(\nFig.\t32.4\n).\tThus\tatherosclerosis\tis\tthe\tunderlying\tcause\tof\nmany\tforms\tof\tCVD. | [
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] |
FIG.\t32.4\nMajor\tclinical\tmanifestations\tof\tatherothrombotic\tdisease.\n\tSource:\t(From\tViles-Gonzalez\tJF,\tet\tal:\nAtherothrombosis:\ta\twidespread\tdisease\twith\tunpredictable\tand\tlife-threatening\tconsequences,\t\nEur\tHeart\tJ\n\t25:1197,\t2004.)\nDyslipidemia\n\trefers\tto\ta\tblood\tlipid\tprofile\tthat\tincreases\tthe\trisk\tof\tdeveloping\tatherosclerosis. | [
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Three\timportant\tbiochemical\tmeasurements\tin\tASCVD\tinclude\tlipoproteins,\n\ttotal\tcholesterol,\tand\ntriglycerides.\tCholesterol\tis\tdelivered\tinto\tcell\twalls\tby\t\nlow-density\tlipoprotein\t(LDL)\n,\tespecially\nsmaller\tparticles.\tTo\tattract\tand\tstimulate\tthe\tmacrophages,\tthe\tcholesterol\tmust\tbe\treleased\tfrom | [
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the\tLDL\tparticles\tand\toxidized,\ta\tkey\tstep\tin\tthe\tongoing\tinflammatory\tprocess.\tAdditionally,\nmacrophages\tmust\tmove\texcess\tcholesterol\tquickly\tinto\t\nhigh-density\tlipoprotein\t(HDL)\n\tparticles\nto\tavoid\tbecoming\tfoam\tcells\tand\tdying.\tThe\ttypical\tdyslipidemic\tcondition\tis\tone\tin\twhich\tLDL\nlevels\tare\televated\t(hyperlipidemia)\tand\tHDL\tlevels\tare\tlow. | [
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levels\tare\televated\t(hyperlipidemia)\tand\tHDL\tlevels\tare\tlow.\nLipoproteins\nLipids\tare\tnot\twater\tsoluble,\tso\tthey\tare\tcarried\tin\tthe\tblood\tbound\tto\tprotein.\tThese\tcomplex\nparticles,\tcalled\t\nlipoproteins\n\tthat\tare\tmanufactured\tin\tthe\tliver,\tvary\tin\tcomposition,\tsize,\tand\ndensity.\tLipoproteins\n\tmeasured\tin\tclinical\tpractice—chylomicrons, | [
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density.\tLipoproteins\n\tmeasured\tin\tclinical\tpractice—chylomicrons,\t\nvery-low-density\tlipoprotein\n(VLDL),\tlow-density\tlipoproteins\t(LDL)\n,\tand\t\nhigh-density\tlipoproteins\t(HDL)\n—consist\tof\nvarying\tamounts\tof\ttriglyceride,\tcholesterol,\tphospholipid,\tand\tprotein.\tEach\tclass\tof\tlipoprotein | [
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] |
actually\trepresents\ta\tcontinuum\tof\tparticles.\tThe\tratio\tof\tprotein\tto\tfat\tdetermines\tthe\tdensity;\tthus\nparticles\twith\thigher\tlevels\tof\tprotein\n\tare\tthe\tmost\tdense\t(e.g.,\tHDLs\thave\tmore\tprotein\tthan\tLDLs).\nThe\tphysiologic\trole\tof\tlipoprotein\tincludes\ttransporting\tlipid\tto\tcells\tfor\tenergy,\tstorage,\tor\tuse\tas | [
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substrate\tfor\tsynthesis\tof\tother\tcompounds\tsuch\tas\tprostaglandins,\tthromboxanes,\tand\tleukotrienes.\nThe\tlargest\tparticles,\t\nchylomicrons\n,\ttransport\tdietary\tfat\tand\tcholesterol\tfrom\tthe\tsmall\tintestine\nto\tthe\tliver\tand\tperiphery.\tOnce\n\tin\tthe\tbloodstream,\tthe\ttriglycerides\twithin\tthe\tchylomicrons\tare | [
