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Het tienjaarlijkse cardiovasculaire risico is een berekende waarschijnlijkheid—uitgedrukt als een percentage—dat een individu binnen het komende decennium een grote cardiovasculaire gebeurtenis zoals een hartinfarct of beroerte zal meemaken, geschat aan de hand van gevalideerde vergelijkingen waarin leeftijd, geslacht, bloeddruk, cholesterol, diabetessatus en rookgedrag worden meegewogen; de huidige richtlijnen reserveren de overweging van aspirine voor primaire preventie voor volw…

Waarom dit belangrijk is

Dit getal is de belangrijkste drempel die artsen gebruiken om te bepalen of de voordelen van aspirine opwegen tegen de risico's op bloedingen bij iemand die nooit een hartziekte heeft gehad.

Definitie

11β-HSD1 is een enzym dat tot expressie komt in vetweefsel en dat inactieve cortison lokaal omzet in actieve cortisol, waardoor de glucocorticoïde signalering binnen vetdepots wordt versterkt; de relatief hogere expressie ervan in visceraal vergeleken met subcutaan vet kan een weefselomgeving creëren die opslag van lipiden en metabole disfunctie bevordert die lijkt op milde ziekte van Cushing.

Waarom dit belangrijk is

Dit enzym koppelt chronische stress op moleculair niveau aan de ophoping van visceraal vet, los van het algemene cortisolgehalte in de bloedbaan.

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Een standaard elektrocardiogram dat de elektrische activiteit van het hart gelijktijdig registreert vanaf twaalf elektrodeposities op de ledematen en de borstkas; wanneer het wordt uitgevoerd tijdens maximale inspanning, kan het ischemische veranderingen — zoals ST-segmentdepressie — aan het licht brengen die in rust onzichtbaar zijn.

Waarom dit belangrijk is

Begrijpen waarom een in rust gemaakt ecg significante verstoppingen kan missen, helpt te verklaren waarom een inspanningstest bij maximale inspanning belangrijk is voor sporters.

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De meest potente en biologisch actieve vorm van oestrogeen, die tijdens de vruchtbare jaren voornamelijk door de eiblaasjes (follikels) wordt geproduceerd; het werkt in op oestrogeenreceptoren in de hersenen en het lichaam om het glucosemetabolisme, de synaptische functie, de stemming en de vasculaire tonus te reguleren, en daalt scherp tijdens de overgang naar de menopauze.

Waarom dit belangrijk is

Begrijpen welke specifieke oestrogeen is betrokken helpt verklaren waarom de menopauze zo'n diepgaande invloed heeft op de hersenen en het hart, en waarom de samenstellingen van hormoontherapie niet uitwisselbaar zijn.

Definitie

Een belangrijke Amerikaanse klinische richtlijn voor het beheer van bloedcholesterol waarin de CAC-score werd opgenomen als hulpmiddel bij de besluitvorming; deze beveelt aan dat statinetherapie kan worden uitgesteld bij asymptomatische personen met een middelmatig risico die een CAC-score van nul hebben, tenzij er sprake is van diabetes, actief roken of een sterke familiegeschiedenis van vroegtijdige hart- en vaatziekten.

Waarom dit belangrijk is

Dit richtsnoer is de belangrijkste autoriteit achter de klinische praktijk om het voorschrijven van statines uit te stellen of te vermijden op basis van een CAC-score van nul.

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Een gezamenlijke klinische richtlijn van het American College of Cardiology en de American Heart Association over strategieën voor het voorkomen van een eerste cardiovasculair event, inclusief aanbevelingen over het juiste gebruik en de beperkingen van standaard risicocalculators en beeldvormende hulpmiddelen bij primaire preventie.

Waarom dit belangrijk is

Deze richtlijn bepaalt wat artsen wordt geadviseerd te doen — en te laten — bij routine-hartonderzoek, en daarom helpt het begrijpen van de reikwijdte ervan patiënten om betere vragen te stellen over de vraag of aanvullende evaluatie gerechtvaardigd is.

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De ESC-richtlijn voor Sportcardiologie 2020 is het op bewijs gebaseerde document van de Europese Vereniging voor Cardiologie dat aanbevelingen bevat over cardiovasculaire screening, risicostratificatie en beslissingen over sportrevalidatie voor competitieve en recreatieve sporters, met inbegrip van masters-sporters met een vermoede of vastgestelde hartaandoening.

Waarom dit belangrijk is

Het vormt de huidige klinische standaard voor hoe artsen oudere sporters moeten beoordelen die mogelijk cardiovasculaire aandoeningen verbergen achter een hoge fysieke fitheid.

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De in 2024 herziene NIA-AA-criteria zijn diagnostische richtlijnen van het National Institute on Aging en de Alzheimer's Association die de ziekte van Alzheimer biologisch definiëren aan de hand van de aanwezigheid van kernbiomarkers voor amyloïde en tau, onafhankelijk van klinische symptomen.

Waarom dit belangrijk is

Het artikel gaat expliciet in op deze criteria om te beargumenteren dat het definiëren van de ziekte van Alzheimer aan de hand van de stroomafwaartse biomarkerafdruk verenigbaar is met vaatziekte als stroomopwaartse oorzaak van die afdruk.

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24S-hydroxycholesterol is een oxysterol dat in de hersenen wordt geproduceerd door enzymatische omzetting van cholesterol, waardoor het de bloed-hersenbarrière kan passeren en in de bloedbaan kan worden geklaard—de primaire uittredingsroute voor hersencolesterol.

Waarom dit belangrijk is

Het is het meetbare bijproduct van de omzet van hersencholesterol en een potentiële biomarker van het cholesterolmetabolisme in het centrale zenuwstelsel.

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De biologisch actieve vorm van folaat die in het bloed circuleert en dient als de methyldonor bij de remethylering van homocysteïne terug naar methionine; het is de vorm die wordt gebruikt door het enzym methionine synthase en wordt als 'L-methylfolaat' in supplementen verkocht.'

Waarom dit belangrijk is

Begrijpen dat dit de actieve folaatvorm is, helpt te verklaren waarom standaard foliumzuur door het lichaam moet worden omgezet voordat het homocysteïne kan verlagen.

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Een geavanceerd CT-systeem waarvan de detector breed genoeg is (160 mm) om het hele hart in één enkele rotatie en hartslag vast te leggen, waardoor de beeldstitching-artefacten die optreden bij smalstere detectoren worden geëlimineerd en stralingsdoses onder 1 millisievert mogelijk worden.

Waarom dit belangrijk is

Het artikel betoogt dat deze technologie het longitudinaal volgen van plaque veiliger en praktischer maakt, wat de potentiële rol ervan in de routinematige preventieve cardiologie ondersteunt.

Definitie

β-adrenerge responsiviteit verwijst naar de gevoeligheid van het hart voor stimulatie door adrenaline en verwante stresshormonen via bètareceptoren; veroudering vermindert deze gevoeligheid, wat beperkt hoe snel en krachtig het hart kan reageren tijdens maximale inspanning, zelfs bij getrainde individuen.

Waarom dit belangrijk is

Een afnemende gevoeligheid voor bètareceptoren is één reden waarom de maximale hartslag daalt met de leeftijd, ongeacht de fysieke conditie, wat een biologisch plafond stelt aan de fysieke prestaties.

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Het primaire ketonlichaam dat wordt geproduceerd tijdens de vetstofwisseling; de bloedconcentratie ervan wordt gebruikt als de belangrijkste biochemische marker van ketose, hetzij opgewekt door vasten, een zeer koolhydraatarm dieet of de inname van exogene ketonsupplementen.

Waarom dit belangrijk is

Het begrijpen van βHB verduidelijkt wat 'in ketose zijn' chemisch gezien daadwerkelijk betekent, wat essentieel is voor het beoordelen van gezondheidsclaims met betrekking tot keto.

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γ-Butyrobetaine (γBB) is een belangrijk metabolisch intermediair dat wordt gevormd in de proximale darm wanneer bacteriën beginnen met het verwerken van L-carnitine uit de voeding; het hoopt zich op met een snelheid die ongeveer 1.000 keer hoger is dan de directe TMA-vorming en dient als een reservoir dat de productie van TMA and TMAO in stand houdt lang nadat een vleeshoudende maaltijd is verteerd.

Waarom dit belangrijk is

Het γBB-reservoir verklaart waarom een enkele dieetverandering je TMAO-waarden mogelijk niet snel verlaagt — de darm heeft een grote voorraad om uit te putten.

Definitie

ABCA1 is een eiwit dat cholesterol uit cellen pompt en overdraagt aan HDL-deeltjes voor de reis terug naar de lever.

Waarom dit belangrijk is

Het is de eerste stap van het omgekeerde cholesteroltransport. Mensen met twee kapotte kopieën ontwikkelen de ziekte van Tangier, met bijna geen HDL - een natuurlijk experiment in wat HDL daadwerkelijk doet.

Definitie

Membraaneiwitten in macrofaag-schuimcellen die intracellulair cholesterol exporteren naar extracellulaire acceptoren zoals apoA-I en HDL; hun activering tijdens verlaging van het lipidengehalte is een stappenplan voor plaque-regressie, waardoor met lipiden beladen cellen hun cholesterolbelasting kunnen kwijtraken.

Waarom dit belangrijk is

Het zijn de moleculaire 'uitgangen' waardoor cholesterol dat gevangen zit in vaatwandcellen kan worden verwijderd; het begrijpen ervan maakt duidelijk hoe lipidenverlagende therapie op cellulair niveau werkt.

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Een buikaorta-aneurysma is een verwijding van de aorta in de buik die voornamelijk wordt veroorzaakt door chronische ontsteking, atherosclerotische belasting en een ongeremde proteolytische cascade waarin matrix-metalloproteïnasen het elastine- en collageenskelet van de wand afbreken.

Waarom dit belangrijk is

AAA deelt zijn hoofdoorzaak met coronaire hartziekte en perifeer arterieel vaatlijden, waardoor het een relevant risico is voor iedereen die al cardiovasculaire risicofactoren beheert.

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Abetalipoproteïnemie is een zeldzame autosomaal recessieve aandoening die wordt veroorzaakt door functieverliessende mutaties in het MTTP-gen, dat vereist is voor de assemblage en secretie van ApoB-bevattende lipoproteïnen; aangedane individuen hebben een bijna totale afwezigheid van circulerende ApoB-deeltjes, waarbij het totale cholesterol typisch onder de 30 mg/dL ligt en LDL-C vaak onmeetbaar is. Ondanks ernstige niet-cardiale complicaties (vetmalabs...

Waarom dit belangrijk is

Het is het dichtstbijzijnde reële bewijs dat zonder ApoB-bevattende deeltjes atherosclerose in wezen niet optreedt.

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Absolute risico is de daadwerkelijke kans dat iets u overkomt, uitgedrukt in een percentage. Als uw absolute risico op een hartaanval in de komende tien jaar 12 procent is, betekent dit dat ongeveer 12 van de 100 mensen zoals u er een zouden krijgen.

Waarom dit belangrijk is

Dit verschilt van het relatieve risico, dat slechts twee groepen vergelijkt. Een medicijn dat het risico met 25 procent vermindert klinkt enorm, maar als je initiële risico minuscuul was, is het voordeel in de praktijk ook minuscuul. Vraag altijd naar het absolute aantal.

Definitie

De ACC/AHA Pooled Cohort Equations zijn een set cardiovasculaire risicocalculators die gezamenlijk zijn ontwikkeld door het American College of Cardiology en de American Heart Association, geïntroduceerd in 2013, die het tienjaarsrisico op een eerste atherosclerotisch cardiovasculair aandoening schatten met behulp van leeftijd, geslacht, ras, cholesterol, bloeddruk, diabetes en rookstatus.

Waarom dit belangrijk is

Zij zijn de meest gebruikte risicocalculator in de Verenigde Staten en bepalen vaak aan wie statinetherapie wordt aangeboden — het begrijpen van hun beperkingen verklaart waarom aanvullende tests soms nodig zijn.

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Een grote gerandomiseerde studie naar evacetrapib die het HDL-cholesterol aanzienlijk verhoogde en het LDL-cholesterol verlaagde, maar er desondanks niet in slaagde om de cardiovasculaire uitkomsten te verbeteren bij patiënten met een hoog risico, ondersteunt hiermee verder de opvatting dat HDL-C eerder een merker is dan een causaal beschermende factor.

Waarom dit belangrijk is

Versterkt waarom het HDL-verhogende effect van kokosnootolie geen betekenisvol cardiovasculair voordeel is.

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ACCORD was een grote studie waarin werd onderzocht of het zeer agressief verlagen van de bloedsuikerspiegel bij mensen met type 2-diabetes hartaanvallen zou voorkomen.

Waarom dit belangrijk is

Dat deed het niet, en de intensieve arm kende meer sterfgevallen. De les was dat het verlagen van een getal niet automatisch hetzelfde is als de patiënt helpen — een thema dat door de hele cardiologie heen terugkeert.

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Een ACE-remmer (angiotensine-converterend-enzym-remmer) is een klasse geneesmiddel dat de bloeddruk verlaagt en de belasting van het hart vermindert door het enzym te blokkeren dat bloedvaten vernauwt. ACE-remmers gingen deel uitmaken van de standaardzorg na een hartinfarct en behoren tot de behandelingen die in het artikel worden genoemd als behandelingen die arriveerden nadat de initiële daling van de coronaire mortaliteit al was begonnen.

Waarom dit belangrijk is

ACE-remmers illustreren hoe effectieve geneesmiddelen de overleving kunnen verbeteren en herhaling kunnen voorkomen, zelfs na een hartinfarct, wat de 'farmacologische consolidatiefase' van de afname vertegenwoordigt.

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De komvormige holte in het bekken waarin de kop van het femur past, waarmee het heupgewricht wordt gevormd; een fractuur van het acetabulum verstoort dit gewricht en kan het dragen van gewicht en de functie van de onderste ledematen tijdens het herstel ernstig beperken.

Waarom dit belangrijk is

Heupfracturen en bekkenletsels hebben aanzienlijke implicaties voor cardiovasculaire revalidatie, met name voor oudere sporters die hun conditie op peil willen houden.

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Een zeer reactief en toxisch tussenproduct dat ontstaat wanneer alcoholdehydrogenase ethanol afbreekt in de lever; aceetaldehyde bevordert oxidatieve stress, beschadigt cellulaire verbindingen en oefent directe cardiotoxische effecten uit, met name bij personen met een verminderde activiteit van aldehyde-dehydrogenase.

Waarom dit belangrijk is

Het is de belangrijkste toxische boosdoener achter de directe schade van alcohol aan hartspiercellen.

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Acuut coronair syndroom (ACS) is de verzamelnaam voor elke plotselinge afname van de bloedtoevoer naar het hart — van onstabiele angina pectoris tot een volwaardig hartinfarct — veroorzaakt door een plotseling gescheurde of geërodeerde plaque.

Waarom dit belangrijk is

De exacte diagnose hangt af van bloedonderzoek en een ecg, maar de onderliggende gebeurtenis is dezelfde: een plaque die rustig in de wand zat, scheurt open. Daarom moet nieuwe of erger wordende pijn op de borst dezelfde dag nog worden beoordeeld, in plaats van een afwachtende houding aan te nemen.

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Een metalloproteïase-enzym dat het extracellulaire domein van membraangebonden receptoren knipt en omzet in oplosbare circulerende vormen; in de context van IL-6-signaaltransductie knipt ADAM17 de membraangebonden IL-6-receptor (mIL-6R) om de oplosbare vorm (sIL-6R) te genereren die bredere pro-inflammatoire trans-signaaltransductie door het hele lichaam mogelijk maakt.

Waarom dit belangrijk is

De activiteit van ADAM17 bepaalt hoeveel IL-6-signaaltransmissie de vaatwand bereikt — een cruciale stap in de vraag of lipide-afzettingen escaleren tot gevaarlijke plaque.

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ADAPTABLE was een pragmatische gerandomiseerde studie bij 15.076 patiënten met vastgestelde atherosclerotische hart- en vaatziekten waarin 81 mg versus 325 mg aspirine per dag werd vergeleken; de studie toonde geen significant verschil in cardiovasculaire uitkomsten of ernstige bloedingen tussen de twee doseringen, wat 81 mg ondersteunt als de geprefereerde onderhoudsdosis.

Waarom dit belangrijk is

Het is de grootste directe vergelijking tot nu toe van de twee meest voorkomende aspirinedoseringen, wat direct inzicht geeft in welke dosis patiënten en artsen zouden moeten kiezen.

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Adaptieve intimale verdikking is een normale, niet-pathologische focale toename van de meest binnenste arteriële laag die optreedt bij bochten en takpunten als reactie op verstoorde bloedstroom; het wordt gekenmerkt door gladde spiercellen in een proteoglycaan-collageenmatrix en omvat, in tegenstelling tot atherosclerotische laesies, geen lipidenaccumulatie of inflammatoire schuimcelinfiltratie.

Waarom dit belangrijk is

Het begrijpen van dit onderscheid helpt te verduidelijken waarom niet elke verdikking van een slagaderwand een ziekte is—het ten onrechte classificeren als atherosclerose heeft historisch gezien de prevalentieschattingen overdreven.

Definitie

Toegevoegde suiker is suiker die tijdens de verwerking of bereiding aan voedsel wordt toegevoegd, in plaats van suiker die van nature in fruit of melk voorkomt.

Waarom dit belangrijk is

Te veel toegevoegde suiker kan triglyceriden verhogen, lichaamsvet rond de middel toevoegen en het lichaam richting insulineresistentie duwen. Al deze drie maken hart- en vaatziekten waarschijnlijker.

Definitie

Het gen dat codeert voor alcoholdehydrogenase 1B, het enzym dat verantwoordelijk is voor de eerste stap in het ethanolmetabolisme; genetische varianten in ADH1B (met name rs1229984) beïnvloeden hoe snel alcohol wordt afgebroken en worden vaak gebruikt als instrumentele variabelen in Mendeliaanse randomisatiestudies naar alcohol en cardiovasculair risico.

Waarom dit belangrijk is

Het gebruik ervan bij Mendeliaanse randomisatie stelt onderzoeker in staat om de effecten van alcohol te bestuderen zonder de leefstijlverstorende factoren die observationele studies teisteren.

Definitie

Trouw zijn aan de behandeling betekent dat je je medicijnen daadwerkelijk inneemt zoals ze zijn voorgeschreven, dag in, dag uit.

Waarom dit belangrijk is

Dit is belangrijker dan de meeste mensen zich realiseren. Cholesterolmedicijnen werken doordat ze je deeltjesaantal over vele jaren verlagen. Het overslaan van dosissen vermindert het voordeel niet slechts een beetje — het kan het grootste deel ervan tenietdoen, omdat de bescherming afkomstig is van de totale blootstelling over tijd.

Definitie

Adipokines zijn bioactieve moleculen — waaronder leptine, adiponectine, TNF-α en IL-6 — die door vetcellen worden afgescheiden en die fungeren als hormonen of signaaleiwitten om de stofwisseling, insulinegevoeligheid, ontstekingen en energiebalans in het hele lichaam te reguleren.

Waarom dit belangrijk is

De wetenschap dat vetweefsel chemisch communicatie onderhoudt met andere organen helpt verklaren hoe overtollig visceraal vet systemische aandoeningen ver buiten de buik kan aanwakkeren.

Definitie

Adiponectine is een adipokine dat de insulinegevoeligheid vergroot en de vetzuuroxidatie bevordert via AMPK-activatie; de circulerende spiegels ervan dalen naarmate visceraal vet zich ophoopt, waardoor een lage adiponectinespiegel een vroege indicator is van cardiometabool risico.

Waarom dit belangrijk is

Adiponectinspiegels bieden een kijkje in de metabole gezondheid die metingen van het lichaamsgewicht volledig missen.

Definitie

Adjudicatie is het proces waarin een onafhankelijke commissie elk gerapporteerd voorval in een trial beoordeelt en beslist wat er daadwerkelijk is gebeurd, zonder te weten welke behandeling de patiënt heeft gekregen.

Waarom dit belangrijk is

Het voorkomt dat entoesiasme de resultaten vormt. Of een ziekenhuisbezoek als een hartinfarct werd meegeteld, mag niet afhangen van in welke arm van de trial de patiënt zich bevond.

Definitie

AGE's zijn verbindingen die ontstaan wanneer eiwitten of vetten worden blootgesteld aan suikers of hoge kooktemperaturen; in vlees dat op hoge temperatuur is bereid, binden ze zich aan een receptor genaamd RAGE op bloedvatcellen, wat een ontstekingscascade teweegbrengt. Het artikel vermeldt ze als een van de verschillende componenten van rood vlees — naast verzadigd vet en heemijzer — die de cardiovasculaire gezondheid kunnen schaden, los van TMAO.

Waarom dit belangrijk is

Ze illustreren waarom het isoleren van TMAO als 'het' schadelijke ingrediënt in rood vlees een complex voedingspatroon te simpel voorstelt.

Definitie

Een reeks langlopende prospectieve cohortstudies naar gezondheidsuitkomsten bij Zevende-dags Adventisten, een bevolkingsgroep met een hoog percentage vegetariërs; uit de bevindingen blijkt onder meer dat veganisten een 62% lager risico op diabetes type 2 hebben dan niet-vegetariërs, ongeacht het lichaamsgewicht.

Waarom dit belangrijk is

Deze onderzoeken leveren enkele van de sterkste epidemiologische bewijzen die plantaardige diëten in verband brengen met een verminderd risico op chronische ziekten.

Definitie

Een grote prospectieve cohortstudie van ongeveer 96.000 Zevendedagsadventisten in Noord-Amerika, die van waarde is in de nutritionele epidemiologie omdat lage percentages van roken en alcoholgebruik in deze populatie belangrijke gedragsmatige verstorende factoren verminderen, waardoor een zuiverdere beoordeling van voedingspatronen op sterfte- en ziekteresultaten mogelijk is.

Waarom dit belangrijk is

Veel van het bewijsmateriaal dat wordt aangehaald voor de voordelen van vegetarisme voor een lang leven is direct afkomstig van dit cohort, dus weten wat het is, helpt je om de kwaliteit van die claims te beoordelen.

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De adventitia is de taaie buitenste laag van een slagader, grotendeels bestaande uit bindweefsel, zenuwen en de kleine bloedvaten die de vaatwand voeden.

Waarom dit belangrijk is

Het werd lange tijd beschouwd als verpakkingsmateriaal. Nu wordt begrepen dat het een actieve rol speelt bij ontstekingen en bij de manier waarop een slagader zich hermodelleert naarmate plaque groeit.

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Een inspanning die volledig wordt volgehouden door middel van oxidatieve metabolisme, waarbij wordt gesteund op een continue toevoer van zuurstof om ATP te produceren; het werelduurrecord wielrennen is op deze manier geclassificeerd omdat elke significante verschuiving naar anaërobe trajecten de energiereserves snel uitput en de prestaties belemmert.

Waarom dit belangrijk is

Aërobe capaciteit is een kernmeting van de cardiovasculaire gezondheid en een voorspeller van langetermijnresultaten op het gebied van hartaandoeningen.

Definitie

Aerobische training is een gelijkmatige activiteit waarbij je ademhaling een tijdje versnelt, zoals stevig wandelen, fietsen, zwemmen of joggen.

Waarom dit belangrijk is

Het verbetert de conditie, bloeddruk, bloedsuikerspiegel en de werking van je bloedvaten. Het is een van de beste dingen die je voor je gezondheid kunt doen. Maar het verlaagt je ApoB-deeltjesaantal niet erg sterk, en daarom kunnen zeer fitte mensen nog steeds plaque hebben.

Definitie

Het metabolische proces waarbij cellen, waaronder neuronen, glucose afbreken in de aanwezigheid van zuurstof om ATP-energie te genereren; oestrogeen stimuleert deze efficiënte route in de hersenen, en de afname ervan tijdens de menopauze kan de hersenen dwingen tot minder efficiënte brandstofbronnen.

Waarom dit belangrijk is

Dit is het specifieke energiemechanisme dat de hersenen verliezen wanneer het oestrogeeniveau daalt, waardoor dit cruciaal is om hersenmist tijdens de menopauze te begrijpen.

Definitie

Een gestructureerde trainingsmethode waarbij korte perioden van intensieve inspanning worden afgewisseld met actieve herstelperioden — bijvoorbeeld vier minuten bijna maximale inspanning, gevolgd door drie minuten rustig aan — waarvan in klinische studies is aangetoond dat deze de AF-last vermindert en de VO₂ max effectiever verbetert dan continue duurtraining.

Waarom dit belangrijk is

AIT is het voorgeschreven trainingsprogramma bij uitstek voor behandelde patiënten met atriumfibrilleren, omdat het de conditie opbouwt en tegelijkertijd de chronische volumebelasting vermijdt die verdere littekenvorming in de boezems veroorzaakt.

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De weerstand kracht uitgeoefend door lucht op een bewegend object; op grote hoogte vermindert een lagere lucht dichtheid de aerodynamische weerstand, wat de reden is dat wielerbaanrecords vaak worden gevestigd op banen op grote hoogte ondanks de verminderde zuurstofbeschikbaarheid.

Waarom dit belangrijk is

Het verklaart de strategische keuze van Aguascalientes voor de poging—minder luchtweerstand betekent hogere snelheden voor hetzelfde vermogen.

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Een specialist die het luchtweerstandsprofiel van een atleet en diens uitrusting—inclusief lichaamshouding, helm, snelpak en wielen—analyseert en optimaliseert om de luchtweerstand te minimaliseren en de snelheid bij een specifiek vermogen te maximaliseren.

Waarom dit belangrijk is

In een tijdrit van een uur is aërodynamische weerstand vaak de allergrootste bepalende factor voor de afgelegde afstand, waardoor deze rol centraal staat bij recordpogingen.

Definitie

Een maatstaf voor hoeveel procent van de tijd een persoon in boezemfibrilleren is, uitgedrukt als een percentage of totale duur over een monitoringsperiode; katheterablatie is erop gericht om de AF-last te verminderen, zelfs wanneer het AF niet volledig elimineert.

Waarom dit belangrijk is

Helpt lezers te begrijpen dat het succes van een ablatie vaak gedeeltelijk in plaats van absoluut is.

