IAS - Biology - SB - Sample Topic 1 PDF
IAS - Biology - SB - Sample Topic 1 PDF
IAS - Biology - SB - Sample Topic 1 PDF
©Pearson 2018
Ann Fullick
with Frank Sochacki
Student Book 1
BIOLOGY
PEARSON EDEXCEL INTERNATIONAL AS/A LEVEL
Published by Pearson Education Limited, 80 Strand, London, WC2R 0RL. Acknowledgements
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on the website: https://qualifications.pearson.com Figure on page 60 based on data from American Journal of Epidemiology similar
to this http://healthhubs.net/heartdisease/waist-size-predicts-heart-disease-risk-
Text © Ann Fullick and Pearson Education Limited 2018 better-than-bmi/;Figure on page 68 from pro.activ sponsored studies; Figure on
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work have been asserted by them in accordance with the Copyright, Designs and Extract on page 22 from Luyckx J., Baudouin C. Trehalose: an intriguing
Patents Act 1988. disaccharide with potential for medical application in ophthalmology. Clinical
ophthalmology (Auckland, NZ) 5 (2011): 577; Extract on page 70 from Mostafa
First published 2018 Q Al-Shamiri. Heart failure in the Middle East. Current Cardiology Reviews 2013
May; 9(2):174–178https://www.ncbi.nlm.nih.gov/pmc/articles /PMC3682400/#R10;
21 20 19 18 Extract on page 96 from Qingling Zhang, Zhiming Qiu, Kian Fan Chung, Shau-Ku
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nih. gov/pmc/articles /PMC4311080/#r3; Extract on page 97 from Qingling Zhang,
British Library Cataloguing in Publication Data Zhiming Qiu, Kian Fan Chung, Shau-Ku Huang. Journal of Thoracic Disease. 2015
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Endorsement statement
In order to ensure that this resource offers high-quality support for the associated
Pearson qualification, it has been through a review process by the awarding
body. This process confirmed that this resource fully covers the teaching and
learning content of the specification at which it is aimed. It also confirms that it
demonstrates an appropriate balance between the development of subject skills,
knowledge and understanding, in addition to preparation for assessment.
While the publishers have made every attempt to ensure that advice on the
qualification and its assessment is accurate, the official specification and
associated assessment guidance materials are the only authoritative source of
information and should always be referred to for definitive guidance.
Pearson examiners have not contributed to any sections in this resource relevant to
examination papers for which they have responsibility.
Examiners will not use endorsed resources as a source of material for any
assessment set by Pearson. Endorsement of a resource does not mean that the
resource is required to achieve this Pearson qualification, nor does it mean that it is
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CONTENTS iii
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COURSE STRUCTURE iv
ABOUT THIS BOOK vi
PRACTICAL SKILLS viii
ASSESSMENT OVERVIEW x
TOPIC 1 2
TOPIC 2 74
TOPIC 3 148
TOPIC 4 220
MATHS SKILLS 294
PREPARING FOR YOUR EXAMS 302
COMMAND WORDS 308
GLOSSARY 309
INDEX 320
iv COURSE STRUCTURE
TOPIC 1 TOPIC 2
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TOPIC 3 TOPIC 4
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This book is written for students following the Pearson Edexcel International Advanced Subsidiary (IAS)
Biology specification. This book covers the full IAS course and the first year of the International A Level
(IAL) course.
The book contains full coverage of IAS units (or exam papers) 1 and 2. Each unit in the specification has
two topic areas. The topics in this book, and their contents, fully match the specification. You can refer to
the Assessment Overview on page x for further information. Students can prepare for the written Practical
Paper (unit 3) by using the IAL Biology Lab Book (see page viii of this book).
Each topic is divided into chapters and sections to break the content down into manageable chunks.
Each section features a mix of learning and activities.
Did you know? Worked examples show you Subject vocabulary Checkpoint
Interesting facts how to work through questions, Key terms are highlighted in blue in the Questions at the end of each
help you remember and set out calculations. text. Clear definitions are provided at the section check understanding
the key concepts. end of each section for easy reference, of the key learning points in
and are also collated in a glossary at each chapter.
the back of the book.
ABOUT THIS BOOK vii
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Thinking Bigger
At the end of most chapters
there is an opportunity to read
and work with real-life research
and writing about science.
The activities help you to read
real-life material that’s relevant
to your course, analyse how
scientists write, think critically
and consider how different
aspects of your learning piece
together.
Skills
These sections will help you
develop transferable skills, which
are highly valued in further study
and the workplace.
Exam Practice
Exam-style questions at
the end of each chapter are
tailored to the Pearson Edexcel
specification to allow for practice
and development of exam-
writing technique. They also
allow for practice responding
to the command words used in
the exams (see the command
words glossary at the back of
this book).
viii PRACTICAL SKILLS
PRACTICAL SKILLS
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Practical work is central to the study of biology. The Pearson Edexcel International Advanced Subsidiary (IAS) Biology
specification includes nine Core Practicals that link theoretical knowledge and understanding to practical scenarios.
In order to develop practical skills, you should carry out a range of practical experiments related to the topics covered in
your course. Further suggestions in addition to the Core Practicals are included below.
TOPIC 1 CP1 Use a semi-quantitative method with Benedict’s reagent to estimate the
MOLECULES, TRANSPORT AND HEALTH concentrations of reducing sugars and with iodine solution to estimate
the concentrations of starch, using colour standards.
TOPIC 2 CP3 Investigate membrane properties including the effect of alcohol and
MEMBRANES, PROTEINS, DNA AND temperature on membrane permeability.
GENE EXPRESSION
CP4 Investigate the effect of temperature, pH, enzyme concentration
and substrate concentration on the initial rate of enzyme-catalysed
reactions.
CP6 Prepare and stain a root tip squash to observe the stages of mitosis.
TOPIC 4 CP7 Use a light microscope to:
PLANT STRUCTURE AND FUNCTION, (i) make observations, draw and label plan diagrams of transverse
BIODIVERSITY AND CONSERVATION sections of roots, stems and leaves
(ii) make observations, draw and label cells of plant tissues
(iii) identify sclerenchyma fibres, phloem, sieve tubes and xylem
vessels and their location.
Your knowledge and understanding of practical skills and activities will be assessed in all examination papers for the
IAS Level Biology qualification.
• Papers 1 and 2 will include questions based on practical activities, including novel scenarios.
• Paper 3 will test your ability to plan practical work, including risk management and selection of apparatus.
ASSESSMENT OVERVIEW
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The following tables give an overview of the assessment for Pearson Edexcel International Advanced Subsidiary course
in Biology. You should study this information closely to help ensure that you are fully prepared for this course and
know exactly what to expect in each part of the examination. More information about this qualification, and about the
question types in the different papers, can be found on page 302 of this book.
PERCENTAGE PERCENTAGE
PAPER / UNIT 1 MARK TIME AVAILABILITY
OF IAS OF IAL
MOLECULES, DIET, TRANSPORT AND 40% 20% 80 1 hour January, June and October
HEALTH 30 minutes First assessment : January 2019
Written examination
Paper code
WBI11/01
Externally set and marked by
Pearson Edexcel
Single tier of entry
PERCENTAGE PERCENTAGE
PAPER / UNIT 2 MARK TIME AVAILABILITY
OF IAS OF IAL
CELLS, DEVELOPMENT, BIODIVERSITY 40% 20% 80 1 hour January, June and October
AND CONSERVATION 30 minutes First assessment : June 2019
Written examination
Paper code
WBI12/01
Externally set and marked by
Pearson Edexcel
Single tier of entry
PERCENTAGE PERCENTAGE
PAPER / UNIT 3 MARK TIME AVAILABILITY
OF IAS OF IAL
PRACTICAL SKILLS IN BIOLOGY 1 20% 10% 50 1 hour January, June and October
Written examination 20 minutes First assessment : June 2019
Paper code
WBI13/01
Externally set and marked by
Pearson Edexcel
Single tier of entry
ASSESSMENT OVERVIEW xi
TRANSPORT AND
HEALTH
CHEMISTRY
1A BIOLOGISTS FOR
CHAPTER
Water is essential to life. Everyone knows this. Yet the jerboa, a small rodent found throughout Asia and
Northern Africa, may never drink water in its life. The jerboa (family Dipodidae) is found in both hot and cold
deserts from the Sahara Desert to the Gobi Desert. It is extremely well adapted for dry desert environments and
gets the water it needs from the food it eats. This includes plant leaves, roots and seeds, and in some cases
insects. Jerboas also produce tiny amounts of very concentrated urine to get rid of their waste products, another
adaptation for saving the water needed for life.
Biology is the study of living things. The basic unit of life is the cell, but underpinning all life is chemistry. The way
atoms are bonded together affects the way chemicals work in the cells – and that affects everything, from the
way plants make food by photosynthesis to the way your eyes respond to light.
In this chapter, you will be looking at some of the important ways in which atoms and molecules interact to
make up the chemistry of life. You will be using these basic principles throughout your biology course because
they are fundamental to the structures and functions of all the organisms you will study.
You will see how the chemistry of water enables life to survive and chemical reactions to continue. You will look
at carbohydrates, from the simplest sugars to the most complex polysaccharides. These molecules have a wide
variety of uses in organisms, from the fuel for cellular respiration to the main structural material in plants. As you
discover how the molecules are joined together, you will recognise the relationships between the structure of
the molecules and their functions in the body.
The same links between structure and function are clear when you look at the structure of lipid molecules. For
example, lipids are used as energy stores in both animals and plants. Lipids are non-polar molecules but you will
discover how they can become polar in combination with other inorganic groups such as phosphates. This
polarity has great importance for the characteristics of the cell membrane.
At the end of this chapter, you will study the structure of proteins. They are long chains of amino acids that are
held together by chemical bonds to make complex structures. The bonds include the covalent bonds, ionic
bonds and hydrogen bonds.
LEARNING OBJECTIVES
◼◼ Understand the importance of water as a solvent in transport, including its dipole nature.
The basic unit of all elements is the atom. When the atoms of two or more different elements react,
they form a compound. An atom is made up of a nucleus containing positive protons and neutral
neutrons. The nucleus is surrounded by negative electrons. We can show this in a model as electrons
orbiting around the nucleus in shells. When an atom has a full outer shell of electrons, it is stable
and does not react. However, most atoms do not have a full outer shell of electrons. In chemical
reactions, these electrons are involved in changes that give the atom a stable outer shell. There are
two ways they can achieve this.
•• Ionic bonding: the atoms involved in the reaction give or receive electrons. One atom, or part of
the molecule, gains one or more electrons and becomes an anion (a negative ion). The other atom,
or part of the molecule, loses one or more electrons and becomes a cation (a positive ion). Strong
forces of attraction called ionic bonds hold the oppositely charged ions together (see fig B).
2
1
Key
or represents
a single electron 1
2
Na 1 Cl Na Cl
•• Covalent bonding: the atoms involved in the reaction share electrons (see fig D). Covalent
bonds are very strong and the molecules formed are usually neutral. However, in some covalent
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compounds, the molecules are slightly polarised: this means that the electrons in the covalent bonds
are not quite evenly shared. Consequently, the molecule has a part that is slightly negative and a
part that is slightly positive. This separation of charge is called a dipole, and the tiny charges are
represented as δ + and δ – (see fig F). The molecule is described as a polar molecule. This polarity
is particularly common if the bond involves one or more hydrogen atoms.
H 1 H H H
(1) (1) (2)
hydrogen hydrogen hydrogen
atom atom molecule
H 1 H 1 O H O H
(1) (1) (2,6) (2,8)
hydrogen hydrogen oxygen atom water molecule
atom atom
▲ fig D The formation of hydrogen molecules and water molecules are examples of covalent bonding.
IMPORTANT CATIONS
•• Sodium ions (Na+) – these are needed in nerve impulses, sweating and many secretory systems in
animals (see Book 2 Chapter 8A).
•• Calcium ions (Ca2+) – these are needed for the formation of calcium pectate for the middle lamella
between two cell walls in plants, and for bone formation and muscle contraction in animals (see
Section 4A.1 and Book 2 Chapters 7B and 7C).
•• Hydrogen ions (H+) – these are needed in cellular respiration and photosynthesis, and in numerous
pumps and systems as well as pH balance (see Section 2A.4 and Book 2 Chapters 5A and 7A).
•• Magnesium ions (Mg2+) – these are needed for production of chlorophyll in plants (see Book 2
Chapter 5A).
6 1A.1 THE CHEMISTRY OF LIFE CHEMISTRY FOR BIOLOGISTS
Hδ1
Hδ1 Hδ1
Oδ2
Hδ1
▲ fig G Hydrogen bonding in water molecules, based on attraction
between positive and negative dipoles.
in it (see Sections 1B.2, 4A.4 and 4A.5). All these properties are a result of dipoles and hydrogen bonding
between water molecules. Make sure that you can explain the link
•• As water cools to 4 °C, it reaches its maximum density. As it between the property and the hydrogen bonding.
cools further, the molecules become more widely spaced. As
a result, ice is less dense than water and floats, forming an
insulating layer and helping to prevent the water underneath it CHECKPOINT
from freezing. It also melts quickly because, being at the top, it
is exposed to the sun. It is very unusual for the solid form of a SKILLS PROBLEM SOLVING
substance to be less dense than the liquid form. This unusual
1. What is a dipole?
property enables organisms to live in water, even in countries
where it gets cold enough to freeze in winter. 2. What are the differences between ionic substances and polar
substances?
•• Water is slow to absorb and release heat – it has a high specific
3. How are hydrogen bonds formed between water molecules
heat capacity. The hydrogen bonds between the molecules
and what effect do they have on the properties of water?
need a lot of energy to separate them. This means the
temperature of large bodies of water such as lakes and seas 4. Discuss how the properties of water affect living organisms.
does not change much throughout the year. This makes them
good habitats for living organisms. EXAM HINT
•• Water is a liquid – it cannot be compressed. This is an In exam questions, the command word discuss suggests that you may
important factor in many hydraulic mechanisms in living need to consider possible negative effects as well as the more
organisms. obvious benefits to living organisms. You should identify the issue
•• Water molecules are cohesive – the forces between the that is being assessed within the question. Explore all aspects of the
molecules mean they stick together. This is very important for issue. Investigate the issue by reasoning or argument.
the movement of water from the roots to the leaves of plants
(see Sections 4A.3 and 4A.4). SUBJECT VOCABULARY
•• Water molecules are adhesive – they are attracted to other
anion a negative ion
different molecules. This is also important in plant transport
cation a positive ion
systems and in surface tension.
ionic bonds bonds formed when atoms give or receive electrons;
•• Water has a very high surface tension because the attraction they result in charged particles called ions
between the water molecules, including hydrogen bonds, is covalent bonds bonds formed when atoms share electrons; covalent
greater than the attraction between the water molecules and molecules may be polar if the electrons are not shared equally
the air. As a result, the water molecules hold together forming a dipole the separation of charge in a molecule when the electrons in
thin ‘skin’ of surface tension. Surface tension is very important covalent bonds are not evenly shared
in plant transport systems, and also affects life at the surface of polar molecule a molecule containing a dipole
ponds, lakes and other water masses (see fig I). dissociation splitting of a molecule into smaller molecules, atoms, or
ions, especially by a reversible process
LEARNING TIP hydrogen bonds weak electrostatic intermolecular bonds formed
Remember that co means two similar things together, as in cohabit, between polar molecules containing at least one hydrogen atom
and ad means two different things together.
▲ fig I Without surface tension, a raft spider like this could not move
across the water and hunt.
2C
ARBOHYDRATES 1: SPECIFICATION
MONOSACCHARIDES AND
REFERENCE
DISACCHARIDES
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LEARNING OBJECTIVES
◼◼ Know the difference between monosaccharides and disaccharides.
◼◼ Know how to use Benedict’s reagent.
◼◼ Know how monosaccharides (glucose, fructose and galactose) join to form disaccharides (maltose, sucrose and
lactose) through condensation reactions forming glycosidic bonds, and how they can be split through hydrolysis
reactions.
•• Pentose sugars (n = 5) have five carbon atoms and the and this affects the polymers that are made. You will learn more
general formula C5H10O5. Ribose and deoxyribose are about α- and β-glucose in Section 4A.5.
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CH2OH CH2OH 4 1 4 1
6 6
H 5 O H H 5 O OH HO OH
3 2 OH HO 3 2
4
H 1 4
H 1 condensation
OH H OH H
H2O
HO 3 2 OH HO 3 2 H 6 6
H 5 O H H 5 O H
H OH H OH
4 1 4 1
or, even more simply:
O
HO OH
3 2 3 2
maltose
α-glucose β-glucose 1,4-glycosidic bond
6 6 ▲ fig E The formation of a glycosidic bond. The condensation reaction
H 5 O H H 5 O OH between two monosaccharides results in a disaccharide and a molecule
of water.
4 1 4 1
When different monosaccharides join together, different
HO 3 2
OH HO 3 2
H disaccharides are made, and these have different properties. Many
disaccharides taste sweet. Table A shows some of the more
In these diagrams, the positions of carbon atoms are common ones.
represented by their numbers only.
Note carefully the different arrangement of atoms DISACCHARIDE SOURCE MONOSACCHARIDE
around the carbon 1 atom in α -glucose and β -glucose.
sucrose stored in plants such as glucose + fructose
▲ fig D Hexose sugars have a ring structure. The arrangement of the atoms sugar cane
on the side chains can make a significant difference to the way in which lactose milk sugar – this is the main glucose + galactose
the molecule can be used by the body. The carbon atoms are numbered in
carbohydrate found in milk
order to identify the different arrangements.
maltose malt sugar – found in glucose + glucose
Glucose has two isomers (different forms): α-glucose and germinating seed such as
β-glucose. The two isomers have different arrangements of the barley
atoms on the side chains of the molecule. The different isomers
table A Three common disaccharides
form different bonds between neighbouring glucose molecules,
10 1A.2 CARBOHYDRATES 1 CHEMISTRY FOR BIOLOGISTS
SUBJECT VOCABULARY
monomer a small molecule that is a single unit of a larger molecule called a polymer
LEARNING TIP polymer a long-chain molecule made up of many smaller, repeating monomer units joined together by
Remember that ‘iso’ means chemical bonds
same, the same atoms. macromolecule a very large molecule often formed by polymerisation
starch a long-chain polymer formed of glucose monomers
sucrose a sweet-tasting disaccharide formed by the joining of glucose and fructose by a 1,4-glycosidic
bond
glucose a hexose sugar
monosaccharide a single sugar monomer
disaccharide a sugar made up of two monosaccharide units joined by a glycosidic bond, formed in a
condensation reaction
polysaccharide a polymer consisting of long chains of monosaccharide units joined by glycosidic bonds
triose sugar a sugar with three carbon atoms
pentose sugar a sugar with five carbon atoms
ribose a pentose sugar that is part of the structure of RNA
deoxyribose a pentose sugar that is part of the structure of DNA
deoxyribonucleic acid (DNA) a nucleic acid that is the genetic material in many organisms
ribonucleic acid (RNA) a nucleic acid which is the genetic material in some organisms and is involved in
protein synthesis
hexose sugar sugar with six carbon atoms
isomers molecules that have the same chemical formula, but different molecular structures
condensation reaction a reaction in which a molecule of water is removed from the reacting molecules as
a bond is formed between them
glycosidic bond a covalent bond formed between two monosaccharides in a condensation reaction,
which can be broken down by a hydrolysis reaction to release the monosaccharide units
reducing sugars sugars that react with blue Benedict’s solution and reduce the copper(II) ions to copper(I)
ions giving an orangey-red precipitate
non-reducing sugars sugars that do not react with Benedict’s solution
3 CARBOHYDRATES 2: SPECIFICATION
1A
REFERENCE
POLYSACCHARIDES
1.2(i) 1.2(ii) 1.3 1.4 CP1
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LEARNING OBJECTIVES
◼◼ Know the difference between monosaccharides, disaccharides and polysaccharides, including glycogen and starch.