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in\tthe\tbloodstream,\tthe\ttriglycerides\twithin\tthe\tchylomicrons\tare\nhydrolyzed\tby\tlipoprotein\tlipase\t(LPL),\tlocated\ton\tthe\tendothelial\tcell\tsurface\tin\tmuscle\tand\tadipose\ntissue.\t\nApolipoproteins\n\tcarry\tlipids\tin\tthe\tblood\tand\talso\tcontrol\tthe\tmetabolism\tof\tthe\tlipoprotein | [
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] |
molecule.\tApo\tC-II,\tone\tof\tthe\tapolipoproteins,\tis\ta\tcofactor\tfor\tLPL.\tWhen\tapproximately\t90%\tof\tthe\ntriglyceride\tis\thydrolyzed,\n\tthe\tparticle\tis\treleased\tback\tinto\tthe\tblood\tas\ta\tremnant.\tThe\tliver\nmetabolizes\tthese\tchylomicron\tremnants,\tbut\tsome\tdeliver\tcholesterol\tto\tthe\tarterial\twall\tand\tthus | [
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are\tconsidered\tatherogenic.\tConsumption\tof\thigh-fat\tmeals\tproduces\tmore\tchylomicrons\tand\nremnants.\tPlasma\tstudies\tare\tdone\twhen\tfasting;\tchylomicrons\tare\tnormally\tabsent.\nVLDL\tparticles\tare\tsynthesized\tin\tthe\tliver\tto\ttransport\n\tendogenous\ttriglyceride\tand\tcholesterol. | [
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endogenous\ttriglyceride\tand\tcholesterol.\nTriglyceride\taccounts\tfor\t60%\tof\tthe\tVLDL\tparticle.\tThe\tlarge,\tbuoyant\tVLDL\tparticle\tis\tbelieved\tto\nbe\tnonatherogenic.\tVegetarian\tand\tlow-fat\tdiets\tincrease\tthe\tformation\tof\tlarge\tVLDL\tparticles.\nSmaller\tVLDL\tparticles\t(i.e.,\tremnants)\tare\tformed\tfrom\ttriglyceride\thydrolysis\tby\tLPL.\tNormally | [
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these\tremnants,\tcalled\t\nintermediate-density\tlipoproteins\t(IDLs)\n,\tare\tatherogenic\tand\tare\ttaken\nup\tby\treceptors\ton\tthe\tliver\tor\tconverted\tto\tLDLs.\tSome\tof\tthe\tsmaller\tLDL\tparticles\tstay\tin\tthe\nblood,\tare\toxidized,\tand\tare\tthen\ttaken\tinto\tthe\tarterial\twall.\tClinically,\ta\ttotal\ttriglyceride\tlevel\tis\ta | [
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assessed\tin\tisolation.\n\tAfter\tLDL\tformation,\t60%\tis\ttaken\tup\tby\tLDL\treceptors\ton\tthe\tliver,\tadrenals,\nand\tother\ttissues.\tThe\tremainder\tis\tmetabolized\tvia\tnonreceptor\tpathways.\tThe\tnumber\tand\tactivity\nof\tthese\tLDL\treceptors\tare\tmajor\tdeterminants\tof\tthe\tLDL\tlevel\tin\tthe\tblood.\tApolipoprotein\tB\tis\tthe | [
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0.09617123752832413,
0.020899146795272827
] |
HDL\tlevels\tand\trisk\tof\ncardiovascular\tevents.\tAnd\tgenerally\ta\thigh\tHDL\tlevel\tis\tconsidered\theart-protective.\tHowever\tthere\nis\trecent\tevidence\tthat\tvery\thigh\tlevels\tof\tHDL\tcholesterol\t(greater\tthan\t97)\tare\tactually\ta\trisk\nfactor\t(\nMadsen\tet\tal,\t2017\n).\nTotal\tcholesterol | [
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0.07342380285263062,
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0.0797225683927536,