Definitie

Het terugkeren van atriumfibrilleren na een periode van succesvolle ritmecontrole, ongeacht of dit door ablatie of medicatie is bereikt; bij duursporters bedraagt het recidiefpercentage na een enkele ablatie ongeveer 40%, en aanhoudende vergroting van de boezems en fibrose zijn de belangrijkste voorspellende factoren.

Waarom dit belangrijk is

Het risico op herhaling is de centrale klinische vraag die het artikel behandelt voor sporters die een ablatie overwegen.

Definitie

De Agatston-score is de specifieke formule die wordt gebruikt om een calcium-CT-scan om te zetten in één enkel getal, waarbij elke calciumafzetting wordt gewogen op basis van de dichtheid en de grootte ervan.

Waarom dit belangrijk is

Wanneer iemand zegt "mijn calciumscore is 150", is dit de schaal die ze bedoelen. Omdat het weegt op dichtheid, kunnen twee mensen met vergelijkbare hoeveelheden calcium een verschillende score krijgen.

Definitie

Agatston-eenheden zijn de gestandaardiseerde scooreenheden die worden gebruikt om kransslagaderkalk te kwantificeren op een CT-scan, berekend op basis van de dichtheid en oppervlakte van verkalkte laesies; een score van nul duidt op geen detecteerbare verkalkte plaque, terwijl scores van 300 of hoger — die uitsluitend werden gevonden in de aatleletengroep in de Britse Masters-studie — wijzen op zware verkalking.

Waarom dit belangrijk is

Ze zijn de universele munteenheid voor het rapporteren van de resultaten van een calciumscan, dus het begrijpen van de schaal helpt u te interpreteren wat uw eigen score betekent.

Definitie

Voor leeftijd gecorrigeerde sterfte is een sterftecijfer dat statistisch is gecorrigeerd zodat verschillen in de leeftijdsopbouw van populaties — of van dezelfde populatie in de loop van de tijd — vergelijkingen niet vertekenen. Het beantwoordt de vraag: zou het sterftecijfer zijn veranderd als de leeftijdsopbouw constant was gebleven?

Waarom dit belangrijk is

Aangezien sterfgevallen als gevolg van een hartaanval veel vaker voorkomen bij ouderen, is het misleidend om de ruwe sterftecijfers over verschillende decennia met elkaar te vergelijken zonder deze correctie — dit vormt de basis voor de bewering in het artikel dat er sprake is van een daling van 81%.

Definitie

Een gestandaardiseerd supplement geproduceerd door langdurige koude rijping van rauwe knoflook, dat in water oplosbare organozwavelverbindingen concentreert; gerandomiseerde CT-beeldvormingsonderzoeken hebben aangetoond dat het plaque met lage attenuatie (zachte, scheurgevoelige coronaire plaque) kan verminderen bij patiënten met het metabool syndroom.

Waarom dit belangrijk is

AGE heeft momenteel sterker direct plaque-beeldvormend bewijs bij mensen dan nattokinase, waardoor het een nuttig vergelijkingspunt is voor iedereen die supplementopties evalueert.

Definitie

In de context van atherosclerose verwijst aggregatie naar het samenklonteren van ApoB-bevattende lipoproteïnedeeltjes nadat deze zijn vastgehouden door proteoglycanen in de vaatwand, een stap die macrofaagfagocytose en schuimcelvorming op^{*}$.

Waarom dit belangrijk is

Het begrijpen van aggregatie verschuift de verklaring van plaquevorming van eenvoudig 'geoxideerd vet' naar een beter door bewijs ondersteund retentie-en-klonteringsmechanisme.

Definitie

AI-QCT is een geavanceerde coronaire CT-analysetechniek die gebruikmaakt van kunstmatige intelligentie om plaquecomponenten – waaronder niet-verkalkte en plaque met een lage attenuatie – te kwantificeren en te karakteriseren, verder dan wat een standaard CAC-score kan detecteren.

Waarom dit belangrijk is

Het legt de 'superscan'-technologie uit die gevaarlijke zachte plaque kan opsporen, zelfs wanneer een CAC-score nul is.

Definitie

Een gerandomiseerd onderzoek waarbij langzaam vrijkomende niacine werd toegevoegd aan intensieve statinetherapie bij patiënten met vastgestelde hart- en vaatziekten; ondanks het verhogen van HDL-C leverde niacine geen vermindering op van cardiovasculaire aandoeningen, wat bijdraagt aan het bewijs dat verhoging van HDL-C niet causaal hartbeschermend is.

Waarom dit belangrijk is

Nog een bewijs dat de eigenschap van kokosolie om het HDL te verhogen niet moet worden geïnterpreteerd als hartbescherming.

Definitie

Luchtdichtheid is de massa van lucht per volume-eenheid; op grote hoogte of bij een verhoogde temperatuur is de lucht minder dicht, wat de aerodynamische weerstand die een wielrenner moet overwinnen vermindert en een hogere snelheid mogelijk maakt bij hetzelfde vermogen.

Waarom dit belangrijk is

Lagere aërodynamische weerstand op grote hoogte is een reden waarom velodrooms op grote hoogte de voorkeur genieten voor pogingen om records te verbreken, wat illustreert hoe omgevingsfysica wisselwerkt met de cardiovasculaire prestatie.

Definitie

Alcohol is het ingrediënt in bier, wijn en sterke drank dat ervoor zorgt dat ze bedwelmend zijn.

Waarom dit belangrijk is

Jaren lang werd mensen verteld dat een dagelijks glas wijn goed was voor het hart. Nieuwere en betere studies hebben dat idee ontkracht. De mensen die weinig dronken, waren om andere redenen gezonder. Alcohol verhoogt de bloeddruk en triglyceriden, en er is geen hoeveelheid die artsen aanbevelen voor hartbescherming.

Definitie

Een vorm van gedilateerde cardiomyopathie veroorzaakt door chronisch zwaar alcoholgebruik—typisch gedefinieerd als ongeveer 80 gram ethanol per dag gedurende ten minste vijf jaar—waarbij aanhoudende ethanoltoxiciteit de hartspier verzwakt en vergroot; in tegenstelling tot veel oorzaken van hartfalen is ACM vaak aanzienlijk omkeerbaar bij aanhoudende onthouding.

Waarom dit belangrijk is

De omkeerbaarheid ervan bij het stoppen met alcohol biedt een zeldzaam voorbeeld van zinvol herstel van de hartfunctie door uitsluitend een verandering van levensstijl.

Definitie

Het gen dat codeert voor aldehyde-dehydrogenase 2, dat acetaldehyde - een giftige ethanolmetaboliet - omzet in onschadelijk acetaat; individuen die de ALDH2*2-variant dragen, die veel voorkomt bij Oost-Aziatische populaties, hebben een verminderde enzymactiviteit, wat leidt tot ophoping van acetaldehyde, het flushing-syndroom en een verhoogd cardiotoxisch risico bij het drinken.

Waarom dit belangrijk is

Deze variant illustreert hoe genetica de individuele kwetsbaarheid voor alcoholgerelateerde hartschiade vormgeeft.

Definitie

Alirocumab, verkocht als Praluent, is een injecteerbaar antilichaam dat PCSK9 blokkeert en eens in de twee tot vier weken wordt toegediend.

Waarom dit belangrijk is

Het verlaagt LDL en ApoB met ongeveer de helft bovenop een statine, en verminderde herhalingsgebeurtenissen bij patiënten die herstellen van een hartaanval.

Definitie

Activin receptor-like kinase 1 is een endotheelreceptor die, samen met SR-B1, betrokken is bij de receptorgemedieerde transcytose van apoB-bevattende lipoproteïnedeeltjes door de endotheelbarrière naar de arteriële intima, een concentratieafhankelijk proces dat een vroeg stadium in de atherogenese vertegenwoordigt.

Waarom dit belangrijk is

Het identificeert een specifieke biologische toegangspoort waardoor circulerende deeltjes de slagaderwand binnendringen, wat bevestigt waarom de deeltjesconcentratie in de loop der tijd belangrijk is.

Definitie

Sterfte door alle oorzaken betekent overlijden door welke oorzaak dan ook, en niet alleen door hartaandoeningen — de meest omvattende en minst te manipuleren uitkomst die een studie kan meten.

Waarom dit belangrijk is

Sommige behandelingen verbeteren een specifiek cardiovasculair cijfer, terwijl ze niets doen aan – of zelfs verslechteren – uw algehele kans om aan al het andere te overlijden. Een studie die de sterfte door alle oorzaken beïnvloedt, weegt zwaarder dan een studie die alleen rapporteert over een cardiovasculair-specifiek eindpunt.

Definitie

Alpha-linolenic acid (ALA, 18:3n-3) is a plant-derived omega-3 polyunsaturated fatty acid found notably in canola oil and flaxseed; it is chemically distinct from the omega-6 linoleic acid that dominates most other seed oils, which is why canola oil is not considered interchangeable with high-linoleic oils.

Waarom dit belangrijk is

Grouping canola with other seed oils without acknowledging its omega-3 content distorts the nutritional comparison.

Definitie

A prescribing strategy in which a statin is taken every other day rather than daily, used clinically to reduce muscle symptoms in intolerant patients while preserving a meaningful portion of LDL-lowering effect, particularly with longer-half-life statins.

Waarom dit belangrijk is

A practical flexibility option athletes can discuss with their clinician when daily statin use causes symptoms.

Definitie

A sealed sleeping enclosure that simulates the reduced oxygen levels found at high altitude by lowering the partial pressure of oxygen inside; athletes use it to stimulate red blood cell production and improve oxygen-carrying capacity without relocating permanently to altitude.

Waarom dit belangrijk is

Improved oxygen delivery directly affects cardiovascular efficiency and endurance performance, making altitude simulation a practical training tool for heart-healthy athletes.

Definitie

A performance strategy in which endurance athletes train at elevation — in this case the Bicentenario Velodrome in Aguascalientes, Mexico, at roughly 1,800 m above sea level — to stimulate adaptations such as increased red blood cell production that enhance oxygen delivery.

Waarom dit belangrijk is

Altitude physiology is relevant to understanding how even elite, highly trained athletes can harbor undetected coronary artery disease.

Definitie

Competing or training at elevation—such as the Bicentenario Velodrome in Aguascalientes at roughly 6,000 feet—where thinner air reduces aerodynamic drag, allowing cyclists to travel farther in an hour than at sea level, but also causing faster fatigue due to lower oxygen availability.

Waarom dit belangrijk is

Megdal chose a high-altitude venue specifically to exploit reduced air resistance, while managing the physiological cost of racing at elevation.

Definitie

An Alu element is a type of short, repetitive 'jumping gene' abundant in primate genomes that can insert itself into new genomic locations; the insertion of an Alu element into the CMAH locus caused the 92-base-pair deletion that permanently inactivated Neu5Gc synthesis in ancestral humans.

Waarom dit belangrijk is

A single random genomic event caused by this mobile DNA sequence is proposed to be the root cause of human-specific susceptibility to red-meat-associated heart disease.

Definitie

Alzheimer's disease is a brain illness that slowly destroys memory and thinking.

Waarom dit belangrijk is

It used to be treated as completely separate from heart disease. Newer research suggests the two share more than we thought, including the same cholesterol-carrying particles and damage to the tiny blood vessels that feed the brain.

Definitie

The AMORIS (Apolipoprotein MOrtality RISk) study was a large Swedish prospective cohort that measured ApoB and other lipid fractions and demonstrated that ApoB was a stronger predictor of cardiovascular events than LDL-C, particularly in cases of discordance between the two measures.

Waarom dit belangrijk is

AMORIS is one of the foundational studies demonstrating that counting atherogenic particles matters more than measuring cholesterol mass alone.

Definitie

AMP-activated protein kinase is a cellular energy sensor that, when activated, suppresses cholesterol and fatty acid synthesis and exerts anti-inflammatory effects; bempedoic acid has been proposed to activate this pathway as part of its mechanism beyond simple LDL lowering.

Waarom dit belangrijk is

It is cited as a potential explanation for bempedoic acid's hsCRP-lowering effect, which is distinct from statins' mechanism.

Definitie

The gene encoding salivary amylase, the enzyme that begins starch digestion in the mouth; humans carry multiple copies of this gene, and a 2024 study in Science found that its duplication dates back nearly 800,000 years, suggesting starch digestion was a core human metabolic strategy long before agriculture.

Waarom dit belangrijk is

Understanding our evolutionary capacity to process carbohydrates helps explain why blanket low-carb or meat-only dietary prescriptions may not align with human biology.

Definitie

The amyloid hypothesis is the long-dominant theory of Alzheimer's disease holding that abnormal accumulation of amyloid-beta protein plaques in the brain is the primary initiating cause of neurodegeneration and cognitive decline.

Waarom dit belangrijk is

Understanding this hypothesis is essential context for evaluating whether vascular disease — not amyloid — may be the earlier, upstream driver of Alzheimer's.

Definitie

Anabolic resistance is when older muscles stop responding well to protein. A younger person can eat a modest amount of protein and build muscle. An older person eating the same amount may build almost none.

Waarom dit belangrijk is

This is why protein needs go up with age rather than down, especially for older athletes trying to hold onto muscle.

Definitie

Angina is chest discomfort that happens when the heart muscle isn't getting enough oxygen. People describe it as pressure, tightness, squeezing, or burning, and it can spread to the arm, neck, or jaw.

Waarom dit belangrijk is

Not everyone gets classic chest pain. Some people just feel short of breath, unusually tired, or sick to their stomach. Very fit people sometimes feel almost nothing at all, which is exactly what makes their disease dangerous.

Definitie

Angiogenesis is the sprouting of new capillaries from existing microvessels, driven primarily by tissue hypoxia through HIF-1α–mediated transcription of vascular endothelial growth factor (VEGF). Because capillaries lack a muscular wall, they improve local oxygen diffusion but cannot compensate for a significant obstruction in a large coronary artery.

Waarom dit belangrijk is

Understanding the difference between angiogenesis and arteriogenesis clarifies why growing new tiny vessels is not enough to protect the heart during intense exercise.

Definitie

An angiogram is a test where doctors thread a thin tube into your arteries and inject dye, so the inside of the arteries shows up on an X-ray.

Waarom dit belangrijk is

It shows the open channel that blood flows through. Its big weakness is that it does not show the artery wall — and plaque grows in the wall. An artery can look almost normal on an angiogram while carrying a lot of disease.

Definitie

Angiographic regression refers to a measurable decrease in the size of a coronary artery blockage as seen on X-ray imaging of the coronary arteries; the article cites the Lifestyle Heart Trial as demonstrating that intensive plant-based diet and lifestyle changes can produce this effect.

Waarom dit belangrijk is

It is the scientific term for what the article describes as 'shrinking blockages,' giving readers a precise label for this clinically important phenomenon.

Definitie

Angioplasty is a procedure where a small balloon is inflated inside a narrowed artery to push the blockage open. A stent is usually left behind to hold it open.

Waarom dit belangrijk is

It is very good at relieving symptoms and saving lives during a heart attack. What it does not do is fix the disease itself, which is spread throughout all your arteries, not just the one spot that got fixed.

Definitie

ANGPTL3 is a protein that slows the breakdown of triglyceride-rich particles in the blood.

Waarom dit belangrijk is

People born with a broken copy have low triglycerides, low LDL, and less heart disease — which made it an obvious drug target. Evinacumab blocks it and is used in the most severe inherited cholesterol disorders.

Definitie

An anomalous coronary artery is a congenital malformation in which a coronary artery originates from the wrong location or follows an abnormal path; during intense exertion the vessel can be compressed, reducing blood flow to the heart muscle and triggering ischemia or fatal arrhythmia.

Waarom dit belangrijk is

It is a leading structural cause of exertional sudden death in young athletes and is poorly detected by electrocardiography, requiring imaging for diagnosis.

Definitie

Antagonistic pleiotropy is an evolutionary hypothesis in which a gene or biological trait confers a survival or reproductive advantage early in life while becoming harmful later; applied to cardiovascular disease, it suggests that lipid-transport systems that may have offered benefits in ancestral environments become disadvantageous across long modern lifespans of caloric abundance.

Waarom dit belangrijk is

It offers one explanation for why humans are biologically susceptible to atherosclerosis despite its ultimately lethal consequences.

Definitie

Anti-HMGCR immune-mediated necrotizing myopathy is a rare autoimmune muscle disease, affecting roughly 2 per 100,000 statin users per year, in which the body generates antibodies against HMG-CoA reductase; unlike ordinary statin myalgia, it persists and worsens after the drug is stopped and requires immunosuppressive treatment.

Waarom dit belangrijk is

This condition is often mistaken for ordinary statin muscle pain, but stopping the statin alone will not resolve it — recognizing it early can prevent severe permanent muscle damage.

Definitie

The ability of moderate alcohol consumption to reduce clot formation through mechanisms including decreased fibrinogen levels and reduced platelet reactivity; while this may slightly lower ischemic stroke risk, the same blood-thinning effect raises the risk of hemorrhagic stroke, illustrating alcohol's double-edged cardiovascular profile.

Waarom dit belangrijk is

Understanding this trade-off helps explain why any apparent benefit for one type of stroke comes at the cost of increased risk for another.

Definitie

An anticoagulant reduces the blood's ability to clot by interfering with clotting proteins. Warfarin and apixaban are examples.

Waarom dit belangrijk is

It is a different tool from aspirin, which acts on platelets instead. Anticoagulants are used for atrial fibrillation and clots in veins; using one where the other is needed leaves a person poorly protected.

Definitie

An antihypertensive is any drug used to lower high blood pressure. The article distinguishes antihypertensives — which became widely used from the 1970s onward — from statins, noting that blood-pressure drugs contributed to coronary mortality decline well before statin therapy was available.

Waarom dit belangrijk is

Blood-pressure control through antihypertensives is one of the most evidence-backed ways to prevent heart attacks and strokes, making deterioration in population blood-pressure control a key reason the recent stall in progress is worrying.

Definitie

An antioxidant is a substance that mops up damaging molecules in the body. Vitamin E and beta-carotene are examples.

Waarom dit belangrijk is

The theory sounded great, and antioxidant pills were popular for years. But when researchers actually tested them in large trials, they did not prevent heart attacks, and a few appeared to cause harm. It is a good reminder that a sensible-sounding idea still has to be tested.

Definitie

Antiplatelet therapy uses drugs that make platelets less likely to clump — aspirin, clopidogrel, ticagrelor.

Waarom dit belangrijk is

It is the mainstay after a stent or a heart attack, where a clot forming on a damaged or instrumented surface is the immediate danger. The benefit is always weighed against bleeding.

Definitie

The Antithrombotic Trialists' Collaboration is a landmark individual-participant meta-analysis that pooled data from major aspirin trials; it found that aspirin's proportional reduction in vascular events is similar in primary and secondary prevention, but the absolute benefit in primary prevention is far smaller—roughly 0.06% per year—because baseline event rates are much lower.

Waarom dit belangrijk is

This analysis is the statistical foundation for why aspirin recommendations differ so sharply between people with and without established heart disease.

Definitie

A prescription oral antiviral drug combining nirmatrelvir and ritonavir that inhibits SARS-CoV-2 replication; it is typically prescribed early in infection to reduce the severity and duration of COVID-19, including in individuals with underlying conditions such as cardiovascular disease.

Waarom dit belangrijk is

Cardiovascular disease patients are at elevated risk from COVID-19, making antiviral treatment options particularly relevant.

Definitie

The aorta is the biggest artery in your body. It carries blood out of the heart and down through the chest and belly, sending branches everywhere.

Waarom dit belangrijk is

Because it handles so much pressure, it can stretch, stiffen with age, or develop a bulge. In athletes, the aorta is often slightly larger than average, which raises questions about what counts as normal.

Definitie

An aortic aneurysm is a bulge in the wall of the aorta, like a weak spot on a garden hose.

Waarom dit belangrijk is

Small ones often cause no trouble and are simply watched over time. Larger ones can tear or burst, which is a life-threatening emergency. Size and how fast it is growing are what doctors watch most closely.

Definitie

The capacity of the aorta to expand during systole and recoil during diastole, acting as a pressure buffer that smooths pulsatile blood flow; compliance decreases as collagen cross-linking and fibrosis stiffen the arterial wall with inactivity or aging.

Waarom dit belangrijk is

Loss of aortic compliance is the root mechanical cause of the cardiovascular aging discussed throughout this article and can be partially restored by committed exercise.

Definitie

Aortic dissection is a life-threatening emergency in which a tear in the aortic intima allows blood to split through the medial layer, creating a false lumen; it presents as sudden, severe tearing or ripping chest or back pain that is at its worst from the very first second, and may cause unequal pulses between arms.

Waarom dit belangrijk is

Recognizing the difference between dissection pain and ordinary exertional soreness can be the difference between life and death for an athlete with undiagnosed aortic disease.

Definitie

The section of the aorta immediately above the heart where it exits the left ventricle; it is a common site for early atherosclerotic plaque formation and is routinely measured in mouse models of heart disease to quantify plaque burden.

Waarom dit belangrijk is

Plaque measured at the aortic root is a standard benchmark for judging how severely atherosclerosis has progressed.

Definitie

Aortic stenosis is a narrowing or hardening of the aortic valve — the heart's primary outflow valve — that obstructs blood flow from the left ventricle to the aorta; elevated Lp(a) is recognised as the second leading cause of calcific aortic stenosis.

Waarom dit belangrijk is

It shows that Lp(a) harms the heart beyond arteries alone, making Lp(a) testing relevant even for people focused on valve health.

Definitie

The aortic valve is the one-way gate between the heart's main pumping chamber and the aorta.

Waarom dit belangrijk is

It can narrow with age as calcium builds up on it, or leak. Elevated Lp(a) is one of the few known risk factors for the narrowing, connecting valve disease to the same particle biology as plaque.

Definitie

Aortic wall stress is the mechanical tension per unit area acting on the aortic wall, calculated from transmural pressure, vessel radius, and wall thickness; cardiac MRI studies in patients with thoracic aortic disease have measured peak AWS of 257–323 kPa during moderate aerobic exercise, well below the 850–1,200 kPa rupture threshold.

Waarom dit belangrijk is

AWS is the key measurable variable that determines how close an aneurysmal aorta is to mechanical failure during any given level of physical exertion.

Definitie

Aortopathy is a broad clinical term encompassing any disease process that compromises the structural integrity or function of the aortic wall, including both inflammatory-atherosclerotic conditions such as AAA and heritable structural disorders such as Marfan syndrome.

Waarom dit belangrijk is

Athletes with undiagnosed aortopathy face unique risks during intense exertion that would not apply to a healthy individual with a similarly enlarged aorta.

Definitie

A large glycoprotein chain attached to the LDL core of a lipoprotein(a) particle whose structure closely resembles plasminogen, thereby inhibiting the body's natural clot-dissolving system and contributing to thrombotic risk on top of Lp(a)'s atherogenic and pro-inflammatory effects.

Waarom dit belangrijk is

It explains the third prong of Lp(a)'s 'triple threat'—beyond carrying cholesterol and oxidized phospholipids, it actively interferes with clot breakdown.

Definitie

ApoB is a protein that sits on the outside of every cholesterol particle that can get stuck in your artery wall and cause plaque. Each of those particles carries exactly one ApoB.

Waarom dit belangrijk is

That one-to-one rule is what makes it so useful. Measuring ApoB counts the particles. A standard cholesterol test measures the cargo inside the particles instead, which can be misleading if your particles are unusually empty or full.

Definitie

Discordance is when your ApoB and your LDL cholesterol tell two different stories. Your LDL looks fine, but your particle count is high — or the reverse.

Waarom dit belangrijk is

It happens when your particles are carrying less cholesterol than usual, so it takes more of them to add up to the same number on the lab report. It is especially common in people with insulin resistance or diabetes. When the two disagree, ApoB is the one that tracks your actual risk.

Definitie

The APOB R3500Q (p.Arg3527Gln) founder variant is a mutation in the APOB gene found in roughly 12% of Pennsylvania Old Order Amish — far above its 0.1–0.4% prevalence in white European populations — that causes familial defective ApoB-100 and persistently elevated LDL-C from birth.

Waarom dit belangrijk is

This variant serves as a natural experiment showing that lifelong LDL elevation leads to a dramatically higher burden of coronary calcification even in a population with a healthy lifestyle and favorable genetic background.

Definitie

ApoB-100 is the full-length form of apolipoprotein B found on LDL, VLDL, IDL, and remnant lipoproteins; its positively charged amino-acid domains bind ionically to negatively charged proteoglycan side chains in the arterial wall, physically trapping the particle in the intima and initiating plaque formation.

Waarom dit belangrijk is

It is the molecular 'hook' that locks harmful particles inside artery walls—understanding it explains why particle count matters more than cholesterol weight alone.

Definitie

ApoB-48 is a truncated isoform of apolipoprotein B produced in the intestine and found exclusively on chylomicrons and their remnants; unlike ApoB-100, it is not measured by standard clinical ApoB assays in the fasting state, meaning routine ApoB tests reflect atherogenic particle burden from liver-derived lipoproteins rather than dietary fat absorption.

Waarom dit belangrijk is

Knowing this isoform exists clarifies what a standard ApoB blood test does and does not count, so you can interpret your results accurately.

Definitie

Lipoproteins—including LDL, IDL, VLDL, and their remnants—that each carry one molecule of apolipoprotein B on their surface; particle number (rather than cholesterol mass alone) is a key driver of atherosclerosis because each particle can be retained in the arterial wall.

Waarom dit belangrijk is

The article repeatedly explains that metabolic 'wins' on keto do not offset a rise in apoB/LDL, making this concept central to the keto-vs-WFPB comparison.

Definitie

ApoB-years is a proposed research metric that represents cumulative apolipoprotein B exposure over time, expressed as the area under the apoB-versus-age curve in mg/dL·years; it is intended to capture integrated atherogenic particle burden more directly than any single measurement, but has not yet been validated as a clinical tool or treatment threshold.

Waarom dit belangrijk is

Understanding that lifetime particle exposure — not just today's number — drives plaque build-up reframes why early prevention matters.

Definitie

A lipid risk metric comparing the concentration of ApoB (reflecting all atherogenic particles) to ApoA1 (reflecting HDL, the primary reverse-cholesterol-transport particle); used in INTERHEART as a proxy for dyslipidemia, it had an odds ratio of 3.43 for myocardial infarction and the highest population attributable risk of any single risk factor studied.

Waarom dit belangrijk is

It captures both the 'bad' particle burden and the 'good' particle capacity in a single number, offering a more complete picture of lipid-related risk than LDL-C alone.