◼◼ Explain how monosaccharides join to form polysaccharides through condensation reactions forming glycosidic
bonds, and how these can be split through hydrolysis reactions.
◼◼ Relate the structures of monosaccharides, disaccharides and polysaccharides to their roles in providing and
storing energy.
The most complex carbohydrates are the polysaccharides. They are made of many monosaccharide units
joined by condensation reactions that create glycosidic bonds (see Section 1A.2 fig E). Polysaccharides
do not have the sweet taste of many mono- and disaccharides, but these complex polymers include some
very important biological molecules.
Molecules with between 3 and 10 sugar units are known as oligosaccharides, while molecules
containing 11 or more monosaccharides are known as true polysaccharides. The glycosidic bonds in the
polysaccharide can be broken to release monosaccharide units for cellular respiration.
The glycosidic bond between two glucose units is split by a process known as hydrolysis (see fig A).
The hydrolysis reaction is the opposite of the condensation reaction that created the molecule, so water
is added to the bond. Starch and glycogen are gradually broken down into shorter and shorter chains and
eventually single sugars are left. Disaccharides break down to form two monosaccharides. Hydrolysis
takes place during digestion in the gut, and also in the muscle and liver cells when the carbohydrate stores
are broken down to release sugars for use in cellular respiration (see Book 2 Chapter 7A).
α-glucose α-glucose
6 6
H 5 O H H 5 O H
4 1 4 1
HO OH HO OH
3 2 3 2
condensation hydrolysis
H2O H2O
LEARNING TIP
6 6
5 5 Glycosidic bonds are formed
H O H H O H
with the removal of a molecule
4 1 4 1
of water in condensation
reactions.
O
HO OH Glycosidic bonds are broken
3 2 3 2
with the addition of a molecule
maltose 1,4-glycosidic bond
of water in hydrolysis reactions.
▲ fig A Glycosidic bonds are made by condensation reactions and broken down by hydrolysis.
Any glucose in the food you eat can be absorbed and used
EXAM HINT
directly in your cells. Other monosaccharides and disaccharides
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– for example, fructose, maltose and sucrose – are also easily Be sure you can relate the structure of the molecule to its function as
a storage molecule.
absorbed in the body and rapidly converted to glucose. So foods
containing monosaccharides and disaccharides are a good source Coiling makes it compact so it takes up less space and doesn’t get in
the way of organelles or substances moving around the cell.
of relatively instant energy (see fig B). However, these cannot be
used to store energy because they are chemically active, and they Large molecules are insoluble so they do not interfere with the water
potential of the cell.
are very soluble in water, so they affect the water balance of the
cells. You will find out why that is so important in Chapter 2A.
PRACTICAL SKILLS CP1
Testing for starch
If you add a few drops of reddish-brown iodine solution to a sample
containing starch (whether it is a solid sample or a sample in
solution), the iodine solution will turn blue-black (see fig C).
▲ fig B These medjool dates contain a lot of fructose. That is why they taste
so sweet and give you instant energy.
O O
– so why are the molecules so different? It all depends on the 1
carbon atoms involved in the glycosidic bonds. O
1,4-glycosidic bond 4
O
Amylose has only 1,4-glycosidic bonds, which is why the
molecules are long unbranched chains.
O
GLYCOGEN
DID YOU KNOW?
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Glycogen is sometimes referred to as ‘animal starch’ because it is the only carbohydrate energy When starch is cooked all the
store found in animals. It is also an important storage carbohydrate in fungi. Chemically, glycogen coiled molecules unwind and
is very similar to the amylopectin molecules in starch, and it also has many α-glucose units. Like get tangled together. This is
starch, it is very compact, but the glycogen molecule has more 1,6-glycosidic bonds than the starch why flour can thicken a gravy
molecule, giving it many side branches. This means that glycogen can be broken down very rapidly. or sauce, and why you can
This makes it an ideal source of glucose for animals which may require rapid release of energy at make glue from flour. It also
certain times of high activity levels (see fig E). explains why the molecules
(a) must be coiled. If they were
nucleus not coiled, the cytoplasm
would be a solid tangled
mass of starch molecules.
glycogen
granules
H O H H O H
H H
1 EXAM HINT
OH H OH H
O Be clear about the differences
OH
O between 1,4-glycosidic bonds
H OH H OH and 1,6-glycosidic links. It is
easy to get them wrong and
CH2OH CH2OH 6 CH2 CH2OH CH2OH lose marks as a result.
O O 5 O O O
H H H H H H H H H H
H H H H H
1 4
OH H OH H 4 OH H OH H OH H
O O O O
OH OH
3 2
H OH H OH H OH H OH H OH SUBJECT VOCABULARY
▲ fig E In (a) you can see liver cells full of small glycogen granules, stained pink in this micrograph. If your blood oligosaccharides molecules
glucose levels are low, this glycogen store in your liver can be broken down to provide the glucose you need for with between 3 and 10
cellular respiration. In (b) you can see the structure of glycogen with 1,4 and 1,6-glycosidic bonds. monosaccharide units
The chemical structure of glycogen shown in fig E (b) looks very similar to that of amylopectin. hydrolysis a reaction in which
However, when you look at bigger sections of the molecules in fig F you can see that glycogen has bonds are broken by the
addition of a molecule of water
many more branches than amylopectin.
ATP adenosine triphosphate,
the molecule that acts as
a universal energy supply
amylose molecule in all cells
end products the final
products of a chemical reaction
amylose a complex
carbohydrate containing only
α-glucose monomers joined
together by 1,4-glycosidic
bonds so the molecules form
long unbranched chains
amylopectin a complex
carbohydrate made up of
amylopectin glycogen α-glucose monomers joined by
▲ fig F You can clearly see the many side branches which allow glycogen to be broken down so quickly when you 1,4-glycosidic bonds with some
compare amylose, amylopectin and glycogen. 1,6-glycosidic bonds so the
molecules branch repeatedly
CHECKPOINT SKILLS CREATIVITY glycogen a complex
carbohydrate with many
1. Explain why sugars such as glucose and sucrose are useful for immediate energy, but are not suitable as α-glucose units joined by
long-term energy stores. 1,4-glycosidic bonds with many
2. Explain how the structure of carbohydrates is related to their function as storage molecules providing 1,6-glycosidic bonds, giving it
the fuel for cellular respiration in animals and plants. many side branches
SPECIFICATION
REFERENCE
LEARNING OBJECTIVES
◼◼ Know how a triglyceride is synthesised by the formation of ester bonds during condensation reactions between
glycerol and three fatty acids.
◼◼ Describe the differences between unsaturated and saturated fatty acids.
The lipids are another group of organic substances that play a vital role in organisms. They are an
integral part of all cell membranes and are also used as an energy store. Lipids contain many carbon–
hydrogen bonds and almost no oxygen. When lipids are oxidised in the respiration process, the bonds
are broken and carbon dioxide and water are the final products. This reaction can be used to drive the
production of much ATP (see Sections 1A.3, 2A.2 and 2A.4 and Book 2 Chapter 5A). Lipids,
especially triglycerides, store about three times as much energy as the same mass of carbohydrates.
Many plants and animals convert spare food into oils or fats as an energy store to use when needed.
For example, the seeds of plants contain lipids to provide energy for the seedling when it starts to
grow, which is why seeds are such an important food source for many animals.
H H H H H H H H H H H H H H H H H
▲ fig C Displayed formula of stearic acid, a saturated fatty acid found in both plant and animal fats
H H H H H H H H H H H H H H H H H O
H C C C C C C C C C C C C C C C C C C OH
H H H H H H H H H H H H H
carbon–carbon double bond
▲ fig D Displayed formula of linoleic acid, a polyunsaturated fatty acid
CHEMISTRY FOR BIOLOGISTS 1A.4 LIPIDS 15
A triglyceride is made when glycerol combines with three fatty acids. A bond is formed in a condensation When you discuss unsaturated
reaction between the carboxyl group (–COOH) of a fatty acid and one of the hydroxyl groups (–OH) of fatty acids, make it clear that the
the glycerol. A molecule of water is removed and the bond created is called an ester bond. This type of double bonds are between
condensation reaction is called esterification (see fig E). The nature of the lipid formed depends on carbon atoms. Refer to them as
which fatty acids are joined together. For example, lipids containing saturated fatty acids are more likely carbon–carbon double bonds,
to be solid at room temperature than those containing unsaturated fatty acids. Longer chain fatty acids not just double bonds.
are also more likely to produce solid fats.
For simplicity, fatty acids are represented by this general O
formula where ‘R’ represents the hydrocarbon chain.
The fatty acids below are drawn in reversed form. R C OH
H O H O ester bond
3H2O
H C OH HO C R H C O C R
O O
hydrolysis LEARNING TIP
H C OH HO C R H C O C R Remember that animal fats are
O condensation O usually saturated fatty acids and
are more likely to be solid at
H C OH HO C R H C O C R room temperature. This is why
a spread made from plant oils
H H is quite spreadable when you
take it out of the fridge, but
Note: there are only 6 atoms of
oxygen in a triglyceride molecule. butter is not.
▲ fig E The formation of ester bonds
CHECKPOINT
1. Explain how triglycerides are formed.
2. Describe the main difference between a saturated and an unsaturated fatty acid, and the effect of SKILLS ADAPTIVE LEARNING
this difference on the properties of the lipids formed from unsaturated fatty acids compared to
lipids formed from saturated fatty acids.
SUBJECT VOCABULARY
lipids a large family of organic molecules that are important in cell membranes and as an energy store in
many organisms; they include triglycerides, phospholipids and steroids
fatty acids organic acids with a long hydrocarbon chain
glycerol propane-1,2,3-triol, an important component of triglycerides
ester bonds bonds formed in a condensation reaction between the carboxyl group (–COOH) of a fatty acid
and one of the hydroxyl groups (–OH) of glycerol
saturated fatty acid a fatty acid in which each carbon atom is joined to the one next to it in the
hydrocarbon chain by a single covalent bond
unsaturated fatty acid a fatty acid in which the carbon atoms in the hydrocarbon chain have one or more
double covalent bonds in them
monounsaturated fatty acid a fatty acid with only one double covalent bond between carbon atoms in the
hydrocarbon chain
polyunsaturated fatty acid a fatty acid with two or more double covalent bonds between carbon atoms in
the hydrocarbon chain
esterification the process by which ester bonds are made
SPECIFICATION
REFERENCE
LEARNING OBJECTIVES
◼◼ Know the basic structure of an amino acid.
◼◼ Understand the formation of polypeptides and proteins, as amino acid monomers linked together by condensation
reactions to form peptide bonds.
◼◼ Understand the significance of a protein’s primary structure in determining its secondary structure, three-
dimensional structure and properties, and the types of bond involved in its three-dimensional structure.
◼◼ Know the molecular structure of a globular protein and a fibrous protein and understand how their properties relate
to their functions (including haemoglobin and collagen).
About 18% of your body is made up of protein. Proteins make FORMING PROTEINS FROM AMINO ACIDS
hair, skin and nails, the enzymes needed for metabolism and Amino acids join by a reaction between the amino group of
digestion, and many of the hormones that control the different one amino acid, and the carboxyl group of another. They
body systems. They enable muscle fibres to contract, make join in a condensation reaction and a molecule of water is
antibodies that protect you from disease, help clot your blood and released. A peptide bond is formed when two amino acids
transport oxygen in the form of haemoglobin. Understanding join, and a dipeptide is the result (see fig B). The R group is
the structure of proteins helps you understand the detailed biology not involved in this reaction. More and more amino acids join
of cells and organisms. Like carbohydrates and lipids, proteins to form polypeptide chains, which contain from about 100 to
contain carbon, hydrogen and oxygen. In addition, they all contain many thousands of amino acids. A polypeptide forms a protein
nitrogen and many proteins also contain sulfur. when the structure of the chain changes by folding or coiling or
Proteins are a group of macromolecules made up of many associates with other polypeptide chains.
small monomer units called amino acids joined together by amino acid 1 amino acid 2 (inverted)
condensation reactions. Amino acids combine in long chains to R1 H H O
produce proteins. There are about 20 different naturally occurring
amino acids that can combine in different ways to produce a wide H N C C OH + H N C C OH
range of different proteins.
H H O R2
AMINO ACIDS
All amino acids have the same basic structure, which is
represented as a general formula. There is always an amino group condensation hydrolysis
(–NH2) and a carboxyl group (–COOH) attached to a carbon
atom (see fig A). The group known as the R group varies between
H 2O H2O
amino acids. Some amino acids contain sulfur and selenium in
their R group. The R groups are not involved in the reactions
R1 H H O
which join the amino acids together, but the structure of the R
group does affect the way the amino acid interacts with others H C C
N C C N OH
within the protein molecule. This will mainly depend on whether
the R group is polar or not, and these interactions affect the peptide
H H O R2
bond
tertiary structure of the protein formed (see page 18).
general formula dipeptide
R This part is common
to all amino acids and ▲ fig B Amino acids are the building blocks of proteins, joined together
H N C C OH is just shown as a by peptide bonds.
H H O shaded rectangle in
glycine
the examples below.
cysteine
BONDS IN PROTEINS
H CH2 SH The peptide bond between amino acids is a strong bond. Other
bonds are also made between the amino acids in a chain, to create
▲ fig A Some different amino acids. In the simplest amino acid, glycine, R is the 3D structures of the protein. They depend on the atoms in the
a single hydrogen atom. In a larger amino acid such as cysteine, R is much R group and include hydrogen bonds, disulfide bonds and ionic
more complex. bonds.
CHEMISTRY FOR BIOLOGISTS 1A.5 PROTEINS 17
HYDROGEN BONDS
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You were introduced to hydrogen bonds in Section 1A.1. These same bonds are essential in protein
structures. In amino acids, tiny negative charges are present on the oxygen of the carboxyl groups
and tiny positive charges are present on the hydrogen atoms of the amino groups. When these
charged groups are close to each other, the opposite charges attract, forming a hydrogen bond.
Hydrogen bonds are weak but, potentially, they can be made between any two amino acids in the
correct position, so there are many of them holding the protein together very firmly. They are very
important in the folding and coiling of polypeptide chains (see fig C). Hydrogen bonds break easily
and reform if pH or temperature conditions change.
DISULFIDE BONDS
Disulfide bonds form when two cysteine molecules are close together in the structure of a
polypeptide (see fig C). An oxidation reaction occurs between the two sulfur-containing groups,
resulting in a strong covalent bond known as a disulfide bond. These disulfide bonds are much
stronger than hydrogen bonds but they happen much less often. They are important for holding the
folded polypeptide chains in place.
β-pleated sheet
hydrogen bond
disulfide bond
α-helix
▲ fig C Hydrogen bonds and disulfide bonds maintain the shape of protein molecules and this determines
their function.
IONIC BONDS
Ionic bonds can form between some of the strongly positive and negative amino acid side chains
which are sometimes found deep inside the protein molecules. They are strong bonds, but they are
not as common as the other structural bonds.
Your hair is made of the protein keratin. Some methods of styling hair change the bonds within the protein
molecules. Blow drying or straightening hair breaks the hydrogen bonds and temporarily reforms them
with the hair curling in a different way until the hydrogen bonds reform in their original places.
Perming is a chemical treatment which is used in some hair salons to completely change the way hair
looks for weeks or months. The chemicals break the disulfide bonds between the polypeptide chains
and reform them in a different place. This effect is permanent – hair will stay styled in that particular
way until it is cut off.
PROTEIN STRUCTURE
Proteins can be described by their primary, secondary, tertiary and quaternary structure (see fig D).
•• The primary structure of a protein is the sequence of amino acids that make up the polypeptide
chain, held together by peptide bonds. LEARNING TIP
Remember that fibrous proteins
•• The secondary structure of a protein is the arrangement of the polypeptide chain into a regular,
have a simpler structure and so
repeating three-dimensional (3D) structure, held together by hydrogen bonds. One example is tend to be more stable to
the right-handed helix (α-helix), a spiral coil with the peptide bonds forming the backbone and changes in temperature and pH.
the R groups protruding in all directions. Another is the ß-pleated sheet, in which the polypeptide
chain folds into regular pleats held together by hydrogen bonds between the amino and carboxyl
ends of the amino acids. Most fibrous proteins have this type of structure. Sometimes there is
no regular secondary structure and the polypeptide forms a random coil.
18 1A.5 PROTEINS CHEMISTRY FOR BIOLOGISTS
•• The tertiary structure is another level of 3D organisation in addition to the secondary structure
LEARNING TIP
in many proteins. The amino acid chain, including any α-helices and β-pleated sheets, is folded
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Remember that the primary further into complicated shapes. Hydrogen bonds, disulfide bonds and ionic bonds between the R
structure of proteins is the result
groups of nearby amino acids hold these 3D shapes in place (see page 17). Globular proteins are
of peptide bonds between
amino acids.
an example of tertiary structures.
The secondary structure is the •• The quaternary structure of a protein is only found in proteins consisting of two or more
result of hydrogen bonding polypeptide chains. The quaternary structure describes the way these separate polypeptide chains
between nearby amino acids fit together in three dimensions. Examples include some very important enzymes and the blood
but R groups do not affect it. pigment haemoglobin.
Ionic bonds, hydrogen bonds Changes in conditions such as temperature or pH affect the bonds that keep the 3D shapes of
and disulfide bridges are a result
proteins in place. Even small changes can cause the bonds to break, resulting in the loss of the 3D
of interactions between the
shape of the protein. This is called denaturation. Because the 3D structure of these proteins is
R groups and create the tertiary
structure. important to the way they work, changing conditions inside the body can cause proteins such as
enzymes to stop working properly.