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0.17912884056568146,
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0.02034393884241581,
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0.09064791351556778,
0.044520214200019836,
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0.06941595673561096,
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0.12158206105232239,
0.051587771624326706,
0.11044494807720184,
0.055356841534376144
] |
factor\t(\nMadsen\tet\tal,\t2017\n).\nTotal\tcholesterol\nA\ttotal\tcholesterol\tmeasurement\tcaptures\tcholesterol\tcontained\tin\tall\tlipoprotein\tfractions:\t60%\tto\n70%\tis\tcarried\ton\tLDL,\t20%\n\tto\t30%\ton\tHDL,\tand\t10%\tto\t15%\ton\tVLDL.\nTriglycerides\nThe\ttriglyceride-rich\tlipoproteins\tinclude\tchylomicrons,\tVLDLs,\tand\tany\tremnants\tor\tintermediary | [
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0.00156530668027699,
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0.014102657325565815,
0.09613989293575287,
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0.11214698106050491,
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0.03185576573014259,
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0.053406935185194016,
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0.03355109691619873,
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Fasting\ttriglyceride\tlevels\tare\tclassified\tas\tnormal\n(<150\tmg/dL),\tborderline\thigh\t(150\tto\t199\tmg/dL),\thigh\t(200\tto\t499\tmg/dL),\tand\tvery\thigh\t(<500\nmg/dL)\t(\nStone\tet\tal,\t2014\n).\nPatients\twith\tfamilial\tdyslipidemias\thave\thigh\ttriglyceride\tlevels\t(\nhypertriglyceridemia\n). | [
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] |
hypertriglyceridemia\n).\nTriglycerides\tin\tthe\tvery\thigh\trange\tplace\tthe\tpatient\tat\trisk\tfor\tpancreatitis.\tTriglyceride\nmeasurements\tare\tnow\tconsidered\talong\n\twith\tglucose\tintolerance,\thypertension,\tlow\tHDL\ncholesterol,\tand\thigh\tLDL\tcholesterol\tas\tpart\tof\tthe\t\nmetabolic\tsyndrome\n.\nGenetic\thyperlipidemias | [
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metabolic\tsyndrome\n.\nGenetic\thyperlipidemias\nThe\tstudy\tand\tidentification\tof\tthe\tgenes\tresponsible\tfor\tthe\tfamilial\tforms\tof\thyperlipidemia\thave\nprovided\tinsight\tinto\tthe\troles\tof\tenzymes,\tapolipoproteins,\tand\treceptors\ton\tcells\tinvolved\tin\tlipid\nmetabolism.\tSeveral\tforms\tof\thyperlipidemia\n\thave\tstrong\tgenetic\tcomponents\tand\tare\tdescribed\nhere. | [
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have\tstrong\tgenetic\tcomponents\tand\tare\tdescribed\nhere.\nFamilial\thypercholesterolemia\nFamilial\thypercholesterolemia\t(FH)\n\tis\ta\tgenetic\tdisorder\tcharacterized\tby\televated\tLDL\ncholesterol\tand\tpremature\tCVD,\twith\ta\tprevalence\tof\tapproximately\tone\tin\t200\tto\t500\tfor\nheterozygotes\tin\tNorth\tAmerica\tand\tEurope\t(\nBrautbar,\t2015\n). | [