Definitie

APOC3 is the gene for a protein that blocks the clearance of triglyceride-rich particles from your blood.

Waarom dit belangrijk is

Less of it means faster clearance. People carrying a naturally broken copy have lower triglycerides and fewer heart attacks, which is strong evidence that these particles are causing harm rather than just tagging along.

Definitie

APOE is a gene that comes in three common versions, labeled E2, E3, and E4. It controls how efficiently your liver clears leftover fat particles.

Waarom dit belangrijk is

The E4 version raises both cholesterol and Alzheimer's risk, which is one of the threads connecting heart disease and brain disease. Knowing your type does not change treatment much, but it can explain an otherwise puzzling lipid pattern.

Definitie

The APOE ε4 allele is a common variant of the apolipoprotein E gene and the largest known common genetic risk factor for late-onset Alzheimer's disease; it promotes cerebrovascular damage and blood-brain barrier breakdown independently of its effects on amyloid and tau.

Waarom dit belangrijk is

The article argues APOE ε4 acts substantially through vascular pathways, bridging systemic lipoprotein biology and brain disease and supporting the broader vascular hypothesis.

Definitie

An apolipoprotein is a protein attached to a fat-carrying particle in your blood. Fat and water don't mix, so these proteins act like a wrapper that lets fat travel safely through the bloodstream.

Waarom dit belangrijk is

Different wrappers mark different kinds of particles. ApoB marks the harmful ones. ApoA-I marks HDL. Knowing which wrapper you are measuring tells you which particles you are counting.

Definitie

Apolipoprotein A-I is the main structural protein of HDL particles, roughly the HDL equivalent of what ApoB is for the harmful ones.

Waarom dit belangrijk is

It carries out the actual work of collecting cholesterol from cells. Measuring it gives a slightly better picture of HDL function than the cholesterol number alone, though neither has proven useful as a treatment target.

Definitie

Apolipoprotein E is a protein that serves as the primary cholesterol carrier within the brain, shuttling cholesterol from cholesterol-synthesizing astrocytes to neurons via a brain-specific lipoprotein system entirely separate from plasma lipoproteins.

Waarom dit belangrijk is

Its brain-specific role in cholesterol transport is distinct from its well-known role in plasma lipid metabolism and Alzheimer's disease risk.

Definitie

Arachidonic acid is a long-chain omega-6 fatty acid produced in the body from linoleic acid; it serves as a precursor to both pro-inflammatory and anti-inflammatory signaling molecules called eicosanoids, meaning its role in inflammation is more complex than the simple 'seed oils cause inflammation' narrative suggests.

Waarom dit belangrijk is

It is the key intermediate in the proposed inflammatory pathway linking seed oils to heart disease, so knowing what it actually does clarifies why that theory is incomplete.

Definitie

In cardiovascular lipidology, area under the curve refers to the cumulative, time-integrated exposure to atherogenic lipoproteins over a lifetime; it captures the idea that decades of moderately elevated LDL-C or ApoB deliver far more total arterial damage than a brief period of very high levels.

Waarom dit belangrijk is

This concept explains why starting lipid-lowering therapy at 30 rather than 50 can fundamentally change long-term heart-disease risk.

Definitie

Arginine is an amino acid found in whole foods such as walnuts that serves as the biochemical precursor the body uses to synthesize nitric oxide, thereby supporting endothelial relaxation and healthy blood vessel dilation.

Waarom dit belangrijk is

Its presence in whole-food sources—but not in refined oils—helps explain why whole walnuts preserve vascular function while extracted oils impair it.

Definitie

ARIC, the Atherosclerosis Risk in Communities study, has followed thousands of American adults since the late 1980s.

Waarom dit belangrijk is

Decades of follow-up let researchers watch risk factors measured in middle age play out into actual events much later. It is one of the studies behind the idea that exposure over time, not a single reading, is what counts.

Definitie

Arrhythmogenic cardiomyopathy is an inherited disease, often caused by variants in desmosomal proteins such as plakophilin-2, in which heart muscle is progressively replaced by fatty or fibrous tissue, creating an electrical substrate for life-threatening ventricular arrhythmias; endurance exercise volume is associated with earlier and more severe disease expression.

Waarom dit belangrijk is

It is one of the leading causes of exercise-related sudden death in young people, and exercise itself can accelerate the underlying disease process.

Definitie

Structural or electrical changes in heart tissue — such as enlarged atria and patchy fibrosis — that make the heart susceptible to sustaining an abnormal rhythm; in athletes, years of high-volume training can create such a substrate even in the absence of symptoms.

Waarom dit belangrijk is

Explains why AF tends to recur in athletes even after successful ablation.

Definitie

ARRIVE was a randomized placebo-controlled trial of 100 mg aspirin daily in roughly 12,500 moderate-cardiovascular-risk adults without diabetes; it found no significant reduction in the primary cardiovascular composite endpoint and more gastrointestinal bleeding, partly because actual event rates were far lower than anticipated due to widespread statin and antihypertensive use.

Waarom dit belangrijk is

ARRIVE illustrates how improvements in other preventive treatments have reduced the baseline risk that made aspirin useful, changing the benefit–risk equation.

Definitie

The deposition of calcium crystals within the arterial wall, which stiffens the vessel and in coronary arteries is used as a marker of atherosclerotic burden; some evidence suggests vitamin K2 may help inhibit its progression.

Waarom dit belangrijk is

Understanding calcification helps explain why vitamin K2 is studied as a cardiovascular supplement and why a high calcium score signals elevated risk.

Definitie

The physical removal of cholesterol and other lipids from within the arterial wall, observed histologically in non-human primate models after dietary fat restriction; it represents the earliest and most fundamental step in structural plaque regression.

Waarom dit belangrijk is

It confirms that the regression seen in imaging trials reflects a real biological change in artery composition, not just a measurement artifact.

Definitie

A deposit within the artery wall made up of lipids, immune cells, cellular debris, and fibrous tissue that accumulates over time and can narrow or block blood flow; also called an atherosclerotic lesion or atheroma.

Waarom dit belangrijk is

Plaque formation is the central process linking microplastic exposure to heart attack and stroke risk in this study.

Definitie

Remodeling is the way an artery changes shape as plaque builds up. Often the artery bulges outward to make room, keeping the opening in the middle wide enough for blood to pass.

Waarom dit belangrijk is

This is why heart disease can hide for decades. The artery is quietly filling with plaque, but because it expanded outward, tests that only look at the opening say everything is fine.

Definitie

Arterial stiffness is a measure of how much an artery's wall resists expansion with each pulse of blood; it increases with age as elastin is lost and collagen accumulates, and manifests clinically as a rising systolic blood pressure alongside a falling or stable diastolic blood pressure after about age 60.

Waarom dit belangrijk is

Arterial stiffness is a direct, measurable consequence of vascular aging that contributes independently to cardiovascular risk.

Definitie

Arteriogenesis is the structural remodeling of pre-existing small arterio-arteriolar anastomoses into mature, muscular conducting arteries, driven primarily by increased fluid shear stress rather than tissue hypoxia. Unlike angiogenesis, which produces only tiny capillaries, arteriogenic vessels can handle meaningful bulk arterial flow.

Waarom dit belangrijk is

It is the mechanism behind the heart's 'backup pipes' and explains both why fit athletes tolerate coronary blockages silently and why that protection has a hard ceiling.

Definitie

An artery is a blood vessel that carries blood away from the heart to the rest of the body.

Waarom dit belangrijk is

Artery walls have layers. Plaque does not build up inside the open channel like gunk in a pipe — it builds up inside the wall itself. That difference explains a lot about why heart disease is so easy to miss.

Definitie

A finding on a cardiac test that mimics a sign of disease but is actually caused by technical interference, movement, or normal variation rather than a true abnormality; physicians must distinguish artifacts from genuine pathological signals to avoid misdiagnosis.

Waarom dit belangrijk is

Dr. Megdal's doctor initially dismissed his ST depression as an artifact—a decision that delayed diagnosis and illustrates a key challenge in interpreting exercise EKGs in athletes.

Definitie

ASCVD is the clinical shorthand for disease caused by plaque buildup in the arteries — it covers coronary artery disease, most strokes, and peripheral artery disease under one label.

Waarom dit belangrijk is

It's the term driving guideline recommendations and risk calculators, because it groups the different places plaque can cause trouble into the single risk that lifestyle and medication decisions are actually aimed at reducing.

Definitie

Aspirin makes blood platelets less sticky, so clots are less likely to form.

Waarom dit belangrijk is

If you have already had a heart attack or stroke, daily aspirin usually helps. If you have not, the picture changed: newer studies found the bleeding risk roughly cancels out the benefit for most healthy adults. This is one of the clearest examples of medical advice reversing based on better evidence.

Definitie

ASPREE was a large randomized trial testing daily low-dose aspirin versus placebo in adults aged 70 and older (65 and older for U.S. minorities) who were free of cardiovascular disease; it found no significant reduction in cardiovascular events and a higher rate of major bleeding and all-cause mortality in the aspirin group, forming a key basis for recommending against aspirin initiation in older…

Waarom dit belangrijk is

ASPREE is one of the three pivotal modern trials that shifted guidelines away from routine aspirin use in healthy older people.

Definitie

ASTEROID was a trial that gave patients the highest dose of rosuvastatin and photographed their coronary plaque with intravascular ultrasound before and after.

Waarom dit belangrijk is

It showed measurable plaque shrinkage — one of the first clear demonstrations that very low LDL can reverse disease, not merely halt it.

Definitie

A landmark 2006 serial IVUS study in which rosuvastatin 40 mg daily for 24 months produced statistically significant reductions in both percent atheroma volume and total atheroma volume, providing the first large-scale evidence that intensive statin therapy can regress coronary plaque.

Waarom dit belangrijk is

ASTEROID established aggressive LDL lowering as a proven strategy for shrinking plaques and set the benchmark for subsequent regression trials.

Definitie

Astrocytes are a type of support cell (glia) in the brain that act as the primary cholesterol-manufacturing cells of the central nervous system, supplying cholesterol to neurons for membrane maintenance and myelin support. Because lipoproteins in the blood cannot cross the blood–brain barrier, the brain depends almost entirely on astrocyte-derived cholesterol synthesis.

Waarom dit belangrijk is

Disruption of astrocyte cholesterol production is implicated in neurodegenerative conditions, and understanding this isolated synthesis helps explain why systemic LDL levels do not directly reflect brain cholesterol status.

Definitie

Atherogenesis is the step-by-step process of a plaque forming.

Waarom dit belangrijk is

It starts when an ApoB particle slips into the artery wall and gets trapped. The body treats it as an invader and sends in immune cells. Those cells eat the trapped cholesterol, get stuck themselves, and die there. Repeat this for twenty years and you have a plaque.

Definitie

Atherogenic dyslipidemia is a lipid pattern characterized by elevated triglycerides, low HDL cholesterol, and an increased proportion of small, dense LDL particles; it is commonly seen with insulin resistance, visceral obesity, and sedentary behavior, and is associated with accelerated atherosclerosis.

Waarom dit belangrijk is

Standard cholesterol tests can miss this pattern, making it an important concept for understanding hidden cardiovascular risk.

Definitie

A logarithmically derived ratio of triglycerides to HDL cholesterol used as a marker of atherogenic lipoprotein particle size and cardiovascular risk; the article notes that an elevated AIP correlates with coronary calcium burden and major adverse cardiovascular events independent of traditional risk factors.

Waarom dit belangrijk is

AIP offers an additional layer of risk information beyond the CAC score itself, particularly for patients with borderline results.

Definitie

The atherogenic lipoprotein hypothesis is the scientific proposition that apolipoprotein B-containing lipoproteins are the primary causal drivers of atherosclerotic cardiovascular disease, meaning the number of these particles circulating in the blood directly determines the rate of plaque formation in arterial walls.

Waarom dit belangrijk is

Understanding this hypothesis explains why researchers have shifted focus from total cholesterol to particle counts as the key measure of heart disease risk.

Definitie

Atherogenic particles are the ApoB-containing lipoproteins—including LDL, IDL, VLDL, and lipoprotein(a)—that can enter and be retained in the artery wall to initiate and sustain plaque growth; the article uses the term to describe what must be lowered substantially and sustainably to achieve plaque regression.

Waarom dit belangrijk is

The article's main practical message is to lower these particles, so readers need a precise understanding of what the term covers beyond just 'LDL'.

Definitie

The total count of ApoB-containing lipoprotein particles circulating in the bloodstream—including LDL, VLDL remnants, and Lp(a)—as distinct from the cholesterol mass they carry; the European Atherosclerosis Society consensus holds that particle number, best captured by ApoB measurement, is a more accurate predictor of atherosclerotic risk than LDL-C concentration alone.

Waarom dit belangrijk is

Shifting focus from cholesterol mass to particle number is the central scientific reframing of the article, explaining why ApoB measurement is replacing traditional LDL-C testing.

Definitie

Atheroma is another word for the fatty deposit inside an artery wall — essentially a synonym for plaque, used more often in research writing.

Waarom dit belangrijk is

The root gives us "atherosclerosis." It comes from a Greek word for gruel, describing what the soft core of a plaque actually looks like.

Definitie

Atherosclerosis is the disease behind most heart attacks and many strokes. Cholesterol particles get stuck in the wall of an artery, the body sends immune cells to clean up, and over years that mess hardens into plaque.

Waarom dit belangrijk is

The key thing to understand is that it starts young — often in the teens and twenties — and grows silently for decades before anyone notices. By the time it causes a symptom, it has usually been building for most of your life.

Definitie

A condition in which plaques composed of lipids, inflammatory cells, and fibrous tissue build up within the walls of the coronary arteries, narrowing them and reducing blood flow to the heart; it is the leading cause of heart attacks worldwide.

Waarom dit belangrijk is

Megdal's diagnosis and self-reported reversal of this condition is the medical backdrop that makes his athletic achievements particularly striking.

Definitie

The measurable reduction in the size or lipid content of coronary artery plaques, documented by angiography or imaging; it requires a sustained biochemical environment of low circulating LDL and low inflammatory signaling so that cholesterol efflux from the arterial wall exceeds influx.

Waarom dit belangrijk is

It is the central clinical goal of the dietary protocols discussed in the article—moving beyond slowing disease to actually reversing it.

Definitie

The athlete calcification paradox is the well-documented finding that lifelong endurance athletes accumulate more coronary artery calcium and total plaque than sedentary people of similar age, yet have substantially lower cardiovascular mortality — meaning more 'rust' does not translate into greater death risk in this population.

Waarom dit belangrijk is

It is the central finding that forces doctors and athletes to rethink what a high calcium score actually means in a person who exercises intensely.

Definitie

The athlete paradox is the observation that some lifelong endurance athletes have higher coronary artery calcium scores and greater total plaque burden than less active peers, despite otherwise favorable cardiovascular risk profiles, suggesting that extreme chronic exercise may independently promote arterial calcification.

Waarom dit belangrijk is

It challenges the simple assumption that more exercise always means lower heart disease risk.

Definitie

Athlete's heart describes the normal changes that happen to a heart trained hard for years. The walls thicken a bit, the chambers get bigger, and the resting pulse drops.

Waarom dit belangrijk is

These changes are healthy adaptations, not disease. The complication is that they can look similar to real heart problems on a test, so they need to be read by someone who understands athletes.

Definitie

Atorvastatin, sold as Lipitor, is one of the two strongest statins and among the most prescribed medicines in the world.

Waarom dit belangrijk is

At high dose it typically lowers LDL by around half. It is inexpensive, generic, and backed by more outcome evidence than almost any other drug in medicine.

Definitie

ATP-citrate lyase is an enzyme that acts two steps upstream of HMG-CoA reductase in the mevalonate pathway, cleaving citrate to supply the raw material for cholesterol synthesis; bempedoic acid inhibits this enzyme to reduce hepatic cholesterol production.

Waarom dit belangrijk is

Because ACLY is the target of bempedoic acid, understanding it explains how this newer drug lowers LDL by a mechanism distinct from statins.

Definitie

Atrial fibrillation, often shortened to AFib, is a fast and irregular heartbeat that starts in the upper chambers of the heart.

Waarom dit belangrijk is

Because those chambers quiver instead of squeezing properly, blood can pool and form a clot, which may travel to the brain and cause a stroke. Interestingly, endurance athletes get AFib more often than couch potatoes — one of the few ways heavy exercise raises a risk instead of lowering it.

Definitie

Microscopic scarring of atrial muscle tissue, often resulting from chronic mechanical stretch or inflammation; fibrosis disrupts normal electrical conduction and is a well-established predictor of AF recurrence after ablation.

Waarom dit belangrijk is

Fibrosis is one of the main reasons why ablation is less durable in long-term endurance athletes.

Definitie

The brief interval after each electrical activation during which atrial muscle cells cannot respond to a new stimulus; when this period is shortened — as occurs during sympathetic surges or with vagal tone — the atria become more vulnerable to rapid, disorganized firing and AF onset.

Waarom dit belangrijk is

A shorter refractory period is one of the key electrical mechanisms linking intense exercise to AF in trained athletes.

Definitie

Structural and electrical changes in the atria — including enlargement, wall thickening, fibrosis, and altered ion-channel expression — that develop in response to chronic pressure or volume overload; in endurance athletes, sustained high cardiac output drives this process and increases AF susceptibility.

Waarom dit belangrijk is

Atrial remodeling is the underlying mechanism linking years of hard endurance training to elevated AF risk.

Definitie

A form of atrial flutter whose reentrant circuit does not follow the classic right-atrial pathway but instead arises from fibrotic or scarred tissue elsewhere in the atria; in athletes post-ablation, it often signals disease progression beyond the originally isolated pulmonary vein triggers.

Waarom dit belangrijk is

Its emergence after ablation is a warning sign that the underlying arrhythmogenic substrate is advancing, not resolved.

Definitie

A statistical measure of a diagnostic test's ability to discriminate between patients who will and will not experience an event, ranging from 0.5 (no better than chance) to 1.0 (perfect discrimination); in the CONFIRM2 registry, AI-QCT raised the AUC for predicting major cardiac events from 0.62 to 0.75.

Waarom dit belangrijk is

The AUC figure is how the article quantifies the improvement in predictive accuracy that AI-QCT provides over standard testing.

Definitie

Disorders in which the immune system mistakenly attacks the body's own tissues; Cordain argues that grains—which are evolutionarily recent foods—are associated with certain autoimmune conditions, citing gluten-related and lectin-related mechanisms as possible triggers.

Waarom dit belangrijk is

This claim is a key reason the Paleo framework discourages grains and is worth understanding when evaluating grain-free diets.

Definitie

An automated external defibrillator, or AED, is a portable device that can shock a stopped heart back into rhythm. It talks you through what to do, and it will not deliver a shock unless one is needed.

Waarom dit belangrijk is

When someone collapses from cardiac arrest, survival drops with every passing minute. A bystander with an AED nearby saves far more lives than waiting for an ambulance.

Definitie

Autophagy is a cellular housekeeping process by which cells break down and recycle damaged proteins and organelles; in arterial macrophages, it helps clear lipid debris and prevents the accumulation of plaque. The article's 2024 Nature Metabolism finding suggests that high single-meal protein doses may suppress autophagy in these immune cells, potentially worsening atherosclerosis in animal model…

Waarom dit belangrijk is

Autophagy in artery-wall immune cells is the proposed mechanism linking large protein meals to cardiovascular risk, making it central to the article's '25-gram paradox.'

Definitie

Autopsy-negative sudden unexplained death is a classification applied when a complete post-mortem examination, including cardiac-specific pathological review, identifies no structural cause for a fatal cardiac event; it represents the single largest adjudicated category in contemporary NCAA athlete SCD data at approximately 20% of cases.

Waarom dit belangrijk is

Knowing that one in five young cardiac deaths leaves no structural trace explains why screening strategies focused solely on anatomy cannot prevent all events.

Definitie

Autoxidation is the spontaneous reaction of fats with atmospheric oxygen, initiated and propagated without an external ignition source; the rate increases with the number of double bonds in a fatty acid, making highly polyunsaturated seed oils more prone to going rancid during storage or repeated heating than saturated or monounsaturated fats.

Waarom dit belangrijk is

It is the chemical basis for advice to store oils in cool, dark conditions and avoid reusing frying oil.

Definitie

The mean internal diameter measured across an entire standardized arterial segment between reference markers, as opposed to the single narrowest point; the Megdal study uses ALD change across red tick–marked segments to document diffuse, wall-wide regression in the LAD and Circumflex rather than improvement at one focal spot only.

Waarom dit belangrijk is

ALD reveals whether the whole artery is healthier, not just whether one isolated hot-spot improved.

Definitie

A catheter-based procedure in which a small balloon is inflated inside a narrowed coronary artery to compress the plaque and widen the vessel; widely used before stents were developed but limited by a high rate of the artery re-narrowing (restenosis) after the procedure.

Waarom dit belangrijk is

Balloon angioplasty was the predecessor to stenting and understanding its limitations explains why stents became the dominant approach.

Definitie

The Baltimore Longitudinal Study of Aging is a long-running prospective cohort study that tracked healthy men over decades and documented that total testosterone declines roughly 1–2% per year after the third decade, while free and bioavailable testosterone fall more steeply at about 2–3% per year as SHBG simultaneously rises.

Waarom dit belangrijk is

It provides foundational data on how male hormone levels change with age, supporting the clinical importance of measuring bioavailable rather than total testosterone.

Definitie

An uncoated metal mesh tube implanted inside a coronary artery to hold it open; unlike drug-eluting stents, it carries no medication and has a higher tendency to become re-blocked by overgrowth of arterial tissue (neointimal hyperplasia).

Waarom dit belangrijk is

Understanding the difference between stent types helps patients ask informed questions about which device is being recommended and why.

Definitie

The Bassler hypothesis was a 1970s claim by physician Thomas Bassler that completing a standard marathon conferred near-absolute protection against fatal coronary atherosclerosis; autopsy studies in the late 1970s and 1980s documenting coronary artery disease in runners who died during training quickly disproved it.

Waarom dit belangrijk is

Understanding this discredited idea explains why doctors once assumed fit athletes were immune to heart disease — and why its collapse reshaped how we screen athletes today.

Definitie

A protein that supports the survival, growth, and plasticity of neurons; estradiol promotes BDNF-associated signaling pathways, and its decline during menopause may reduce synaptic maintenance and contribute to memory complaints.

Waarom dit belangrijk is

BDNF is a key molecular bridge between estrogen loss and cognitive changes, making it relevant to understanding menopausal brain health.

Definitie

Belly fat that sits deep in the abdomen, wrapped around the organs, is called visceral fat. It is different from the softer fat you can pinch under the skin.

Waarom dit belangrijk is

Visceral fat is active. It sends out chemical signals that raise blood sugar, blood pressure, and triglycerides. This is why waist size can predict heart trouble better than weight on the scale.

Definitie

Bempedoic acid is a cholesterol-lowering pill that works in the liver, at a point just before where statins act.

Waarom dit belangrijk is

Its main advantage is that it stays out of muscle tissue, so it rarely causes the muscle aches some people get from statins. That makes it a useful option for people who truly cannot tolerate a statin.

Definitie

Benefit–risk balance refers to the quantitative comparison of the absolute reduction in harmful events a treatment prevents against the absolute increase in harmful events it causes; for aspirin, this balance is highly favorable in secondary prevention (where event rates are high) but close to neutral or unfavorable in primary prevention (where event rates are low).

Waarom dit belangrijk is

This concept is the central framework of the entire aspirin debate—the same drug can be lifesaving for one person and harmful for another depending on their underlying risk.

Definitie

A beta blocker is a medicine that slows the heart and makes it beat less forcefully, which lowers blood pressure and reduces how much oxygen the heart needs.

Waarom dit belangrijk is

Common examples include metoprolol and carvedilol. They are widely used after heart attacks and in heart failure, where a calmer, slower heart is easier on damaged muscle.

Definitie

Impaired capacity of the insulin-secreting beta cells of the pancreatic islets to produce sufficient insulin in response to rising blood glucose; in type 2 diabetes, prolonged metabolic stress can cause irreversible beta-cell loss that limits the degree of disease reversal possible.

Waarom dit belangrijk is

The article uses beta-cell dysfunction as a parallel to myocardial scarring to illustrate the broader principle that suppressing a disease process does not always undo the organ damage it has already caused.

Definitie

An alternative homocysteine remethylation route, operating mainly in the liver and kidney, that uses betaine rather than 5-methyltetrahydrofolate as the methyl donor; it supplements but does not replace the folate-dependent pathway.

Waarom dit belangrijk is

It explains why homocysteine lowering with B vitamins is sometimes incomplete and why organ-specific factors like liver and kidney health affect the response.

Definitie

Enlargement of both the left and right atria, a structural change driven in endurance athletes by years of high cardiac output and sustained volume loading; it creates a stretched, electrically unstable tissue environment that predisposes to atrial fibrillation.

Waarom dit belangrijk is

Understanding why the atria enlarge helps explain why reducing training volume — not just treating symptoms — is essential for long-term rhythm control.

Definitie

An indoor cycling track located in Aguascalientes, Mexico, at approximately 1,887 meters above sea level, known for its steeply banked turns and high-altitude conditions that favour aerodynamic speed for record attempts.

Waarom dit belangrijk is

The venue's altitude and banking angle are central to understanding the conditions—and trade-offs—under which Megdal set his world hour record.

Definitie

A bicuspid aortic valve has two flaps instead of the usual three. It is present from birth in roughly one person in a hundred.

Waarom dit belangrijk is

It is the most common heart abnormality people are born with. It tends to narrow earlier in life and often comes with a wider aorta, so both need periodic monitoring.

Definitie

Biglycan is a small leucine-rich proteoglycan present in the arterial subendothelial matrix that, along with versican and decorin, binds apoB-containing lipoprotein particles through ionic interactions, contributing to their retention in the intima as an initiating step in atherosclerosis.

Waarom dit belangrijk is

Understanding the specific molecules that trap particles helps explain why reducing particle number is more important than cholesterol content per particle.

Definitie

Bile acids are made by your liver from cholesterol and released into the gut to help digest fat.

Waarom dit belangrijk is

This is the body's main route for disposing of cholesterol. Soluble fiber works by binding bile acids so they leave the body instead of being reabsorbed, forcing the liver to pull more cholesterol from the blood.

