Explain why exercise is part of a weight-loss programme.

Weight-loss depends on the energy input and energy output (expenditure).

To lose weight, energy output should exceed energy input.

Energy output can be increased by performing exercise.
Exercise will increase the respiration of carbohydrates in the muscles so that there is
no extra energy to be stored as fat.
In addition, exercise causes muscles to respire fat in order to reduce the body mass.

A carbohydrate-loading diet is used by athletes in some athletic events. This diet involves
increasing the intake of carbohydrates and decreasing activity several days before the event.
Carbohydrate-loading is however not a suitable method of preparation for all athletic
events.Explain what type of athletic event can be prepared for using a carbohydrate-loading
diet.
It is suitable for shorts bursts of intense activity/ high intensity events/ power events.
E.g. sprinting or weight lifting.
Carbohydrates will be converted into glucose that will be stored as glycogen and
this glycogen will be converted back to glucose for quick provision of energy
for the event.

Describe what is meant by anticoagulants

Anticoagulants are drugs that prevent clot formation or prevent a clot that has formed from
enlarging by breaking it up.
Discuss the three groups of anticoagulants
1. Inhibitors of synthesis of clotting factors
These anticoagulants inhibit the production of certain clotting factors in the liver.

 One example is warfarin (brand name: Coumadin). It stops synthesis of

prothrombin.
2. Inhibitors of thrombin.
These drugs interfere with blood clotting by blocking the activity of thrombin.
They include heparin and lepirudin (Refludan).
3. Inhibitors of stickiness/aggregation of platelets (Antiplatelet drugs or platelets
aggregation inhibitory drugs)
These drugs interact with platelets, to block them from aggregating or adhering
to one another or sticking to one another into harmful clots.
They include aspirin , ticlopidine (Ticlid), clopidogrel (Plavix), tirofiban
(Aggrastat), and eptifibatide (Integrilin).

Explain how anticoagulants can help reduce the eects of CVDs.

Anticoagulants reduce the stickiness of platelets and therefore prevent the formation of a blood
clot.
They also interfere with the synthesis of clotting factors in the liver such as prothrombin and
therefore prevent blood clotting.
They inhibit action of thrombin
The above 3 effects of anticoagulants reduce the risk of blood vessels being blocked by blood
clots and hence allow the normal flow of blood in the arteries.
When atherosclerosis develops, fatty deposits called
deposits cause aected blood vessels called

Atheroma

form. These

arteries to harden and narrow,

reducing the supply of blood to the tissues. This can cause a heart attack or, if the
brain/ carotid artery is aected, it can cause a stroke.

Shortly after the loss of blood flow due to blockage of coronary artery, heart muscle cells stop
contracting and start to die. About 8 minutes after the loss of blood flow the heart muscle cells no
longer contract. After about 20 minutes the heart muscle cells begin to die. Give an explanation
for these two events.
Due to anaerobic respiration in the heart muscle lactic acid builds up which inhibits
respiratory enzymes, reducing ATP production
At 8 minutes ATP is not sufficient for contraction
After 20 minutes ATP levels are too low that they cannot sustain the survival of the cell
If blood flow is restored within 30 minutes most heart muscle cells will eventually recover.
Suggest an explanation for this recovery
This blood flow provides oxygen that oxidises and removes lactic acid

 Aerobic respiration starts and increases the production of ATP for muscle contraction
Describe the term systolic and diastolic pressure
The systolic pressure is the maximum pressure when the ventricles contracts; 120mmHg
The diastolic pressure is the minimum pressure when the ventricles relaxes; 80mmHg
The two are measured using sphygmomanometer
Explain how lowering blood cholesterol levels can reduce the risk of CVD
This reduces formation of atheroma on artery wall
This reduces the development of atherosclerosis
This in turn ensures lumen of arteries remain wide, lowers BP, no clot formation and
there is no loss of elasticity of the artery
All the above reduce the risk of CVD
Age and gender are risk factors for CVDS. Explain
Age- the lumen and the elasticity of the arteries decrease with age. In addition the arteries
are easily damaged with age so HBP increases with increase in age
Gender- women are less likely to develop CVD than men before menopause because
oestrogen offers some protection to women against CVD. Oestrogen regulates choolestrol
levels through two ways i) It acts on the liver to cause an overall reduction in the total
amount of cholesterol in the body
ii) It increases the amount of HDL produced as it reduces LDL
Omega-3 and Omega-6 are essential fatty acids that need to be included in the diet. These fatty
acids are present in animal fats. Omega-3 has been shown to lower blood pressure. What else
reduced blood pressure?
Anti- hypertensives:
Diuretics
Calcium channel blockers
Beta blockers
ACE inhibitors
Vasodilators
List the risks associated with anti hypertensives
Dizziness because of reduction in blood pressure
Coughs
Swelling of ankles
Impotence
Stroke
Constipation
Briefly describe the factors/ substances that reduce cholesterol levels
Statins- affect the activity of HMG-COA reductase in the liver cells
Soluble fibers inhibit the absorption of cholesterol in the intestine so that it is lost in
feaces
Sternos and steros- they have similar structure to cholesterol hence compete with
cholesterol for absorption and this reduces blood cholesterol
Oestrogen
Which lipoprotein carries cholesterol from?
i)
Liver to body tissues - LDL
ii)
Body tissues to the liver- HDL
iii)
Intestinal cells to the liver- chylomicrons
A blood clot may form when a blood vessel wall becomes damaged. Cell fragments
called platelets/ thrombocytes stick to the wall of the damaged blood vessel forming
a plug. A series of chemical changes occur in the blood, resulting in prothrombin
being converted into thrombin. Thrombin is an enzymethat catalyses the conversion
of fibrinogen into long insoluble strands of fibrin. These strands form a mesh that
trap blood cells and platelets to form the clot.