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heterozygotes\tin\tNorth\tAmerica\tand\tEurope\t(\nBrautbar,\t2015\n).\nIn\tFH\televated\tcholesterol\tis\talready\tpresent\tat\tbirth\tand\tresults\tin\tearly\n\tatherosclerotic\tdisease.\nThe\toptimal\tage\trange\tfor\tscreening\tis\tbetween\t2\tand\t10\tyears.\tCurrently,\tit\tis\tconsidered | [
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] |
testing\ta\tstandard\tof\tcare\tfor\tpatients\twith\tdefinite\tor\tprobable\tFH,\tas\twell\tas\tfor\ttheir\tat-risk\nrelatives.\tThey\trecommended\ttesting\tfor\tthe\tgenes\tencoding\tthe\tlow-density\tlipoprotein\treceptor\n(LDLR),\tapolipoprotein\tB,\tand\tproprotein\tconvertase\n\tsubtilisin/kexin\t9\t(PCSK9)\t(\nSturm\tet\tal,\t2018\n). | [
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] |
subtilisin/kexin\t9\t(PCSK9)\t(\nSturm\tet\tal,\t2018\n).\nTreatment\twith\tstatin\tdrugs\timproves\tarterial\tfunction\tand\tstructure\t(\nMasoura\tet\tal,\t2011\n).\nUltrasound\tof\tthe\tAchilles\ttendon\tfor\t\nxanthomas\n\t(cholesterol\tdeposits\tfrom\tLDL)\tcorrectly\tidentifies\nthe\tmajority\tof\tFH\tpatients\t(\nHarada,\t2017\n).\nPolygenic\tfamilial\thypercholesterolemia | [
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Harada,\t2017\n).\nPolygenic\tfamilial\thypercholesterolemia\nPolygenic\tFH\tis\tthe\tresult\tof\tmultiple\tgene\tdefects.\tThe\t\nAPOE-4\n\tallele\n\tis\tcommon\tin\tthis\tform.\tThe\ndiagnosis\tis\tbased\ton\ttwo\tor\tmore\tfamily\tmembers\thaving\tLDL\tcholesterol\tlevels\tabove\tthe\t90th\npercentile\twithout\tany\ttendon\txanthomas.\tUsually\tthese\tpatients\thave\tlower\tLDL\tcholesterol\tlevels | [
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is\tthe\tmost\tprevalent\tprimary\tdyslipidemia,\tbut\tits\nprecise\tdefinition\tis\tcontroversial.\tFCHL\tis\tcharacterized\tby\tfluctuations\tin\tserum\tlipid\nconcentrations\tand\tmay\tpresent\tas\tmixed\thyperlipidemia,\tisolated\thypercholesterolemia,\nhypertriglyceridemia,\tor\tas\ta\tnormal\tserum\tlipid\tprofile\tin\tcombination\twith\tabnormally\televated | [
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levels\tof\tapolipoprotein\tB.\t(\nBello-Chavolla\tet\tal,\t2018\n).\tSeveral\tlipoprotein\tpatterns\tmay\tbe\tseen\tin\npatients\twith\tFCHL.\tThese\tpatients\tcan\thave\t(1)\televated\tLDL\tlevels\twith\tnormal\ttriglyceride\tlevels | [
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(type\tIIa),\t(2)\televated\tLDL\tlevels\twith\televated\ttriglyceride\tlevels\t(type\tIIb),\tor\t(3)\televated\tVLDL\nlevels\t(type\tIV).\tOften\tthese\tpatients\thave\tthe\tsmall,\tdense\tLDL\tassociated\twith\tASCVD.\nConsequently\n\tall\tforms\tof\tFCHL\tcause\tpremature\tdisease;\tapproximately\t15%\tof\tpatients\twho\thave | [