Definitie

A next-generation coronary scaffold made from materials that are gradually broken down and absorbed by the body over time, leaving no permanent metallic structure inside the artery.

Waarom dit belangrijk is

Because no metal remains, bioabsorbable stents avoid the lifelong risk of in-stent thrombosis associated with permanent metal devices.

Definitie

Bioavailable testosterone is the sum of the free (unbound) and albumin-bound fractions of circulating testosterone—the portion actually accessible to tissues—as opposed to the SHBG-bound fraction, which is biologically inert under normal conditions.

Waarom dit belangrijk is

This is the clinically meaningful number that predicts symptoms; total testosterone alone can be misleading.

Definitie

A popular term for self-experimentation with diet, supplements, technology, or lifestyle practices aimed at optimizing physical performance, health, or longevity; it lacks a standardized scientific definition and often promotes unvalidated interventions.

Waarom dit belangrijk is

Knowing the term helps readers critically evaluate trendy health claims that may outpace the supporting evidence.

Definitie

A medication derived from living cells or biological sources rather than chemical synthesis; unlike small-molecule drugs such as statins, biologics are typically large proteins administered by injection and are designed to target specific molecules in the body.

Waarom dit belangrijk is

Understanding that Repatha is a biologic helps explain why it works through a completely different mechanism than statins and has a distinct side-effect profile.

Definitie

The tendency of established structural damage—such as calcified plaques or myocardial scar tissue—to persist even after the active disease process driving that damage has been halted, because the biochemical and cellular remodeling involved is largely irreversible.

Waarom dit belangrijk is

This concept explains why early intervention produces better outcomes than late intervention, a recurring theme in the article's discussion of plaque types and heart-attack scarring.

Definitie

Biological latency in atherosclerosis is the interval between the start of arterial injury from ApoB-containing particles and the point at which a lesion grows large enough for clinical imaging to detect it; autopsy studies of young soldiers and the Bogalusa Heart Study confirm that microscopic disease is common long before any scan turns positive.

Waarom dit belangrijk is

Latency explains why a clean heart scan in a young person with very high cholesterol can be misleading rather than reassuring.

Definitie

A biomarker is something measurable in the body that tells you about health or disease — a lab value, a scan result, a blood pressure reading.

Waarom dit belangrijk is

The catch is that changing a biomarker does not automatically mean you have changed your fate. A number can improve while the underlying disease keeps going. Good biomarkers are ones that have been proven to track real outcomes.

Definitie

A carbon atom flanked on both sides by carbon-carbon double bonds in a fatty acid chain; this configuration is particularly vulnerable to free-radical attack and is the structural reason polyunsaturated fats oxidize faster than saturated or monounsaturated fats.

Waarom dit belangrijk is

This is the precise chemical feature that makes seed oils less stable at high heat, grounding the cooking-stability advice in molecular reality.

Definitie

The Bloch pathway is one of two main routes by which lanosterol is converted to cholesterol, proceeding through the intermediate desmosterol before a final reduction by the enzyme DHCR24. It predominates in the testes, adrenal glands, and developing neurons, where the desmosterol intermediate itself serves a biological function.

Waarom dit belangrijk is

Defects in specific enzymes of this pathway cause inherited sterol disorders that can present with cardiovascular and neurological complications.

Definitie

A blood clot is a clump of blood cells and protein that forms to stop bleeding.

Waarom dit belangrijk is

Clots are lifesaving when you cut yourself. They are dangerous when they form inside an artery. Most heart attacks happen when a plaque cracks open and a clot forms on top of it, suddenly shutting off blood flow.

Definitie

Blood pressure is the force of blood pushing against your artery walls. It is written as two numbers, like 120/80. The top number is the pressure when your heart squeezes, the bottom is when it relaxes.

Waarom dit belangrijk is

High blood pressure damages artery walls over time and makes it easier for cholesterol particles to get in. It usually causes no symptoms at all, which is why it gets missed for years.

Definitie

Blood sugar, or glucose, is the fuel your cells run on. Your body works hard to keep it in a narrow range.

Waarom dit belangrijk is

When it stays high for years, it damages blood vessels throughout the body — including the ones feeding your heart, kidneys, eyes, and nerves. High blood sugar often shows up alongside high triglycerides and a high particle count.

Definitie

The total circulating volume of blood in the body; endurance training expands plasma volume and red cell mass, increasing oxygen delivery to muscles and contributing to higher VO₂max in trained athletes.

Waarom dit belangrijk is

Expanded blood volume is one of the key physiological adaptations distinguishing elite masters athletes from sedentary age-matched individuals.

Definitie

The blood–brain barrier is a highly selective cellular interface lining the brain's blood vessels that blocks lipoprotein particles from entering the central nervous system, meaning the brain must synthesize all of its own cholesterol locally.

Waarom dit belangrijk is

Understanding this barrier explains why lipid-lowering drugs do not deplete brain cholesterol, addressing a common concern about statin safety and cognitive effects.

Definitie

A CT imaging phenomenon in which dense calcified deposits appear larger than they truly are due to signal spillover, creating a bright 'halo' that can obscure adjacent non-calcified plaque or distort lumen assessment.

Waarom dit belangrijk is

This artifact is a key reason standard CAC scans can underestimate the full extent of coronary disease lurking beside calcified spots.

Definitie

Five geographic regions—Okinawa, Sardinia, Loma Linda, Nicoya, and Ikaria—identified by researcher Dan Buettner where people live significantly longer than the global average; their diets are consistently 90–95% plant-based, centered on legumes, whole grains, and tubers.

Waarom dit belangrijk is

Blue Zone populations offer real-world, long-term evidence of which dietary patterns are associated with exceptional longevity.

Definitie

Body mass index, or BMI, is a number calculated from your height and weight, used as a rough measure of body size.

Waarom dit belangrijk is

It is convenient but crude. It cannot tell muscle from fat, and it says nothing about where your fat is stored. A muscular athlete can land in the overweight range while being perfectly healthy, and a thin person can carry dangerous visceral fat.

Definitie

The Bogalusa Heart Study examined the arteries of children and young adults who died in accidents in a Louisiana town.

Waarom dit belangrijk is

The findings were startling: fatty streaks and early plaque in teenagers, and more of it in those with higher cholesterol and blood pressure. It is direct evidence that heart disease begins decades before anyone feels anything.

Definitie

Brachial artery flow-mediated dilation (FMD) is a noninvasive ultrasound test that measures how much the brachial artery in the upper arm widens in response to increased blood flow, reflecting nitric oxide-dependent endothelial function; it is a surrogate marker associated with cardiovascular risk in observational studies but is not itself a clinical endpoint like heart attack or stroke.

Waarom dit belangrijk is

Many dietary fat studies use FMD as an outcome, so knowing its limitations helps readers weigh those results appropriately.

Definitie

A major artery branching from the aortic arch that supplies blood to the head, neck, and right arm; in mouse atherosclerosis studies it is a key site for plaque measurement because it develops lesions rapidly and reproducibly.

Waarom dit belangrijk is

The 624% plaque increase reported at this artery is the study's most striking finding, so knowing what it is matters.

Definitie

The Bradford Hill criteria are a set of nine principles—including strength of association, consistency, biological plausibility, and dose-response—used to evaluate whether an observed statistical association between an exposure and a disease is likely to be causal.

Waarom dit belangrijk is

They are the standard framework scientists use to judge whether LDL truly causes heart disease rather than just correlating with it.

Definitie

A small group of riders who accelerate away from the main field (peloton) during a race, hoping to hold their lead to the finish line.

Waarom dit belangrijk is

The tactical decision to chase the breakaway drove the high-intensity cardiovascular effort that is the athletic centrepiece of the article.

Definitie

A randomized controlled trial (Wright et al., 2017) testing a whole food plant-based diet in a community setting for obesity, ischemic heart disease, or diabetes; the WFPB group achieved greater weight loss at six and twelve months than any other trial that did not mandate calorie restriction or exercise.

Waarom dit belangrijk is

It is one of the few RCTs directly comparing plant-based eating to usual care for weight loss without confounding calorie counting.

Definitie

The foundational molecular mechanism described by Nobel laureates Michael Brown and Joseph Goldstein, showing that liver cells regulate their own cholesterol uptake through surface receptors that bind and clear LDL from the bloodstream; this discovery explained familial hypercholesterolemia and became the biological rationale for statins, PCSK9 inhibitors, and all subsequent LDL-lowering therapie…

Waarom dit belangrijk is

Every cholesterol-lowering drug discussed in the article ultimately works by exploiting or augmenting this pathway, making it the conceptual bedrock of modern lipid medicine.

Definitie

A short-chain fatty acid produced when gut bacteria ferment dietary fiber; it strengthens the intestinal barrier, reducing the leakage of bacterial toxins (such as LPS) into the bloodstream that would otherwise drive systemic inflammation.

Waarom dit belangrijk is

It connects diet and gut health directly to cardiovascular inflammation, showing that what you eat shapes your inflammatory risk.

Definitie

A randomized controlled trial of 506 participants that tested high-dose B vitamins (5 mg folic acid, 0.4 mg B-12, 50 mg B-6) versus placebo for approximately three years, with carotid intima-media thickness progression as the primary endpoint; the main result was negative.

Waarom dit belangrijk is

It is the largest imaging trial directly testing whether B vitamins slow arterial plaque progression in people with mildly elevated homocysteine.

Definitie

Bypass surgery takes a healthy blood vessel from somewhere else in your body and uses it to route blood around a badly blocked coronary artery.

Waarom dit belangrijk is

Like a stent, it restores blood flow to muscle that was starving. Also like a stent, it treats one location. The disease process continues in the rest of your arteries unless the underlying causes are addressed.

Definitie

C-reactive protein, or CRP, is a substance your liver makes when there is inflammation somewhere in your body. A sensitive version of the test, hs-CRP, is used to estimate heart risk.

Waarom dit belangrijk is

A high result means inflammation, but not where it is coming from — a cold, arthritis, or gum disease will raise it too. It adds information but does not replace measuring your particle count.

Definitie

A measure of a predictive model's ability to correctly rank individuals by risk, equivalent to the Area Under the ROC Curve (AUC); it ranges from 0.5 (no better than chance) to 1.0 (perfect discrimination), with values above 0.80 generally considered clinically useful.

Waarom dit belangrijk is

It allows direct comparison of how well traditional risk scores versus AI imaging actually identify who will have a heart attack.

Definitie

The least functionally impaired category in UCI paracycling, reserved for athletes with a limb deficiency, leg-length discrepancy, or impaired muscle power or range of movement that is mild enough to allow racing on a standard bicycle.

Waarom dit belangrijk is

Classification determines who an athlete competes against and which records apply, making it essential context for evaluating Megdal's performances.

Definitie

CAD-RADS (Coronary Artery Disease Reporting and Data System) is a standardized grading scale used to report findings from coronary CT angiography, ranging from 0 (no plaque or stenosis) to 5 (at least one totally occluded artery); the index patient scored CAD-RADS 0, reflecting no detectable plaque above the imaging threshold.

Waarom dit belangrijk is

Knowing what CAD-RADS 0 means—and what it cannot rule out—is essential to interpreting the 'perfect' scan result discussed throughout the article.

Definitie

Calcific aortic valve stenosis is a condition in which calcium deposits progressively stiffen and narrow the aortic valve, ultimately obstructing blood flow from the heart; Lp(a)-borne oxidized phospholipids are a principal driver of the underlying valvular inflammation and calcification.

Waarom dit belangrijk is

It explains why some people with seemingly controlled cholesterol still develop severe heart valve disease requiring surgery.

Definitie

Calcification is when calcium gets deposited into a plaque, turning part of it hard and bony.

Waarom dit belangrijk is

It sounds bad, and a high total amount does signal a lot of disease. But the hardening itself is partly the body's repair job — a hard, stable plaque is less likely to crack open than a soft, greasy one. This is why statins and heavy exercise can both make plaque look more calcified while making it safer.

Definitie

Calcified plaque is the hardened, calcium-filled part of a plaque. It shows up brightly on a CT scan, which is what a calcium scan measures.

Waarom dit belangrijk is

Athletes often have more calcified plaque than non-athletes, but it tends to be the dense, stable kind. The amount and the type both matter, not just the total number.

Definitie

A CT imaging artifact in which a dense calcified deposit spreads or 'blooms' beyond its true boundaries due to detector limitations, obscuring adjacent soft tissue and making it impossible to assess non-calcified plaque sitting next to the calcium.

Waarom dit belangrijk is

The article cites calcium blooming as a key reason conventional CT missed dangerous soft plaque, and explains how photon-counting CT solves it.

Definitie

A calcium score (coronary artery calcium score) is a number derived from a CT scan that quantifies the total amount of calcified plaque in the coronary arteries; a score of zero indicates no detectable calcified plaque, while higher scores reflect greater plaque burden and elevated cardiovascular risk.

Waarom dit belangrijk is

It is the most direct, widely available way to see whether plaque has actually formed in your arteries, going beyond what cholesterol tests can reveal.

Definitie

A sustained reduction in calorie intake without malnutrition that consistently downregulates growth signaling, enhances autophagy, and extends lifespan in a wide range of organisms; it is considered one of the most reproducible pro-longevity interventions in experimental biology.

Waarom dit belangrijk is

Caloric restriction is the benchmark intervention against which most dietary longevity strategies are compared, and it underpins advice about avoiding chronic overeating earlier in life.

Definitie

Canakinumab is a monoclonal antibody that targets interleukin-1β (IL-1β), a key inflammatory signaling protein; it was the active drug in the CANTOS trial, where it reduced cardiovascular events without affecting LDL cholesterol.

Waarom dit belangrijk is

Its cardiovascular benefit without any cholesterol lowering was landmark evidence that inflammation is a therapeutic target in heart disease in its own right.

Definitie

CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) was a large randomized trial that tested canakinumab, a drug blocking the inflammatory signal IL-1β, against placebo; at its prespecified 150 mg dose it reduced major cardiovascular events by roughly 15% without lowering LDL cholesterol, providing direct human evidence that inflammation drives heart attacks through a pathway indepen…

Waarom dit belangrijk is

It proved that targeting inflammation alone — separate from cholesterol — can reduce heart attacks, a finding that reshaped how scientists think about what drives plaque rupture.

Definitie

The CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) trial was a landmark randomized controlled trial that tested whether canakinumab, an IL-1β inhibitor, could reduce cardiovascular events in high-risk patients with elevated hs-CRP after myocardial infarction; its positive results provided the first direct clinical evidence that inflammation is a causal, therapeutically modifiabl…

Waarom dit belangrijk is

CANTOS changed how cardiologists think about residual risk by showing inflammation is not just a bystander—it is a treatable target.

Definitie

Capillary density refers to the number of tiny blood vessels per unit of muscle tissue; regular endurance exercise increases capillary density, improving oxygen and nutrient delivery to working muscles, an adaptation that drugs cannot produce.

Waarom dit belangrijk is

Higher capillary density is part of the structural fitness that keeps muscles and organs well-supplied as we age.

Definitie

Capillary rarefaction is the age-related loss of capillary density within skeletal muscle, which increases the distance oxygen must travel from blood to muscle fibers and reduces the efficiency of oxygen extraction during exercise.

Waarom dit belangrijk is

It is one of the peripheral mechanisms that erodes aerobic capacity in older athletes even when the heart itself is well-preserved.

Definitie

An 8-carbon saturated fatty acid found in small amounts in coconut oil (~7–9%) and concentrated in purified MCT oils; it is rapidly absorbed, transported directly via the portal vein, and oxidized in the liver, accounting for most of the thermogenic and ketogenic effects attributed to MCT preparations in research studies.

Waarom dit belangrijk is

Most metabolism studies praising MCTs used oils rich in C8:0—not coconut oil—making this distinction crucial for evaluating coconut oil's weight-loss claims.

Definitie

Carbohydrates are the sugars and starches in food — bread, rice, pasta, fruit, potatoes, sweets.

Waarom dit belangrijk is

Quality matters more than quantity for most people. Whole grains, beans, and vegetables behave very differently in the body than white flour and sugar, even though they are all technically carbohydrates.

Definitie

A concentrated, rapidly absorbed source of simple carbohydrates in a semi-liquid form, consumed immediately before or during endurance exercise to maintain blood glucose and delay glycogen depletion.

Waarom dit belangrijk is

Fueling strategy before a maximal aerobic effort is a practical cardiovascular nutrition topic relevant to heart patients who exercise.

Definitie

A carbohydrate-restricted diet is a dietary pattern that substantially limits carbohydrate intake—ranging from strict ketogenic diets to broader low-carb approaches—and is the dietary context in which the Lean Mass Hyper-Responder phenotype and associated LDL elevations are most commonly observed.

Waarom dit belangrijk is

Knowing this term helps readers understand why the LDL debate has intensified alongside the popularity of keto eating.

Definitie

CARDIA has followed young adults from their twenties into later life, tracking fitness, cholesterol, blood pressure, and what eventually happened to them.

Waarom dit belangrijk is

Because it started so early, it captured the years when plaque is silently forming. It supplies much of the evidence that risk factors in your twenties shape your arteries in your fifties.

Definitie

Cardiac arrest is when the heart suddenly stops pumping and the person collapses, stops breathing normally, and loses consciousness within seconds.

Waarom dit belangrijk is

It is not the same as a heart attack. A heart attack is a plumbing problem — blocked blood flow. Cardiac arrest is an electrical problem — the heart's rhythm falls apart. A heart attack can trigger one, but so can other things. Without CPR and a defibrillator, survival drops fast.

Definitie

Cardiac catheterization is a procedure where a thin tube is threaded through a blood vessel, usually from the wrist or groin, up into the heart's arteries.

Waarom dit belangrijk is

Doctors use it to see blockages, measure pressures, and often to place a stent in the same session. It is how many people first learn how much disease they actually have.

Definitie

Clinically significant heart-related occurrences—including myocardial infarction, unstable angina, and cardiac death—used as outcome endpoints in cardiovascular trials.

Waarom dit belangrijk is

Trials are ultimately judged on whether they reduce cardiac events, not just on changes in imaging or blood tests.

Definitie

A condition in which blood flow to the heart muscle is insufficient to meet its oxygen demand, typically caused by narrowed coronary arteries; it can produce chest pain (angina), reduced exercise capacity, or, if severe, a heart attack.

Waarom dit belangrijk is

Ischemia is the underlying mechanism linking blocked arteries to the symptoms and performance losses described throughout the article.

Definitie

A specialized MRI technique for the heart that can characterize the location, pattern, and extent of myocardial injury, helping distinguish ischemic infarction from non-ischemic conditions such as myocarditis or takotsubo syndrome.

Waarom dit belangrijk is

CMR is essential in MINOCA workup because it reveals where and how the heart muscle was injured, guiding the search for an underlying mechanism.

Definitie

Cardiac MRI uses magnetic fields rather than X-rays to image the heart in fine detail, with no radiation.

Waarom dit belangrijk is

It is the best test for scarring in the heart muscle, which makes it valuable for distinguishing an athlete's healthy enlarged heart from genuine disease.

Definitie

A medically supervised program of exercise, education, and lifestyle modification prescribed after a cardiac event such as a heart attack, designed to improve cardiovascular function and reduce the risk of future events.

Waarom dit belangrijk is

The article presents cardiac rehab as the clearest real-world hint that improving VO₂ max can causally lower mortality.

Definitie

Cardiomyopathy is disease of the heart muscle itself, rather than of the arteries feeding it.

Waarom dit belangrijk is

The muscle may thicken, stretch, or stiffen. Several forms are inherited, and they are among the leading causes of sudden death in young athletes — a different problem entirely from plaque.

Definitie

The measurable restoration of heart and lung function following disease or injury, assessed through indices such as ejection fraction, VO2 max, and resting heart rate; it forms the physiological basis for structured cardiac rehabilitation programs.

Waarom dit belangrijk is

Quantifying cardiopulmonary recovery allows clinicians and patients to track whether lifestyle and exercise interventions are producing real biological benefit.

Definitie

Cardiorespiratory fitness is how well your heart, lungs, and muscles work together to use oxygen during hard exercise. It is often measured as VO2 max.

Waarom dit belangrijk is

It is one of the strongest predictors of how long you will live — stronger than most lab values. But being extremely fit does not make you immune to plaque, which is a hard lesson many endurance athletes have learned.

Definitie

Cardiovascular disease is the umbrella term for problems with the heart and blood vessels, including heart attacks, strokes, and blocked leg arteries.

Waarom dit belangrijk is

It is the leading cause of death worldwide. Most of it traces back to the same underlying process: plaque slowly building in artery walls over decades.

Definitie

A cardiovascular outcomes trial is a large, long-term randomized controlled trial specifically designed to measure whether a drug reduces major cardiovascular events such as heart attack, stroke, or cardiovascular death, rather than only improving a lab value or surrogate marker; regulators began requiring them for diabetes drugs after 2008.

Waarom dit belangrijk is

CVOTs are why we know these medicines actually prevent heart attacks, not just lower blood sugar — a distinction critical for evaluating their real-world benefit.

Definitie

Carnitine is a nutrient found mostly in red meat. Your body also makes some on its own.

Waarom dit belangrijk is

It matters here because gut bacteria can convert carnitine into a compound called TMAO, which has been linked to heart disease. How strong that link really is remains debated.

Definitie

The carotid arteries run up either side of your neck and supply blood to your brain.

Waarom dit belangrijk is

They are easy to scan with ultrasound, so researchers often use them to study plaque without needing to look at the heart directly. Plaque in a carotid artery can break loose and cause a stroke.

Definitie

Carotid intima-media thickness is an ultrasound measurement of the combined thickness of the inner two layers of the carotid artery wall in the neck; a faster rate of thickening indicates accelerating atherosclerosis, and it is used as a surrogate marker for cardiovascular risk in trials such as ELITE.

Waarom dit belangrijk is

It is a key surrogate endpoint used to test whether hormone therapy slows arterial aging without needing to wait for heart attacks to occur.

Definitie

The rate at which the combined thickness of the innermost two layers of the carotid artery wall increases over time, measured by ultrasound and used as a surrogate imaging marker of atherosclerosis progression or regression in clinical trials.

Waarom dit belangrijk is

Many homocysteine studies used this measure instead of counting heart attacks, making it essential for interpreting whether B vitamins actually slow plaque development.

Definitie

The CASCADE FH Registry is a United States-based patient registry that prospectively collects clinical, genetic, and treatment data from individuals with familial hypercholesterolemia; in HoFH research it has provided key evidence comparing outcomes between patients diagnosed and treated in childhood versus adulthood.

Waarom dit belangrijk is

Registry data from CASCADE FH quantified the survival benefit of early diagnosis and treatment, directly shaping current pediatric screening recommendations.

Definitie

A case-control study starts with people who already have a disease, finds similar people who do not, and looks backward for differences.

Waarom dit belangrijk is

It is efficient for rare conditions. Its weakness is that it relies on recall and records from the past, and people who are ill tend to remember their history differently.

Definitie

A case-crossover study compares a person's exposure in the short period just before an acute event — such as a heart attack — with their exposure during earlier 'control' periods in their own life, making each person their own control. The article uses case-crossover data to report that the odds of myocardial infarction roughly double in the hour after acute anger.

Waarom dit belangrijk is

This design is why the 'anger triggers heart attacks' finding is more credible than it might first appear — but it measures acute triggers, not long-term risk.

Definitie

The dominant protein in cow's milk, accounting for roughly 80% of its total protein content; rodent studies have shown that casein can promote tumour growth at high intake levels and suppress it at lower levels, findings that have been influential but also contested when extrapolated to other animal proteins.

Waarom dit belangrijk is

Understanding casein's specific effects helps evaluate whether cancer-risk claims about animal protein apply broadly or only to dairy-derived protein.

Definitie

Catecholaminergic polymorphic ventricular tachycardia is an inherited channelopathy in which abnormal calcium handling in heart muscle cells causes life-threatening ventricular arrhythmias triggered specifically by the catecholamine surge of exercise or emotional stress, with a structurally normal heart at autopsy.

Waarom dit belangrijk is

CPVT illustrates how exercise can be directly arrhythmogenic through biochemical rather than mechanical mechanisms, and it is easily missed by standard structural screening.

Definitie

A USA Cycling licence category indicating an intermediate-level amateur road racer, below Category 1–2 elite amateurs and professionals; used to benchmark the competitive field Megdal trains against in Memphis.

Waarom dit belangrijk is

Knowing the category helps readers gauge how demanding Megdal's training environment is relative to his age-group competition.

Definitie

A procedure in which a cardiologist threads a thin flexible tube (catheter) into the heart and uses energy — typically radiofrequency heat or cryotherapy — to destroy small areas of tissue responsible for triggering abnormal electrical signals; the main interventional treatment for AF.

Waarom dit belangrijk is

The article centers on what athletes can expect from ablation, so knowing how the procedure works matters.

Definitie

CAUGHT-CAD is a 2025 randomized trial that studied patients with a family history of premature coronary artery disease and found that Coronary CT Angiography — rather than standard calcium scoring alone — was necessary to detect non-calcified plaque and direct timely clinical intervention.

Waarom dit belangrijk is

The trial is cited as direct evidence that standard calcium scanning is insufficient for people with strong inherited cardiac risk.

Definitie

Causation means one thing actually makes another thing happen. It is different from correlation, which only means two things tend to show up together.

Waarom dit belangrijk is

This distinction runs through almost every health headline you read. Wine drinkers were healthier — but the wine was not the reason. Sorting real causes from tag-alongs is most of the work in medical research.

Definitie

Caveolar transcytosis is a process by which LDL and other ApoB-containing lipoprotein particles are transported across the endothelial cell layer into the arterial wall via small membrane-bound vesicles called caveolae; receptors including LDLR, SR-B1, and ALK1 participate in this pathway, and higher blood ApoB concentrations increase the rate of particle entry in a concentration-dependent manner.

Waarom dit belangrijk is

This mechanism explains at a molecular level why very high ApoB concentrations overwhelm the artery's defenses and drive plaque formation regardless of metabolic fitness.

Definitie

Coronary CT angiography is a non-invasive imaging test that uses X-ray computed tomography to produce detailed pictures of the coronary arteries, allowing doctors to detect and characterize both calcified and non-calcified plaque without inserting a catheter.

Waarom dit belangrijk is

It is the key imaging tool used to detect the 'silent' plaque buildup described in athletes throughout the article.