Primary structure the linear sequence cysteine alan
ine lysine
of amino acids in a peptide. glycine
leucine
Collagen fibres combine with the bone tissue, giving it tensile strength, in the same way as the steel
rods in reinforced concrete. In the genetic disease osteogenesis imperfecta, the collagen triple helix
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does not develop properly. Consequently, the bone does not have as much tensile strength; it is brittle
and breaks very easily.
1
three 2
chains procollagen 3 4
assemble peptidase assembly assembly
67 nm
▲ fig F The complex quaternary structure of haemoglobin produces a globular protein containing four haem groups
which can carry oxygen to the tissues of the body.
20 1A.5 PROTEINS CHEMISTRY FOR BIOLOGISTS
CONJUGATED PROTEINS
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The shape of a protein molecule is usually very important in its function. Some protein molecules
are joined with (conjugated to) another molecule called a prosthetic group (see fig F). This
structural feature usually affects the performance and functions of the molecules. These molecules
are called conjugated proteins. Haemoglobin is a large protein with iron as the prosthetic group.
It is a conjugated protein as well as a globular protein. Lipoproteins are formed when proteins are
conjugated with lipids – you will find out more about these important biological molecules when you
look at factors affecting the health of your heart in Chapter 1B.
Glycoproteins are proteins with a carbohydrate prosthetic group. The carbohydrate part of the
molecule helps them to hold a lot of water and also makes it harder for protein-digesting enzymes
(proteases) to break them down. Lots of lubricants used by the human body – such as mucus and
the synovial fluid in the joints – are glycoproteins. Their water-holding properties make them slippery
and viscous, which reduces friction. This also helps to explain why the mucus produced in the
stomach protects the protein walls from digestion.
Lipoproteins are very important in the transport of cholesterol in the blood. The lipid part of the
molecule enables it to combine with the lipid cholesterol. There are two main forms of lipoproteins
in your blood – low-density lipoproteins (LDLs) (around 22 nm in diameter) and high-density
lipoproteins (HDLs) (approximately 8–11 nm in diameter). The HDLs contain more protein than
LDLs, which is partly why they are denser – proteins are more compact molecules than lipids. You
will discover the impact of different lipoproteins on the risk of developing cardiovascular diseases
in Section 1C.4.
EXAM HINT
Remember that amino acids are joined together by peptide bonds to make dipeptides and then
polypeptides. However, the 3D structures of proteins are the result of hydrogen bonds, disulfide bonds,
hydrophobic links and ionic bonds between amino acids within the polypeptide chains.
CHECKPOINT
1. Explain how the order of amino acids in a protein affects the structure of the whole protein.
SKILLS REASONING 2. Hydrogen bonds are weaker than disulfide bonds and ionic bonds, but they are more important in
maintaining protein structure. Why is this?
3. The body uses many resources to maintain a relatively constant internal environment. With reference
to proteins, explain why constant internal conditions are so important.
CHEMISTRY FOR BIOLOGISTS 1A.5 PROTEINS 21
SUBJECT VOCABULARY
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haemoglobin a red pigment that carries oxygen and gives the erythrocytes their colour
amino acids the building blocks of proteins consisting of an amino group (—NH2) and a carboxyl group
(—COOH) attached to a carbon atom and an R group that varies between amino acids
peptide bond the bond formed by condensation reactions between amino acids
dipeptide two amino acids joined by a peptide bond
polypeptide a long chain of amino acids joined by peptide bonds
disulfide bond a strong covalent bond produced by an oxidation reaction between sulfur groups in
cysteine or methionine molecules, which are close together in the structure of a polypeptide
fibrous proteins proteins that have long, parallel polypeptide chains with occasional cross-linkages that
produce fibres; they have little tertiary structure
denaturation the loss of the 3D shape of a protein (e.g. caused by changes in temperature or pH)
collagen a strong fibrous protein with a triple helix structure
globular proteins large proteins with complex tertiary and sometimes quaternary structures, folded into
spherical (globular) shapes
hydrophobic a substance that tends to repel water and that will not mix with or dissolve in water
hydrophilic a substance with an affinity for water that will readily dissolve in or mix with water
colloid a suspension of molecules that are not fully dissolved
prosthetic group the molecule incorporated in a conjugated protein
conjugated proteins protein molecules joined with or conjugated to another molecule called a
prosthetic group
lipoproteins conjugated proteins with a lipid prosthetic group
glycoproteins conjugated proteins with a carbohydrate prosthetic group
proteases protein-digesting enzymes
1A THINKING BIGGER
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DRY EYES?
Dry eyes is a condition that is caused by dry air and over-use of air conditioning. Both of these environmental factors are common
in Middle Eastern countries. Biological molecules have an amazing number of different roles in living organisms, including some you
would not expect. In this activity, you will discover how current research shows that the disaccharide trehalose can protect proteins from
damage in stressful conditions. This property is being used to make dry eyes more comfortable – and possibly protect the brain from the
damage that can result from ageing.
From: Luyckx J., Baudouin C. Trehalose: an intriguing disaccharide with potential for medical application in ophthalmology. Clinical ophthalmology
(Auckland, NZ) 5 (2011): 577
CHEMISTRY FOR BIOLOGISTS THINKING BIGGER 23
COMMUNICATION,
SCIENCE COMMUNICATION SKILLS CREATIVITY
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This extract comes from a paper published in Clinical Ophthalmology, an online journal. Think INTERPRETATION NOTE
about the type of writing being used and the audience it is intended for as you try and answer
Think about the level of
the following questions.
scientific detail that is suitable
1 (a) What aspects of this writing tell you it is more like a scientific paper than a general for your expected audience.
interest article in a magazine? How will you ensure your article
(b) Many words in this article may be unfamiliar. But words are often made up of familiar is eye-catching and interesting?
components. Break up the word anhydrobiosis and it becomes an-hydro-biosis (an =
non, hydro = water and biosis = life). So anhydrobiosis means life without water. Choose
two other unfamiliar words used in the article. Find out what they mean and suggest why
they have been used by the authors.
(c) How do you think these ideas about trehalose and the way it may be used to help
human health might be presented in a newspaper or on a news or science website? Have
a go at writing an article for a public interest website yourself.
(d) If trehalose can really help protect people’s sight and prevent brain diseases such as
Huntington’s and Alzheimer’s this would make a big difference to people’s lives. Notice how
careful the author is. Why are scientific papers so cautious in the way they report things?
fig B The desert plant Selaginella lepidophylla is a ‘resurrection’ plant – it can withstand almost complete dehydration
and recover within about 24 hours, thanks to high levels of trehalose in the plant cells.
1A EXAM PRACTICE
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1 Water is one of the most essential molecules for life. (e) Draw two water molecules showing the bonding between
(a) Which diagram most accurately represents a water molecule? the water molecules. [3]
H2 Hδ2 Hδ1 H1 (Total for Question 2 = 9 marks)
1
O δ2
O δ2
O 3 Carbohydrates
δ
O include monosaccharides, disaccharides and
polysaccharides.
A HΒ2 B Hδ2 C Hδ1 D H
1
(a) A disaccharide can be split by:
Hδ2 Hδ1 H1 A hydrolysis of glycosidic bonds
B condensation of glycosidic bonds
δ2
O δ
O
C hydrolysis of ester bonds
Hδ2 C Hδ1 D H1 [1] D condensation of ester bonds. [1]
(b) (i) Name the bond that occurs between two water (b) Amylose is an example of a:
molecules.[1] A monosaccharide
(ii) State the property of water that enables these
bonds to form. [1] B disaccharide
(iii) These intermolecular bonds give water a property C polysaccharide
called cohesion. Describe two ways in which D trisaccharide. [1]
cohesion is important to living things. [2]
(c) Complete this table to show the components and bonding
(c) Water has a high specific heat capacity. Assess how within each carbohydrate.
important this property is to living things. [2]
(d) Explain how a molecule of sodium chloride can dissolve Lactose Amylose Glycogen
in water. [3] Component
(Total for Question 1 = 10 marks) monosaccharides
Bonds between
2 Water is a good solvent. monosaccharides [6]
(a) Which of the following particles will not dissolve in water? (Total for Question 3 = 8 marks)
A Na+ ion
B oxygen molecule 4 Disaccharides and polysaccharides consist of
monosaccharides joined together.
C maltose molecule
D starch molecule [1] (a) Name the bond holding the monosaccharides together.
A ionic
(b) Mosquito larvae live in water. They appear to be attached
to the surface of the water. Which property of water B ester
enables the larvae to do this? C glycosidic
A Water is most dense at 4 °C D hydrogen [1]
B Hydrogen bonds hold the water molecules together (b) What is the function of starch molecules?
C Water is a polar molecule A provide a source of energy for plants
D Water cannot be compressed [1] B store energy in all living organisms
(c) Words written in water-based ink will smudge when C store energy in plants
water is spilled on the paper. Words written in ballpoint D store energy in animals [1]
pen are not affected.
(c) A disaccharide can be hydrolysed to its two
Explain this using your knowledge of the properties monosaccharides. Explain the term hydrolysis. [2]
of water. [2]
(d) State the role of glycogen molecules and explain why they
(d) It is better to use a pencil for writing if the paper may are well suited to the role. [5]
get wet. Use your knowledge of solvents to justify
this statement. [2] (Total for Question 4 = 9 marks)
CHEMISTRY FOR BIOLOGISTS EXAM PRACTICE 25
5 (a) Which is the best description of an amino acid? 6 (a) Complete the table below describing the different levels
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A contains the elements carbon, hydrogen and oxygen of protein structure (primary, secondary, tertiary, or
B an amino group at one end and a carboxyl group at the quaternary structure). [4]
other end Level of protein structure
C a small molecule containing peptide bonds Description (primary, secondary,
D an amino group with an R group attached [1] tertiary, or quaternary)
Hydrophobic amino acids such
(b) Proteins are polymers of amino acids joined by peptide as proline are not found on the
bonds formed between the: surface of protein molecule
A R groups The molecule contains three
B R group and the amino group polypeptide chains
C R group and the carboxyl group The protein molecule contains
D carboxyl group and the amino group. [1] short helical sections separated
by pleated sheets
(c) Collagen and haemoglobin are both proteins that have 40% of the amino acids in the
a primary structure consisting of amino acids joined molecule are glutamine
together by peptide bonds.
(b) Amino acids contain a residual or R group.
(i) Explain what is meant by the term primary structure
Describe how the R group can affect the structure
of a protein. [1]
of a protein. [4]
(ii) Name the type of reaction that occurs when a peptide
bond is broken causing a dipeptide to split into two (c) Explain, using examples, why globular proteins are
amino acids. [1] more metabolically active than fibrous proteins. [4]
(d) Collagen contains the amino acids glycine and serine. The (Total for Question 6 = 12 marks)
diagram below shows a dipeptide formed from these two
amino acids.
H O
N C C N C C
H OH
CH2
OH
H H O
N C C 1
H H OH
Glycine Serine
TRANSPORT AND
HEALTH
MAMMALIAN
1B TRANSPORT SYSTEMS
CHAPTER
If a car breaks down, mechanics can replace worn-out parts, put in new oil and transmission fluid, or change
perished or worn-out pipes. We do not expect doctors to be able to do the same for our bodies. But they can
do a lot to replace or repair the various parts of the circulatory system. The heart can have new valves, new
blood vessels to supply the muscle and can even be replaced in a transplant. The blood vessels can be opened
up, unblocked or replaced with grafts from other healthy areas of the body. Blood can be replaced by
transfusions, and the bone marrow that makes the blood cells can be replaced by transplants. Doctors have
even developed techniques by which they can operate on the circulatory system of a fetus in the uterus, to
give blood transfusions or repair some heart conditions long before birth.
In this chapter, you will be looking at mammalian transport systems. This involves studying the general
principles of circulatory systems and why larger organisms need a complex circulatory system. You will learn
about the details of the human blood, blood vessels and heart.
You will consider how blood fluid and blood cells help to transport gases and other substances in the blood
and how haemoglobin – the pigment which carries oxygen – attracts oxygen and then releases it when and
where it is needed. You will discover the way that the blood vessels are well adapted to their roles in different
parts of the circulatory system and what can go wrong if they are not healthy. Finally, you will learn about the
heart as a complex organ with a well-coordinated cycle of contraction.
•• The surface area in contact with the outside environment is very Volume 13 5 1 mm3 23 5 8 mm3 43 5 64 mm3
large when compared to the volume of the inside of the organism. Surface area 6:1 3:1 3:2
Its surface area to volume ratio (sa : vol) is large, so there is to volume ratio
a relatively big surface area over which substances can diffuse into
or out of the organism (see figs A and B).
•• The metabolic demands are low – the organisms do not regulate
their own temperature and the cells do not use much oxygen and
food or produce much carbon dioxide. radius 0.5 µm 1 µm 2 µm
Single-celled organisms and very small multicellular organisms do Surface area
not need specialised transport systems because diffusion is enough to 3.14 µm2 12.57 µm2 50.27 µm2
4p r 2
supply their needs.
Volume
4
3p r
3
0.52 µm3 4.19 µm3 33.51 µm3
Surface area 6:1 3:1 3:2
to volume ratio
LEARNING TIP
Remember that small organisms have a small surface area. But this
surface area is large compared to the volume inside the organism, so
▲ fig A The surface area : volume ratio of this tiny jellyfish larva is relatively it has a large surface area to volume ratio.
large so simple diffusion can supply all its needs.
MAMMALIAN TRANSPORT SYSTEMS 1B.1 THE PRINCIPLES OF CIRCULATION 29
THE NEED FOR TRANSPORT IN MULTICELLULAR system with the blood contained within tubes. The blood makes a
continuous journey out to the most distant parts of the body and
ANIMALS
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not damage the vessels and allows gas exchange to take place. If
this oxygenated blood at low pressure went straight into the big CHECKPOINT
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vessels that carry it around the body, it would move very slowly.
However, the oxygenated blood returns to the heart, so it can be SKILLS ADAPTIVE LEARNING
pumped hard and sent around the body at high pressure. This 1. Explain why large animals cannot take in all the substances they
means it reaches all the tiny capillaries between the body cells need from outside the body through their skin.
quickly, supplying oxygen for an active way of life. 2. What are the main characteristics of a mass transport system?
veins returning capillary beds in tissue 3. In fish, blood is supplied to the body tissues at low pressure.
to the heart Why is low pressure sufficient in organisms such as fish?
4. Explain why a double circulation is ideal for an active animal
that maintains its own body temperature independently of
the environment.
pulmonary arteries
artery carrying to head
blood to the lungs
arteries to the SUBJECT VOCABULARY
pulmonary lungs upper body
circulation and head diffusion the movement of the particles in a liquid or a gas down a
concentration gradient from an area where they are at a relatively
high concentration to an area where they are at a relatively low
concentration
concentration gradient the change in the concentration of solutes
pulmonary vein carrying present in a solution between two regions; in biology, this typically
blood back to the heart means across a cell membrane
surface area to volume ratio (sa : vol) the relationship between the
surface area of an organism and its volume
vertebrates animals with a backbone or spinal column; they include
mammals, birds, reptiles, amphibians and fish
systemic
circulation mass transport system an arrangement of structures by which
substances are transported in the flow of a fluid with a mechanism for
aorta – the moving it around the body
heart – the pump major artery single circulation system a circulation in which the heart pumps the
which forces blood leaving blood to the organs of gas exchange and the blood then travels on
around the body the heart arteries around the body before returning to the heart
to the double circulation system a circulation that involves two separate
body circuits, one of deoxygenated blood flowing from the heart to the gas
exchange organs to be oxygenated before returning to the heart, and
deoxygenated blood one of oxygenated blood leaving the heart and flowing around the
capillary beds in tissue body, returning as deoxygenated blood to the heart
oxygenated blood
systemic circulation carries oxygenated blood from the heart
▲ fig D A double circulation sends blood at high pressure, carrying lots to the cells of the body where the oxygen is used, and carries the
of oxygen, to the active cells of the body. Take note: this is a schematic deoxygenated blood back to the heart
diagram. In a real double circulation, all of the blood vessels enter and
oxygenated blood blood that is carrying oxygen
leave from the top of the heart.
deoxygenated blood blood that has given up its oxygen to the cells
EXAM HINT in the body
When you write about mass transport systems, make it clear that they pulmonary circulation carries deoxygenated blood to the lungs and
are needed to overcome the limits of diffusion in organisms with a oxygenated blood back to the heart
small surface area : volume ratio.
SPECIFICATION
REFERENCE
LEARNING OBJECTIVES
◼◼ Understand the role of haemoglobin in the transport of oxygen and carbon dioxide.
◼◼ Understand the oxygen dissociation curve of haemoglobin, the Bohr effect and the significance of the oxygen affinity
of fetal haemoglobin compared with adult haemoglobin.
◼◼ Understand the blood clotting process.
red blood
The erythrocytes transport oxygen from the lungs to all the cells.
cell They are well adapted for their function. The biconcave disc
platelet shape of the cells means that they have a large surface area to
white volume ratio, so oxygen can diffuse into and out of them rapidly
blood (see fig B). Having no nucleus leaves much more space inside the
cell
cells for the haemoglobin molecules that carry the oxygen. In fact,
each red blood cell contains around 250–300 million molecules of
haemoglobin and can carry approximately 1000 million molecules
▲ fig A This light micrograph shows red blood cells, white blood cells of oxygen. Haemoglobin also carries some of the carbon dioxide
and platelets. produced in respiration back to the lungs. The rest is transported
in the plasma.
32 1B.2 THE ROLES OF THE BLOOD MAMMALIAN TRANSPORT SYSTEMS
The oxygen levels are relatively low in the body tissues. The
concentration of oxygen in the cytoplasm of the red blood
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In the lungs, the carbon dioxide concentration is low, so carbonic anhydrase catalyses the reverse
reaction and free carbon dioxide diffuses out of the blood and into the lungs (see fig D).
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HHb H+ HCO3–
Hydrogencarbonate ions pass
Hb out of the red blood cells by
Haemoglobin acts as a buffer, Cl–
diffusion, and chloride ions move
accepting the hydrogen ions to erythrocyte
in. This is called the chloride shift.
form haemoglobinic acid to avoid
changing the pH of the blood.
plasma
plasma
▲ fig D The transport of carbon dioxide from the tissues to the lungs depends on the reaction of carbon dioxide with
water, controlled by an enzyme in the red blood cells.
100
90
LEARNING TIP
Saturation with oxygen/%
A
80 B
70 C Remember that as CO2 builds
up it affects the pH and this has
60
an effect on the protein
50
structure, so haemoglobin does
40 A 5 2.7 kPa CO2 not work as well (i.e. it has a
30 lower affinity for oxygen).
B 5 6.7 kPa CO2
20
10 C 5 10.6 kPa CO2
0
0 2 4 6 8 10 12
Partial pressure of oxygen/kPa
▲ fig E As the proportion of carbon dioxide in the environment rises, the haemoglobin curve moves down and to
the right, so it gives up oxygen more easily. This is known as the Bohr effect.