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an\tMI\tbefore\tthe\tage\tof\t60\thave\tFCHL.\tThe\tdefect\tin\tFCHL\tis\thepatic\toverproduction\tof\tapo\tB-100\n(VLDL)\tor\ta\tdefect\tin\tthe\tgene\tthat\tproduces\thepatic\tlipase,\tthe\tliver\tenzyme\tinvolved\tin\ttriglyceride\nremoval\tfrom\tthe\tbloodstream.\tPatients\twith\tFCHL\tusually\thave\tother\trisk\tfactors\tsuch\tas\tobesity,\nhypertension, | [
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hypertension,\n\tdiabetes,\tor\tmetabolic\tsyndrome.\tIf\tlifestyle\tmeasures\tare\tineffective,\ttreatment\nincludes\tmedication.\tPatients\twith\televated\ttriglyceride\tlevels\talso\tneed\tto\tavoid\talcohol.\nFamilial\tdysbetalipoproteinemia\nFamilial\tdysbetalipoproteinemia\n\t(type\tIII\thyperlipoproteinemia)\tis\trelatively\tuncommon. | [
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] |
(type\tIII\thyperlipoproteinemia)\tis\trelatively\tuncommon.\nCatabolism\tof\tVLDL\tand\tchylomicron\tremnants\tis\tdelayed\tbecause\t\nAPOE-2\n\treplaces\t\nAPOE-3\n\tand\nAPOE-4.\n\tFor\tdysbetalipoproteinemia\tto\tbe\tseen,\tother\trisk\tfactors\tsuch\tas\tolder\tage,\thypothyroidism,\nobesity,\tdiabetes,\tor\tother\tdyslipidemias\tsuch\tas\tFCHL\tmust\tbe\tpresent.\tTotal\tcholesterol\tlevels | [
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range\tfrom\t300\tto\t600\tmg/dL,\tand\ttriglyceride\tlevels\trange\tfrom\t400\tto\t800\tmg/dL.\tThis\tcondition\ncreates\tincreased\trisk\tof\tpremature\tASCVD\tand\tperipheral\tvascular\tdisease.\tDiagnosis\tis\tbased\ton\ndetermining\tthe\n\tisoforms\tof\t\nAPOE.\n\tTreatment\tinvolves\tweight\treduction,\tcontrol\tof\thyperglycemia | [
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APOE.\n\tTreatment\tinvolves\tweight\treduction,\tcontrol\tof\thyperglycemia\nand\tdiabetes,\tand\tdietary\trestriction\tof\tsaturated\tfat\tand\tcholesterol.\tIf\tthe\tdietary\tregimen\tis\tnot\neffective,\tdrug\ttherapy\tis\trecommended.\nMedical\tdiagnosis\nNoninvasive\ttests\tsuch\tas\telectrocardiograms,\ttreadmill\tstress\ttests,\tthallium\tscans,\tand | [
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echocardiography\tare\tused\tinitially\tto\testablish\ta\tcardiovascular\n\tdiagnosis.\tA\tmore\tdefinitive,\ninvasive\ttest\tis\t\nangiography\n\t(\ncardiac\tcatheterization\n),\tin\twhich\ta\tdye\tis\tinjected\tinto\tthe\tarteries,\nand\tradiographic\timages\tof\tthe\theart\tare\tobtained.\tMost\tnarrowing\tand\tblockages\tfrom | [
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more\tlikely\tto\thave\ta\tfuture\tcoronary\tevent\tthan\tthose\twith\ta\tnegative\tscan.\nApproximately\ttwo\tthirds\tof\tcases\tof\tacute\tcoronary\tsyndromes\t(unstable\tangina\tand\tacute\tMI)\nhappen\tin\tarteries\tthat\tare\tminimally\tor\tmildly\tobstructed.\tThis\tillustrates\tthe\trole\tof\tthrombosis\tin\nclinical\tevents.\tIn\tthe\tischemia\tof\tan\tinfarction, | [
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clinical\tevents.\tIn\tthe\tischemia\tof\tan\tinfarction,\n\tthe\tmyocardium\tor\tother\ttissue\tis\tdeprived\tof\toxygen\nand\tnourishment.\tWhether\tthe\theart\tis\table\tto\tcontinue\tbeating\tdepends\ton\tthe\textent\tof\tthe\nmusculature\tinvolved,\tthe\tpresence\tof\tcollateral\tcirculation,\tand\tthe\toxygen\trequirement.\nPrevention\tand\tmanagement\tof\trisk\tfactors | [