Definitie

Cellular senescence is a state in which damaged cells permanently stop dividing but remain metabolically active, secreting inflammatory signals that can promote local tissue damage; in aging arteries, senescent cells cluster at plaque sites and contribute to chronic low-grade vascular inflammation.

Waarom dit belangrijk is

Senescent cells are one of the key mechanisms by which aging adds cardiovascular risk beyond simple cholesterol exposure.

Definitie

The CENIT (Coronary Disease and the Effect of High-Intensity Interval Training) trial was a randomized study of 60 patients with stable coronary artery disease that used intravascular ultrasound to measure whether six months of supervised HIIT at 85–95% of peak heart rate changed plaque volume compared with standard care. It found HIIT reduced percent atheroma volume by 1.2% and total normalized…

Waarom dit belangrijk is

It is one of the few trials showing exercise can shrink measurable plaque in people already on heart medication.

Definitie

A model of fatigue proposing that the brain anticipates physiological limits and reduces muscle recruitment before the body actually reaches failure, acting as a protective regulatory system rather than allowing true muscular exhaustion.

Waarom dit belangrijk is

It reframes fatigue as a negotiable brain signal rather than a fixed physical wall, with implications for how athletes and cardiac rehab patients push through perceived limits.

Definitie

The outward pseudo-force experienced by a rider as the banked track redirects the bicycle through a curve; on steeply banked velodromes the effective gravitational load on the rider can approach twice normal body weight, imposing additional cardiovascular and musculoskeletal stress.

Waarom dit belangrijk is

Repeated high G-force loading in each lap raises physical strain during sustained maximal cardiac output, relevant to any athlete managing heart disease.

Definitie

Cerebral amyloid angiopathy is a condition in which amyloid-beta protein deposits accumulate in the walls of small blood vessels in the brain, weakening them and predisposing to microbleeds and impaired blood flow.

Waarom dit belangrijk is

CAA illustrates how vascular and amyloid pathology directly overlap in the brain, complicating the separation of 'pure' Alzheimer's from vascular dementia.

Definitie

Cerebral small vessel disease refers to a spectrum of pathological changes affecting the small arteries, arterioles, capillaries, and venules of the brain, distinct from large-artery atherosclerosis in its drivers and manifestations. It produces white-matter lesions, lacunar infarcts, and contributes to cognitive decline and vascular dementia.

Waarom dit belangrijk is

CSVD illustrates that arterial disease is not confined to the heart—the same risk factors silently damage the brain's tiny vessels, linking cardiovascular and cognitive health.

Definitie

Disease affecting the blood vessels supplying the brain, including stroke; cited alongside cardiovascular disease as an outcome reduced by vegetarian and vegan diets in an umbrella review of meta-analyses.

Waarom dit belangrijk is

Shows that the cardiovascular benefits of plant-based diets extend beyond the heart to include brain circulation.

Definitie

A clinical study evaluating the impact of AI-QCT coronary plaque analysis on physician treatment decisions; it found that AI-derived results changed management in 57.1% of patients, increasing statin use by 28.1%, aspirin prescribing by 23%, and reducing unnecessary downstream testing by 37%.

Waarom dit belangrijk is

It demonstrates that AI imaging translates into concrete changes in patient care, not merely better pictures.

Definitie

CETP is a protein that swaps cholesterol and triglycerides between HDL and the harmful ApoB particles.

Waarom dit belangrijk is

Blocking it raises HDL dramatically, so drug companies spent billions trying. Most of those drugs failed to prevent heart attacks, and one caused harm. It became the clearest evidence that raising HDL is not itself a treatment.

Definitie

A class of drugs designed to block cholesterol ester transfer protein, an enzyme that shuttles cholesterol from HDL to LDL particles; clinical trials such as ILLUMINATE and ACCELERATE showed that pharmacologically raising HDL-C this way did not reduce cardiovascular events, shifting the field's focus toward HDL function rather than concentration.

Waarom dit belangrijk is

Their failure helped overturn the assumption that simply raising 'good cholesterol' numbers protects the heart.

Definitie

A clinical scoring tool used to estimate stroke risk in patients with atrial fibrillation, assigning points for risk factors such as age, sex, hypertension, diabetes, heart failure, prior stroke, and vascular disease; a score of 2 or higher typically triggers a recommendation for oral anticoagulation.

Waarom dit belangrijk is

Knowing your score determines whether you must stay on blood thinners — a decision that directly affects which sports are safe to play.

Definitie

A channelopathy is an inherited disorder of cardiac ion-channel proteins that disrupts the electrical signals controlling heart rhythm without producing any visible structural abnormality detectable at autopsy; examples include long QT syndrome and catecholaminergic polymorphic ventricular tachycardia.

Waarom dit belangrijk is

Channelopathies can cause sudden death in a structurally normal heart, making them invisible to tests that look only for physical abnormalities.

Definitie

A large ecological study conducted in the 1980s comparing diet patterns, biomarkers, and disease mortality across rural Chinese counties with largely plant-based diets; it reported dramatically lower coronary artery disease mortality and substantially lower serum cholesterol levels in rural China compared with the United States.

Waarom dit belangrijk is

This project is a foundational reference for the link between plant-dominant diets and lower cardiovascular mortality, though its ecological design limits causal inference.

Definitie

A long-running longitudinal study of elderly and oldest-old adults in China, widely used to examine survival, diet, and healthspan in people aged 80 and above, including centenarians.

Waarom dit belangrijk is

This is the primary source for the article's claim that strict vegetarian patterns may be associated with lower odds of reaching 100 in very old age.

Definitie

CHIP is a condition in which a mutation in a bone marrow stem cell gives its descendants a growth advantage, so that a measurable fraction of a person's blood cells share that mutation; it becomes increasingly common with age and is associated with roughly a two-fold increase in coronary heart disease risk, likely because the mutant immune cells behave more aggressively in the artery wall.

Waarom dit belangrijk is

CHIP is an under-recognized age-related mechanism that raises heart disease risk independently of traditional risk factors like cholesterol.

Definitie

Cholesterol is a waxy substance your body needs. It goes into cell walls, hormones, vitamin D, and the bile that digests your food. You would die without it.

Waarom dit belangrijk is

The problem is not cholesterol existing. The problem is how much of it is riding around in your bloodstream inside particles that can burrow into artery walls.

Definitie

When cholesterol accumulates past what a plaque can hold in solution, it crystallizes into sharp needle-like structures.

Waarom dit belangrijk is

These crystals physically damage immune cells and trip the NLRP3 alarm, producing a burst of inflammation. They can also puncture a fibrous cap from the inside.

Definitie

Cholesterol efflux capacity is a laboratory test of how well someone's HDL actually pulls cholesterol out of cells — a measure of function rather than quantity.

Waarom dit belangrijk is

It predicts risk better than the HDL number does, which supports the view that HDL quality is what matters. It remains a research test, not something you can order routinely.

Definitie

See CETP for the full entry.

Definitie

Cholesterol synthesis is your body making its own cholesterol, mostly in the liver. Almost every cell can do it.

Waarom dit belangrijk is

This is why cutting cholesterol out of your food does less than people expect — when you eat less, your body simply makes more. It is also why statins work: they slow the factory rather than blocking the food.

Definitie

A large-scale pooled analysis of randomized trials of LDL-lowering therapies that demonstrated each approximately 1 mmol/L reduction in LDL-C reduces major vascular events by just over one-fifth per year, with no evidence of a safe lower threshold, providing key quantitative support for treating elevated LDL-C.

Waarom dit belangrijk is

It gives the specific numbers behind why LDL-raising from coconut oil is clinically relevant, not just a statistical abstraction.

Definitie

Cholesterol-years is a cumulative-exposure metric that multiplies a person's average LDL-C level (in mg/dL) by the number of years they have carried that level, analogous to pack-years for tobacco. The concept holds that it is the total lifetime burden of apoB-containing lipoproteins, not any single reading, that determines when and how severely atherosclerosis develops.

Waarom dit belangrijk is

Understanding cumulative exposure explains why modest LDL levels sustained for decades can be more dangerous than high levels for a short period—and why early treatment matters far more than late treatment.

Definitie

Cholesteryl esters are storage forms of cholesterol in which a fatty acid is attached to cholesterol; they accumulate in large quantities inside foam cells and the extracellular spaces of plaques, and their depletion—measured as regression of the lipid-rich pool—is a primary marker of plaque improvement in primate regression studies.

Waarom dit belangrijk is

Understanding what actually clears during reversal (cholesteryl ester pools, not fibrous or calcified tissue) sets realistic expectations for what treatment can achieve.

Definitie

Choline is a nutrient found in eggs, red meat, and liver. Your body genuinely needs it, especially for the brain.

Waarom dit belangrijk is

Like carnitine, it can be converted by gut bacteria into TMAO. This is the biological chain that connects certain foods to a possible heart risk through the gut microbiome.

Definitie

Chondroitin sulfate is a negatively charged glycosaminoglycan chain attached to arterial proteoglycans such as biglycan and versican; it binds ionically to the positively charged ApoB-100 protein on LDL particles, anchoring them in the subendothelial space and initiating the atherosclerotic process.

Waarom dit belangrijk is

It is the molecular 'Velcro' that traps LDL in artery walls—a key reason why the arterial wall is not a passive bystander in heart disease.

Definitie

Chronic kidney disease is a lasting reduction in the kidneys' ability to filter waste from the blood.

Waarom dit belangrijk is

It raises cardiovascular risk independently and steeply — many people with kidney disease die of heart disease before their kidneys fail. It also alters calcium handling in blood vessels.

Definitie

A sustained reduction in blood pH caused by an excess of acid-producing foods relative to base-producing foods; high animal-protein diets have been proposed to cause this state and thereby leach calcium from bones, though modern evidence does not support this mechanism when overall mineral intake is adequate.

Waarom dit belangrijk is

This claim has been used to argue that high-protein diets harm bone health—knowing the evidence helps you weigh that concern.

Definitie

A psychological strategy of breaking a large, overwhelming task into smaller, manageable units to reduce perceived difficulty and sustain motivation; used in cardiac rehabilitation and endurance sport to help patients and athletes continue through prolonged discomfort.

Waarom dit belangrijk is

It provides a practical mental framework for managing pain and effort during extended physical or medical challenges.

Definitie

A chylomicron is a very large particle that carries fat from a meal out of your intestines and into your bloodstream.

Waarom dit belangrijk is

Whole chylomicrons are too big to squeeze into an artery wall, so they are not directly dangerous. But as they shrink and drop off their cargo, the leftovers — called remnants — are small enough to get in and cause trouble.

Definitie

Circumferential wall stress is the tensile force acting around the circumference of an artery due to internal blood pressure; it rises with higher pressure and greater arterial diameter, and repeated extreme elevations during intense exercise may contribute to structural changes in the arterial wall.

Waarom dit belangrijk is

The article identifies exercise-driven surges in this force—reaching up to 250 mmHg—as a potential driver of the mechanical remodeling that may facilitate atherogenesis in endurance athletes.

Definitie

One of the two main branches of the left coronary artery, which curves around the back of the heart to supply the lateral and posterior left ventricular wall; the Megdal Serial Angiogram shows the Circumflex improved from mild-to-moderate narrowing (30–45%) in 2014 to improved patency below 20% in 2018, contributing to the evidence of diffuse, systemic regression.

Waarom dit belangrijk is

Improvement in the Circumflex alongside the LAD shows the healing was not confined to one artery, strengthening the case for a true systemic effect.

Definitie

Creatine kinase is an enzyme released from damaged muscle cells into the bloodstream; a markedly elevated blood CK level is used to confirm that muscle injury is genuine and pharmacological rather than purely symptom-based.

Waarom dit belangrijk is

CK testing is the frontline blood test that helps doctors determine whether a patient's muscle pain is truly caused by a statin or by another source.

Definitie

CLEAR Outcomes was a large trial that tested bempedoic acid in people who couldn't tolerate statins, to see whether it lowered heart attack and stroke risk the way statins do.

Waarom dit belangrijk is

It did — event rates fell in step with the drop in LDL and ApoB, in a population that had few other options. It's the main outcome evidence behind recommending bempedoic acid rather than just a cholesterol-lowering pill with no proof of preventing events.

Definitie

A clinical trial is a study where researchers give one group a treatment and another group a placebo or standard care, then compare what happens.

Waarom dit belangrijk is

When people are assigned randomly, it is the most reliable way we have to find out if something truly works. Observational studies can only watch what people already do, which leaves room for other explanations.

Definitie

The gene encoding the enzyme CMP-N-acetylneuraminic acid hydroxylase, which converts Neu5Ac to Neu5Gc in most mammals; humans carry an inactivating mutation in this gene and therefore cannot synthesize Neu5Gc.

Waarom dit belangrijk is

Understanding why humans are uniquely vulnerable to dietary Neu5Gc requires knowing that a single gene mutation set us apart from other mammals.

Definitie

A genetically engineered mouse that lacks both the CMAH gene (making it unable to produce Neu5Gc, like humans) and the LDL receptor gene (making it prone to high cholesterol and atherosclerosis); used to study how dietary Neu5Gc and anti-Neu5Gc antibodies affect plaque development.

Waarom dit belangrijk is

This is the key experimental model providing mechanistic evidence that Neu5Gc may accelerate atherosclerosis, so understanding what it is helps evaluate the strength of that evidence.

Definitie

Coconut oil is a cooking fat that got marketed as a superfood despite being very high in saturated fat.

Waarom dit belangrijk is

Studies consistently show it raises LDL cholesterol, similar to butter. The health-food reputation came from marketing and a few misread studies, not from evidence that it protects your heart.

Definitie

A combined measure of a rider's aerodynamic drag, calculated as the product of the drag coefficient and the frontal surface area; a lower CdA means less air resistance and faster speeds for the same power output.

Waarom dit belangrijk is

In an hour record, aerodynamic efficiency can matter as much as raw power—even small reductions in CdA translate to significant distance gains.

Definitie

A defined group of patients followed over time under similar conditions; Esselstyn's cohort, for example, consisted of patients with advanced coronary artery disease who agreed to follow a strict plant-based diet.

Waarom dit belangrijk is

Knowing what a cohort is helps readers understand why results from a selected group may or may not generalise to the wider population.

Definitie

A cohort study follows a large group of people over time, recording what they eat or do and what happens to their health years later.

Waarom dit belangrijk is

These studies are valuable for spotting patterns, but they cannot prove cause. People who choose a habit usually differ in other ways too, and those differences can be the real explanation.

Definitie

Colchicine is an old, cheap anti-inflammatory drug, used for centuries in gout, now repurposed for heart disease.

Waarom dit belangrijk is

It reduces events in people who keep having them despite well-controlled cholesterol. It is the most practical evidence so far that treating inflammation directly adds something.

Definitie

COLCOT (Colchicine Cardiovascular Outcomes Trial) was a randomized trial in which low-dose colchicine, an anti-inflammatory drug, was given to patients shortly after a heart attack; it reduced the risk of a subsequent major cardiovascular event by 23% compared with placebo, establishing that targeting inflammation independently of cholesterol lowers cardiovascular risk.

Waarom dit belangrijk is

It is one of the trials showing that fighting inflammation — not just lowering cholesterol — can prevent heart attacks.

Definitie

A biochemical process in which collagen fibers within arterial walls form stable chemical bonds between adjacent molecules, reducing tissue elasticity and contributing to irreversible arterial stiffening; it is accelerated by sedentary behavior and advancing age.

Waarom dit belangrijk is

This process explains why the window for reversing arterial stiffness closes after roughly age 65, creating the urgency for midlife intervention.

Definitie

Collateral circulation is a network of small backup blood vessels that can grow around a blocked artery, like a detour around a closed road.

Waarom dit belangrijk is

People who develop good collaterals sometimes survive blockages that would otherwise be devastating. Long-term exercise appears to encourage them, which may be one reason very fit people can have severe disease without symptoms.

Definitie

Collateral flow index is an invasive measurement obtained during balloon occlusion of a coronary artery that quantifies the proportion of normal antegrade blood flow supplied by collateral vessels. It is used in research to objectively assess how well the heart's backup circulation compensates for a blockage.

Waarom dit belangrijk is

It provides a concrete number for how much protection the 'backup pipes' actually offer, and studies using CFI have shown both the benefits and strict limits of exercise-induced collateral growth.

Definitie

Compensatory enlargement, described by Glagov, is the outward expansion of an artery's wall as plaque accumulates inside it, allowing the channel where blood flows to remain relatively open despite substantial hidden disease; on modern CT imaging, this positive remodeling is considered a high-risk plaque feature associated with lipid-rich, potentially vulnerable plaque rather than evidence of hea…

Waarom dit belangrijk is

It explains why a person can carry serious atherosclerosis yet have a nearly normal-looking angiogram — the disease hides in the wall, not the channel.

Definitie

The process by which an artery expands its outer diameter to preserve luminal blood flow as plaque accumulates within the vessel wall; luminal narrowing is typically delayed until plaque occupies roughly 40% of the internal elastic lamina area, making early disease invisible to lumen-focused imaging.

Waarom dit belangrijk is

It explains why standard imaging can report 'normal' arteries even when substantial plaque is already present inside the vessel wall.

Definitie

A composite endpoint bundles several different outcomes together and counts whichever happens first.

Waarom dit belangrijk is

Bundling makes trials smaller and faster. It can also mislead, because a headline reduction may be driven entirely by the least serious component — more procedures avoided rather than fewer deaths.

Definitie

Compositional stabilization refers to a shift in plaque biology away from a lipid-rich, inflamed, rupture-prone state toward a denser, less active state, achieved through ApoB lowering or anti-inflammatory treatment; it reduces the likelihood of a plaque triggering an acute coronary event without necessarily shrinking the total plaque volume visible on imaging.

Waarom dit belangrijk is

It reframes the goal of treatment from 'making plaque disappear' to 'making plaque less dangerous.'

Definitie

Compound heterozygous describes a genetic state in which an individual inherits two different pathogenic mutations in the same gene—one from each parent—rather than two copies of the identical mutation; in HoFH, compound heterozygosity for two distinct LDLR mutations still abolishes or severely impairs LDL receptor function and produces the full HoFH phenotype.

Waarom dit belangrijk is

Most HoFH patients are compound heterozygotes rather than true homozygotes, which affects genetic testing strategies and family screening.

Definitie

Computed tomography, or CT, takes X-ray images from many angles and reconstructs them into cross-sections of the body.

Waarom dit belangrijk is

It is the technology behind both the calcium scan and CT angiography — the two tests that let doctors see coronary plaque without threading a catheter into an artery.

Definitie

Concentration-time exposure, in the context of atherosclerosis, refers to the cumulative dose of ApoB-containing particles that an artery wall has experienced over time — the product of how high the particle level is and how many years it has been elevated — rather than a single snapshot measurement.

Waarom dit belangrijk is

It explains why a person's lifetime cholesterol history matters far more than one test result, and why starting lipid lowering early has such a large long-term benefit.

Definitie

A confidence interval is the range of values that are statistically compatible with what a study found.

Waarom dit belangrijk is

It shows how solid a result is. A narrow interval means a precise finding; a wide one that crosses "no effect" means the study could not really tell whether the treatment worked.

Definitie

A large international multicenter registry study of patients undergoing coronary CT angiography that documented the prevalence and clinical significance of coronary artery disease — including adverse events — even among patients whose coronary artery calcium score was zero.

Waarom dit belangrijk is

The CONFIRM data underpin the warning that a zero calcium score can still coexist with dangerous plaque, a finding directly relevant to people with inherited cardiac risk.

Definitie

A large, multinational registry of over 6,000 patients in which AI-quantified coronary plaque features were evaluated for their ability to predict major adverse cardiovascular events; the registry showed that AI-derived plaque analysis improved the area under the ROC curve for event prediction from 0.62 to 0.75 compared with standard methods.

Waarom dit belangrijk is

CONFIRM2 is the primary evidence the article cites that AI-QCT measurably improves risk prediction beyond existing tools.

Definitie

A confounder is a variable that is associated with both the exposure being studied (such as TMAO) and the outcome (such as heart disease), making it appear as though one causes the other when a third factor is actually responsible. The article lists renal function, insulin resistance, systemic inflammation, and age as major confounders that inflate the apparent cardiovascular risk of high TMAO in…

Waarom dit belangrijk is

Confounding is the central methodological problem that explains why the TMAO-heart disease link looks stronger in some studies than the genetic evidence supports.

Definitie

Confounding is when a hidden third factor makes two unrelated things look connected.

Waarom dit belangrijk is

Classic example: people who take vitamins are healthier. But they also exercise more, smoke less, and see doctors more often. The vitamin gets credit for what those other habits did. Untangling confounding is why good studies are so hard to run.

Definitie

Conjugated equine estrogens are a mixture of estrogen compounds derived from horse urine and taken as an oral pill; they were the form of estrogen used in the WHI trial, and unlike bioidentical estradiol, they undergo hepatic first-pass metabolism and raise coagulation factors.

Waarom dit belangrijk is

Distinguishing CEE from modern bioidentical estradiol patches is essential for interpreting the WHI results correctly.

Definitie

A paradoxical shrinkage of the external elastic membrane that can accompany plaque regression, causing the vessel wall to contract inward rather than expand outward; the result is that lumen size stays the same or even decreases even as total plaque volume falls.

Waarom dit belangrijk is

It explains why successful plaque-shrinking therapy does not always widen the artery or relieve symptoms, a counterintuitive finding patients and clinicians need to understand.

Definitie

The removal of body heat by the movement of air or fluid across the skin; at altitude the lower air density reduces convective heat loss, raising core temperature and impairing muscle efficiency during exercise.

Waarom dit belangrijk is

Reduced convective cooling at altitude or in hot environments accelerates fatigue and directly limits cardiovascular performance.

Definitie

A class of deep-learning architecture designed to detect spatial patterns in image data; in AI-QCT, CNNs are trained on large coronary CT datasets with invasive validation to recognize and classify plaque components automatically.

Waarom dit belangrijk is

CNNs are the computational engine that allows AI-QCT to outperform human readers in identifying high-risk plaque.

Definitie

A long-running prospective observational study based at the Cooper Clinic in Dallas that has followed a large cohort of patients over decades and contributed foundational data on the association between family history and coronary heart disease death in men.

Waarom dit belangrijk is

Research from this study is part of the evidence base showing that a family history of cardiac death predicts long-term coronary risk independently of other standard risk factors.

Definitie

A large Danish cohort study that analyzed lipid and lipoprotein concentrations in over 13,000 cord blood samples with longitudinal follow-up, providing normative reference data for cholesterol trajectories from birth through the first 14–16 months of life.

Waarom dit belangrijk is

It established that babies reach near-adult LDL-C and ApoB levels far earlier than anyone expected—reframing when cardiovascular risk actually begins.

Definitie

A very large Danish study that measured lipids, including Lp(a) and remnant cholesterol, in tens of thousands of people and followed their health for years.

Waarom dit belangrijk is

Denmark's national health records make follow-up unusually complete. Much of what we know about remnant cholesterol and Lp(a) as independent risks comes from this dataset.

Definitie

Small membrane-bound transport carriers (typically 60–80 nm in diameter) that bud from the endoplasmic reticulum to ferry newly synthesized proteins to the Golgi apparatus; their limited size means large molecules such as procollagen require specialized machinery like TANGO1 to exit the ER.

Waarom dit belangrijk is

Understanding COPII size constraints explains why the MIA3/TANGO1 pathway is indispensable for collagen secretion and plaque stability.

Definitie

CoQ10 is a compound your cells use to help generate energy in the mitochondria. Statins reduce production of it slightly, since it shares a manufacturing pathway with cholesterol.

Waarom dit belangrijk is

It's the basis for a popular but poorly substantiated claim that statins cause fatigue and muscle pain by depleting CoQ10 — a theory sold hard by supplement marketers, though trials haven't shown that supplementing it actually prevents statin symptoms.

Definitie

CORDIOPREV compared a Mediterranean diet against a low-fat diet in people who already had coronary disease, following them for seven years.

Waarom dit belangrijk is

It is one of the few long, well-run dietary trials in people with established disease, and it reported fewer events on the Mediterranean pattern.

Definitie

CORDIOPREV is a randomized controlled trial that compared a Mediterranean diet to a modestly low-fat diet (approximately 28–30% of calories from fat) in patients with established coronary artery disease; it confirmed Mediterranean dietary superiority over that comparator but did not test the ultra-low-fat (

Waarom dit belangrijk is

It is the main secondary RCT for the Mediterranean diet in patients with existing heart disease, and its limitations in scope are relevant to understanding what the evidence does and does not show.

Definitie

The coronary arteries are the small vessels that wrap around the outside of your heart and feed the heart muscle itself.

Waarom dit belangrijk is

They are surprisingly small — roughly the width of a coffee stirrer. When one gets blocked, the muscle it feeds starts to die within minutes.

Definitie

CABG is an open-heart surgical procedure in which a surgeon uses a blood vessel harvested from elsewhere in the body—typically a leg vein or chest-wall artery—to create a new route for blood flow around a blocked coronary artery.

Waarom dit belangrijk is

Understanding CABG helps patients grasp why surgery is sometimes recommended over stenting, particularly when multiple arteries are severely diseased.

Definitie

Coronary artery calcium is a measure of calcified plaque deposits in the walls of the coronary arteries, quantified by CT scan and expressed as an Agatston score; higher scores indicate greater cumulative plaque burden and predict future cardiovascular events.

Waarom dit belangrijk is

Studies discussed in the article use CAC as the primary marker showing that lifelong endurance athletes can have paradoxically high plaque burden.

Definitie

A non-contrast, ECG-gated CT scan that detects and quantifies calcified plaque in the coronary arteries; the resulting Agatston score reflects the extent of coronary calcification and serves as a direct, disease-based measure of atherosclerotic burden rather than a statistical estimate of risk.

Waarom dit belangrijk is

Understanding what the score actually measures—and what it can miss—is essential for interpreting your own results or those of a fit, seemingly healthy patient.

Definitie

A coronary artery calcium score, or CAC score, comes from a quick CT scan that measures how much hardened plaque is in your heart's arteries. No dye, no needles, about ten minutes.

Waarom dit belangrijk is

A score of zero is genuinely reassuring for most middle-aged people. A high score means real disease is present, even if you feel perfectly fine. It is one of the few tests that can show you your disease instead of just estimating your odds.