FETAL HAEMOGLOBIN
A fetus in the uterus depends on its mother to supply it with oxygen. Oxygenated blood from the
mother flows through the placenta close to the deoxygenated fetal blood. If the blood of the fetus
had the same affinity for oxygen as the blood of the mother, very little oxygen would be transferred.
Fortunately, the blood of the fetus contains a special form of the oxygen-carrying pigment called
fetal haemoglobin. Fetal haemoglobin has a higher affinity for oxygen than the adult haemoglobin
of the mother. Consequently, the fetal haemoglobin can remove oxygen from the maternal blood even
when the proportion of oxygen is relatively low (see fig F). The maternal and fetal blood also run in
34 1B.2 THE ROLES OF THE BLOOD MAMMALIAN TRANSPORT SYSTEMS
opposite directions. This makes the oxygen concentration gradient between the mother’s blood and
that of her fetus as steep as possible, maximising the oxygen transfer to the blood of the fetus.
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100
90 B
You have a limited volume of blood. In theory, a minor cut could endanger life as the torn blood vessels
allow blood to escape. First, your blood volume will reduce and if you lose too much blood, you will
die. Second, pathogens can get into your body through an open wound. In normal circumstances, your
body protects you through the clotting mechanism of the blood. This mechanism seals damaged blood
vessels to minimise blood loss and prevent pathogens getting in.
FORMING A CLOT
Plasma, blood cells and platelets flow from a cut vessel. Contact between the platelets and
components of the tissue (e.g. collagen fibres in the skin) causes the platelets to break open in
large numbers. They release several substances, two of which are particularly important.
•• Serotonin causes the smooth muscle of the blood vessel to contract. This narrows the blood
vessels, cutting off the blood flow to the damaged area.
•• Thromboplastin is an enzyme that starts a sequence of chemical changes that clot the blood
(see fig H).
damaged tissues
release
platelets
release
Ca2+ thromboplastin
prothrombin
catalyses
thrombin
catalyses
forms
fibrinogen fibrin clot
▲ fig H The cascade of events that results in a life-saving or life-threatening clot. When you cut yourself, this is the
process which seals the blood vessels and protects the delicate new tissues that form underneath.
3 More platelets and red blood cells pouring from the wound get trapped in the fibrin mesh.
This forms a clot.
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4 Special proteins in the structure of the platelets contract, making the clot tighter and tougher to
form a scab that protects the skin and vessels underneath as they heal.
In a sequence such as clot formation, a small event is amplified through a series of steps. However,
sometimes the body’s clotting mechanism is started in the wrong place, and this can lead to serious
problems in the blood vessels. A clot in the vessels that supply your heart muscle with blood can cause
a heart attack and a clot in the brain can cause a stroke (see Section 1B.5).
CHECKPOINT
SKILLS CRITICAL THINKING 1. Red blood cells are unusual because they do not have a nucleus. Explain how this is an adaptation for
their role in carrying oxygen, and why they have a limited life.
2. Describe how oxygen is transported in the blood.
3. Explain why fetal haemoglobin needs to have a higher affinity for oxygen than adult haemoglobin.
4. Prothrombin and fibrinogen are both precursors. Discuss the similarities and differences between
these two proteins.
5. There is a rare condition in babies that causes excessive internal bleeding, which can cause brain
damage and even death. Newborn babies in most countries in the world are routinely given vitamin K
either by injection or orally. Suggest how these two facts might be linked.
SUBJECT VOCABULARY
cardiovascular system the mass transport system of the body made up of a series of vessels with a pump
(the heart) to move blood through the vessels
circulation the passage of blood through the blood vessels
active transport the movement of substances into or out of the cell using ATP produced during cellular
respiration
buffer a solution which resists changes in pH
leucocytes white blood cells; there are several different types which play important roles in defending the
body against the entry of pathogens and in the immune system
platelets cell fragments involved in the clotting mechanism of the blood
megakaryocytes large cells that are found in the bone marrow and produce platelets
oxyhaemoglobin the molecule formed when oxygen binds to haemoglobin
carbaminohaemoglobin the molecule formed when carbon dioxide combines with haemoglobin
carbonic anhydrase the enzyme that controls the rate of the reaction between carbon dioxide and water
to produce carbonic acid
Bohr effect the name given to changes in the oxygen dissociation curve of haemoglobin that occur due to
a rise in carbon dioxide levels and a reduction of the affinity of haemoglobin for oxygen
fetal haemoglobin a form of haemoglobin found only in the developing fetus with a higher affinity for
oxygen than adult haemoglobin
serotonin a chemical that causes the smooth muscle of the blood vessels to contract, narrowing them and
cutting off the blood flow to the damaged area
thromboplastin an enzyme that sets in progress a cascade of events that leads to the formation of a blood
clot
prothrombin a large, soluble protein found in the plasma that is the precursor to an enzyme called
thrombin
thrombin an enzyme that acts on fibrinogen, converting it to fibrin during clot formation
precursor a biologically inactive molecule which can be converted into a closely related biologically active
molecule when needed
fibrinogen a soluble plasma protein which is the precursor of the insoluble protein fibrin
fibrin an insoluble protein formed from fibrinogen by the action of thrombin that forms a mesh of fibres
that trap erythrocytes and platelets to form a blood clot
3 CIRCULATION IN THE SPECIFICATION
REFERENCE
1B BLOOD VESSELS
1.7
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LEARNING OBJECTIVES
◼◼ Understand how the structures of blood vessels (arteries, veins and capillaries) relate to their functions.
ARTERIES
Arteries carry blood away from your heart towards the cells of your body. The structure of an artery
is shown in fig A. Almost all arteries carry oxygenated blood. The exceptions are:
•• the pulmonary artery – carrying deoxygenated blood from the heart to the lungs LEARNING TIP
•• the umbilical artery – during pregnancy, this carries deoxygenated blood from the fetus to Remember that all arteries carry
the placenta. blood away from the heart, so
they have thick walls and lots of
The arteries leaving the heart branch off in every direction, and the diameter of the lumen, the collagen to withstand the high
central space inside the blood vessel, gets smaller the further away it is from the heart. The very pressure.
smallest branches of the arterial system, furthest from the heart, are the arterioles.
external layer
of tough tissue tough outer
The middle layers of layer
the artery wall contain
elastic fibres and smooth
muscle; arteries nearest endothelium
the heart have more elastic
fibres, those further from
the heart have a greater
proportion of muscle tissue.
Blood is pumped out from the heart in a regular rhythm, about 70 times a minute. Each heartbeat EXAM HINT
sends a high-pressure flow of blood into the arteries. The major arteries close to the heart must You will study the structure and
withstand these pressure surges. Their walls contain a lot of elastic fibres, so they can stretch to the function of the types of
accommodate the greater volume of blood without being damaged (see fig B). Between surges, the blood vessel separately.
However, you should
elastic fibres return to their original length, squeezing the blood to move it along in a continuous flow.
remember that the vessels do
The pulse you can feel in an artery is the effect of the surge each time the heart beats. The blood
not exist separately – they are
pressure in all arteries is relatively high, but it falls in arteries further away from the heart. These are all interlinked within the whole
known as the peripheral arteries. circulatory system.
38 1B.3 CIRCULATION IN THE BLOOD VESSELS MAMMALIAN TRANSPORT SYSTEMS
can diffuse between cells and the blood quickly. Also, because
EXAM HINT
the diameter of each individual capillary is small, the blood
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The role of the elastic fibres in artery walls is to return to their original travels relatively slowly through them, giving more opportunity for
length to help maintain the pressure. This is called recoil. The elastic
diffusion to occur (see fig C). The smallest capillary is no wider
recoil does not help to increase pressure, it simply helps to maintain the
pressure – so do not suggest that the recoil helps pump blood along.
than a single red blood cell.
In the peripheral arteries, the muscle fibres in the vessel walls Capillaries have a very simple structure which is well adapted
contract or relax to change the size of the lumen, controlling the to their function. Their walls are very thin and contain no elastic
blood flow. The smaller the lumen, the harder it is for blood to fibres, smooth muscle or collagen. This helps them fit between
flow through the vessel. This controls the amount of blood that individual cells and allows rapid diffusion of substances between
flows into an organ, so regulating its activity. You will find out the blood and the cells. The walls consist of just one very thin cell.
more about this important response in Book 2 Topic 7. Oxygen and other molecules, such as digested food molecules
and hormones, quickly diffuse out of the blood in the capillaries
aorta into the nearby body cells, and carbon dioxide and other waste
molecules diffuse into the capillaries. Blood entering the capillary
elastic fibres network from the arteries is oxygenated. When it leaves, it carries
less oxygen and more carbon dioxide.
2.5 cm smooth muscle
waste material oxygen and
collagen fibres e.g. carbon dioxide food molecules
medium-sized artery
elastic fibres
arteriole
elastic fibres
smooth muscle
30 μm
collagen fibres ▲ fig C The very thin walls of capillaries allow rapid diffusion of oxygen,
carbon dioxide and digested food molecules. The lumen is just wide
enough for red blood cells to pass through.
▲ fig B The relative proportions of different tissues in different arteries.
Collagen gives general strength and flexibility to both arteries and veins. VEINS
Veins carry blood back towards the heart. Most veins carry
LEARNING TIP deoxygenated blood. The exceptions are:
The role of the muscles in the wall of the arterioles is to reduce the size
•• the pulmonary vein – carrying oxygen-rich blood from the
of the lumen to increase resistance – this can reduce blood flow to
lungs back to the heart for circulation around the body
areas that do not need so much blood and will cause the oxygenated
blood to flow to other tissues. Remember to link this to things you •• the umbilical vein – during pregnancy, it carries oxygenated
may learn later such as how blood flow to the skin changes when you blood from the placenta into the fetus.
are too hot or too cold. Tiny venules lead from the capillary network, combining into
larger and larger vessels going back to the heart (see fig D).
CAPILLARIES
Arterioles lead into networks of capillaries. These are very small LEARNING TIP
vessels that spread throughout the tissues of the body. The Remember that all veins carry blood back to the heart so they have
capillary network links the arterioles and the venules. Capillaries low pressure and do not need a thick wall.
branch between cells – no cell is far from a capillary, so substances
MAMMALIAN TRANSPORT SYSTEMS 1B.3 CIRCULATION IN THE BLOOD VESSELS 39
vein semilunar
valve shut
muscle
relaxed
artery
CHECKPOINT
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SUBJECT VOCABULARY
arteries vessels that carry blood away from the heart
veins vessels that carry blood towards the heart
capillaries tiny vessels that spread throughout the tissues of the body
lumen the central space inside the blood vessel
arterial system the system of arteries in the body
arterioles the very smallest branches of the arterial system, furthest from the heart
peripheral arteries arteries further away from the heart but before the arterioles
venules the very smallest branches of the venous system, furthest from the heart
inferior vena cava the large vein that carries the returning blood from the lower parts of the body to
the heart
superior vena cava the large vein that carries the returning blood from the upper parts of the body to
the heart
venous system the system of veins in the body
semilunar valves half-moon shaped, one-way valves found at frequent intervals in veins to prevent the
backflow of blood
SPECIFICATION
REFERENCE
LEARNING OBJECTIVES
◼◼ Relate the structure and operation of the mammalian heart, including the major blood vessels, to its function.
◼◼ Know the cardiac cycle.
In most animal transport systems, the heart is the organ that moves the blood around the body. In
mammals, the heart is a complex, four-chambered muscular organ that sits in the chest protected by
the ribs and sternum. In an average lifetime, the heart beats about 3 000 000 000 (3 × 109) times and
will pump over 200 million litres of blood – quite a workload.
left pulmonary
superior vena cava vein (from left
lung)
semilunar valve
semilunar valve
bicuspid valve
right atrium
tendinous cords
tricuspid valve
thick cardiac
inferior vena cava muscle of left
ventricle
aorta ▲ fig B The coronary arteries,
which you can clearly see here,
thinner cardiac muscle carry oxygenated blood from
apex of heart
of right ventricle septum the aorta to the heart muscle,
providing it with oxygen and
▲ fig A The structure of the human heart digested food and removing
carbon dioxide.
42 1B.4 THE MAMMALIAN HEART MAMMALIAN TRANSPORT SYSTEMS
THE ACTION OF THE HEART which are relatively close to the heart. The delicate capillaries
of the lungs need blood delivered at relatively low pressure. The
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EXAM HINT left side must produce sufficient force to move the blood under
When describing the action of the heart, remember that blood flows pressure to all the extremities of the body and overcome the
through both sides at the same time. Make it clear that both atria elastic recoil of the arteries. Semilunar valves prevent the blood
pump at the same time and both ventricles pump at the same time. flowing back from the aorta into the ventricle.
1 The inferior vena cava collects deoxygenated blood from the
lower parts of the body, while the superior vena cava receives LEARNING TIP
deoxygenated blood from the head, neck, arms and chest. Remember that the valves do not operate on their own. They open
Deoxygenated blood is delivered to the right atrium. and close as blood pressure changes in the chambers on either side
of the valve. When the pressure is higher on one side it will push the
2 The right atrium receives the blood from the great veins. As it valve open. When it is higher on the other side, it will close the valve.
fills with blood, the pressure builds up and opens the tricuspid
valve, so the right ventricle starts to fill with blood too. The septum is a thick wall of muscle and connective tissue
When the atrium is full it contracts, forcing more blood into between the two sides of the heart. It prevents the oxygenated
the ventricle. The atrium has thin muscular walls because it blood mixing with the deoxygenated blood.
receives blood at low pressure from the inferior vena cava
and the superior vena cava and it needs to exert relatively DID YOU KNOW?
little pressure to move the blood into the ventricle. One- In an embryo, there is a gap in the septum called the foramen
way semilunar valves (like the valves in veins described in ovale and the blood from the two sides of the heart can mix. This
Section 1B.3) at the entrance to the atrium stop a backflow of does not matter because the lungs of the fetus do not function
blood into the veins. and little blood flows to them. At birth, this hole closes over as
3 The tricuspid valve consists of three flaps and is also the lungs begin to function. If it does not, the baby has a condition
known as an atrioventricular valve because it separates an called patent foramen ovale or ‘hole in the heart’. This may be
atrium from a ventricle. The valve allows blood to pass from so small it does not really matter. If it is large, it must be closed
the atrium to the ventricle, but not in the other direction. The by surgery.
tough tendinous cords, also known as valve tendons or
heartstrings, make sure the valves are not turned inside out by
the pressure exerted when the ventricles contract. DID YOU KNOW?
4 The right ventricle is filled with blood under some pressure
Inside the heart
The diagrams we use of the inside of a mammalian heart make it
when the right atrium contracts, then the ventricle contracts.
look very clean and simple (see fig A). But when you dissect the
Its muscular walls produce the pressure needed to force blood
heart of a mammal such as a sheep or a cow, you can see that
out of the heart into the pulmonary arteries. These carry
it is much more complicated. Cutting open a heart and exploring
the deoxygenated blood to the capillaries in the lungs. As the
the connections between the blood vessels and the chambers
ventricle starts to contract, the tricuspid valve closes to prevent
of the heart, and seeing the structure of the valves, helps you
blood flowing into the atrium. Semilunar valves, like those in
understand how it works as a three-dimensional pump (see fig C).
veins, prevent the blood flowing back from the arteries into
the ventricle.
5 The blood returns from the lungs to the left side of the heart in
the pulmonary veins. The blood is at relatively low pressure
after passing through the extensive capillaries of the lungs. The
blood returns to the left atrium, another thin-walled chamber
that performs the same function as the right atrium. It contracts
to force blood into the left ventricle. Backflow is prevented
by another atrioventricular valve known as the bicuspid
valve, which has only two flaps.
6 As the left atrium contracts, the bicuspid valve opens and the
left ventricle is filled with blood under pressure. As the left
ventricle starts to contract the bicuspid valve closes to prevent
backflow of blood to the left atrium. The left ventricle pumps
the blood out of the heart and into the aorta, the major artery
of the body. This carries blood away from the heart at even
higher pressure than the major arteries that branch off from it.
The muscular wall of the left side of the heart is much thicker ▲ fig C A dissected mammalian heart
than that of the right. The right side pumps blood to the lungs,
MAMMALIAN TRANSPORT SYSTEMS 1B.4 THE MAMMALIAN HEART 43
The beating of your heart produces the sounds that are your
1. Describe the path of blood around the human body, identifying at
heartbeat. The sounds are not made by the contracting of the which points the blood is oxygenated and where it is
heart muscle but by the heart valves closing. The two sounds deoxygenated. Explain how this system efficiently supplies cells
of a heartbeat are often described as ‘lub-dub’. The first sound with the oxygen they need.
(‘lub’) comes when the ventricles contract and the blood is forced
against the atrioventricular valves. The second sound (‘dub’) 2. Discuss the relationship between structure and function for these
comes when the ventricles relax and a backflow of blood hits the parts of the heart:
semilunar valves in the pulmonary artery and aorta. The rate of (a) semilunar valves
your heartbeat shows how frequently your heart is contracting. (b) atria
(c) ventricles including the thickness of the muscle walls
THE CARDIAC CYCLE
(d) tendinous cords.
Your heart is continuously contracting then relaxing. The
contraction of the heart is called systole. Systole can be divided
into atrial systole, when the atria contract together forcing SUBJECT VOCABULARY
blood into the ventricles, and ventricular systole, when the
ventricles contract. Ventricular systole happens about 0.13 septum the thick muscular dividing wall through the centre of the
heart that prevents oxygenated and deoxygenated blood from mixing
seconds after atrial systole, and forces blood out of the ventricles
cardiac muscle the special muscle tissue of the heart, which has an
into the pulmonary artery and the aorta. Between contractions the
intrinsic rhythm and does not fatigue
heart relaxes and fills with blood. This relaxation stage is called
myoglobin a respiratory pigment with a stronger affinity for oxygen
diastole. One cycle of systole and diastole makes up a single than haemoglobin.
heartbeat, which lasts about 0.8 seconds in humans. This is known right atrium the upper right-hand chamber of the heart that receives
as the cardiac cycle (see fig D). You will learn more about how deoxygenated blood from the body
the rate of the heartbeat is controlled in Book 2 Topic 7. right ventricle the lower chamber that receives deoxygenated blood
from the right atrium and pumps it to the lungs
tricuspid valve (atrioventricular valve) the valve between the right
semilunar valves atrium and the right ventricle that prevents backflow of blood from
closed the ventricle to the atrium when the ventricle contracts
tendinous cords (valve tendons, heartstrings) cord-like tendons
thatmake sure the valves are not turned inside out by the large
pressure exerted when the ventricles contract
pulmonary arteries the blood vessels that carry deoxygenated
atrioventricular blood from the heart to the lungs
valves open
pulmonary veins the blood vessels that carry oxygenated blood
back from the lungs to the heart
Diastole – the
left atrium the upper left-hand chamber of the heart that receives
heart is relaxed
and fills with blood.
oxygenated blood from the lungs
left ventricle the chamber that receives oxygenated blood from the
left atrium and pumps it around the body
semilunar
bicuspid valve (atrioventricular valve) the valve between the left
valves atrium and the left ventricle that prevents backflow of blood into the
open atrium when the ventricle contracts
aorta the main artery of the body; it leaves the left ventricle of the
heart carrying oxygenated blood under high pressure
systole the contraction of the heart
atrioventricular atrial systole when the atria of the heart contract
valves closed ventricular systole when the ventricles of the heart contract
Systole – the heart (atria diastole when the heart relaxes and fills with blood
followed by ventricles) cardiac cycle the cycle of contraction (systole) and relaxation
contracts and forces (diastole) in the heart
blood out to the lungs
and around the body.