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Prevention\tand\tmanagement\tof\trisk\tfactors\nThe\tidentification\tof\trisk\tfactors\tfor\tASCVD\tand\tstroke\thas\tbeen\ta\tlandmark\tachievement.\tThe\nprimary\tprevention\tof\n\tthese\tdisorders\tinvolves\tthe\tassessment\tand\tmanagement\tof\tthe\trisk\tfactors\tin\nthe\tasymptomatic\tperson.\tPersons\twith\tmultiple\trisk\tfactors\tare\tthe\ttarget\tpopulation,\tespecially | [
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Lifestyle\trisk\tfactors\nTobacco\tuse,\tparticularly\tcigarettes\nPhysical\tinactivity\nPoor\tdiet\nStress\nInsufficient\tsleep\nExcessive\talcohol\tconsumption\nRelated\tconditions\nHypertension\nObesity\t(body\tmass\tindex\t>30)\nMetabolic\tsyndrome\t(including\treduced\tHDL,\televated\ttriglycerides,\tabdominal\tobesity)\nModified\tfrom\tNational\tInstitutes\tof\tHealth, | [
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Modified\tfrom\tNational\tInstitutes\tof\tHealth,\n\tNational\tHeart,\tLung,\tand\tBlood\tInstitute,\tNational\tHigh\nBlood\tPressure\tEducation\tProgram:\tThe\tseventh\treport\tof\tthe\tJoint\tNational\tCommittee\ton\tprevention,\ndetection,\tevaluation,\tand\ttreatment\tof\thigh\tblood\tpressure,\tNIH\tPublication\tNo.\t04-5230,\tAugust\t2004. | [
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Risk\tfactor\treduction\thas\tbeen\tshown\tto\treduce\tCVD\tin\tpersons\tof\tall\tages.\tMany\tcoronary\tevents\ncould\tbe\tprevented\twith\tadoption\n\tof\ta\thealthy\tlifestyle\t(eating\ta\theart-healthy\tdiet,\texercising\nregularly,\tmanaging\tweight,\tand\tnot\tusing\ttobacco)\tand\tadherence\tto\tlipid\tand\thypertension\tdrug\ntherapy\t(\nStone\tet\tal,\t2014 | [
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therapy\t(\nStone\tet\tal,\t2014\n).\tThe\tFramingham\tHeart\tStudy,\tconducted\tover\tseveral\tdecades,\thas\nprovided\ta\tplethora\tof\tuseful\tinformation\tto\tresearchers\t(see\t\nFocus\tOn\n:\tFramingham\tHeart\tStudy\n).\n\t\nFOCUS\tON\nFramingham\tHeart\tStudy\nThe\tFramingham\tHeart\tStudy\t(FHS)\thas\tconducted\tseminal\tresearch\tdefining\tcardiovascular | [
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disease\t(CVD)\trisk\tfactors\tand\tfundamentally\tshaping\tpublic\thealth\tguidelines\tfor\tCVD\tprevention\nover\tthe\tpast\tfive\tdecades.\tThe\tsuccess\tof\tthe\toriginal\tcohort,\tinitiated\tin\t1948,\tpaved\tthe\tway\tfor\nfurther\tepidemiologic\tresearch\tin\tpreventive\tcardiology.\nSince\t1948\tvarious\n\tleading\tinvestigators\t(Dr.\tJoseph\tMountain,\tDr.\tThomas\tDawber,\tDr.\tWilliam | [
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Kannel,\tand\tDr.\tWilliam\tCastelli)\thave\tbeen\tstudying\tthe\tpopulation\tof\tFramingham,\nMassachusetts,\tto\tdetermine\tthe\tprevalence\tand\tincidence\tof\tCVD\tand\tfactors\trelated\tto\tits\ndevelopment.\tThis\tis\tthe\tlargest\tepidemiologic\tstudy\tof\tCVD\tin\tthe\tworld.\tInitial\tstudy\nparticipants\t(\nn\n\t=\t5209)\twere\thealthy\tadults\tbetween\t30\tand | [