Definitie

Coronary artery disease is plaque buildup in the arteries feeding the heart muscle.

Waarom dit belangrijk is

It is the most common form of heart disease and the usual cause of heart attacks. It builds silently for decades, which is why the first symptom for many people is also a serious event.

Definitie

An abnormal, pathological dilation of a coronary artery segment beyond 1.5 times the diameter of an adjacent normal segment; the article explicitly rules it out as an explanation for the observed vessel widening in the Megdal angiograms, confirming the enlargement reflects true regression rather than disease-related over-expansion.

Waarom dit belangrijk is

Distinguishing healthy regression from ectasia ensures the 'wider pipe' seen in the 2018 images is good news, not a different problem.

Definitie

Narrowing of a coronary artery lumen, typically caused by atherosclerotic plaque, which reduces blood flow to the heart muscle; measured as a percentage of the original vessel diameter.

Waarom dit belangrijk is

Stenosis is the structural abnormality that lifestyle trials aim to reduce, so knowing the term helps readers interpret claims about 'reversal.'

Definitie

A measurable reduction in the size or severity of atherosclerotic plaque within the coronary arteries, confirmed by imaging; the Ornish Lifestyle Heart Trial demonstrated regression after one year on a low-fat plant-based diet, with further improvement at five years.

Waarom dit belangrijk is

Regression—rather than mere slowing of progression—is the gold standard outcome that distinguishes the most effective cardiovascular interventions.

Definitie

A coronary care unit is a specialised hospital ward where heart-attack patients are continuously monitored for dangerous heart rhythms and can be defibrillated immediately if one occurs. Introduced in the early 1960s, it was the single biggest step forward in acute heart-attack survival before modern drugs arrived.

Waarom dit belangrijk is

The CCU demonstrated that continuous monitoring and rapid defibrillation — not drugs or surgery — drove the first major improvement in surviving a heart attack.

Definitie

Coronary CT angiography, or CCTA, is a CT scan done with dye in your veins that produces detailed pictures of your heart's arteries.

Waarom dit belangrijk is

Unlike a calcium scan, it can see soft plaque as well as hard plaque, and unlike an invasive angiogram it requires no catheter. It shows both how narrow an artery is and what the plaque is made of.

Definitie

Coronary flow reserve compares blood flow through the heart's arteries at rest with flow when the heart is working hard.

Waarom dit belangrijk is

A poor result with clear large arteries points to trouble in the tiny vessels instead — a real and often missed cause of chest pain, especially in women.

Definitie

Coronary heart disease is the narrowing or blockage of the arteries that supply blood to the heart muscle, caused by the buildup of atherosclerotic plaque; it is the leading cause of heart attack and cardiac death worldwide.

Waarom dit belangrijk is

It is the underlying condition the entire article is about, and knowing its formal name helps readers follow medical sources and statistics.

Definitie

Non-invasive or invasive techniques—such as quantitative coronary angiography or intravascular ultrasound—used to visualise the size and character of plaques inside the coronary arteries; the Ornish and Esselstyn work is notable for using objective coronary imaging rather than relying solely on symptom or event data.

Waarom dit belangrijk is

Regression of atherosclerosis demonstrated by imaging carries more direct mechanistic weight than event counts alone, which is why the article emphasises it.

Definitie

Coronary microvascular dysfunction is impaired function of the tiny arterioles and capillaries supplying the heart muscle, resulting in reduced blood flow and exercise intolerance even when the major coronary arteries appear normal on angiography.

Waarom dit belangrijk is

CMD can cause symptoms and limit performance in older athletes whose large-artery tests come back clean, making it an easy-to-miss contributor to exercise intolerance.

Definitie

Coronary thrombosis is the formation of a blood clot inside a coronary artery, blocking blood flow to the heart muscle — the underlying event in most heart attacks. It was first described as a recognisable clinical syndrome in a living patient in 1912.

Waarom dit belangrijk is

Understanding that a clot, not just a diseased artery, triggers the acute event explains why clot-dissolving drugs and antiplatelet therapies became central to heart-attack treatment.

Definitie

A sudden, intense, transient constriction of an epicardial coronary artery severe enough to halt blood flow and cause myocardial ischemia or infarction, which typically resolves before angiography is performed, leaving an apparently normal-looking vessel.

Waarom dit belangrijk is

Vasospasm is one of the key 'invisible' causes of MINOCA—it causes real heart damage yet leaves no lasting obstruction for standard tests to detect.

Definitie

The cortisol awakening response (CAR) is the sharp rise in cortisol that normally occurs in the 30–45 minutes after waking, and is used as a measure of how well the HPA axis is functioning. The article notes that in Whitehall II the CAR did not predict cardiovascular mortality, whereas a flatter diurnal cortisol slope did.

Waarom dit belangrijk is

Understanding what cortisol patterns actually matter — and which ones don't — helps you evaluate claims about stress hormones and heart risk.

Definitie

The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial randomized 2,287 patients with stable coronary artery disease to PCI plus optimal medical therapy or medical therapy alone, finding no significant difference in death or heart attack rates over up to 15 years of follow-up.

Waarom dit belangrijk is

It is the landmark study showing that stents do not help most stable heart disease patients live longer than medication and lifestyle changes alone.

Definitie

COVID-19 infection is associated with transient reductions in cardiopulmonary fitness, VO₂ max, and muscular endurance; even after acute illness resolves, residual fatigue and reduced aerobic capacity can persist for weeks and pose risks if high-intensity exercise is resumed prematurely.

Waarom dit belangrijk is

Returning to strenuous exercise after COVID-19 carries specific cardiovascular risks, including myocarditis, that are important for heart health readers to understand.

Definitie

COX-1 is an enzyme found in platelets that produces thromboxane A₂, a chemical that promotes platelet clumping and blood vessel narrowing; aspirin permanently blocks COX-1 by chemically modifying a specific site (Ser-530) in the enzyme, which is the molecular basis of aspirin's antiplatelet effect.

Waarom dit belangrijk is

Knowing what COX-1 does clarifies exactly how aspirin prevents clots—and why its inhibition carries both benefit and bleeding risk.

Definitie

An involuntary, painful muscle contraction that can occur during prolonged maximal exercise, often associated with fatigue and electrolyte shifts; in the article, Megdal begins cramping in the final minutes of his hour-long maximal effort.

Waarom dit belangrijk is

Muscle cramping near peak exertion is a signal of physiological stress relevant to anyone pushing cardiovascular limits during exercise.

Definitie

An enzyme released into the bloodstream when muscle cells are damaged; elevated CK levels are used as a biomarker of skeletal muscle injury, and statin use—especially around intense exercise—can raise CK beyond the elevation caused by training alone.

Waarom dit belangrijk is

The key lab marker used to distinguish statin-related muscle damage from normal exercise-induced soreness in athletes.

Definitie

A prospective trial of 513 patients that compared AI-assisted CCTA analysis with invasive quantitative coronary angiography and fractional flow reserve, demonstrating high concordance and supporting AI-QCT as a viable non-invasive substitute for catheter-based ischemia assessment.

Waarom dit belangrijk is

CREDENCE directly validates that an AI scan can replace expensive, invasive procedures for judging whether a blockage is flow-limiting.

Definitie

A precision gene-editing technique that chemically converts a single DNA base (letter) in the genome to another without cutting the double strand, enabling permanent and targeted changes to a gene's function; in cardiovascular research it has been used in primates to permanently silence the PCSK9 gene in liver cells, producing lasting LDL reductions from a single treatment.

Waarom dit belangrijk is

Base editing is the mechanism behind the 'one-and-done' gene therapy approach that could eventually eliminate the need for any ongoing cholesterol medication.

Definitie

A mass-start bicycle road race contested on a short, closed circuit—typically a city block or similar loop—requiring repeated tight cornering and making crash risk substantially higher than open-road events.

Waarom dit belangrijk is

Understanding the format explains why finishing safely in a criterium is itself an achievement, separate from placing well.

Definitie

In the context of health literacy, the disciplined habit of questioning the source, funding, and methodology behind medical claims before accepting them as fact.

Waarom dit belangrijk is

Without it, patients are vulnerable to conflicting headlines and commercially motivated health advice.

Definitie

A cross-sectional study takes a single snapshot of a population at one moment.

Waarom dit belangrijk is

It can show that two things occur together but never which came first. Studies of this kind are frequently reported as if they showed cause, and they cannot.

Definitie

A non-invasive imaging test that uses computed tomography with intravenous contrast to produce detailed three-dimensional pictures of the coronary arteries, revealing both calcified and non-calcified (soft) plaque as well as luminal narrowing; it offers more information than a calcium score alone.

Waarom dit belangrijk is

The article specifically recommends CT angiography over a calcium score because it detects soft plaque that a calcium scan would miss.

Definitie

CT coronary angiography (also called coronary CT angiography or CCTA) is a non-invasive imaging test that uses a CT scanner and injected contrast dye to produce detailed images of the coronary arteries, revealing both calcified and non-calcified (soft) plaques as well as the degree of any narrowing.

Waarom dit belangrijk is

Unlike a calcium scan, it shows the type and texture of plaque, helping identify unstable lesions that pose the greatest rupture risk.

Definitie

CT-FFR is a non-invasive technique that applies computational fluid dynamics to coronary CT angiography data to estimate the functional significance of a coronary stenosis without an invasive catheter. It helps determine whether an anatomical narrowing seen on imaging is actually restricting blood flow enough to cause ischemia.

Waarom dit belangrijk is

For athletes with high calcium scores or detected plaques, CT-FFR can clarify whether a narrowing is truly dangerous during peak-effort exercise.

Definitie

The Cholesterol Treatment Trialists' Collaboration pools the raw data from every major statin trial rather than just comparing published summaries.

Waarom dit belangrijk is

With hundreds of thousands of patients, it produced the central finding of modern lipid care: each unit of LDL reduction buys a roughly proportional reduction in events, no matter how you achieve it.

Definitie

The specific site within a coronary artery identified as the originating source of the acute ischemic event, which in MINOCA may represent plaque disruption, erosion, thrombus, or dissection detectable by intracoronary imaging even when angiography appears unobstructed.

Waarom dit belangrijk is

Identifying the culprit lesion is crucial for directing the correct treatment in MINOCA rather than applying a one-size-fits-all approach.

Definitie

Cumulative exposure is the total amount of harmful cholesterol particles your arteries have been soaked in across your entire life — how high, multiplied by how long.

Waarom dit belangrijk is

This is the single most important idea on this site. Someone with a moderately high level since age 20 can end up with more damage than someone with a very high level starting at 55. Plaque adds up. Starting earlier matters more than starting harder.

Definitie

Curing a disease means stopping the process that causes it. Reversing means undoing damage that has already been done. They are not the same thing.

Waarom dit belangrijk is

With heart disease you can stop the process almost completely by driving particle levels low enough. Undoing the existing plaque is slower and only partial. Being clear about which one is being promised matters a great deal when reading health claims.

Definitie

Cynomolgus macaques (Macaca fascicularis) are Old World monkeys highly sensitive to dietary cholesterol that rapidly develop advanced coronary lesions rich in collagen, elastin, and calcification; they have also been used to study how psychosocial stress and social hierarchy accelerate coronary atherosclerosis through sympathetic nervous system activation and elevated cortisol.

Waarom dit belangrijk is

They illustrate that stress hormones, not just diet, can drive plaque development—relevant to anyone asking whether psychological stress affects heart risk.

Definitie

CYP7A1 (cholesterol 7-alpha-hydroxylase) is the rate-limiting liver enzyme that initiates the conversion of cholesterol to bile acids, representing the primary route by which the body eliminates cholesterol. Because the sterol ring cannot be broken down for energy, this hepatic conversion to bile acids is the main disposal mechanism.

Waarom dit belangrijk is

Drugs and dietary factors that upregulate CYP7A1 activity can lower circulating cholesterol by increasing its conversion to bile acids for excretion.

Definitie

The enzyme that catalyzes the first step of transsulfuration, converting homocysteine to cystathionine with vitamin B-6 as a cofactor; inherited loss-of-function mutations in the CBS gene are the most common cause of classical homocystinuria and severe hyperhomocysteinemia.

Waarom dit belangrijk is

CBS deficiency is the clearest proof that extremely high homocysteine damages arteries, making it central to understanding why the mild-range evidence looks so different.

Definitie

A randomized trial of dalcetrapib, a CETP inhibitor that raised HDL-cholesterol, which found no reduction in cardiovascular events after acute coronary syndrome, contributing to evidence that pharmacologically increasing HDL-C does not reliably translate into clinical benefit.

Waarom dit belangrijk is

One of several trials showing that HDL elevation alone does not cancel out cardiovascular risk—directly undermining a key defense of coconut oil.

Definitie

A landmark longitudinal study that measured cardiovascular changes in healthy young men after prolonged bed rest and then after exercise training; its 30-year follow-up showed that just 20 days of bed rest impaired cardiovascular capacity more than three decades of normal aging in the same individuals.

Waarom dit belangrijk is

It is the foundational evidence that much of what we call heart aging is actually reversible deconditioning, not inevitable decline.

Definitie

The DASH (Dietary Approaches to Stop Hypertension) diet is a dietary pattern emphasizing fruits, vegetables, whole grains, low-fat dairy, and reduced sodium and saturated fat, originally developed and tested in randomized trials for its blood-pressure-lowering effects and subsequently studied for broader cardiovascular benefit.

Waarom dit belangrijk is

It is one of the major named dietary patterns compared in evidence reviews of heart disease prevention.

Definitie

De novo lipogenesis is your liver manufacturing fat from scratch, mostly out of excess carbohydrate.

Waarom dit belangrijk is

It is how a very high sugar or refined starch intake ends up raising triglycerides and depositing fat in the liver, even when you are not eating much fat.

Definitie

De novo synthesis refers to the construction of a molecule—here cholesterol—entirely from scratch within the cell, starting from small precursors such as acetyl-CoA, rather than acquiring it from the bloodstream or diet. The roughly 30-step pathway is so energetically costly that cells strongly prefer to take up circulating LDL when it is available.

Waarom dit belangrijk is

Understanding whether a patient overproduces cholesterol or over-absorbs it determines which treatment—a statin or ezetimibe—is likely to work best.

Definitie

A type of machine-learning model with many layers of interconnected processing nodes that learns complex, non-linear patterns from large datasets; in cardiac imaging it is trained to detect and quantify plaque features on CT scans.

Waarom dit belangrijk is

DNN-based analysis underlies the high diagnostic AUC figures quoted in the article and is the technical engine behind AI-assisted coronary plaque reading.

Definitie

The dependency threshold is an informal term for the VO₂ max level—roughly 18–20 mL·kg⁻¹·min⁻¹—below which a person lacks sufficient cardiorespiratory reserve to perform basic activities of daily living independently.

Waarom dit belangrijk is

Knowing this threshold illustrates the direct link between measurable fitness and functional independence in old age.

Definitie

Descending inhibitory pathways are neural circuits that originate in the brainstem and travel down the spinal cord to suppress pain signal transmission before it reaches conscious awareness. They are a key component of exercise-induced hypoalgesia and are strengthened by chronic endurance training.

Waarom dit belangrijk is

They form part of the biological mechanism that elevates an athlete's pain threshold, potentially silencing the cardiac pain that should prompt urgent medical attention.

Definitie

A long-chain omega-3 fatty acid with six double bonds that increases membrane fluidity and disorder; unlike EPA, it does not appear to inhibit oxidation of ApoB-containing lipoprotein particles and was not associated with cardiovascular event reduction in mixed EPA/DHA trials.

Waarom dit belangrijk is

Distinguishing DHA from EPA helps explain why combination omega-3 supplements failed where purified EPA succeeded.

Definitie

Diabetes is a condition where blood sugar stays too high, either because the body makes too little insulin or because it stops responding to the insulin it makes.

Waarom dit belangrijk is

It roughly doubles heart disease risk. Part of that is the sugar damaging blood vessels, and part is that diabetes usually comes bundled with high triglycerides and a high particle count that a standard cholesterol test can miss.

Definitie

Diabetic retinopathy is damage to the small blood vessels in the retina caused by chronically elevated blood sugar; research has shown that ApoB particles can leak through the damaged blood-retinal barrier and deposit as 'hard exudates,' analogous to arterial plaque.

Waarom dit belangrijk is

It highlights that controlling ApoB particle burden matters for preserving vision, not just preventing heart attacks.

Definitie

Diameter stenosis is an angiographic measure of how much a coronary artery's lumen has been narrowed by plaque, expressed as a percentage of the vessel's original diameter; it is used in clinical trials as an objective marker of plaque progression or regression.

Waarom dit belangrijk is

It is the key measurement used to confirm whether a dietary intervention actually shrinks arterial plaque rather than just improving blood markers.

Definitie

Diastolic blood pressure is the bottom number in a blood pressure reading. It is the pressure in your arteries while the heart is relaxing between beats.

Waarom dit belangrijk is

In younger adults it is often the more meaningful of the two numbers. In older adults, the top number usually matters more because arteries have stiffened.

Definitie

Dietary cholesterol is the cholesterol in food — eggs, shrimp, liver, and other animal products.

Waarom dit belangrijk is

For most people it has a surprisingly small effect on blood cholesterol, because the body compensates by making less. Saturated fat in food generally raises blood cholesterol more than cholesterol in food does. This is why egg advice kept flip-flopping for decades.

Definitie

A pattern of atherosclerosis regression in which luminal widening occurs broadly across an entire arterial segment rather than only at a single focal stenosis; the Megdal study documents this via Average Lumen Diameter improvement between the standardized red tick marks on both the LAD and Circumflex, ruling out focal mechanical intervention as the cause.

Waarom dit belangrijk is

Diffuse reversal proves the whole artery wall is healing, not just one spot that might have been stented.

Definitie

DISCO-CT was a randomized imaging trial that added a DASH-centered diet and lifestyle program to optimal medical therapy and measured coronary plaque with CT; it found no difference in total plaque burden between groups but a greater reduction in a broadly defined non-calcified plaque component in the diet group.

Waarom dit belangrijk is

It is one of the few controlled trials to look at whether diet changes actual plaque on a CT scan, and its mixed results illustrate how hard that question is to answer.

Definitie

See ApoB Discordance for the full entry.

Definitie

A process in which measurable markers of cardiovascular disease—such as arterial plaque burden or coronary stenosis—improve significantly in response to intensive lifestyle modification, nutrition, and/or medical therapy, to the point where the disease no longer produces symptoms or detectable progression.

Waarom dit belangrijk is

Distinguishing reversal from mere stabilization is important for patients setting realistic goals for lifestyle and medical intervention.

Definitie

The diurnal cortisol slope is the rate at which cortisol falls from its morning peak to its evening low over the course of a day. A flatter slope — meaning cortisol stays too high into the evening — has been associated in some studies with worse cardiovascular outcomes, including cardiovascular mortality in the Whitehall II cohort.

Waarom dit belangrijk is

It shifts the conversation from 'is my cortisol high?' to 'is my cortisol rhythm healthy?' — a more meaningful question for heart health.

Definitie

DMB (3,3-dimethyl-1-butanol) is a naturally occurring compound found in some olive oils that acts as a competitive inhibitor of the microbial TMA lyase enzyme (CutC/D), reducing TMA and TMAO production without killing gut bacteria and thereby avoiding the risk of antibiotic resistance.

Waarom dit belangrijk is

DMB represents a new class of targeted, non-antibiotic interventions that could lower cardiovascular risk by modulating the microbiome.

Definitie

An epigenetic biological-age model that integrates DNA methylation patterns with measures of cardiorespiratory fitness to estimate how physiologically 'young' an individual is relative to their chronological age.

Waarom dit belangrijk is

It offers a way to quantify the anti-aging effect of high fitness levels beyond simple performance metrics.

Definitie

A guanine nucleotide exchange factor that is recruited to the cytoplasmic domain of SR-B1 following LDL binding, and activates the small GTPase Rac1 to trigger actin cytoskeleton remodeling required for endothelial transcytosis of LDL particles.

Waarom dit belangrijk is

DOCK4 is a key link in the molecular chain that moves LDL from the bloodstream into the artery wall—blocking any step in this chain could reduce plaque formation.

Definitie

Donanemab is an anti-amyloid monoclonal antibody that targets a modified form of amyloid-beta and, like lecanemab, has been shown to remove plaques and modestly slow Alzheimer's progression in clinical trials, with similar risks of brain swelling and bleeding.

Waarom dit belangrijk is

Alongside lecanemab, it confirms amyloid removal is achievable but not curative, reinforcing the case that other upstream causes — including vascular disease — must be addressed.

Definitie

The Danish Osteoporosis Prevention Study (DOPS) was a randomized trial in which women who had just started menopause took oral hormone therapy for ten years; at follow-up, the hormone group had roughly half the rate of major cardiovascular events or death compared with the placebo group, providing one of the strongest hard-outcome signals for early hormone initiation.

Waarom dit belangrijk is

DOPS is one of the few randomized trials reporting actual heart attacks and deaths as endpoints, not just surrogate measures.

Definitie

A dose-response relationship means more of something produces more of an effect, in a consistent gradient.

Waarom dit belangrijk is

It is one of the classic signs that a relationship is causal rather than coincidental. LDL and heart disease show it clearly: the higher and the longer, the more plaque.

Definitie

A dose-response relationship describes how the magnitude of a biological effect changes as the amount of an exposure (such as weekly exercise minutes) increases; in this article, resistance training shows a non-linear dose-response for mortality, with benefits plateauing around 120 minutes per week and a J-shaped curve emerging at very high volumes in older women.

Waarom dit belangrijk is

Knowing that 'more is not always better' is one of the article's central practical messages.

Definitie

A DPP-4 inhibitor is an oral medication that blocks the enzyme dipeptidyl peptidase-4, which normally degrades the body's own GLP-1; by slowing GLP-1 breakdown, these pills raise endogenous GLP-1 levels by only two- to threefold — far less than injectable GLP-1 receptor agonists — and large trials such as SAVOR-TIMI 53 found they do not reduce cardiovascular events.

Waarom dit belangrijk is

The article uses DPP-4 inhibitors to explain why the dose and potency of GLP-1 activation matters for heart protection, not just the drug class.

Definitie

A urine or blood sample collected by officials after a competition to screen for prohibited performance-enhancing substances under the rules of the governing body; athletes setting national or world records are routinely tested to validate the result.

Waarom dit belangrijk is

Anti-doping testing ensures that record performances reflect genuine cardiovascular and physiological capacity rather than pharmacological enhancement.

Definitie

A drug-eluting stent is a small metal mesh tube coated with a medication that is inserted into a narrowed coronary artery to hold it open; the drug coating slowly releases an agent that inhibits scar tissue growth inside the stent, reducing the risk of the vessel re-narrowing.

Waarom dit belangrijk is

DES are the modern stents used in the trials discussed here; understanding their design helps explain why they were expected to outperform earlier bare-metal stents in preventing re-blockage.

Definitie

The combined use of two platelet-inhibiting drugs—typically aspirin and clopidogrel—prescribed after stent implantation to prevent clot formation inside the stent, usually continued for approximately six months after a drug-eluting stent procedure.

Waarom dit belangrijk is

DAPT is essential after stenting but carries its own risk of serious bleeding, illustrating the ongoing trade-offs patients and physicians must weigh.

Definitie

A dual GIP/GLP-1 receptor agonist is a drug — tirzepatide being the leading example — that simultaneously activates receptors for both glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide, two incretin hormones, producing greater weight loss, lipid improvement, and metabolic benefit than GLP-1 receptor agonism alone.

Waarom dit belangrijk is

Knowing that tirzepatide targets two receptors explains why its weight-loss and metabolic effects often exceed those of older GLP-1 drugs.

Definitie

Dyslipidemia is the medical word for an unhealthy pattern of fats in the blood. It can mean high LDL, high triglycerides, low HDL, or some combination.

Waarom dit belangrijk is

The word describes a pattern rather than one number, which is why treatment depends on which part is off and why.

Definitie

Early trial termination occurs when a clinical study is stopped before its planned endpoint, often because interim data appear strongly favorable; this practice tends to inflate the apparent magnitude of treatment effects and reduce the reliability of the findings.

Waarom dit belangrijk is

PREDIMED was stopped early, which is one reason the article argues its reported 30% risk reduction should be interpreted with caution.

Definitie

A prospective neurocognitive substudy of the FOURIER trial that used objective cognitive testing in nearly 2,000 patients to assess whether evolocumab-driven LDL lowering affected memory or cognition, finding no meaningful difference versus placebo over a median follow-up of 19 months.

Waarom dit belangrijk is

It is the most direct clinical trial evidence on whether very low LDL harms brain function.

Definitie

Eccentric remodeling is the adaptive enlargement and strengthening of the heart's ventricular walls that occurs in response to sustained aerobic exercise, resulting in a larger stroke volume and greater cardiac output; it is distinct from the pathological enlargement seen in heart disease.

Waarom dit belangrijk is

This healthy structural change is a key reason fit people have greater cardiac reserve and lower mortality risk.

Definitie

A CT imaging technique that synchronizes image acquisition to the electrical signal of the heart recorded by an electrocardiogram, minimizing motion blur so that coronary structures can be measured accurately; it is the standard method for CAC scoring.

Waarom dit belangrijk is

ECG gating is what allows the scanner to capture sharp images of constantly moving coronary arteries.

Definitie

An echocardiogram is an ultrasound picture of your heart. A technician moves a probe across your chest and sound waves build a moving image of the chambers and valves.

Waarom dit belangrijk is

It shows how well the heart is pumping and whether the valves are working. It does not show plaque in the coronary arteries, so a normal echo does not mean your arteries are clear.

Definitie

Ectopic fat refers to lipid deposits that accumulate in organs not designed for fat storage — including the liver, pancreas, skeletal muscle, and myocardium — causing local lipotoxicity and impairing organ function when subcutaneous storage capacity is overwhelmed.

Waarom dit belangrijk is

Fat in the liver or heart muscle is directly harmful to those organs in ways that fat under the skin is not.

Definitie

A measure of the total afterload—the resistance and pressure load—that the left ventricle must overcome to eject blood into the aorta; as central arteries stiffen with age or inactivity, Ea rises, forcing the heart to work harder with each beat.

Waarom dit belangrijk is

Rising afterload from stiff arteries is a key pathway to heart failure, so understanding Ea explains why arterial stiffness matters beyond just blood pressure.