The enzyme HMG-CoA reductase catalyses the synthesis of cholesterol. When this
enzyme is active, there are fewer LDL receptors on liver cells. These receptors are
needed to remove LDL from the blood.

Statins are a group of cholesterol-reducing drugs that act by inhibiting this enzyme.
List the characteristics of best statin:
- Lower total cholesterol
- Lower LDL
- Raises HDL
Statins inhibit cholesterol synthesis. Statins result in more LDL receptors on the liver
cells, so that more LDL are cleared from the blood and enter the liver cells, hence
lowers the blood cholesterol level. State the risks of treatment using statins
- Constipation
- Cramps
- Liver problems
- Kidney problems
- Respiratory cancer
- Reduced vitamin uptake
- Depression
Describe the term correlation and causation
Correlation- when one variable changes, there is also a change in an
accompanying variable.
Causation- a change in one variable causes/ is responsible for the change in
the other accompanying variable.
One cause of coronary heart disease is atherosclerosis. Describe how
atherosclerosis develops
-

Damage to endothelial cells due to factors such as HPB

This triggers inflammatory response, where there is increase in blood flow to
the damaged area
The accumulation of WBC in damaged area build up cholesterol in this
damaged area forming atheroma.
There is build up of calcium salts, and fibrous tissue on this atheroma forming
plaque
This plaque causes loss of elasticity of artery, narrows the lumen and causes
clot formation causing HBP.
This process is self- perpetuating

Describe the blood clotting process

-

Collagen fibres are exposed in the damaged blood vessels.

Platelets rapidly stick to these collagen fibres and release thromboplastin
(enzyme)
Thromboplastin starts the cascade of events leading to blood clotting.
Thromboplastin, together with calcium ions and vitamin K, converts
prothombin to thrombin (enzyme)

Thrombin converts fibrinogen to fibrin

Fibrin forms a mesh that traps platelets and blood cells to form a blood clot

Snake venom has an enzyme that is involved in blood clotting process. Suggest how
the enzyme in the snake venom could be involved in the blood clotting process.
-

It is similar to one of the enzymes in the clotting process i.e. thromboplastin

which starts the cascade of events as its active site, prothrombin fits to form
thrombin. It could also be thrombin whose active site, fibrinogen fits to form
fibrin.

When taking anti-hypertensive drugs, a doctor monitors both systolic and

diastolic pressure and not systolic pressure alone. Explain this.
To find out whether the drug is effective in reducing both and not one of them.

Diseases of the cardiovascular system are a major cause of death worldwide.

Most cardiovascular diseases are caused by fatty deposits called plaques.
The diagrams below show stages in the development of a plaque and the
narrowing of the lumen of an artery.

(a) Describe how this narrowing of the lumen can increase the risk of further
damage to an artery.
Narrowing leads to higher blood pressure;
This HBP increases risk of further damage to the artery wall / aneurysm
This triggers atherosclerosis or thrombosis (Platelets stick to damaged
wall and triggers blood clotting process)

(b) (i) Describe the sequence of events that results in the formation of a
blood clot.
1.
2.
3.
4.
5.
6.

platelets stick to damaged wall of artery

thromboplastin released from damaged platelets
correct reference to Ca2+ / Vit. K;
prothrombin converted to thrombin;
fibrinogen converted to fibrin;
fibrin mesh traps blood cells forming a clot;

(ii) Explain how a blood clot can cause a heart attack.

blood clot blocks coronary artery;

restricts blood flow to heart muscle;
Lack of oxygen to heart muscle / ischaemic causes anaerobic respiration.
So, there is insufficient energy release for contraction hence infarction/damage to
heart muscle sets in.

Explain why the combination of a high-fat diet and low activity levels may lead to
CVD.
This causes energy imbalance.
Individual becomes overweight /obese. This increases blood pressure. This
causes endothelial damage. This leads to formation of atheroma and clot in
coronary arteries and carotid arteries that either block or narrow down the lumen
of these arteries causing CHD and stroke, respectively.
Increased cholesterol levels increases LDL. This will eventually lead to formation
of atheroma and plaque in coronary arteries and carotid arteries that either
block or narrow down the lumen of these arteries causing CHD and stroke,
respectively.
Obesity leads to diabetes which is a risk factor for CVD due to endothelial
damage. This leads to formation of atheroma and clot in coronary arteries and
carotid arteries that either block or narrow down the lumen of these arteries
causing CHD and stroke, respectively.
High fat diet also increases triglyceride that is stored in the body causing obesity
or overweight.

Diuretics are antihypertensive drugs used to treat some people with CVD. They cause an increase
in fluid loss from the body by stimulating urine production.Suggest how diuretics can help
reduce the risk of CVD.
Less blood volume
This causes lower blood pressure hence less chance of damage to wall of artery
and so no atherosclerosis in coronary arteries.

Pulmonary thrombosis is a condition in which blood clots form in the lungs. Suggest why
blood clots, formed in pulmonary thrombosis, reduce gas exchange in the
lungs.
Reduces the flow of blood to the lungs through pulmonary arteries.
This decreases the concentration gradient of gases

Give reason why blood forms clots only when required:

clotting factors used are present in an inactive form in the blood