▲ fig D The cardiac cycle
SPECIFICATION
REFERENCE
LEARNING OBJECTIVES
◼◼ Understand the course of events that lead to atherosclerosis.
CARDIOVASCULAR DISEASES
Problems with the
cardiovascular cardiovascular system have serious consequences. Globally, almost 18 million
diseases
people die from cardiovascular diseases each year. World Health Organization (WHO) data from
communicable (infectious)
2017 show that cardiovascular diseases were responsible for 31% of all global deaths – it is the
diseases, childbirth and
31% single biggest cause of death and disability (see fig A). What is more, around a third of these deaths
33% nutritional conditions
were in people younger than 70.
injuries
Many cardiovascular diseases are linked to a condition called atherosclerosis.
all other causes
9% 27% ATHEROSCLEROSIS
Atherosclerosis, a hardening of the arteries, is a disease in which plaques (made of a yellowish fatty
substance) build up on the inside of arteries. It can begin in late childhood and continues throughout
cardiovascular diseases life. A plaque can continue to develop until it restricts the flow of blood through the artery or even
communicable (infectious) blocks it completely. Plaques are most likely to form in the arteries of the heart (coronary arteries)
diseases, childbirth and and neck (carotid arteries). The typical development of a plaque is summarised in fig B.
nutritional conditions
artery walls
injuries
LEARNING TIP
Remember that damage to the
endothelium occurs first and
this is often caused by high
blood pressure, often as a result
of smoking. The fatty deposits grow to form an atheroma.
EXAM HINT
Learn the stages of the
development of atherosclerosis:
damage to the endothelium of
the arteries → inflammatory
response → accumulation of Fibrous tissue and calcium salts build up around
the atheroma forming a hardened plaque which
cholesterol → atheroma →
narrows the artery and makes the walls rigid.
fibrous tissue/calcium salts →
plaque → narrowing/loss of ▲ fig B The development of atherosclerosis
elasticity of the artery. We can now look at this development in more detail. Atherosclerosis begins with damage to the
endothelial lining of blood vessels. This damage can be caused by several factors, including high
blood pressure and substances in tobacco smoke. Atherosclerosis usually occurs in arteries rather
than in veins. This is because the blood in the arteries flows fast under relatively high pressure, which
puts more strain on the endothelial lining of the vessels and can cause small areas of damage. In the
veins, the pressure is lower so damage to the endothelium is much less likely.
MAMMALIAN TRANSPORT SYSTEMS 1B.5 ATHEROSCLEROSIS 45
Once damage to the endothelium has occurred, the body’s inflammatory response begins and
white blood cells arrive at the site of the damage. These cells accumulate chemicals from the
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blood, especially cholesterol. This leads to a plaque (also known as an atheroma) forming on the
endothelial lining of the artery (see fig C). Fibrous tissue and calcium salts also build up (increase
in amount) around the atheroma, turning it into a hardened plaque. This hardened area means that
part of the artery wall is less elastic and narrower than it should be. This is atherosclerosis and is
summarised in fig B.
The plaque causes the lumen of the artery to become much smaller. This increases the blood
pressure, making it harder for the heart to pump blood around the body. The raised blood pressure
makes damage more likely in other areas of the endothelial lining and more plaques will form.
This will make the blood pressure even higher, and so the problem gets worse. There are many
factors that are linked to the development of atherosclerosis. You will look at these in more detail
in Chapter 1C. ▲ fig C Fatty deposits like these
in an artery cause disease and
EFFECT OF ATHEROSCLEROSIS ON HEALTH death in millions of people
every year.
Atherosclerosis can have many serious effects on the health of an individual. The development
of atherosclerosis can be summarised as: damage to the endothelium of the arteries → inflammatory
response → accumulation of cholesterol → atheroma → fibrous tissue/calcium salts → plaque →
narrowing/loss of elasticity of the artery.
ANEURYSMS
If an area of an artery is narrowed by plaque, blood tends to collect behind the blockage. The artery
bulges and the wall is put under more pressure than usual, so it becomes weakened. This is known EXAM HINT
as an aneurysm. The weakened artery wall may split open, leading to massive internal bleeding.
Make sure you are clear about
Aneurysms frequently happen in the blood vessels supplying the brain or in the aorta, especially when
all of the different terms.
it passes through the abdomen. The massive blood loss and drop in blood pressure are often fatal, but Atherosclerosis can cause
if aneurysms are diagnosed they can be treated by surgery before they burst. aneurysms, angina and
myocardial infarctions.
RAISED BLOOD PRESSURE
The arteries narrowed due to plaques on the walls cause raised blood pressure. This can lead to
severe damage in a number of organs, including the kidneys, the eyes and the brain. The high
pressure damages the tiny blood vessels where your kidney filters out urea and other substances from
the blood. If the vessels feeding the kidney tubules become narrowed, the pressure inside them gets
even higher and proteins may be forced out through their walls. If you have high blood pressure, your
doctors can test for protein in your urine as a sign of kidney damage.
Similarly, the tiny blood vessels supplying the retina of your eye are easily damaged. If they become
blocked or leak, the retinal cells are starved of oxygen and die and this can cause blindness.
Bleeding from the capillaries into the brain results in one type of stroke (see below).
HEART DISEASE
There are many kinds of heart disease, but the two most common ones are angina and myocardial
infarction (heart attack); both are closely linked to atherosclerosis (see figs B and D).
In angina, plaques build up slowly in the coronary arteries, reducing blood flow to the parts of the
heart muscle beyond the plaques. Often symptoms are first noticed during exercise, when the cardiac
muscle is working harder and needs more oxygen. The narrowed coronary arteries cannot supply
enough oxygenated blood and the heart muscle resorts to anaerobic respiration. This causes a
gripping pain in the chest that can extend into the arms, particularly the left one, and the jaw, and
often also causes breathlessness. The symptoms of angina subside once exercise stops, but the
experience is painful and frightening.
Fortunately, most angina is relatively mild. It can be helped by taking regular exercise, losing weight
and not smoking. The symptoms can be treated by drugs that cause rapid dilation of the coronary
blood vessels so that they supply the cardiac muscle with the oxygen it needs. However, if the
blockage of the coronary arteries continues to get worse, so will the symptoms of the angina. Other
drugs are then used to dilate the blood vessels and reduce the heart rate. Unfortunately, drugs cannot
46 1B.5 ATHEROSCLEROSIS MAMMALIAN TRANSPORT SYSTEMS
▲ fig D Injecting the blood vessels with special dye allows doctors to see
where the coronary arteries are narrowing due to atherosclerosis so they medium heart attack – death
small heart attack – death
can treat the problem. of some heart tissue if
of small amount of heart blockage is at B
tissue if blockage is at A
EXAM HINT
▲ fig E The size and severity of a heart attack is closely related to the
Be clear that angina and myocardial infarction are caused by reduced position of the blockage in the coronary artery.
blood flow to the cardiac muscle – if you say ‘to the heart’ this
suggests reduced flow in the veins carrying blood into the atria rather During a heart attack, there is chest pain in the same areas as in
than arteries carrying oxygenated blood to the muscle itself. an angina attack, but it is much more severe. The pain may occur
In a myocardial infarction, often called a heart attack, one of the at any time, although exercise may start it, and it often lasts for
branches of the coronary artery becomes completely blocked and several hours. Death may occur very rapidly with no previous
part of the heart muscle is permanently starved of oxygen. symptoms, or it may happen after several days of feeling tired and
suffering symptoms mistaken for indigestion.
Many heart attacks are caused by a blood clot resulting from
atherosclerosis. As you have seen, the wall of an artery affected It is very important to react quickly if you suspect someone is
by a plaque is stiffened, making it much more likely to suffer having a heart attack. Give them two full-strength aspirin tablets
cracks or damage. Platelets touch the damaged surface of the to help stop the blood clotting, and get them to hospital as fast as
plaque and the clotting process is triggered (see Section 1B.2). you can.
The plaque itself may rupture and break open, and the cholesterol
that is released will also cause the platelets to trigger the blood STROKES
clotting process. A clot may also develop because the endothelial A stroke is caused by an interruption to the normal blood
lining is damaged, for example by high blood pressure or smoking. supply to an area of the brain. This may be due to bleeding
from damaged capillaries or a blockage cutting off the blood
A clot that forms in a blood vessel is known as a thrombosis. supply to the brain. A blockage is usually caused by a blood
The clot can rapidly block the whole blood vessel, particularly clot, an atheroma or a combination of the two. Sometimes, the
if it is already narrowed by a plaque. A clot that gets stuck in a blood clot forms somewhere else in the body and is carried in
coronary artery is known as a coronary thrombosis. The clot the bloodstream until it gets stuck in an artery in the brain. The
can block the artery, starving the heart muscle beyond that point damage happens very quickly. A blockage in one of the main
of oxygen and nutrients, and this often leads to a heart attack arteries leading to the brain causes a very serious stroke that may
(see fig E). lead to death. In one of the smaller arterioles leading into the
brain, the effects may be less disastrous.
The symptoms of strokes vary, depending on how much of the
brain is affected. Very often, the blood is cut off from one part or
one side of the brain only (see fig F). Symptoms include dizziness,
confusion, slurred speech, blurred vision or partial loss of vision
(usually one eye) and numbness. In more severe strokes, there can
be paralysis, usually on one side of the body.
MAMMALIAN TRANSPORT SYSTEMS 1B.5 ATHEROSCLEROSIS 47
SUBJECT VOCABULARY
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CHECKPOINT
1. When a plaque starts to form on the endothelium (lining) of an
artery, it usually gets worse and worse. Unless the person
changes their lifestyle or gets medical treatment, the lining of
the artery does not return to normal. Explain why this happens,
and why it is so dangerous.
2. (a) Describe in detail the role of atherosclerosis in
cardiovascular disease.
(b) Summarise the similarities and differences between a
heart attack and a stroke.
SKILLS INNOVATION
1 (a) Which statement is incorrect? (d) Heart muscle has a high demand for oxygen. Describe
A All arteries carry oxygenated blood. how heart muscle is supplied with oxygen. [3]
B All veins carry blood at low pressure. (e) The volume of blood pumped by the ventricles is
C All veins carry blood towards the heart. 0.07 dm3. Calculate the cardiac output when the heart
D All arteries carry blood away from the heart. [1] rate is 72 bpm. [2]
(b) Draw a labelled diagram to show the structure of an (Total for Question 2 = 12 marks)
artery wall. [3]
3 (a) The diagram below shows a mammalian heart during
(c) Explain how the structure of an artery wall relates to atrial systole.
its function. [2]
(d) Give two differences between the structure of a vein
and the structure of a capillary. [2]
(Total for Question 1 = 8 marks)
A
gills
body body
lungs
The arrows show the direction of blood flow.
B
(i) Describe the circulation of blood in a fish using the
information in the diagram. [3]
MAMMALIAN TRANSPORT SYSTEMS EXAM PRACTICE 49
(ii) Using the information in both diagrams, evaluate the (b) Describe and explain the function of the semilunar
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4 (a) The graph below shows oxygen dissociation curves for 6 (a) Platelets are fragments of cells that are involved in blood
human myoglobin and human haemoglobin. clotting. Describe how blood clots. [4]
(b) Describe two conditions that are caused by blood clots
100 that form inside the blood vessels. [4]
Percentage saturation with oxygen (%)
myoglobin
90 (c) State the meaning of the term aneurysm and explain how
haemoglobin
80 an aneurysm is caused. [3]
70 (Total for Question 6 = 11 marks)
60
7 (a) The diagram below shows how most carbon dioxide is
50 transported.
40
30 CO2 CO2 + H2O
20 E
10 S
0
0 2 4 6 8 10 I HCO3
Partial pressure of oxygen/kPa
(i) Using the graph, state the partial pressures of oxygen (i) What is the name of the cell represented by
at which myoglobin and haemoglobin are 50% the circle. [1]
saturated with oxygen. [2] A leucocyte
(ii) Calculate the increase in percentage saturation for B neutrophil
haemoglobin between 2 kPa of oxygen and 8 kPa of C erythrocyte
oxygen. Show your working. [2] D stem cell
(b) The muscle of diving mammals such as elephant seals (ii) What is the name of enzyme E. [1]
contains a lot of myoglobin. Use the information in the
A catalase
graph to explain how the myoglobin can help an elephant
seal to dive for longer. [3] B carbonase
C anhydrous carbonase
(c) At increased partial pressures of carbon dioxide, the
D carbonic anhydrase
oxygen dissociation curve for haemoglobin moves to the
right. This is known as the Bohr effect. (iii) Name substance S. [1]
Explain the importance of the Bohr effect. [4] (iv) Identify ion I. [1]
(Total for Question 4 = 11 marks) (b) If ion I is allowed to accumulate inside the cell it could
affect the functioning of the cell.
5 (a) During a dissection of a mammalian heart a student (i) Describe how the accumulation of ion I is prevented.
measured the thickness of the ventricular walls. The left [2]
ventricle wall was 32 mm thick and the right wall was (ii) Explain the effect that accumulation of ion I has on the
11 mm thick. transport of oxygen. [2]
(i) Calculate the thickness of the right ventricle wall (Total for Question 7 = 8 marks)
as a percentage of the left ventricle wall thickness.
Show your working and state your answer to three
significant figures. [2]
(ii) Explain the difference in the thickness of the
ventricle walls. [2]
TOPIC 1 MOLECULES,
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TRANSPORT AND
HEALTH
CARDIOVASCULAR
1C HEALTH AND RISK
CHAPTER
What do you do with your spare time? Do you like to watch TV, read, use the internet or spend time on social
media? According to a recent poll of professionals in the Middle East and North Africa, a third of people spend
more than five hours a day using the internet for leisure. One fifth of people spend at least one hour a day
relaxing online. Compare that to only 4.6% who prefer to play sport and only 2.2% who prefer outdoor pursuits.
Over 35% of people eat out nearly every day. People enjoy an affluent lifestyle – eating well, using a car instead
of walking, relaxing at home or spending time with family and friends. Unfortunately, many people do not
realise that these are also risk factors that increase the probability that they will develop a serious disease of the
heart or blood vessels.
In this topic, you will learn about the meaning of risk and how we perceive risk. Cardiovascular diseases are
those of the heart and blood vessels. You will learn how we can determine what causes cardiovascular diseases
and what increases the chances of us developing such diseases. Diet is an important factor and the things we
choose to eat can increase the risk of developing these life-threatening diseases. Fortunately, making the right
choices can also significantly decrease the risks. You will learn how scientists and health professionals can use
evidence to analyse the risks and how these diseases can be treated.
LEARNING OBJECTIVES
◼ Understand why people’s perception of risks is often different from the actual risks, including underestimating and
overestimating the risks due to diet and other lifestyle factors in the development of heart disease.
◼ Be able to distinguish between correlation and causation.
Every country has diseases which affect its people and may even kill them. Some of these diseases
affect you randomly – there is nothing you can do to change whether you are affected or not. However,
for many diseases, especially non-communicable (non-infectious) conditions such as heart disease
and cancer, you can increase or lower your risk of becoming ill, based on factors in your lifestyle. If
you understand the risk factors, you can help to make yourself and your family healthier.
WHAT IS RISK?
The word risk is used regularly in everyday conversation, but in science it has a very specific meaning.
In science, risk describes the probability that an event will happen. Probability means the chance
or likelihood of the event, calculated mathematically. For example, imagine you have six coloured
balls – red, blue, green, yellow, orange and purple – in a black cloth bag (see fig A). If you reach in
and pull out a single ball, the probability (risk) of getting, say, a green ball can be expressed in one of
three ways:
•• 1 in 6
•• 0.166 66 recurring (0.17)
▲ fig A The risk, chance or •• 17%.
probability that you will pick a
blue ball out of the black bag is This is the case for any one of the six colours in the bag. In the same way, it is possible to work out
1 in 6. If you return the ball to your risk of developing certain specified diseases or of dying from a specified cause.
the bag each time, you will have
exactly the same probability of
picking a blue ball again the next
HOW DO WE PERCEIVE RISK?
time. The probability will always The actual risk of doing something is not always the same as the sense of risk one feels. Most people
be 1 in 6. don’t think twice before getting into their car – but globally you have an annual risk of 1 in 5747 of
being killed in a road traffic accident. On the other hand, many people get very worried before flying,
but commercial flights have a 1 in 4.5–5.5 million risk of crashing. Personal perception of risk is
based on a variety of factors which include:
•• how familiar you are with the activity
•• how much you enjoy the activity
•• whether or not you approve of the activity.
The actual mathematical risk may play very little part in developing your personal perception of risk.
People often overestimate the benefits, or minimise the risk, of behaviour that they want to continue.
For example, there is now strong evidence from around the world that obesity is linked to a range of
diseases such as diabetes, cardiovascular disease and some cancers. However, people like eating and
so they still become overweight. On the other hand, they will over-emphasise the risks of activities
if they want to avoid them or prevent others from doing them. For example, parents over-emphasise
the risk of wandering away to small children, to help make the child behave and stay close.
In another example, there is good scientific evidence that smoking affects our risk of developing
diseases such as atherosclerosis, as well as lung cancer. However, knowledge of the mathematical risk
of an early death if you smoke cigarettes doesn’t always stop people from smoking.
CARDIOVASCULAR HEALTH AND RISK 1C.1 RISK, CORRELATION AND CAUSE 53
EXAM HINT
When provided with data in the form of a graph, make sure you read
the axis titles carefully so that you know what the data refers to.
1C 2 IOF CVDs
NVESTIGATING THE CAUSES SPECIFICATION
1.12
REFERENCE
1.16
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LEARNING OBJECTIVES
◼ Be able to evaluate the design of studies used to determine health risk factors, including sample selection and
sample size used to collect data that are both valid and reliable.
◼ Know how factors such as genetics, age and gender increase the risk of cardiovascular diseases (CVDs).