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participants\t(\nn\n\t=\t5209)\twere\thealthy\tadults\tbetween\t30\tand\n\t62\tyears\tof\tage.\tBecause\tof\tthe\npredominance\tof\twhite\tindividuals\tof\tEuropean\tdescent\tin\tthe\tthree\toriginal\tgenerations\tof\tFHS\nparticipants,\tthe\tFHS\tenrolled\tthe\tOMNI1\tand\tOMNI2\tcohorts\tin\t1994\tand\t2003,\trespectively, | [
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aimed\tto\treflect\tthe\tcurrent\tgreater\tracial\tand\tethnic\tdiversity\tof\tthe\ttown\tof\tFramingham.\nThe\tstudy\tcontinues\ttoday,\tlooking\tat\tthe\tchildren\tand\tgrandchildren\tof\tthe\toriginal\n\tcohort.\nThrough\tthis\tcohort\tstudy,\tthe\tconcept\tof\trisk\tfactors\tand\tthus\tprevention\twas\tborn.\tModifiable | [
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particularly\tin\twomen.\tHeart\tfailure\thas\tbeen\tand\tis\ta\tgrowing\tepidemic.\tThe\tFHS\twas\tone\tof\tthe\nfirst\tto\tdescribe\tthe\tincidence,\tprevalence,\tand\tgrim\tnatural\thistory\tof\theart\tfailure\tand\talso\nidentified\thypertension,\tvalvular\theart\tdisease,\tand\tcoronary\tdisease\n\tas\tkey\tetiologies\tfor\theart\nfailure\t(\nTsao\tand\tVasan,\t2015\n). | [
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as\tkey\tetiologies\tfor\theart\nfailure\t(\nTsao\tand\tVasan,\t2015\n).\nMilestones\tof\tthe\tframingham\theart\tstudy\n1960\tCigarette\tsmoking\tfound\tto\tincrease\tthe\trisk\tof\theart\tdisease.\n1961\tCholesterol\tlevel,\tblood\tpressure,\tand\telectrocardiogram\tabnormalities\tfound\tto\tincrease\nthe\trisk\tof\theart\tdisease. | [
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the\trisk\tof\theart\tdisease.\n1967\tPhysical\tactivity\tfound\tto\treduce\tthe\trisk\tof\theart\tdisease,\tand\tobesity\tfound\tto\tincrease\nthe\n\trisk\tof\theart\tdisease.\n1970\tHigh\tblood\tpressure\tfound\tto\tincrease\tthe\trisk\tof\tstroke.\n1976\tMenopause\tfound\tto\tincrease\tthe\trisk\tof\theart\tdisease.\n1978\tPsychosocial\tfactors\tfound\tto\taffect\theart\tdisease. | [
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1978\tPsychosocial\tfactors\tfound\tto\taffect\theart\tdisease.\n1988\tHigh\tlevels\tof\thigh-density\tlipoprotein\tcholesterol\tfound\tto\treduce\trisk\tof\tdeath.\n1994\tEnlarged\tleft\tventricle\t(one\tof\ttwo\tlower\tchambers\tof\tthe\theart)\tfound\tto\tincrease\tthe\nrisk\tof\n\tstroke.\n1994\tOMNI1\tincluded\tchanging\tracial\tand\tethnic\tdiversity. | [
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2003\tOMNI2\tincluded\tchanging\tracial\tand\tethnic\tdiversity.\n2006\tGenetic\tResearch\tStudy\tbegins\tto\tidentify\tgenes\tunderlying\tCVDs\tin\t9000\tparticipants\nfrom\tthree\tgenerations.\n2008\tDiscovery\tand\tpublication\tof\tfour\trisk\tfactors\tthat\traise\tprobability\tof\tdeveloping\nprecursor | [