Definitie

The minimum time interval after an electrical impulse during which cardiac tissue cannot be re-stimulated; alcohol acutely shortens the atrial ERP, particularly in the pulmonary veins, making the heart more susceptible to the re-entrant electrical circuits that underlie atrial fibrillation.

Waarom dit belangrijk is

Shortening of this period is a key electrical mechanism by which even modest alcohol exposure raises arrhythmia risk.

Definitie

Efferocytosis is the housekeeping process by which immune cells clear away other cells that have died.

Waarom dit belangrijk is

Inside a plaque this cleanup fails. Dead foam cells pile up instead of being removed, and that debris becomes the necrotic core. Restoring the cleanup is an active area of drug research.

Definitie

The epidermal growth factor-like repeat A domain of the LDL receptor to which PCSK9 binds; this binding targets the receptor for lysosomal degradation rather than recycling, and is the molecular site interrupted by PCSK9 inhibitor drugs.

Waarom dit belangrijk is

Knowing the precise binding site clarifies how both monoclonal antibodies and CRISPR-based therapies disrupt PCSK9's action.

Definitie

eGFR is a calculated measure of how efficiently the kidneys filter waste from the blood; because TMAO is cleared almost entirely by the kidneys, a falling eGFR causes TMAO to accumulate in the bloodstream independent of diet or gut bacteria. The article identifies reduced eGFR as the single largest confounder in studies linking high TMAO to cardiovascular events.

Waarom dit belangrijk is

Without accounting for kidney function, studies can wrongly conclude that TMAO itself causes heart disease.

Definitie

Ejection fraction is the percentage of blood the main pumping chamber squeezes out with each beat. A normal value is somewhere around 55 to 70 percent.

Waarom dit belangrijk is

A low number means the heart is not pumping strongly, often after a heart attack or from long-standing high blood pressure.

Definitie

Elastin is a structural protein in the arterial wall that allows blood vessels to stretch and recoil with each heartbeat; with age it degrades and is replaced by stiffer collagen, contributing to arterial stiffening and rising systolic blood pressure.

Waarom dit belangrijk is

Understanding elastin explains why arteries naturally stiffen with age and why blood pressure patterns change after 60.

Definitie

An electrocardiogram — ECG or EKG — records your heart's electrical activity through stickers placed on your skin. It takes about a minute and is painless.

Waarom dit belangrijk is

It can reveal rhythm problems, signs of a current or past heart attack, and some inherited electrical conditions that put young athletes at risk. It is a normal-looking test in many people who still have significant plaque.

Definitie

A cardiologist subspecialist who focuses on the electrical system of the heart, diagnosing and treating arrhythmias; responsible for performing catheter ablation and managing AF in athletes.

Waarom dit belangrijk is

The article repeatedly directs athletes to seek individualized care from an electrophysiologist.

Definitie

The ELITE trial (Early versus Late Intervention Trial with Estradiol) was a randomized trial of 643 women that tested whether starting oral estradiol early (fewer than six years after menopause) versus late (ten or more years after) produced different effects on carotid artery wall thickening; it found slower CIMT progression only in the early-initiation group, providing surrogate-level support f…

Waarom dit belangrijk is

ELITE is the most direct randomized evidence for why starting hormones near menopause may matter for vascular health.

Definitie

An emergency action plan is a written, practiced plan for what happens if someone collapses at a school, gym, or sporting event: who calls 911, who starts CPR, and who runs for the defibrillator.

Waarom dit belangrijk is

Places with a rehearsed plan save dramatically more lives than places that simply own a defibrillator. Having the equipment is not the same as knowing what to do with it.

Definitie

The endocannabinoid system is a network of endogenous lipid signaling molecules and their receptors (including cannabinoid receptors CB1 and CB2) that modulates pain, mood, and energy balance throughout the nervous system. Research now indicates it plays a central role in exercise-induced hypoalgesia, with the runner's high depending on cannabinoid receptor signaling rather than opioid receptors…

Waarom dit belangrijk is

It is a key reason why an athlete's natural pain-blocking ability is so powerful—and why that ability can mask cardiac warning signals during exercise.

Definitie

Cellular mechanisms by which material outside the cell is engulfed in vesicles (endocytosis) and processed through lysosomes; in this context, the route by which dietary Neu5Gc enters human cells and is incorporated into cell-surface structures.

Waarom dit belangrijk is

Explains how a sugar from food physically becomes part of your own tissues, which is the biological basis of the Neu5Gc concern.

Definitie

The thin layer of cells lining the inner surface of all blood vessels; they regulate vascular tone, prevent clotting, and control the passage of substances into the artery wall — and their dysfunction is an early, critical step in atherosclerosis.

Waarom dit belangrijk is

The study's central mechanism hinges on microplastics injuring these cells, triggering inflammation and plaque growth.

Definitie

Endothelial dysfunction is when that thin lining stops doing its job well. Vessels don't widen properly, and the barrier gets leakier.

Waarom dit belangrijk is

It is one of the earliest changes in heart disease, showing up long before any plaque is visible on a scan. Smoking, high blood pressure, high blood sugar, and high particle counts all damage it.

Definitie

The ability of the inner lining of blood vessels to regulate vascular tone, inflammation, and clotting; healthy endothelial cells release nitric oxide to keep arteries relaxed and resistant to plaque formation.

Waarom dit belangrijk is

Impaired endothelial function is an early, reversible step in atherosclerosis, making it a key target of diet and exercise interventions.

Definitie

The endothelial glycocalyx is a thin, gel-like layer of glycoproteins and proteoglycans lining the inner surface of blood vessels; it acts as a selective barrier that limits direct contact between circulating lipoproteins and the arterial wall, and is vulnerable to disruption by disturbed or high-velocity blood flow.

Waarom dit belangrijk is

The article proposes that decades of intense exercise may 'shed' this protective coating at arterial bends, allowing ApoB-containing particles to enter the wall and initiate plaque.

Definitie

Endothelial nitric oxide synthase is the enzyme in artery-lining cells responsible for producing nitric oxide, which relaxes blood vessels and suppresses clot formation; in insulin resistance, impaired insulin-receptor signaling downregulates eNOS, reducing nitric oxide availability and promoting an adhesive, pro-inflammatory arterial surface.

Waarom dit belangrijk is

Reduced eNOS activity is a key reason insulin resistance damages blood vessels beyond just altering cholesterol particles.

Definitie

Bone-marrow-derived precursor cells that circulate in the bloodstream and home to sites of endothelial injury, where they participate in re-endothelialization and microvascular repair; their mobilization is enhanced by statins, aerobic exercise, and whole-food plant-based nutrition.

Waarom dit belangrijk is

They represent one mechanism by which lifestyle and pharmacologic therapy restore the artery's inner lining, reducing future plaque vulnerability.

Definitie

Endothelial vasomotor response is the capacity of the arterial inner lining to release signals—chiefly nitric oxide—that cause the vessel to relax and expand; this function is impaired in atherosclerosis and was shown in primate studies to partially recover relatively early in cholesterol-lowering treatment.

Waarom dit belangrijk is

Recovery of this response is one reason risk falls before plaques visibly shrink, making it important for understanding the timeline of benefit.

Definitie

The process by which a single layer of endothelial cells grows to cover the inner surface of a stent, restoring a natural lining to the artery wall and reducing the risk of clot formation on the exposed metal.

Waarom dit belangrijk is

Incomplete endothelialization is a key reason clots can form years after stent implantation, making it central to long-term stent safety.

Definitie

The endothelium is the ultra-thin, slippery lining on the inside of every blood vessel. It is only one cell thick.

Waarom dit belangrijk is

It is far more than a coating. It controls how much your vessels relax or tighten, keeps blood from clotting where it shouldn't, and decides what gets through into the wall. When it stops working properly, cholesterol particles slip in more easily.

Definitie

The number of calories per gram (or per unit volume) of a food; high-fibre, water-rich plant foods have low energy density, meaning larger volumes can be eaten for fewer calories, promoting satiety and spontaneous calorie reduction without deliberate restriction.

Waarom dit belangrijk is

The article identifies low energy density as a key mechanism by which whole-food plant-based diets facilitate weight loss and metabolic improvement.

Definitie

A dysfunctional state of endothelial nitric oxide synthase in which the enzyme produces superoxide rather than nitric oxide, amplifying oxidative stress and reducing vasodilatory capacity; it is reversed as tetrahydrobiopterin availability is restored during plaque regression.

Waarom dit belangrijk is

It explains why oxidative stress directly impairs the artery's ability to relax and why restoring eNOS function is a key goal of both dietary and pharmacologic therapy.

Definitie

A long-chain omega-3 fatty acid found in marine oils that, in purified form, inhibits oxidation of ApoB-containing lipoprotein particles and exerts anti-inflammatory effects on the arterial wall; it differs structurally and biologically from DHA.

Waarom dit belangrijk is

Knowing that EPA and DHA are distinct molecules with different effects explains why only certain fish-oil formulations showed cardiovascular benefit in trials.

Definitie

A large UK-based prospective cohort that recruited a substantial proportion of vegetarians and vegans, forming part of the broader European Prospective Investigation into Cancer and Nutrition; it reported higher total stroke risk—driven by hemorrhagic stroke—among vegetarians compared with meat-eaters.

Waarom dit belangrijk is

EPIC-Oxford is one of the main sources of evidence that vegetarian diets are not universally protective for all cardiovascular outcomes, particularly stroke.

Definitie

The epicardial coronary arteries are the large, surface-level arteries that run along the outside of the heart and serve as the main conduits supplying blood to the heart muscle; they are the vessels in which atherosclerotic plaque predominantly forms and the primary focus of coronary imaging studies.

Waarom dit belangrijk is

The article discusses how these specific vessels are exposed to unique mechanical forces during exercise and where athlete-specific plaque accumulation is detected on imaging.

Definitie

Epidemiology is the study of health patterns in large groups of people — who gets sick, where, and what they had in common.

Waarom dit belangrijk is

It generates most of the diet headlines you see. It is genuinely useful for spotting clues, but on its own it cannot prove that one thing caused another.

Definitie

A heritable chemical modification—specifically the addition of methyl groups to DNA promoter regions—that alters gene expression without changing the DNA sequence; in fetal aortas exposed to maternal hypercholesterolemia, altered methylation of regulatory regions including those controlling SREBP2 is associated with early atherosclerotic lesion formation.

Waarom dit belangrijk is

It provides a molecular mechanism explaining how a mother's cholesterol can permanently change how her child's body regulates its own cholesterol.

Definitie

In the cardiovascular context, erectile dysfunction is recognized as an early clinical manifestation of systemic endothelial and microvascular disease, because the penile arteries (1–2 mm diameter) reach a symptomatic threshold of narrowing several years before the larger coronary arteries (3–4 mm) do. Studies cite ED as an approximately 3-to-5-year warning sign preceding coronary events in men w…

Waarom dit belangrijk is

Recognizing ED as a potential vascular warning rather than an isolated problem can prompt life-saving cardiovascular screening years before a heart attack.

Definitie

Any nutritional, pharmacological, or physical intervention intended to enhance athletic performance beyond normal capacity; the term is used to evaluate whether a supplement like exogenous ketones provides a proven competitive advantage.

Waarom dit belangrijk is

The term appears without definition when the article questions whether ketone drinks are 'universally proven ergogenic aids.'

Definitie

An ergometer is a stationary exercise device—commonly a cycle or treadmill—used in a clinical setting to deliver a controlled, measurable workload while the patient is monitored, typically with an ECG and blood pressure readings. It is the standard platform for exercise stress testing used to provoke and detect signs of myocardial ischemia.

Waarom dit belangrijk is

Knowing what an exercise stress test involves helps patients understand how ischemia is unmasked in people who show no symptoms at rest.

Definitie

A standardized exercise test performed on a stationary cycle ergometer (or similar device) at progressively increasing workloads to assess cardiovascular function and detect ischemia; Peter Megdal's abnormal result prompted further investigation that revealed coronary artery disease.

Waarom dit belangrijk is

Knowing what triggered a diagnosis helps readers understand which tests can catch hidden heart disease.

Definitie

Erythrocytosis is an abnormal increase in the number of circulating red blood cells, raising blood viscosity (hematocrit); it is a recognized side effect of testosterone therapy because testosterone stimulates red blood cell production, and monitoring hematocrit (with a clinical threshold around 54%) is standard practice during treatment.

Waarom dit belangrijk is

Thick blood can strain the cardiovascular system, so this is a key safety parameter doctors track in men on testosterone therapy.

Definitie

The Esselstyn program is an extremely low-fat, plant-exclusive dietary protocol developed by cardiologist Caldwell Esselstyn at the Cleveland Clinic, which eliminates all animal products and added oils and has been studied as a means of halting and reversing coronary artery disease. The article's interviewee cites Esselstyn's book as a foundational source in his personal research.

Waarom dit belangrijk is

It is one of the most cited dietary interventions in discussions of heart disease reversal and is directly referenced in the article.

Definitie

The nine amino acids—including leucine—that the human body cannot synthesize in adequate amounts and must obtain from diet; adequate EAA availability, particularly leucine, is required to activate muscle protein synthesis, and their sufficiency becomes more critical as anabolic resistance develops with aging.

Waarom dit belangrijk is

EAA content, not just total grams of protein, determines whether a meal actually triggers muscle maintenance in older adults.

Definitie

A naturally occurring estrogen produced by the fetal liver during pregnancy, now under clinical investigation as a menopausal hormone therapy candidate; it is thought to have a more selective tissue profile than conventional estrogens, potentially offering symptom relief with a refined safety profile.

Waarom dit belangrijk is

As a newer treatment option, E4 represents the shift toward more targeted menopause therapies with potentially fewer systemic risks.

Definitie

A model proposing that rapid physiological drops or swings in estradiol levels—rather than chronically low absolute levels—are the primary trigger for mood instability, irritability, and anxiety during the menopausal transition.

Waarom dit belangrijk is

This helps explain why some women feel emotionally destabilized even before estrogen reaches its lowest postmenopausal levels.

Definitie

Estrogen is a hormone, present at much higher levels in women before menopause, that affects blood vessels, cholesterol, and bone.

Waarom dit belangrijk is

It appears to offer some protection to arteries, which is part of why women tend to develop heart disease about ten years later than men. What happens when estrogen drops at menopause, and whether replacing it helps, is more complicated than it was once made to sound.

Definitie

A clinical trial that used serial CCTA to track coronary plaque composition over time in patients receiving icosapent ethyl (a purified omega-3 fatty acid); it demonstrated that the drug produced regression of low-attenuation plaque, establishing CCTA as a tool for monitoring plaque response to therapy.

Waarom dit belangrijk is

It shows that AI-assisted CT imaging can measure whether treatment is actually shrinking the most dangerous type of plaque.

Definitie

An approach to clinical decision-making that integrates the best available research evidence with clinical expertise and patient values, rather than relying on tradition or anecdote alone.

Waarom dit belangrijk is

Knowing what 'evidence-based' means helps readers evaluate whether a health intervention has scientific support or is based on personal belief.

Definitie

Evinacumab is an injectable antibody that blocks ANGPTL3, used for the most severe inherited cholesterol disorders.

Waarom dit belangrijk is

It works even in patients whose LDL receptors barely function, because it lowers cholesterol by a route that does not depend on them. For children with the homozygous form, that distinction is life-changing.

Definitie

Evolocumab is an injectable cholesterol medicine in the PCSK9 inhibitor family, usually given every two to four weeks.

Waarom dit belangrijk is

It works by protecting the liver's cholesterol-removing receptors, and it can cut LDL and ApoB by half or more even in people already on a statin.

Definitie

Exercise capacity is a quantitative measure of the maximum physical work a person can perform, typically assessed during a graded stress test as peak workload in watts, peak oxygen consumption (VO2 max), or metabolic equivalents (METs). In the article, a decline in exercise capacity four months after stenting indicated that the procedure alone had not resolved the underlying disease.

Waarom dit belangrijk is

Exercise capacity is both a practical measure of fitness and an independent predictor of cardiovascular prognosis, making changes in it clinically meaningful.

Definitie

The oxygen cost of producing a given power output or movement speed; trained cyclists maintain relatively stable exercise economy with age even as their absolute aerobic capacity declines, preserving efficiency.

Waarom dit belangrijk is

It helps explain why older elite athletes can still perform well despite lower VO₂max—they waste less oxygen per watt of power produced.

Definitie

A standardized clinical test in which a patient walks or runs on a treadmill at progressively increasing speeds and inclines while heart rate, blood pressure, and ECG are monitored; it can estimate cardiorespiratory fitness and detect myocardial ischemia.

Waarom dit belangrijk is

The 122,000-patient landmark study the article cites used exercise treadmill testing to classify participants into fitness quartiles and link fitness to mortality.

Definitie

Exercise-induced hypoalgesia is the reduction in pain perception that occurs during and after intense physical activity, caused by the release of endogenous opioids and other pain-dampening chemicals; in athletes, this effect can mask cardiac ischemia by blunting the chest pain that would otherwise signal inadequate blood flow to the heart.

Waarom dit belangrijk is

It helps explain why fit people can have serious heart disease without ever feeling the classic warning signs.

Definitie

Nausea that occurs during or immediately after vigorous exercise; although often attributed to training intensity or hydration, in the context of coronary artery disease it can be an atypical symptom of myocardial ischemia that athletes frequently dismiss as a normal training response.

Waarom dit belangrijk is

The author's interval-session nausea turned out to be ischemia — highlighting how atypical symptoms in fit people can mask serious cardiac disease.

Definitie

Ketone bodies—most commonly β-hydroxybutyrate—consumed directly as drinks or esters rather than produced by the body through carbohydrate restriction; they raise blood ketone levels quickly without requiring dietary change and are used both as research tools and as proposed ergogenic supplements.

Waarom dit belangrijk is

Knowing the difference between diet-induced and supplement-induced ketosis helps readers critically assess performance and health claims made for ketone products.

Definitie

Exome sequencing is a genomic technique that reads the protein-coding portions of the genome, allowing researchers to identify rare coding variants—including loss-of-function mutations—that may have large effects on disease risk; it has been used to discover protective variants in genes such as CIDEB and ZNRF3 that would be missed by standard GWAS.

Waarom dit belangrijk is

It uncovers rare but powerful genetic protections against heart disease that population-level studies overlook.

Definitie

The expandability hypothesis proposes that individuals differ in the maximum safe lipid-storage capacity of their subcutaneous fat; when that capacity is exceeded, excess lipids spill into ectopic sites — liver, pancreas, skeletal muscle, and heart — causing lipotoxicity and metabolic dysfunction.

Waarom dit belangrijk is

It explains why two people with the same total fat mass can have very different metabolic health outcomes depending on where their bodies store the excess.

Definitie

The external elastic membrane is the boundary between an artery's muscular wall and surrounding connective tissue; in intravascular imaging, the area enclosed by the EEM is used to quantify total vessel size including both the open channel and the plaque within the wall.

Waarom dit belangrijk is

Measuring to the EEM rather than just the lumen reveals how much the artery has remodeled outward to accommodate hidden plaque — information a standard angiogram cannot provide.

Definitie

Cold-pressed olive oil that meets international standards for low acidity and sensory quality; unlike refined olive oil, it retains natural polyphenols and other minor bioactive compounds that may have antioxidant and anti-inflammatory properties.

Waarom dit belangrijk is

EVOO is frequently contrasted with seed oils in cardiovascular research, and knowing what distinguishes it from ordinary olive oil helps you evaluate the evidence more accurately.

Definitie

The extracellular matrix is the scaffolding of collagen and other fibers that holds tissue together and gives an artery wall its strength.

Waarom dit belangrijk is

It is what a fibrous cap is made of. When inflammatory enzymes break it down faster than cells rebuild it, the cap thins and the plaque becomes fragile.

Definitie

Extrahepatic synthesis refers to cholesterol production occurring outside the liver—in skeletal muscle, skin, kidney, intestine, and other tissues—which in humans accounts for roughly 90% of total daily cholesterol synthesis.

Waarom dit belangrijk is

This challenges the common assumption that the liver is the body's primary cholesterol factory and clarifies why plasma cholesterol levels reflect transport, not the body's total production.

Definitie

Ezetimibe is a pill that blocks your intestines from absorbing cholesterol.

Waarom dit belangrijk is

On its own it lowers cholesterol modestly. Its real value is as a partner drug — added to a statin, it pushes levels lower without increasing the statin dose, and it very rarely causes side effects.

Definitie

The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 2 trial compared FFR-guided PCI against medical therapy alone in stable coronary artery disease, finding that PCI significantly reduced urgent repeat procedures but did not significantly lower mortality or spontaneous heart attack rates at up to 11 years.

Waarom dit belangrijk is

It explains why stents are still widely used—they reliably relieve symptoms and prevent emergency hospital visits, even if they don't extend life.

Definitie

Familial defective ApoB-100 is a genetic disorder caused by a mutation in the APOB gene — most commonly the R3500Q (p.Arg3527Gln) variant — that impairs the ability of LDL particles to bind to the LDL receptor, resulting in lifelong elevation of LDL-C and increased atherogenic particle burden.

Waarom dit belangrijk is

It explains why some people have high cholesterol from birth due to a single inherited variant rather than lifestyle, and why that exposure compounds into significant coronary disease over time.

Definitie

Familial hypercholesterolemia, or FH, is an inherited condition where the liver cannot clear cholesterol from the blood properly. Levels are very high from birth.

Waarom dit belangrijk is

Roughly one in 250 people has it, and most of them don't know. Because the exposure starts in childhood, heart attacks can happen in a person's thirties or forties. It is one of the strongest arguments for checking cholesterol early rather than waiting for middle age.

Definitie

Familial hypobetalipoproteinemia is a genetic condition caused by mutations in the APOB gene that produce truncated, secretion-incompetent proteins, resulting in markedly reduced circulating LDL-C (20–50 mg/dL in heterozygotes, below 10 mg/dL in homozygotes). Affected individuals show substantially lower lifetime ASCVD risk, and homozygotes exhibit minimal plaque on imaging and in autopsy data, r…

Waarom dit belangrijk is

It demonstrates that naturally very low LDL from birth is compatible with normal health and strongly protective against heart disease.

Definitie

Family history means whether your close relatives developed heart disease, and how young they were when it happened.

Waarom dit belangrijk is

Early disease in a parent or sibling — before about 55 in men or 65 in women — is a meaningful warning sign. It can reflect shared genes, shared habits, or both, and it should push you toward testing sooner rather than later.

Definitie

The Family History Index is the numerical output produced by the Inherited Hazard Coefficient formula; it summarizes the aggregate inherited cardiac signal across a person's family tree in a single score that can be used to guide screening decisions.

Waarom dit belangrijk is

Understanding what the index represents helps users interpret their app result and explain it to a clinician.

Definitie

The farnesoid X receptor (FXR) is a nuclear bile acid receptor expressed predominantly in the liver and intestine that, among its many functions, regulates the activity of FMO3 — the hepatic enzyme responsible for converting TMA into TMAO — thereby influencing systemic TMAO levels.

Waarom dit belangrijk is

FXR links bile acid signaling to TMAO metabolism, suggesting that liver health and diet composition together shape cardiovascular risk through this pathway.

Definitie

A metabolic pathway in which cells break down fatty acids to generate ATP when preferred fuels like glucose are insufficient; during estrogen deficiency, the brain may shift toward FAO, which has been linked to white matter injury and increased ketone-body burden.

Waarom dit belangrijk is

This alternative fuel-burning mode helps explain why prolonged menopause may affect brain structure and long-term cognitive resilience.

Definitie

Fatty liver is fat accumulating inside liver cells, now usually called metabolic dysfunction-associated steatotic liver disease.

Waarom dit belangrijk is

It is extremely common, usually silent, and closely tied to insulin resistance. A fatty liver also produces more ApoB particles, so it raises cardiovascular risk as well as liver risk.

Definitie

A fatty streak is the earliest visible stage of atherosclerosis — a flat yellow smear of cholesterol-filled immune cells just under the artery lining.

Waarom dit belangrijk is

They appear in childhood and are present in most teenagers. Not all become plaques, but they are where the process starts, which is why prevention is increasingly discussed as a lifelong matter.

Definitie

The Fate of Early Lesions in Children (FELIC) study examined aortic tissue from children aged 1 to 13 who died of non-cardiovascular causes and compared lesion sizes with those seen in fetal specimens, providing indirect evidence that some fetal fatty streaks regress after birth while also showing that children of hypercholesterolemic mothers accumulate lesions faster through childhood.

Waarom dit belangrijk is

It is the key evidence that early arterial damage is not necessarily permanent—but also that maternal cholesterol during pregnancy leaves a lasting biological tendency.

Definitie

Dairy products such as yogurt, kefir, and aged cheese in which bacteria or molds have partially broken down lactose and proteins, altering the food's matrix and bioactive compound profile; Astrup's research cited in the article suggests saturated fat from fermented dairy does not carry the same cardiovascular risk as saturated fat from ultra-processed foods.

Waarom dit belangrijk is

Distinguishing fermented from non-fermented dairy refines dietary advice beyond a simple 'avoid saturated fat' message and illustrates the food-matrix principle.

Definitie

The process by which the intrauterine environment—particularly maternal nutrition and metabolic state—permanently alters gene expression and metabolic set-points in the developing fetus, with lasting consequences for cardiovascular and metabolic health in later life.

Waarom dit belangrijk is

It means a mother's cholesterol during pregnancy can leave a lasting biological imprint on her child's arteries before birth.

Definitie

FFR is a catheter-based measurement of the pressure drop across a coronary artery narrowing during maximal blood flow; a value of 0.80 or below indicates that the blockage is significantly restricting blood flow and is used to decide whether a stent is physiologically justified.

Waarom dit belangrijk is

FAME 2, a key trial in this article, used FFR guidance to select patients for stenting, making it important to understand what FFR measures and why it changes stenting decisions.

Definitie

FGF21 is a myokine and metabolic hormone produced by muscle (and liver) during exercise that improves insulin sensitivity and glucose uptake by enhancing insulin signaling in target tissues. The article identifies it as one of the biochemical mediators through which strength training may reduce cardiovascular risk.

Waarom dit belangrijk is

Better glucose handling reduces a key driver of atherosclerosis, linking muscle biology directly to heart protection.

Definitie

Fiber is the part of plant food your body cannot digest. It is found in beans, oats, vegetables, fruit, and whole grains.