Everywhere you look, on television, in newspapers and on the evidence than any one of the studies alone. This is called a
internet, there are reports of factors which affect your health. Eat metadata analysis (meta-analysis).
fruit and vegetables, drink orange juice, take lots of exercise, enjoy
these foods – how do we know which advice is based on good EVALUATING SCIENTIFIC STUDIES
science, and which is given to us because someone wants to sell
When considering a study, you need to examine the methodology
us something? There are many ways in which you can evaluate
to see if it is valid. That means that it is properly designed to
the design of studies to decide if the data are meaningful.
answer the question or questions being asked. You also need to
see if the measurements have been carried out with precision. It
DESIGNING STUDIES is important to find out if other scientists have been able to repeat
Most epidemiological studies are based on a very big sample size the methodology and have had similar results – if so, the results
– usually, the bigger the study, the more meaningful the results. are considered more reliable.
The ideal is to investigate one factor or variable, keeping all other It is also important to know who carried out the research, who
variables the same (controlled). However, controlling variables funded it and where it was published. Then to decide whether or
is almost impossible when you are working with human beings. not any of these factors might have affected or biased the study.
The way people live is complex and varies a lot, so it is hard to You need to evaluate the data and conclusions from the study in
detect how any one factor affects people. When a larger number the light of all these factors.
of people are studied, it is more likely that patterns may emerge,
even with all the other differences between the people involved. EXAM HINT
Evidence based on large amounts of data is more likely to be Remember the meaning of the following terms.
statistically significant than evidence based on small studies. Valid: answers the question the scientists are asking
Some epidemiological studies are carried out over a long time. Precise: measurements with little difference between them
These longitudinal studies are very valuable because they Reliable: the investigation is repeatable by other scientists who get
follow the same group of individuals over many years (see fig A). similar results
This means the impact of their known lifestyle on their health They are important in evaluating all practical work and research.
can be tracked over time. For example, the Münster Heart Study
looked at cardiovascular disease in 10 856 men aged 36–65 in In the next few pages, you are going to look at some of the
Europe, following them from the start of the study well into the evidence that scientists have collected suggesting factors that
21st century. The results from this study are still seen as important may – or may not – affect your risk of developing cardiovascular
because so many people were involved over a long period of time. diseases (CVDs). In each case, you need to look carefully at the
The Framingham Study in the US also provided much data – but type of evidence that is presented and think about what else you
was limited because they were all from similar American citizens. need to know to make firm conclusions.
The study started in 1948 and it is still going on – the scientists
have widened the population they gather data from, so it is more RISK FACTORS FOR CVDs
relevant now.
The results from many epidemiological studies have identified
An ambitious new study called the National Children’s Study has a range of risk factors linked to CVDs. These factors divide into
been set up in the US to follow 100 000 children from birth until two main groups – those you can’t change and those you can do
they are 21 years old. From 2008–2012, children were selected to something about (see Section 1C.3).
be representative of the whole of the US population. One major
objective of the study is to examine how environmental inputs and NON-MODIFIABLE RISK FACTORS FOR ATHEROSCLEROSIS
genetic factors interact to affect the health and development of
children. This is believed to be the biggest longitudinal study ever There are three main risk factors for CVDs which cannot (at the
set up. Similarly, the UAE Healthy Future Study will be longitudinal, present time) be changed.
looking at the same group of volunteers over a number of years. •• Genes: studies show that there is a genetic tendency (trend)
Sometimes, scientists look at all the available studies in a subject in some families, and also in some ethnic groups, to develop
area and analyse the available data in a massive literature study. CVDs. These trends can include
This combines small and large studies and can give more reliable – arteries which are easily damaged
CARDIOVASCULAR HEALTH AND RISK 1C.2 INVESTIGATING THE CAUSES OF CVDs 55
80%
heart
– a tendency to develop hypertension which can cause arterial
disease
80%
heart
disease
damage and make CVDs more likely fraternal twins
70%
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fraternal twins
ofof
70%
– problems with the cholesterol balance of the body. identical twins
dying
heart
60% identical twins
dying
heart
•• Age: as you get older, your blood vessels begin to lose their 60%
ofof
twin
elasticity and to narrow slightly. This can make you more likely 50%
twin
dies
50%
to suffer from CVDs, particularly heart disease.
dies
second
40%
second
twin
•• Gender: statistically, under the age of 50, men are more likely 40%
twin
to suffer from heart disease (and other CVDs) than women. 30%
first
the
30%
first
the
The female hormone oestrogen, which is an important factor in
if the
ofof
20%
if the
the woman’s menstrual cycle, appears to reduce the build-up of 20%
Probability
Probability
disease
plaque. This gives women some protection against CVDs until 10%
disease
they go through the menopause when oestrogen levels fall. 10%
0%
0%
LEARNING TIP 36–55
36–55
56–65
56–65
66–75
66–75
76–85
76–85
85+
85+
Age (years)
Remember that risk factors do not cause the disease, they contribute Age (years)
to the chances of developing the disease.
100%
LOOKING AT THE DATA 100%
Identical twin studies are an excellent resource when investigating 80%
whether there is a genetic factor at work, because identical twins 80%
Heritability is the
have exactly the same genes. Any differences should therefore be Heritability is the
60% tendency for heart
Heritability
due to the environment in which they live. A major twin study was 66 tendency
60% disease tofor beheart
Heritability
66 63 inherited.
conducted in Sweden and was based on over 21 000 pairs of twins, 63 57 disease to time
be inherited.
57 Follow-up is the
40% Follow-up time is after
the
both identical and non-identical. This study showed that (for male 40% year of follow-up
year of follow-up
the original studyafter
twins) if one twin died of heart disease between the ages of 36 and the original
20% carried out study
in 1961.
55, then the risk of the other twin also dying of heart disease was 20% carried out in 1961.
eight times higher than if neither was affected (see fig A). However,
as the twins got older, one dying of heart disease had less of a 0%
0% 1987 1992 1996
correlation with the other twin also dying of heart disease. In other 1987 1992 1996
words, there appears to be a clear genetic link to heart disease in Follow-up time
Follow-up time
younger men, but it gets less in much older men. ▲ fig A These are results from an epidemiological study of male twins in
Sweden published in 1994. Although this study was carried out a long time
Epidemiological studies have also identified several lifestyle ago, the findings are still important, because of the large number of twin
factors linked to CVDs, some of which you will look at in the pairs who took part and the length of the study.
following pages. These lifestyle factors are important for health
because they are the factors that we can change. SUBJECT VOCABULARY
longitudinal studies scientific studies which follow the same group
CHECKPOINT of individuals for many years
metadata analysis (meta-analysis) when data from all the available
SKILLS EXECUTIVE FUNCTION studies in a particular area are analysed
valid an investigation which is well designed to answer the question
1. When scientists design a major study, what can they do to try
being asked
and make sure their results will be both valid and reliable?
precision measurements with only slight variation between them
2. Using the data in fig A, answer the following questions. reliable evidence which can be repeated by several different
(a) How do the figures for identical and fraternal twins differ in scientists
the top graph? What does this suggest about a genetic link biased when someone is unfairly for or against an idea (e.g. when a
to heart disease? scientist is paid by someone with a vested interest in a specific result –
(b) What does the bottom graph show you about the apparent they may receive benefit from the outcome)
heritability of heart disease in men? What might affect the evaluate to assess or judge the quality of a study and the significance
fall in apparent heritability as the men got older? of the results
1C 3 RISK FACTORS FOR
SPECIFICATION
REFERENCE
CARDIOVASCULAR DISEASE
1.12 1.16
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LEARNING OBJECTIVES
◼ Be able to evaluate the design of studies used to determine health risk factors, including sample selection and
sample size used to collect data that are both valid and reliable.
◼ Know how factors such as diet, high blood pressure, smoking and inactivity increase the risk of cardiovascular
disease (CVD).
The non-modifiable factors affecting your risk of developing CVDs – age, genetics and gender – are
the same all over the world. However, the numbers of people who die of CVDs varies enormously,
depending on where you live, as you can see in fig A. This tells us that other factors are involved
– factors which vary with your lifestyle. In the rest of this topic, you will find out more about the
lifestyle factors which affect us and influence our risk of developing – or dying from – heart disease.
160 158
Deaths per 100 000 population
heart attack
140
126
120 stroke
109
100 95 95
80 78
60 52
39
40
20
0
Low income Low/middle High/middle High income
countries income countries income countries countries
▲ fig A Deaths from CVDs in different countries (based on 2012 data)
EXAM HINT
When you are given a graph, try to analyse it briefly before looking at the question. Find trends and obvious
comparison points. This will help you to understand what the question is asking for.
Smoking 2 Smoking 1
10 10
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male
8 8
Proportion CAD
Proportion CAD
female
6 6
4 4
2 2
0 0
<45 45–54 55–64 651 <45 45–54 55–64 651
Age (years) Age (years)
▲ fig B Proportion of adults with coronary artery disease (CAD) depending on whether they smoke or not based on
a Jordanian study in 2017.
▲ fig C Doctors can use a blood pressure monitor like this to check that your blood pressure is in the healthy range.
Some people buy and use their own monitor, so they can check their blood pressure regularly to help prevent them
getting CVDs.
58 1C.3 RISK FACTORS FOR CARDIOVASCULAR DISEASE CARDIOVASCULAR HEALTH AND RISK
However, other factors can also raise the blood pressure. For PREVENTING ATHEROSCLEROSIS AND CVDs
example, smoking narrows the blood vessels and raises the blood
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The advice about what is ‘good’ for us and what is ‘bad’ changes.
pressure. Obesity, inactivity, a high level of salt in the diet and This happens because epidemiological studies of links between
stress can also narrow the arteries or affect the way the heart is risk factors and CVDs become more sophisticated and scientific
pumping and raise the blood pressure. When the blood pressure research discovers more reasons why some factors can contribute
is constantly high, the lining of the arteries is more likely to be to atherosclerosis. Current evidence suggests that eating a
damaged, leading to atherosclerosis and ultimately CVDs. So high balanced diet with a variety of fats and plenty of fruit and
blood pressure can also contribute to CVDs. If a doctor discovers vegetables helps prevent atherosclerosis. It helps not to smoke, to
you have high blood pressure, they will try to help you reduce maintain a healthy weight to avoid high blood pressure and type 2
the level by making lifestyle changes or with medication, to try to diabetes, to reduce constant stress and get plenty of exercise. It is
reduce your risk of developing CVDs. important to take action as early as possible because there is clear
evidence of the early signs of atherosclerosis in teenagers and
DIET, OBESITY AND ATHEROSCLEROSIS
even young children, if known risk factors are already in place.
An increasing number of studies suggest that being overweight
does not directly affect your risk of developing CVDs, but it is a
very important indicator of risk. Most scientists think that the best CHECKPOINT
predictors of future CVDs are: 1.
(a) What is the difference between modifiable and non-
•• where fat is stored on your body modifiable risk factors for CVDs?
•• how much exercise you do (b) Give two non-modifiable and two modifiable risk factors
for atherosclerosis.
•• the levels of different fats in your blood.
(c) For each factor you have chosen, explain how it increases
Two other factors which are often a direct result of being the risk of developing atherosclerosis and CVDs.
overweight do increase the risk of atherosclerosis and CVDs. 2. (a) Take the data from fig A and combine the information on
These are: deaths from heart attacks and strokes for each group of
•• high blood pressure – increases the risk of damage to blood countries. Record your answers in a table. This will give you
vessel linings, and so of plaque formation the total number of deaths from CVDs in each.
•• type 2 diabetes – this can result in damage to the lining of the (b) Using your answer to part (a), draw a bar chart of the total
blood vessels which increases the risk of plaque formation. numbers of deaths from CVDs in the different groups of
countries in 2012.
There have been many studies on how diet is linked to
atherosclerosis and CVDs, some looking at general diet, some SKILLS PERSONAL AND SOCIAL RESPONSIBILITY
looking at the role of diet in becoming overweight or obese, and 3. The numbers of deaths from CVDs in poorer countries are
some looking at specific foods. The evidence is very mixed and much lower than in wealthier countries. Using what you know
very difficult to interpret. You can find out more about this in about the risk factors for CVDs, suggest at least three reasons
Section 1C.4. for these differences.
EXAM HINT
Remember that atherosclerosis is a multifactorial disease – there is no SUBJECT VOCABULARY
single cause but there are many factors that contribute to the chances high blood pressure blood pressure that is regularly more than
of it occurring. 140/90 mmHg; this increases your risk of developing CVDs
Smoking is one important factor that increases the chances of hypertension high blood pressure, regularly measuring over
atherosclerosis. Inactivity and diet are other factors. 140/90 mmHg, which increases your risk of developing CVDs
HEALTH
1.12 1.18(i) 1.18(ii)
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LEARNING OBJECTIVES
◼ Know how factors such as diet increase the risk of cardiovascular disease.
◼ Be able to analyse data on the possible significance for health of blood cholesterol levels and levels of high-density
lipoproteins (HDLs) and low-density lipoproteins (LDLs).
◼ Know the evidence for a causal relationship between blood cholesterol levels (total cholesterol and LDL cholesterol)
and cardiovascular disease.
◼ Understand how people use obesity indicators such as BMI and waist-to-hip ratios.
There is strong evidence from around the world that the food we eat has a big effect on our health
in many different ways. It certainly has a big impact on the health of our cardiovascular system.
However, our understanding of what the effect is and how our food affects our risk of developing
cardiovascular diseases keeps changing as scientists learn more.
WEIGHT ISSUES
There is plenty of food in the developed world and people can easily eat more than they need
to supply the metabolic needs of the body. This means that many people have a positive energy
balance. The excess food energy is converted into a store of fat so these people become overweight
and then obese. All the evidence suggests that being obese increases your risk of developing many
different diseases, including CVDs.
1.82
5’11 1.80
The BMI measure was developed in the mid-1800s and it was lower the waist : hip ratio. These include eating less and taking more
originally used to classify normal, relatively inactive people of exercise to reduce the fat stores and reduce the size of the waist.
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average body composition. The normal charts apply to adults only Keeping the waist : hip ratio at a healthy level reduces your overall
– there are special charts for children and teenagers. Young people risk of CVDs, as well as the many other conditions linked to obesity.
grow and their body composition changes as they mature, so both
Being seriously underweight is not good for you either and can
age and gender are important in calculating what is normal until
lead to muscle wasting, heart damage and other health problems.
they become adults. The BMI became widely used for deciding
However, it is the other end of the scale that is causing the most
whether people are a healthy weight for their height and even for
concern. The available data show that around 61% of all adults
predicting the likelihood of CVDs – but doctors increasingly feel
in England (that’s almost 24 million people) are either overweight
it is a very limited tool. Most top athletes would have BMIs in the
or obese, and that the proportion of the population affected is
obese range, because BMI makes no allowance for the difference
continuing to rise. The trend towards obesity is being seen across
in composition of people’s bodies. The reason athletes often
the developed world. For example, Gulf Cooperation Council
have BMIs that suggest they are obese is because BMI does not
countries face challenges with health problems related to obesity.
recognise the difference between fat and muscle. BMI values also
Saudi Arabia (35.2%), Qatar (33.1%) and UAE (33%) face similar
underestimate body fat in older people who have lost a lot of their
concerns.
muscle mass. There are also international differences, with some
groups having a greater or lower than average risk of obesity-
related diseases. More and more, the evidence suggests that BMI TACKLING OBESITY
is not a good predictor of CVDs on its own – but combined with Evidence from around the world suggests that the change in
other factors it is part of the picture (see fig B). energy balance is linked to modern lifestyles rather than simply to
poor individual choices. Energy-rich food is widely available and
8
cheap. The 21st century way of life in many countries involves
aerobically fit
7 almost no exercise – relatively few jobs now require manual
Relative risk of CVD mortality
unfit labour, household tasks are often automated and people drive
6
instead of walking or cycling. So, as the average energy input has
5
increased (or stayed the same), the energy output has decreased
4 and people are gaining weight. Solutions include taxes on fatty
3 foods, town planning to make walking and cycling easier and
educating children to prevent childhood obesity – but there is no
2
clear scientific evidence that any of these solutions work. One
1 thing we do know – since 2006, the number of overweight people
0
in the world is greater than the number of people who do not get
lean normal obese enough to eat. The importance of reducing obesity is shown in
<16.7% 16.7–24.9% >25% the graph in fig C. This also shows that waist : hip ratio is a better
Body fat category (% weight as fat) predictor of heart disease than BMI.
▲ fig B The risk of dying of CVDs differs for people in different weight and 10 waist-to-hip
fitness categories. Being overweight or obese does increase the risk – but it ratio
incidence (per 100 people)
Coronary heart disease
in countries where people eat a lot of fatty meat and dairy foods (mostly saturated fats), many people
die of heart disease. This suggests that high levels of saturated fats in the diet may be a risk factor.
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500
Sweden Ireland
UK Austria
* name at time of study
400 Denmark
Germany
Finland
USA
Age-adjusted heart deaths/100 000 per year
Norway
Belgium
Czechoslovakia*
Switzerland
Australia Netherlands
300 Italy
New Zealand
Bulgaria
Yugoslavia* Poland
South Africa
France
Zimbabwe Uruguay
200 Argentina
Portugal
Trinidad Greece
Spain
Cuba
Egypt
100
Philippines Japan Singapore
Sri Lanka Paraguay Hong Kong Bahamas
Peru Ecuador
Bolivia
Mozambique
0
0 40 60 80 100 120
Animal fat grams/person per day
▲ fig D Data from the early 21st century showing the death rates per 1000 men and women from heart attacks in
different countries compared with the average intake of animal (saturated) fats.
The link between a diet high in saturated fats and a raised incidence of CVDs shows a correlation,
but not a cause. Over the last 50 years or so, many scientific studies showed that a high intake of
saturated fats was often associated with high blood cholesterol levels. Cholesterol is involved in
plaque formation in atherosclerosis, so this suggested a cause for the link between a high-fat diet and
CVDs (see fig E).
40 14
Deaths from CHD per 1000
30 12
each year ( )
LEARNING TIP
Occurrence
0 6
9
6
4.
5.
6.
7.
8.
8.
9.
1–
9–
7–
5–
3–
2–
8–
4.
4.
5.
6.
7.
8.
8.
Oxford and Bristol, Imperial College and the Medical Research Remember that it is the ratio of LDL : HDL that seems to have the
Council in the UK. The results suggested that the links found greatest effect on cardiovascular disease. A healthy ratio is about
between diets high in saturated fats and atherosclerosis and CVDs 3 : 1 LDL : HDL.
had been a correlation and nothing more. Looking at all of the
data from 72 studies they found that diets high in saturated fats did CHECKPOINT
not appear to be linked directly with increases in atherosclerosis
and CVDs. 1.
What is meant by the term BMI?