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precursor\n\tof\theart\tfailure;\tnew\t30-year\trisk\testimates\tdeveloped\tfor\tserious\tcardiac\tevents.\n2009\tResearchers\tfind\tparental\tdementia\tmay\tbe\tlinked\tto\tpoor\tmemory\tin\tmiddle-aged\nadults.\n2011\tBlood\tlipids\tand\tthe\tincidence\tof\tatrial\tfibrillation:\tThe\tmultiethnic\tstudy\tof\natherosclerosis\tand\tthe\tFHS. | [
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atherosclerosis\tand\tthe\tFHS.\nIn\t1971\tthe\toffspring\tstudy\twas\tbegun\tto\tmeasure\tthe\tinfluence\tof\theredity\tand\tenvironment\non\tthe\toffspring\n\tof\tthe\toriginal\tcohort.\tThe\tyounger\tgroup\tappears\tto\tbe\tmore\thealth\nconscious\tbecause\tthey\thave\tlower\trates\tof\tsmoking,\tlower\tblood\tpressures,\tand\tlower | [
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cholesterol\tlevels\tthan\ttheir\tparents\tat\tthe\tsame\tage.\tThe\tGeneration\tIII\tCohort\tStudy\tof\tthe\ngrandchildren\tis\tpresently\tunderway.\nData\tfrom\tFramingham\tHeart\tStudy:\t\nA\ttimeline\tof\tmilestones\tfrom\tthe\tFramingham\theart\tstudy\n\t(website).\nhttp://www.framingham.com/heart/timeline.htm\n,\t2015. | [
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(website).\nhttp://www.framingham.com/heart/timeline.htm\n,\t2015.\nIn\tthe\tmedical\tmodel,\tprimary\tprevention\tof\tASCVD\tand\tstroke\tinvolves\taltering\tsimilar\trisk\nfactors\ttoward\ta\thealthy\tpatient\tprofile.\tFor\tischemic\tstroke,\tatherosclerosis\tis\tthe\tunderlying\ndisease.\tTherefore\toptimal\tlipid\tlevels,\tas\tdetermined\tby\tthe\tNational\tCholesterol\tEducation | [
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Program\t(NCEP)\tfor\thypercholesterolemia,\tare\talso\tthe\ttarget\tlevels\tto\tprevent\tstroke.\nAlthough\tthe\tNational\n\tHeart,\tLung,\tand\tBlood\tInstitute\tcreated\tthe\tNCEP,\tthe\tAHA\thas\tendorsed\nit.\tThe\tAHA\tsuggests\tthat\tprimary\tprevention\tof\tCVD\tshould\tbegin\tin\tchildren\tolder\tthan\tage\t2\n(\nGidding\tet\tal,\t2009 | [
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(\nGidding\tet\tal,\t2009\n).\tDietary\trecommendations\tfor\tchildren\tare\ta\tbit\tmore\tliberal\tthan\tthose\tfor\nadults.\tActivity\tis\temphasized\tin\tmaintaining\tideal\tbody\tweight.\tEarly\tscreening\tfor\tdyslipidemia\tis\nrecommended\tfor\tchildren\twith\ta\n\tfamily\thistory\tof\thypercholesterolemia\tor\tASCVD. | [
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family\thistory\tof\thypercholesterolemia\tor\tASCVD.\nFor\tadults,\ta\ttotal\tcholesterol\tlevel\tof\t170\tmg/dL\tor\tless\tis\tnow\tconsidered\toptimal,\tincluding\tan\nHDL\tof\tat\tleast\t50\tmg/dL.\tThe\tnew\t2013\tguidelines\tno\tlonger\trely\tstrictly\ton\tcholesterol\tlevels\tfor\nadvising\tpatients\tor\tdosing\tmedications.\tInstead\tthe\tpatient’s\toverall\thealth\tis\tevaluated\tfor | [
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