Waarom dit belangrijk is

Soluble fiber grabs onto bile in your gut and carries it out, which forces your liver to pull cholesterol from your blood to make more. That is a genuine cholesterol-lowering effect from food, not just a general healthy-eating claim.

Definitie

Fibrates are pills that lower triglycerides by making the body break down fat-carrying particles more quickly.

Waarom dit belangrijk is

They reliably improve the numbers. Whether they prevent heart attacks is much less clear, and most trials have been disappointing except possibly in people with very high triglycerides and low HDL.

Definitie

The physiological process by which the body dissolves blood clots through the enzyme plasmin; Lp(a) impairs this process by competing with plasminogen for fibrin-binding sites, reducing clot clearance and increasing the risk of an occlusive cardiac event.

Waarom dit belangrijk is

Understanding fibrinolysis clarifies the second major way Lp(a) raises heart attack risk, beyond its role in plaque formation.

Definitie

A protein that catalyzes the breakdown of fibrin, dissolving blood clots; fibrinolytic activity is distinct from plaque removal, because arterial plaque is embedded in the vessel wall rather than circulating in the bloodstream.

Waarom dit belangrijk is

Knowing the difference between clot dissolution and plaque regression is essential for evaluating any 'artery-clearing' supplement claim.

Definitie

The standard unit used to measure the clot-dissolving activity of nattokinase supplements; 2,000 FU per day is the dose found on most commercial bottles and is the dose tested in the NAPS trial.

Waarom dit belangrijk is

Supplement labels express nattokinase potency in FU rather than milligrams, so recognizing this unit is necessary to compare products and study doses.

Definitie

A fibroatheroma is an intermediate-to-advanced atherosclerotic lesion defined by the presence of a true necrotic core beneath a fibrous cap; it represents progression beyond the fatty streak and pathologic intimal thickening stages toward the plaque architecture associated with clinical events.

Waarom dit belangrijk is

Recognizing this stage in the lesion progression helps explain how decades of lipid retention and inflammation eventually create the plaques that cause heart attacks.

Definitie

Non-contractile fibrous tissue that replaces dead heart muscle after a myocardial infarction; because it lacks the electrical and mechanical properties of normal myocardium, it permanently impairs pumping function in the affected region.

Waarom dit belangrijk is

Myocardial fibrotic scarring illustrates why even optimal secondary prevention cannot fully restore heart function after a heart attack, anchoring the article's discussion of biological inertia.

Definitie

The fibrous cap is the tough layer of tissue covering a plaque, separating its greasy core from the bloodstream.

Waarom dit belangrijk is

Think of it as a lid. A thick lid holds. A thin one can tear, and when it does, a clot forms on the spot and a heart attack follows. Much of what cholesterol medicine does is make that lid thicker.

Definitie

Fibrous cap thickness is the measured depth of the protective fibrous layer that separates a plaque's lipid core from the flowing blood; a thin fibrous cap is a hallmark of a vulnerable plaque at high risk of rupturing and triggering a heart attack.

Waarom dit belangrijk is

Cap thickness tells you not just how much plaque is present but how dangerous it is — a thin cap over a large lipid pool is the anatomy of a heart attack waiting to happen.

Definitie

The Fick principle states that maximal oxygen consumption equals cardiac output multiplied by the arteriovenous oxygen content difference; it provides the mathematical framework for separating how much of an athlete's aerobic decline is due to a weakening heart pump versus reduced oxygen extraction by the muscles.

Waarom dit belangrijk is

Understanding this equation shows why both heart-pump capacity and muscle oxygen use must be maintained to preserve endurance performance with age.

Definitie

An elite professional cyclist who holds the UCI Hour Record for able-bodied men, representing the gold-standard benchmark against which amateur and para-athlete hour record performances are contextualised.

Waarom dit belangrijk is

Comparing elite and masters or para performances illustrates the wide spectrum of cardiovascular and aerobic capacity in competitive cycling.

Definitie

A side-branch artery that arises from the Left Anterior Descending (LAD) coronary artery and supplies blood to a portion of the left ventricular wall; in the Megdal study, the origin of the first diagonal branch showed the most dramatic regression—from severe stenosis (60–75%) in 2014 to a fully patent state in 2018.

Waarom dit belangrijk is

This vessel is the single most striking example of reversal in the study, illustrating how complete healing of a dangerous blockage is possible.

Definitie

A biological family member who shares approximately 50 percent of an individual's genetic material, specifically parents, siblings, and children; cardiac events in first-degree relatives carry substantially more inherited risk signal than events in more distant relatives.

Waarom dit belangrijk is

Whether the affected family member is a parent or sibling versus a grandparent or cousin changes how strongly that history should influence your own cardiac risk assessment.

Definitie

Flow-mediated dilation is a non-invasive ultrasound measurement of how much a conduit artery — typically the brachial artery — widens in response to increased blood flow, serving as a marker of endothelial nitric oxide signaling and endothelial function.

Waarom dit belangrijk is

It is one of the key measures used in vascular intervention studies to assess whether diet or drugs improve the health of the artery's inner lining.

Definitie

FMO3 is a liver enzyme that converts the gut-derived gas TMA into TMAO; its activity is suppressed by insulin in healthy individuals but rises substantially when hepatic insulin resistance is present. The article frames FMO3 as a metabolic hub linking gut microbiome activity, liver function, and circulating TMAO levels.

Waarom dit belangrijk is

FMO3 activity explains why people with metabolic disease have higher TMAO even without eating more red meat.

Definitie

A foam cell is an immune cell that has eaten so much trapped cholesterol that it swells up and looks foamy under a microscope.

Waarom dit belangrijk is

These cells came to help, then got stuck and died where they sat. Piles of dead foam cells form the greasy center of a plaque. They are the reason plaque is as much an immune problem as a fat problem.

Definitie

The food matrix refers to the physical and chemical structure of a whole food—cell walls, fiber, protein networks—that surrounds and interacts with its nutrients; fats consumed within an intact food matrix, such as whole almonds versus almond oil, are absorbed more slowly and less completely than the same fats in extracted, purified form.

Waarom dit belangrijk is

It explains why eating nuts and avocados may have different metabolic effects than drizzling the equivalent amount of oil, and is central to the article's recommendation to get more fat from whole foods.

Definitie

A founder population is a group descended from a small number of common ancestors, resulting in reduced genetic diversity and an elevated frequency of certain rare variants; in cardiovascular genetics, founder populations such as specific Icelandic or Finnish cohorts have been used to discover cardioprotective variants that are too rare to detect efficiently in heterogeneous global samples.

Waarom dit belangrijk is

Studying isolated communities with shared ancestry can reveal rare genetic protections against heart disease far more efficiently than studying the general population.

Definitie

A founder variant is a gene mutation that originated in a single ancestor and has reached an unusually high frequency in a genetically isolated population — such as the APOB R3500Q variant in the Old Order Amish — making that community a natural study group for understanding the long-term effects of the mutation.

Waarom dit belangrijk is

Founder populations allow scientists to study the effect of a single genetic change across many individuals who share similar lifestyles, providing clearer evidence about lifelong cholesterol exposure and heart disease.

Definitie

FOURIER tested evolocumab, a PCSK9 inhibitor, in patients who already had cardiovascular disease and were on statins.

Waarom dit belangrijk is

It drove LDL down to around 30 mg/dL and still reduced events, with no sign of a floor below which lowering stopped helping. It largely settled the question of whether very low LDL is safe.

Definitie

The FOURIER trial evaluated the PCSK9 inhibitor evolocumab added to statin therapy and demonstrated that aggressively lowering ApoB-containing particles reduced cardiovascular events; analysis also showed that patients who achieved very low LDL-C but retained high hs-CRP still faced elevated residual risk, supporting the dual-risk model of atherogenesis.

Waarom dit belangrijk is

FOURIER showed that even ultra-low cholesterol does not fully protect you if inflammation remains high—both targets matter.

Definitie

The open-label extension of the FOURIER trial, which tracked patients treated with evolocumab for seven or more years and found sustained cognitive stability even among those maintaining LDL-C below 20 mg/dL.

Waarom dit belangrijk is

Long-term extension data are critical for ruling out slow-developing harms that a shorter trial might miss.

Definitie

Fractional flow reserve measures the pressure drop across a narrowing to find out whether it is actually restricting blood flow.

Waarom dit belangrijk is

Eyeballing an angiogram is unreliable. A lesion that looks tight may pass plenty of blood, and stenting one that does not need it provides no benefit. This test decides which narrowings are worth treating.

Definitie

The Framingham Heart Study began in 1948 in one Massachusetts town and has now followed three generations of families.

Waarom dit belangrijk is

It gave us the phrase "risk factor" and identified cholesterol, blood pressure, and smoking as the drivers of heart disease. Nearly every risk calculator descends from it.

Definitie

The Framingham Offspring Cohort is the second-generation study of the Framingham Heart Study, enrolling the adult children of the original participants; it has provided longitudinal data linking decades of hyperlipidemia exposure in young adulthood to later coronary heart disease risk, independent of lipid levels at midlife.

Waarom dit belangrijk is

Its multi-decade follow-up makes it one of the few datasets capable of testing whether early exposure leaves a lasting cardiovascular imprint.

Definitie

The Framingham Risk Score is a specific ten-year heart-attack-risk calculator built from the Framingham Heart Study's decades of data — the original tool that turned "risk factors" into a number.

Waarom dit belangrijk is

It's still widely cited, but it and its successors were built on older, less diverse populations, so they consistently underestimate risk in groups they weren't trained on — including highly fit masters athletes with real plaque burden.

Definitie

The Frank-Starling mechanism is the heart's intrinsic ability to increase the force of contraction when more blood fills the ventricle during diastole; master athletes exploit this by developing larger, more compliant ventricles that can pump greater stroke volumes even as maximum heart rate falls.

Waarom dit belangrijk is

It explains how well-trained older athletes partially compensate for a lower maximum heart rate by squeezing more blood out with each beat.

Definitie

Free fatty acids are fat molecules travelling loose in the blood after being released from fat stores.

Waarom dit belangrijk is

Visceral fat dumps them straight into the vein feeding the liver. The liver responds by making more triglycerides and more ApoB particles — the mechanical link between belly fat and a bad lipid panel.

Definitie

The free hormone hypothesis is the principle that only the protein-unbound fraction of a hormone is able to cross cell membranes and exert biological effects, making the free (and loosely albumin-bound) fraction the physiologically relevant measure rather than total circulating concentration.

Waarom dit belangrijk is

This concept underlies why doctors are increasingly urged to measure bioavailable rather than total testosterone.

Definitie

Free testosterone is the small fraction (roughly 1–4% of total) that circulates unbound to any protein and can diffuse directly across cell membranes to activate the intracellular androgen receptor.

Waarom dit belangrijk is

It is the most immediately active form of testosterone and a key component of bioavailable testosterone measurement.

Definitie

The Future Revascularization Evaluation in Patients with Diabetes Mellitus trial randomized 1,900 diabetic patients with multivessel coronary artery disease to PCI or CABG, finding that bypass surgery significantly reduced death and heart attack rates compared with stenting over up to 13 years.

Waarom dit belangrijk is

It is the key evidence base for recommending bypass surgery over stenting in patients who have both diabetes and multiple blocked arteries.

Definitie

The French Paradox is the observation that France had relatively low coronary heart disease mortality in the 1980s and 1990s despite high saturated fat consumption; analyses have attributed this apparent paradox to a time-lag in France's adoption of high-fat diets compared with other Western nations, systematic under-certification of CHD deaths by French physicians, and the cumulative nature of a…

Waarom dit belangrijk is

The French Paradox has long been used to question the diet-heart link, so understanding why it is a statistical artifact rather than a genuine exception is important for evaluating nutrition claims.

Definitie

A widely used mathematical formula that estimates LDL cholesterol from total cholesterol, HDL cholesterol, and triglycerides rather than measuring it directly; it becomes unreliable when triglycerides are elevated or blood is drawn in a non-fasting state, which is one reason ApoB measurement is considered more accurate in certain patients.

Waarom dit belangrijk is

Understanding this limitation explains why a 'normal' LDL-C result can still miss meaningful cardiovascular risk.

Definitie

The effective gravitational load experienced by a rider when centripetal acceleration through a steeply banked curve adds to normal body weight; on a 40-degree banked track the combined force can approach twice the rider's resting body weight, increasing cardiovascular and musculoskeletal demand.

Waarom dit belangrijk is

Elevated mechanical load during exercise directly increases cardiac workload and oxygen demand.

Definitie

Gastrointestinal hemorrhage is bleeding within the digestive tract, most commonly in the stomach or upper intestine; it is the most frequent serious bleeding complication of long-term aspirin use and often tips the benefit–risk balance against aspirin in primary prevention.

Waarom dit belangrijk is

It is the main measurable harm seen in large primary-prevention aspirin trials, directly competing with the cardiovascular events the drug is meant to prevent.

Definitie

A multiprotein complex that acts as a positive regulator of mTORC1 by transmitting leucine availability signals from Sestrin2 to the Rag GTPases, which then recruit mTORC1 to the lysosomal surface for activation.

Waarom dit belangrijk is

GATOR2 is part of the precise molecular machinery that translates the leucine content of a meal into a muscle-building signal, relevant to understanding why protein quality matters in aging.

Definitie

The gene dosing effect refers to the amplified probability of carrying a pathogenic cardiac variant when both parents have experienced early cardiac events; having two affected first-degree parents roughly doubles the inherited risk signal compared with one, raising the likelihood of a causative inherited mutation substantially.

Waarom dit belangrijk is

It explains why the app treats two-parent cardiac histories as categorically more alarming than single-parent histories.

Definitie

A gene variant is a small difference in your DNA compared with most other people.

Waarom dit belangrijk is

Some variants raise cholesterol, some lower it, and some barely matter. Studying people who were born with naturally low cholesterol has been one of the most powerful ways to prove that lowering it actually prevents heart attacks.

Definitie

Genetics is the study of what you inherit from your parents.

Waarom dit belangrijk is

Your genes strongly influence your cholesterol, blood pressure, and how early plaque starts forming. What they do not do is seal your fate. Genes set your starting point and how fast the meter runs; what you do about it still changes the outcome.

Definitie

A genome-wide association study (GWAS) scans hundreds of thousands to millions of genetic variants across the entire human genome to identify positions statistically associated with a trait or disease; in cardiovascular research, GWAS has identified common variants near genes such as HMGCR and NPC1L1 that implicate therapeutic targets even when each variant's individual effect is small.

Waarom dit belangrijk is

GWAS is how researchers discovered most of the genetic links between specific proteins and heart disease risk.

Definitie

Gestational diabetes is high blood sugar that appears during pregnancy and usually resolves after delivery.

Waarom dit belangrijk is

Resolving is not the end of it. It signals a metabolism that struggles under load, and it strongly predicts later type 2 diabetes and cardiovascular disease.

Definitie

Ghrelin is a hormone produced primarily in the stomach that stimulates appetite and promotes fat storage; sleep deprivation raises ghrelin levels while lowering leptin, creating a hormonal environment that increases caloric intake and encourages fat accumulation in visceral depots.

Waarom dit belangrijk is

Understanding ghrelin's role explains the biological mechanism linking poor sleep to weight gain and belly fat.

Definitie

GLAGOV added a PCSK9 inhibitor to statin therapy and measured coronary plaque with intravascular ultrasound before and after.

Waarom dit belangrijk is

Plaque shrank, and it shrank even in patients whose starting LDL was already considered good. It is a key piece of evidence that lower is better for reversing disease, not just slowing it.

Definitie

The Glagov effect (compensatory or outward remodeling) is the tendency of an artery to expand its outer diameter as plaque accumulates within the wall, preserving the inner lumen size and blood flow until plaque burden becomes very large; this means significant atherosclerosis can be present without causing measurable narrowing on a standard angiogram.

Waarom dit belangrijk is

The article uses this phenomenon to explain why trained athletes may feel perfectly well and still set personal records despite harboring substantial hidden coronary plaque.

Definitie

The Glagov phenomenon (also called compensatory or outward remodeling) is the tendency of an arterial wall to expand outward as atherosclerotic plaque accumulates, thereby preserving the inner lumen diameter until plaque burden becomes very large. Because lumen size stays normal during this compensatory phase, standard stress tests and angiograms can appear normal even in the presence of substant…

Waarom dit belangrijk is

This explains how a person can feel completely well and pass a stress test while carrying significant hidden arterial disease.

Definitie

Glomerular filtration is the process by which the kidney's glomeruli — tiny capillary networks — filter waste products and small molecules, including TMAO, from the bloodstream into the urine; adequate glomerular filtration clears fish-derived TMAO within roughly 24 hours, whereas chronic kidney disease reduces this clearance and allows TMAO to accumulate.

Waarom dit belangrijk is

This explains why people with kidney disease are especially vulnerable to TMAO-related cardiovascular and renal harm.

Definitie

GLP-1 receptor agonists are injectable medicines — semaglutide and tirzepatide are the best known — that copy a gut hormone controlling appetite and blood sugar.

Waarom dit belangrijk is

They cause substantial weight loss, but the interesting finding is that they reduce heart attacks and strokes faster than the weight comes off. That suggests they are doing something to blood vessels directly, not just shrinking waistlines.

Definitie

Glucocorticoid receptor resistance is a state in which cells become less responsive to cortisol's signalling, so the body's ability to regulate inflammation and other stress responses is impaired even when cortisol levels appear normal. The article lists it as one of the HPA dysregulation patterns associated with adverse cardiovascular phenotypes.

Waarom dit belangrijk is

It explains why measuring cortisol in the blood can miss important stress-related biology — the problem may be in how cells respond, not just how much hormone is circulating.

Definitie

Glucose is the sugar your blood carries to fuel your cells.

Waarom dit belangrijk is

Your body keeps it in a tight range using insulin. When that system starts failing, glucose creeps up — and the damage to blood vessels begins well before the number is high enough to be called diabetes.

Definitie

A carbohydrate chain or sugar molecule attached to proteins or lipids on cell surfaces; Neu5Gc is incorporated into human cell-surface glycans after red meat consumption, where it is recognized by the immune system as foreign.

Waarom dit belangrijk is

Glycans are the structural context in which Neu5Gc is displayed on cells, making this term essential to understanding how the immune reaction is triggered.

Definitie

Glycemic control is how steadily your blood sugar is kept in a healthy range over time.

Waarom dit belangrijk is

Good control clearly protects the small vessels of the eyes, kidneys, and nerves. Its effect on heart attacks is weaker, which is why cholesterol and blood pressure still need treating in their own right.

Definitie

A measure that combines both the quality and quantity of carbohydrate in a meal by multiplying the glycemic index of a food by the amount of carbohydrate it contains; carbohydrate restriction lowers glycemic load and can reduce post-meal blood glucose spikes.

Waarom dit belangrijk is

The article cites reduced glycemic load as one mechanism by which low-carb diets improve short-term glucose control in type 2 diabetes.

Definitie

The glycocalyx is a delicate sugar-rich coating on the inner surface of blood vessels, a kind of gel layer between the blood and the cells.

Waarom dit belangrijk is

It acts as a first barrier and helps the vessel sense blood flow. Damage to it — from high blood sugar, inflammation, or turbulent flow — is one of the earliest events in vascular disease.

Definitie

Glycoconjugates are molecules—typically proteins (glycoproteins) or lipids (glycolipids)—to which sugar chains are covalently attached; sialic acids, including Neu5Gc from dietary red meat, are added to glycoconjugates in the Golgi apparatus and then displayed on cell surfaces.

Waarom dit belangrijk is

The incorporation of foreign Neu5Gc into human glycoconjugates is the key step that transforms a dietary sugar into a target for immune attack on artery walls.

Definitie

Glycosaminoglycans are long, negatively charged sugar chains that are major components of the arterial extracellular matrix and plaque connective tissue; in cynomolgus macaque plaques they are prominent structural constituents that persist after regression of the lipid-rich components.

Waarom dit belangrijk is

They are part of the fibrous scaffold that remains after treatment, explaining why plaques become denser and more stable rather than disappearing entirely.

Definitie

The glymphatic system is a perivascular waste-clearance network in the brain that uses cerebrospinal fluid flowing along blood vessel walls to flush out metabolic byproducts, including amyloid-beta and tau, primarily during sleep.

Waarom dit belangrijk is

Arterial stiffness disrupts the pulse-driven flow that powers this system, offering a direct mechanism by which vascular disease could cause amyloid buildup in the brain.

Definitie

GRADE (Grading of Recommendations, Assessment, Development and Evaluations) is a widely used framework for rating the certainty of evidence behind a clinical finding, classifying it as high, moderate, low, or very low based on factors such as study design, risk of bias, consistency, directness, and precision of results.

Waarom dit belangrijk is

Knowing how GRADE works helps readers understand why two studies showing the 'same' result can still carry very different levels of confidence.

Definitie

The gut microbiome is the enormous community of bacteria living in your intestines. There are trillions of them, and they are not passive passengers.

Waarom dit belangrijk is

They break down parts of your food into new compounds that enter your bloodstream. That means what you eat can affect your heart indirectly, through what your bacteria make out of it.

Definitie

A hazard ratio compares how quickly events happen in two groups. A ratio of 0.75 means events occurred at three-quarters the rate in the treated group.

Waarom dit belangrijk is

It is a relative measure, so it says nothing about how common the event was to begin with. A hazard ratio of 0.5 sounds dramatic whether the risk fell from 40 percent to 20 or from 0.4 percent to 0.2.

Definitie

Human chorionic gonadotropin is a hormone that mimics luteinizing hormone (LH), stimulating testicular Leydig cells to produce testosterone; in men on testosterone replacement therapy it is used to preserve intratesticular testosterone production and maintain spermatogenesis, which exogenous testosterone alone suppresses.

Waarom dit belangrijk is

Men concerned about fertility or testicular atrophy during testosterone therapy need to understand the role hCG plays.

Definitie

HDL, or high-density lipoprotein, is the particle often called "good cholesterol." It picks up cholesterol from tissues and carries it back to the liver.

Waarom dit belangrijk is

The nickname has aged badly. People with naturally high HDL are healthier, but drugs that raise HDL have repeatedly failed to prevent heart attacks. High HDL seems to be a sign of good health rather than a cause of it.

Definitie

A functional measure of HDL's ability to accept cholesterol from cholesterol-laden macrophages in arterial walls and transport it to the liver for removal; emerging evidence suggests CEC predicts cardiovascular risk more accurately than the simple blood concentration of HDL cholesterol.

Waarom dit belangrijk is

A high HDL number on a standard test does not guarantee protection — what the HDL actually does matters more.

Definitie

Healthspan is the portion of a person's life spent in good health, free from serious disease, disability, or significant functional decline, as distinguished from total lifespan, which counts all years alive regardless of health status.

Waarom dit belangrijk is

Focusing on healthspan rather than lifespan alone shifts the goal from simply living longer to living better for longer.

Definitie

A composite research endpoint used in long-term cohort studies—such as the Nurses' Health Study—defined as surviving to older age free from major chronic diseases (including cardiovascular disease), significant cognitive decline, and functional impairment; the 2024 Nurses' Health Study analysis found higher midlife plant-protein intake to be a significant predictor of this outcome.

Waarom dit belangrijk is

Using 'healthy aging' as an endpoint captures cardiovascular benefit more completely than disease incidence alone, making it a stronger measure of dietary impact.

Definitie

A confounding phenomenon in which moderate drinkers tend to have higher socioeconomic status, better diets, and more active lifestyles, making alcohol appear protective when it may simply be a marker for other health-promoting behaviors.

Waarom dit belangrijk is

It is one of the main reasons observational studies on alcohol and heart health can be misleading.

Definitie

The difference between a person's biological heart age—estimated from electrocardiographic, vascular, or risk-factor models—and their chronological age; a positive gap indicates that the heart is functionally older than the calendar age and predicts higher cardiovascular risk and worse survival.

Waarom dit belangrijk is

Seeing a concrete gap in 'years' is shown to motivate behavior change more effectively than abstract risk percentages.

Definitie

A heart attack happens when blood flow to part of the heart muscle is cut off and that muscle starts to die.

Waarom dit belangrijk is

The usual trigger is not a slow closing of the artery. It is a plaque cracking open, with a clot forming on top in minutes. That is why heart attacks so often strike people who felt fine the day before, and why plaques too small to cause symptoms can still kill.

Definitie

A person who has been diagnosed with significant cardiac disease—such as severe atherosclerotic heart disease—and has not died from it, often implying they have managed or reversed their condition through medical treatment, lifestyle change, or both.

Waarom dit belangrijk is

Understanding this term helps readers recognize that cardiac diagnoses are not always fatal or permanently disabling, and that meaningful recovery is possible.

Definitie

Heart failure means the heart cannot pump well enough to meet the body's needs. The name is misleading — it does not mean the heart has stopped.

Waarom dit belangrijk is

It causes breathlessness, swollen legs, and fatigue. Common causes include past heart attacks, long-standing high blood pressure, and valve problems.

Definitie

Heart rate is how many times your heart beats per minute.

Waarom dit belangrijk is

A lower resting rate usually reflects better fitness — trained endurance athletes often sit in the 40s. On its own, though, resting heart rate says very little about whether you have plaque.

Definitie

Heart rate variability (HRV) is the natural beat-to-beat variation in the time between heartbeats, and is used as a non-invasive measure of autonomic nervous system balance — higher variability generally reflecting greater parasympathetic (rest-and-digest) activity. It is listed in the article as one of the outcomes measured in meditation trials.

Waarom dit belangrijk is

HRV is frequently cited as a marker of stress resilience and cardiovascular health, so knowing what it actually measures helps you evaluate wearable-device claims.

Definitie

The physiological adaptation to exercising in warm environments, including increased plasma volume, earlier onset of sweating, and reduced cardiovascular strain at a given temperature; athletes who train in cool climates lack this adaptation and experience greater heart-rate elevation and performance decline when competing in heat.

Waarom dit belangrijk is

Poor heat tolerance raises cardiovascular stress during exertion, which is a meaningful risk factor for older athletes and heart patients exercising in warm conditions.

Definitie

The Heinz Nixdorf Recall Study is a German population-based cohort study; a sub-analysis of 108 male marathon runners aged 50 and older found they had coronary artery calcium scores higher than risk-factor-matched controls despite lower Framingham Risk Scores, and that all coronary events during follow-up occurred exclusively in runners with CAC scores of 100 or above.

Waarom dit belangrijk is