Our picture of the relationship between fat in the diet and 2. Ali weighs 65 kg and is 1.68 m tall. Calculate Ali’s BMI. What
cholesterol in the blood is further complicated by lipoproteins, does this tell you about him?
conjugated proteins (see Section 1B.5) which transport lipids 3. Using the graph in fig A, what are the highest and lowest
around the body. weights that would be healthy for an individual who is:
•• Low-density lipoproteins (LDLs) are made from saturated (a) 6 feet tall
fats, cholesterol and protein and bind to cell membranes before (b) 1.58 metres tall?
being taken into the cells. If there are high levels of some (c) At what weight would these individuals be defined
LDLs, your cell membranes become saturated and so more medically as obese?
LDL cholesterol remains in your blood. SKILLS REASONING
•• High-density lipoproteins (HDLs) are made from
unsaturated fats, cholesterol and protein. They carry cholesterol 4. (a) What are the limitations of using BMI as a predictor of
from body tissues to the liver to be broken down, lowering cardiovascular health?
blood cholesterol levels. HDLs can even help to remove (b) What is the waist-to-hip ratio and why is it often used to
cholesterol from fatty plaques on the arteries which reduces the indicate obesity and predict heart health?
risk of atherosclerosis. 5. (a) Explain the apparent link between dietary fats, blood
cholesterol, LDLs and HDLs.
Scientists are now confident that the balance of these lipoproteins
in your blood is a good indication of your risk of developing (b) Why do scientists look at a whole range of indicators
atherosclerosis and the associated CVDs (see fig F). including your BMI or waist-to-hip ratio, your blood
cholesterol and HDLs and LDLs, and your history of
smoking and exercise when they try to decide your risk of
Deaths from CHD per 1000 population
40 6. In 2014, a report was published which suggested that the link
between fat in the diet and the risk of atherosclerosis and CVDs
30 was a correlation but that it was not causative. Many ordinary
people felt confused and upset when this report was discussed
20 on news programmes. Others were very pleased. Suggest
reasons for both of these responses.
10
0
<2.5 2.5–3.0 3.1–3.6 3.7–4.3 >4.3
SUBJECT VOCABULARY
LDL/HDL ratio body mass index (BMI) a calculation to determine if you are a
▲ fig F This evidence from a well-known European study into heart disease healthy weight by comparing your weight to your height in a
appears to show a clear link between the LDL/HDL ratio and deaths from simple formula
coronary heart disease (CHD). low-density lipoproteins (LDLs) lipoproteins which transport lipids
around the body
Blood cholesterol and LDL/HDL levels are not simply related to
high-density lipoproteins (HDLs) lipoproteins which transport
diet. The way your body metabolises the fats you eat and manages cholesterol from body tissues to the liver and can help reduce risks
the levels of cholesterol and balance of lipoproteins in your of CVDs
blood are all linked to your genetic make-up. Some people can
metabolise almost any amount of fat and maintain a good balance
of LDLs and HDLs. Other people cannot cope so well and even
small amounts of fat in the diet are reflected in raised blood
cholesterol levels.
1C 5 D IETARY ANTIOXIDANTS AND SPECIFICATION
REFERENCE
CARDIOVASCULAR DISEASE
1.13 1.14 1.15
CP2
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LEARNING OBJECTIVES
◼ Understand the link between dietary antioxidants and the risk of cardiovascular disease.
◼ Be able to distinguish between correlation and causation and recognise conflicting evidence.
Your diet is not all about the fats you eat. Lots of studies show that eating lots of fruit and vegetables
benefits your health in many ways – including reducing your risk of developing CVDs. The graph in
fig A is one piece of evidence which shows how eating five or more portions of fruit or vegetables
a day can lower your risk of having a heart attack. It was based on data from a longitudinal study of
more than 84 000 women and 42 000 men over eight years, looking at their fruit and vegetable intake
and cardiac health.
1.2
Relative risk of coronary
1.0
heart disease
0.8
0.6
0.4
EXAM HINT
0.2
Remember to look closely at
0 the data you are given. This
<3.0 3.0–3.9 4.0–4.9 5.0–5.9 6.0–6.9 ≥7.0 graph shows the relative risk of
Fruit and vegetable intake (servings per day) developing coronary heart
▲ fig A This graph shows the impact of eating increasing amounts of fruit and vegetables on the risk for coronary disease compared to a person
heart disease. eating fewer than three servings
of fruit and vegetables per day.
attack (some fatal, some not). Of the men who showed low vitamin C levels, 13.2% had heart attacks,
compared with 3.8% of the men who showed no sign of vitamin C deficiency. Many people began
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eating lots of vitamin C rich foods, and taking vitamin C supplements, in the belief that they were
reducing their risk of having heart disease.
Then, in 2016, a major metadata study was published in the International Journal of Molecular
Sciences. It looked at all the evidence for the antioxidant properties of vitamin C as an explanation of
the known benefits of fruit and vegetables on heart health. The conclusions were that there was no
relationship between them. The study even showed that taking vitamin C supplements could damage
heart health. This is a good example of where there is contradictory evidence – and where scientists
must look at all of that evidence to avoid coming to the wrong conclusions.
EXAM HINT
Ensure that you know about
measuring vitamin C levels –
there could be questions
directly about the experimental
procedure and how to make it
valid, precise and reliable. ▲ fig B Citrus fruit contains vitamin C, which can be tested for with DCPIP.
CHECKPOINT
1. Look at fig A. Calculate the percentage reduction in deaths from heart disease if everyone ate:
(a) five portions of fruit and vegetables every day
(b) seven or more portions of fruit and vegetables every day.
2.
What is the difference between the data that show a link between the amount of fruit and vegetables
eaten and heart health, and the evidence looking at the effect of antioxidants on heart health?
SKILLS EXECUTIVE FUNCTION
SUBJECT VOCABULARY
antioxidants molecules that inhibit the oxidation of other molecules which can lead to chain reactions
that may damage cells
SPECIFICATION
REFERENCE
LEARNING OBJECTIVES
◼ Understand how people use scientific knowledge about the effects of diet, including obesity indicators, exercise and
smoking to reduce their risk of coronary heart disease.
There is much scientific evidence about the main factors that increase the risk of heart disease.
A lot of that evidence is used by governments and health organisations to produce advice on how to
improve our health. Why do they do this?
OVERWEIGHT OR UNDERFIT?
Most people are aware that obesity is linked to CVDs, and many go on
slimming diets to try to lose weight. Most people also know that taking
regular exercise helps protect against CVDs – but more people choose to
go on a diet than choose to take regular exercise. The results of a study
carried out over an average of eight years on 20 000 men aged from
30 to 83 years are given in Section 1C.4 fig B. Fitness was defined by
how much oxygen they used during exercise. The results show that if you
are obese and fit you have a lower risk of dying from CVDs than someone
▲ fig A Infographics like this one published in Gulf News help
who is not obese but unfit. Obviously, being the correct weight and fit is people understand the factors which affect their heart health.
best of all!
The problem is that many people enjoy their food, and don’t take sufficient exercise. It takes a lot of LEARNING TIP
effort to cut down the amount of food you eat and change to eating healthier foods including lots of Remember to read all the
fruit and vegetables. information in graphics.
66 1C.6 USING THE EVIDENCE CARDIOVASCULAR HEALTH AND RISK
SALT AND CVDs Part of the problem is that people find it difficult to distinguish between perceived risk and actual
risk. They can see a risk applies to an average of a group, but not to themselves as individuals. If
The Yanomami Indians in
you see people smoking, eating a high-fat, high-salt diet, never exercising and yet appearing well, the
Brazil eat far less salt than
evidence of your own experience contradicts and overrides the evidence from research reported
people in the developed world
in the media. People then underestimate the risk of CVDs associated with smoking, obesity, lack of
and have much lower blood
exercise or a high-salt diet.
pressure levels. This evidence
was used to draw a link There are other reasons that lead to mistakes when people assess risk. Sometimes people will
between high salt levels, high continue smoking because they don’t want to gain weight. Smoking speeds up the metabolism and
blood pressure and CVDs. reduces the appetite, which both help to control body mass. Here, the health risks of obesity are
After much more research, overestimated in comparison with those of smoking. In other words, the risks of smoking are ignored
there is wide agreement because people do not want to get fat. Also, the nicotine in tobacco smoke is addictive to many
among scientists that high people, and this makes it very difficult to give up smoking.
levels of dietary salt increase
When people calculate their personal risk/benefit situation, it is easy to think that the immediate
blood pressure in many
benefit (pleasure in eating high-fat food, smoking, not wanting to make the effort to exercise) is more
people in the developed
important than the apparently low risk of heart disease.
world. Processed foods
typically have high levels of
salt, and often people add CHECKPOINT
salt to their food. If people
1. Why do you think people are more likely to try to lose weight than to take more exercise?
eat less processed food, add
less salt to their own cooking, SKILLS DECISION MAKING
and food manufacturers add 2. What are the limitations of drawing conclusions about the effect of salt on blood pressure from a
less salt to their products, we study comparison of the Yanomami in Brazil and the population of a country such as the UK or
might be able to lower our Qatar? Do you think people in developed countries under- or overestimate the risk of eating too
salt intake from the current much salt, and what influences these perceptions?
daily average of 9–12 g to the 3. M
any governments spend millions of pounds on health advertising each year. Discuss whether or not
recommended level of less this is a waste of money.
than 5–6 g of salt per day.
LEARNING OBJECTIVES
◼ Know the benefits and risks of treatments for CVDs including antihypertensives, statins, anticoagulants and platelet
inhibitors.
Once a patient has signs of cardiovascular disease, there are a threatening. The second major risk is the side-effects that may
number of different treatment options available. Changing lifestyle, result from the way your body reacts to the drugs. Each type of
such as improving diet, giving up smoking and taking more exercise drug has its own possible side-effects (see fig A). For a drug to be
can help but there are also various drugs that can be given. The drugs given a licence for use, the benefits of the treatment must be judged
aim to reduce the risks associated with CVDs by helping to prevent to outweigh any side-effects.
problems developing. However, all medicines carry some risk.
The side-effects from commonly used antihypertensives include
coughs, swelling of the ankles, impotence, tiredness and fatigue, and
CONTROLLING BLOOD PRESSURE constipation. These are not serious compared with the health risks
As you have seen, hypertension or high blood pressure is a major from high blood pressure – but to the patient they may feel very
risk factor for cardiovascular diseases. significant. High blood pressure often doesn’t make you feel ill, but
the medication needed to control it can affect your quality of life.
ANTIHYPERTENSIVES
Doctors find many patients stop taking their medication – the side-
Drugs that reduce blood pressure are known as effects make them ignore the much larger but invisible risk of CVDs.
antihypertensives. Some commonly prescribed antihypertensive
drugs are described below.
•• Treatment often begins with diuretics, which increase the volume
of urine produced. This eliminates excess fluids and salts, so that
the blood volume decreases. With less blood, a smaller volume is
pumped from the heart and the blood pressure falls.
•• Beta blockers interfere with the normal system for controlling
the heart. They block the response of the heart to hormones
such as adrenaline, which normally act to speed up the heart and
increase the blood pressure (you will find out more in Book 2
Topic 7). So, beta blockers make the heart rate slower and the ▲ fig A All medically licensed drugs come with instructions and information
contractions less strong, so the blood pressure is lower. which includes possible side-effects known to be caused by the drug.
men women smokers diabetes high BP elderly HDL < 40 HDL > 40
0
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–10 –15%
–20
–29%
–30 –34%
%
–50 –54%
–59%
–60
▲ fig B These data show the benefits of statins in reducing the risk of CVDs in Asian Indians, who are a particularly high-risk group. Statins had a strong positive
benefit to a range of patients.
A UK study showed that men who took a particular statin for five
years had a lower risk of death or heart attack, even 10 years
after they stopped taking the drug. The study involved 6595
middle-aged men. It showed that for the first five years, the overall
risk of heart attack or death from any type of heart disease was Plant sterols (g/d)
11.8% for the men who took the statin, compared with 15.5% for 0 0.5 1 1.5 2 2.5 3 3.5
men who took a placebo (an inactive substance that resembles 0
the drug but has no action in the body). The risk was reduced 2–2.5 g of plant sterols
daily significantly reduces
the most while the men were taking the drug, but some level of LDL cholesterol by ~10%
protection lasted for up to 10 years afterwards.
Most people use statins with little or no ill effect. Side-effects of
–4
muscle and joint aches and nausea, constipation and diarrhoea
are sometimes reported. However, there are two serious but very
rare side-effects. In a tiny number of people, statins trigger a form
of muscle inflammation which can be fatal. For example, the US
Food and Drug Administration (FDA) reported 3339 cases of
LDL cholesterol (% change)
ANTICOAGULANTS AND PLATELET INHIBITORY DRUGS It is difficult to achieve the correct balance between preventing
the blood from clotting too easily while allowing it to clot
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SUBJECT VOCABULARY
antihypertensive drug which reduces high blood pressure
▲ fig D Aspirin is a relatively cheap drug. It has been used traditionally diuretics drugs which increase the volume of urine produced
as a painkiller. It is also a very effective way of preventing many
cardiovascular problems. beta blockers drugs which block the response of the heart to
hormones such as adrenaline
The risks of taking aspirin are well known – it irritates the sympathetic nerve inhibitors drugs which inhibit sympathetic
stomach lining and causes bleeding in the stomach which can nerves, keeping arteries dilated
become serious. A combination of aspirin and clopidogrel can ACE inhibitors drugs which block the production of angiotensin
reduce the risk of developing a range of cardiovascular diseases side-effect a secondary, usually undesirable effect of a drug or
by 20–25% in some low-risk patients. However, based on data medical treatment
from several studies it appears that, for some patients, the risk of statins drugs that lower the level of cholesterol in the blood
side-effects is much higher when the two drugs are combined. placebo an inactive substance resembling a drug being trialled which
For example, for every 1000 patients at high risk of CVDs treated is used as an experimental control
for 28 months, five cardiovascular events would be avoided – plant stanols and sterols similar in structure to cholesterol, these
but three major stomach bleeds would be caused. In lower-risk compounds can help reduce blood cholesterol in those consuming
patients, 23 cardiovascular events would be avoided while 10 them
major bleeds would be caused. anticoagulant a substance that interferes with the manufacture of
prothrombin in the body
platelet inhibitory drugs drugs used to prevent blood clots forming
by preventing platelets clumping together
1C THINKING BIGGER
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MIDDLE EAST
CONTINUOUS LEARNING, INTELLECTUAL
INTEREST AND CURIOSITY, COMMUNICATION,
EMPATHY/PERSPECTIVE TAKING
One in four adults in Saudi Arabia are expected to suffer a heart attack within the next 10 years. In the Middle East, the average age for
onset of heart failure is 10 years lower than in Western Countries. Heart disease is a multifactorial disease – many factors contribute to
the risks of developing heart disease. However, the final failure of the heart can often be attributed to one contributing factor. While 70%
of heart failure in the West can be attributed to coronary artery disease, this is not the case in the Middle East.
ABSTRACT
The clinical syndrome of heart failure is the final pathway for References
a myriad of diseases that affect the heart, and is a leading and Hazebroek M., Dennert R., Heymans S. Idiopathic dilated
growing cause of morbidity and mortality worldwide. Evidence- cardiomyopathy: possible triggers and treatment strategies.
based guidelines have provided clinicians with valuable data Neth Heart J 2012 Aug; 20(7–8)332–335
for better applying diagnostic and therapeutic tools, particularly https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402574/
the overwhelming new imaging technology and other, often Arjen Radder. MENA has a heart disease problem. The solution is
expensive, therapies and devices, in heart failure patients. In both basic and high-tech. World Economic Forum May 2017
the Middle East, progress has recently been made with the https://www.weforum.org/agenda/2017/05/cardiovascular-disease-
development of regional and multi-centre registries to evaluate the is-threatening-the-middle-easts-health-connected-technology-is-
quality of care for patients with heart failure. A new heart function the-answer/
clinic recently began operation and has clearly resulted in a Hala Khalef. Heart disease causes 45% of early deaths in Middle
reduced readmission rate for heart failure patients. Many Middle East. The National 2010 January
Eastern countries have observed increases in the prevalence of https://www.thenational.ae/uae/heart-disease-causes-45-of-early-
the risk factors for the development of heart failure, including deaths-in-middle-east-1.499807
diabetes mellitus, obesity, and hypertension, with heart failure in Why the number of heart attack cases are growing. The Kahjeel
the Middle Eastern population developing earlier than it is in their Times 2015 October
Western counterparts by at least 10 years. The earlier onset of https://www.khaleejtimes.com/nation/uae-health/why-the-
disease is the result of the earlier onset of coronary artery disease, number-of-heart-attack-cases-are-growing
highlighting the need for Middle Eastern countries to establish In Middle East and North Africa, health challenges are becoming
prevention programs across all age groups. The health systems similar to those in western countries. The World Bank 2013
across the Middle East need to be modified in order to provide September
improved evidence-based medical care. Existing registries also http://www.worldbank.org/en/news/press-release/2013/09/04/
need to be expanded to include long-term survey data, and middle-east-north-Africa-health-challenges-similar-western-
additional funding for heart failure research is warranted. countries
From: Mostafa Q Al-Shamiri. Heart failure in the Middle East. Current Cardiology Reviews 2013 May; 9(2):174–178
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682400/#R10
ANALYSIS,
SCIENCE COMMUNICATION SKILLS INTERPRETATION
1 (a) Who do you think the intended audience is? INTERPRETATION NOTE
(b) What is the intended message the author is trying to give? This article is an abstract from a
(c) There are a number of terms used in the article. Select three unfamiliar terms from the longer article in the journal
article and research their meaning. Suggest why those terms have been used. Current Cardiology Reviews.
Think about the type of writing
(d) An abstract is meant to indicate to the reader what is contained in the rest of the
used.
document. From the abstract, a researcher might decide whether or not to read the rest
of the article. What sort of information would you expect to find in the rest of this article?
CARDIOVASCULAR HEALTH AND RISK THINKING BIGGER 71
Now you are going to think about the science in the article. You will be surprised how much you
know already, but if you choose to do so, you can return to these questions later in your course.
2 (a) What are the main contributing factors to development of heart failure mentioned by
the author?
(b) Name two more contributing factors.
3 Changes in lifestyle and diet have been blamed for huge increases in the risk factors.
For example, diabetes has increased by 87% between 1990 and 2010.
(a) What lifestyle changes are likely to cause such an increase in diabetes?
(b) What changes in diet may contribute to such an increase in diabetes?
4 The author is writing about epidemiology. That is the branch of medicine which deals
with the incidence, distribution and possible control of diseases and other factors relating
to health. How does understanding the incidence of heart failure and the factors that
contribute to it help the medical profession to combat heart failure?
5 Common causes of heart failure are ischaemic heart disease, uncontrolled hypertension
and valvular disease. However, in up to 50% of the cases its exact cause remains unknown;
this condition is called idiopathic cardiomyopathy. The table shows the results of an
epidemiological study.
CAUSE OF HEART FAILURE % OF CASES IN EACH COUNTRY
OMAN EGYPT SAUDI ARABIA YEMEN
ischaemic heart disease 52 66 52 52
valvular disease 8.5 22.5 10.5 7
hypertension 25 25
idiopathic 8.3 11
cardiomyopathy
(a) Which cause of heart failure should be the focus of most research?
(b) Suggest why the exact cause of heart failure may be unknown in up to 50% of cases.
▲ fig A Heart disease, in particular coronary artery disease, is an increasing problem in the Middle East.
Research the risk factors for heart disease. Find out what can be done to reduce these factors.
Prepare a leaflet designed to help people understand how their lifestyle and diet affect their chances
of developing heart disease.
Provide advice to someone who has been told that they are at risk of developing heart disease.
1C EXAM PRACTICE
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1 (a) What is an atheroma? (b) The illustration below shows the coronary arteries in the
A a hardened part of the artery wall heart with the position of three possible blockages labelled
B a swelling in the artery wall A, B and C.
C a fatty deposit in the artery wall
D a narrowing of the artery wall [1]
(b) Justify the use of the term multifactorial when used to
describe atherosclerosis. [2]
(c) (i) Which of the following is not a risk factor for
atherosclerosis?
A obesity
B high-salt diet
C high-fibre diet
D lack of exercise [1] C
(ii) One weight loss plan suggests eating a diet with no
B
carbohydrate but allows eating as much protein and fat
as you like. Discuss the merits of such a diet. [6]
A
(Total for Question 1 = 10 marks)
Female
6
0
<45 45–54 55–64 651
Age (years)
Smoking 1
10
Male
8
Proportion CAD
Female
6
4
(Total for Question 2 = 9 marks) 2
(ii) Suggest why there is no data for women in the 55–64 (ii) Suggest three changes in lifestyle that a health
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age bracket. [1] professional might advise for this man. [3]
(iii) What does the lack of data for women in the 55–64 (iii) Name another quick and easy measure that people
age bracket suggest about the study? That it is: could use to indicate if they are obese. [1]
A not valid (c) Despite increasing evidence of the risks caused by obesity,
B not reliable approximately one-third of the population in the Middle
C not precise East are obese. Discuss why so many people are obese. [3]
D not repeatable. [1] (Total for Question 5 = 10 marks)
(iv) Assuming that smoking affects women to the same
extent as men, what proportion of women would 6 A person at risk of cardiovascular disease may be given
you expect to have CAD in the 55–64 age bracket medication to reduce their risk.
of smokers? [3] (a) How might anticoagulants or platelet inhibitors reduce the
(Total for Question 3 = 13 marks) risk of a heart attack or stroke? [2]
(b) Factors such as high blood pressure and type 2 diabetes are
4 (a) Describe the main stages in the formation of an
a direct result of obesity. Evaluate the use of medication
atheroma.[3]
such as antihypertensives and statins to treat people who
(b) Explain how atherosclerosis can lead to a heart attack. [3] are at risk of cardiovascular disease. [4]
(c) The average age for a first heart attack in the UAE is 20
(c) The graph below shows the relative risk of coronary heart
years younger than the global average. A recent survey of
disease plotted against the number of servings of fruit and
850 heart attack patients in the UAE gave the following
vegetables eaten per day.
results. 1.2
High blood High blood
Risk factor Diabetes
pressure cholesterol Relative risk of coronary 1.0
heart disease
Number of patients 380 212 0.8
with risk factor 0.6
% of patients with 38 44.7
risk factor 0.4
0.2
Calculate the number of patients in the survey who had
diabetes.[2] 0
<3.0 3.0–3.9 4.0–4.9 5.0–5.9 6.0–6.9 ≥7.0
Calculate the % of heart attack patients in the survey who
Fruit and vegetable intake (servings/per day)
had high blood cholesterol. [2]
(i) People are advised to eat at least five servings of fruit
(d) State two other risk factors that increase the chance of a
and vegetables per day. Justify this advice using the
heart attack. [2]
information in the graph. [3]
(Total for Question 4 = 12 marks) (ii) Suggest what evidence there is in the graph to modify
the advice. [2]
5 (a) Explain why perceived risk is often not the same as
actual risk. [2] (Total for Question 6 = 11 marks)
(b) One risk factor for cardiovascular disease is obesity.
The table below shows the BMI scale.
BMI Category
18.5–24.9 normal
25–29.9 overweight
30–34.9 obese
35–39.9 dangerously obese
(i) What is the BMI for a man who is 1.8 metres tall and
weighs 115 kg?
A 0.03
B 30.6
C 35.5
D 63.9 [1]
SPECIFICATION
MATHS SKILLS
REFERENCE
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USING RATIOS, FRACTIONS AND PERCENTAGES To multiply fractions together, simply multiply the numerators
Ratios, fractions and percentages help you to express one together and multiply the denominators together.
quantity in relation to another with precision. Ratios compare like
WORKED EXAMPLE
quantities using the same units. Fractions and percentages are
important mathematical tools for calculating proportions. __27 × __49 = ___
8
63
RATIOS To divide fractions, simply invert or flip the second fraction and
A ratio is used to compare quantities. You can simplify ratios by multiply.
dividing each side by a common factor. For example 12 : 4 can be
simplified to 3 : 1 by dividing each side by 4. WORKED EXAMPLE
__23 ÷ __79 = __23 × __97 = ___
18 __6
21 = 7
MATHS SKILLS 295
percentage questions.
The key rule to remember when using equations is that any
To increase a value by a given percentage, use a percentage operation that you apply to one side of the equation must also be
multiplier. applied to the other side.
each number of the data set equally and can be used for further statistical analysis such as
calculating a standard deviation. However, a disadvantage of the mean is that it may be affected
by extreme values.
The median is the middle value when the values are arranged in order. The median of a data set is
found by putting the values in order from lowest to highest and then finding the middle value. If there
is an even number of values, the median is found by calculating the mean of the two middle values.
The mode is the value that occurs most often. The mode of a data set is found by identifying the
most frequent value. It may not be possible to calculate the mode if there are two or more values
with the same highest frequency.
WORKED EXAMPLE
Find the mean, median and mode of the following data set:
7, 12, 18, 6, 2, 12
To find the mean, we add up all of the values in the data set and divide them by the number of values.
x
__
mean = S n
(7 + 12 + 18 + 6 + 2 + 12)
= __________________________
6
57
= ___
6
= 9.5
To find the median, we need to arrange the values in increasing order: 2, 6, 7, 12, 12, 18.
Since there is an even number of values, we need to look at the two middle values and find the mean. The
third value is 7 and the fourth value is 12.
(7 + 12)
median = ________
= 9.5
2
To find the mode, we need to identify the value that occurs most frequently. The only number that occurs
more than once is 12.
mode = 12
EXAM HINT
You will need to recall the equation to use and probably select the data to use from a table of results or
some other source.
WORKED EXAMPLE
The table below shows the results of a survey looking into the number of units of alcohol consumed in a week
by a sample of patients. Find the mean number of units of alcohol consumed per week.
70
0 + 14 + 48 + 54 + 120 + 230
= ______________________________
WORKED EXAMPLE
70
466
_____ A pupil investigates the effect that two newly developed fertilisers (A
=
70 and B) have on the growth of potato crops. Fourteen 10 m2 areas of a
= 6.6571 field were sectioned off and treated with either fertiliser A or B. The table
= 6.7 to 1 d.p. below shows the yields of potatoes from the test areas following harvest.
(a) Calculate the mean and standard deviation for the test plot yields for
EXAM HINT fertilisers A and B.
You are given the data but this is level 2 maths because there are
(b) Interpret the results of your answers to (a).
three steps in the calculation. You need to multiply units per week
by the number of patients and then add up those values before TEST PLOT YIELD/Kg
dividing by the number of patients. FERTILISER PLOT PLOT PLOT PLOT PLOT PLOT PLOT
1 2 3 4 5 6
UNDERSTANDING MEASURES OF DISPERSION INCLUDING STANDARD A 25 27 34 18 21 26 28
DEVIATION AND RANGE B 17 35 42 19 35 22 44
Two different sets of data may have similar averages but
statisticians are interested in looking deeper into the data for (a) To calculate the mean yield for A:
meaningful differences in dispersion. For example, if one data 25 + 27 + 34 + 18 + 21 + 26 + 28 = 179
set refers to patients who are given a new cancer drug and a 179/7 = 25.6 kg to 1 d.p.
second data set refers to patients who are given a placebo drug, To calculate the standard deviation for A:
it is very important to look for key differences in the dispersion (25 – 25.6)2 = 0.36 (27 – 25.6)2 = 1.96
of data, such as standard deviation and range, and not just at (34 – 25.6)2 = 70.56 (18 – 25.6)2 = 57.76
measures of average. 2
(21 – 25.6) = 21.16 (26 – 25.6)2 = 0.16
RANGE (28 – 25.6)2 = 5.76
The range of a set of data is the difference between the highest Sum of squares = 157.72
and lowest values in the set. To find the range, subtract the
smallest value in the set from the largest value in the set. EXAM HINT
STANDARD DEVIATION You will not be expected to recall the equation for standard
deviation. It is important that you set out any part of the
Standard deviation is a measure of the dispersion or ‘spread’ of
calculation clearly. If your final answer is incorrect, you may still
data around the mean. gain marks for using the correct technique.
A low standard deviation indicates that the data have a narrow
Divide by the number of plots:
range and the points are closely grouped to the mean. This
could indicate greater reliability. 157.72/7 = 22.5314
A high standard deviation indicates that the data points have Now calculate the square root of this value:
_________
a larger range and are less well grouped. This might indicate √ 22.5314
= 4.8 to 1 d.p.
lower reliability. To calculate the mean yield for B:
To calculate the standard deviation, use the formula: 17 + 35 + 42 + 19 + 35 + 22 + 44 = 214
__________ 214/7= 30.6 kg to 1 d.p.
√ ¯)
S(x – x
2
s= _________
n
To calculate the standard deviation for B:
where s = standard deviation, x is an individual value, ¯
x = the (17 – 30.6)2 = 184.96 (35 – 30.6)2 = 19.36
mean value, n = the number of values. 2
(42 – 30.6) = 129.96 (19 – 30.6)2 =134.56
TECHNIQUE (35 – 30.6)2 = 19.36 (22 – 30.6)2 = 73.96
1 Calculate the mean of the data set by finding the sum of the (44 – 30.6)2 = 179.56
values and then dividing by the number of values. This is ¯
x.
Sum of squares = 741.72
2 For each data value, calculate the difference between the data __________
√ 741.72/7
= 10.3 kg to 1 d.p.
value and the mean. Record these figures in a table.
(b) Fertiliser B produces a greater yield of potato crop (19% increase
3 Find the square of each of these differences. Record these
from fertiliser A), however the variation in crop yield (as shown by
figures in a new column in your table.
the standard deviation) of plots treated with fertiliser B is much
4 Find the sum of these squares. This is S(x – ¯ x) 2. greater and so fertiliser A produces a more consistent crop yield.
5 Divide this figure by the number of items in the data set.
S(x – ¯ x )2
This is _______
n
298 MATHS SKILLS
UNDERSTANDING SIMPLE PROBABILITY
The term probability is used to talk about the likelihood of an event happening on a scale of 0 to 1.
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A probability of 0 means that it is impossible that an event will occur. A probability of 1 means that it
is certain that an event will occur. You should be comfortable interpreting probabilities in a scientific
context, such as the probability of developing a disease or inheriting a specific gene.
INTERPRETING A SCATTERGRAM
A scattergram is a useful way of representing the relationship between two variables. To draw a
scattergram, first choose appropriate scales and label both axes. Then, use a pencil to draw a small
point (a cross or sharp dot) for each pair of variables.
A scattergram can be used to interpret whether there is correlation between two variables. We say
that there is correlation between two variables if when one variable changes, there is also a change in
the other variable.
If the points are distributed tightly around a line, the variables are strongly correlated.
If the points are loosely distributed around a line, the variables are weakly correlated.
If there is no pattern in the distribution of points, there is no correlation.
Correlation can be positive (as one variable increases, the other also increases) or negative (as one
variable increases, the other decreases).
A scattergram may include one or more points that lie outside of the main spread of values. Such a
point is called an outlier or anomaly and it can be ignored.
To draw a line of best fit, use a ruler to draw a straight line that passes as close as possible to all of
the points. You can use a line of best fit to make estimations. This is called interpolation. The more
closely correlated the variables, the more accurate your estimate is likely to be.
WORKED EXAMPLE
EXAM HINT
Variable D
Variable B
Variable F
CONSTRUCTING HISTOGRAMS
Constructing frequency tables and histograms is often the first step to looking carefully at a set
of raw continuous data and helps us to begin to look for patterns and behaviours in a data set.
Histograms are very similar to bar charts but there are two differences.
In a bar chart, each column represents a discrete category. The columns are of equal widths and
always separated.
In a histogram, the columns represent continuous data. The width of the columns is usually the
same for each category. However, for more advanced work the widths may vary. The columns are
always adjacent.
TECHNIQUE
1 Find the range of your values.
2 Choose the categories that you will use. Make sure that they are continuous (i.e. there are no gaps
and there is no overlap between categories).
3 Create a frequency table.
4 Plot your data, ensuring that frequency is represented on the y-axis and that the categories are
represented on the x-axis.
MATHS SKILLS 299
The weights of field mice found in a specified area of farmland to the c. An example of a linear relationship is the relationship between
nearest gram are shown below. Draw a histogram to represent the degrees Celsius and degrees Fahrenheit, which can be represented
by the equation F = _ 5 C + 32 where C is temperature in degrees
weights of field mice. 9
Weights of field mice (g): 42, 66, 75, 44, 52, 56, 60, 81, 64, 54, 37, 59, Celsius and F is temperature in degrees Fahrenheit.
47, 79, 66, 76, 53, 35, 40, 63, 56, 28, 43, 78, 83, 50, 38, 67, 68, 47, Conversion of
52, 49, 32, 46, 72, 58, 58 Celsius temperatures to Fahrenheit
To choose our categories, we first identify the range of the data. The
120
Fahrenheit temperature
highest value is 83 g and the lowest value is 28 g. The categories we
choose need to at least cover this range. One sensible way of splitting 100
(40°C, 104°F)
this range is to use four categories each covering an interval of 20 g: 80
(30°C, 86°F)
WEIGHT/g FREQUENCY 60 (20°C, 68°F)
40 (10°C, 50°F)
20–39 5
20 (0°C, 32°F)
40–59 18
0
60–79 12 0 10 20 30 40
80–99 2 Celsius temperature
We can now use this frequency data to draw a histogram. CALCULATE A RATE OF CHANGE FROM A GRAPH SHOWING A LINEAR
20
RELATIONSHIP
The rate of change from a graph showing a linear relationship is
15
Frequency
WORKED EXAMPLE (d) Calculate the difference in rate between the reactions at
30 seconds. (4 marks)
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Volume of gas/cm3
conical flask
30
40 °C
reaction mixture 20
10 °C
(catalase + hydrogen peroxide) 10
Experimental result 0
20 40 60 80 100
Volume of gas after
80
30 seconds/cm3
Time/seconds
60
(marks awarded for: axes correct way round, axes labelled
40
with units, points plotted correctly, suitable line drawn)
20
(d) We draw a tangent to each curve at 15 seconds so that we
0
10 20 30 40 50 60 can use the gradient of the curve to calculate the rate.
Temperature/°C Experimental result
40
Volume of gas/cm3
Display both sets of results on a graph with an appropriate scale. Difference in rate between reactions at 15 seconds
(4 marks) = 0.8 − 0.38 = 0.42 cm3 s−1
MATHS SKILLS 301
WORKED EXAMPLE
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A photomicrograph of a T helper cell was taken using an electron microscope set at a magnification of
×50 000. In the image, several organelles were clearly identified and measured.
(a) Calculate the actual object length of each organelle. (4 marks)
ORGANELLE IMAGE LENGTH/mm OBJECT LENGTH/μm
nucleus 240
endoplasmic reticulum 360
lysosome 10
mitochondrion 120
(b) A lysosome is a spherical organelle. Calculate the surface area and volume of a lysosome. (3 marks)
(c) Calculate the surface area to volume ratio of a lysosome. (2 marks)
Male with
Tay-Sachs disease
Dan Max Lilly
Question analysis
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• Generally one piece of information is required for each mark given in the
question. There are two marks available for this question so make sure you
make two distinct points.
• Clarity and brevity are the keys to success on short open questions. For one
mark, it is not always necessary to write complete sentences.
COMMENTARY
This is an average answer because:
• The student will get one mark for remembering that people only suffer
from a recessive genetic disorder if they inherit two copies of the recessive
allele from their parents.
• The student has not explained what made the allele potentially cause a
disorder: the version of the gene is faulty and does not code for a protein
properly.
QUESTION TYPE: OPEN RESPONSE The command word in this question is describe. This means
Molecules are transported across the cell membrane in a that you need to give an account of something. You do not
number of different ways. need to include a justification or reason. Three marks are
available so three distinct points need to be made.
Describe the structure of a cell membrane. (3) Remember that you can use bullet points or diagrams in
Question analysis your answer.
• With any question worth three or more marks, think about your answer
and the points that you need to make before you write anything down.
Keep your answer concise, and the information you write relevant to the
question. You will not gain marks for writing down biology that is not
relevant to the question (even if correct) but it will cost you time.
COMMENTARY
This is an average answer because:
• The student has made five points, three of which meet the criteria needed
to get full marks.
• The last sentence is poorly phrased: glycoproteins are molecules including
a short carbohydrate group which is already attached to a protein.
306 SAMPLE EXAM ANSWERS
• It helps with extended writing questions to think about the number of marks available
and how they might be distributed. For example, if the question asked you to give the
arguments for and against a particular case, then assume that there would be equal
numbers of marks available for each side of the argument and balance the viewpoints you
give accordingly. However, you should also remember that marks will also be available for
giving an overall conclusion so you should be careful not to omit that.
• It is vital to plan out your answer before you write it down. There is always space given
on an exam paper to do this so just jot down the points that you want to make before you
answer the question in the space provided. This will help to ensure that your answer is
coherent and logical and that you don’t end up contradicting yourself. However, once you
have written your answer go back and cross these notes out so that it is clear they do not
form part of the answer.
COMMENTARY
This is an average answer because:
zz Some important details have been missed. The student does not mention repeating the
experiment to check for anomalies or controlling variables to ensure the results are valid.
zz The student has not detailed how the heart rate is to be counted. The heart will beat
between 100–200 times a minute so a sensible method would be by using a felt pen to
place a dot on a piece of paper every time the heart beats.
SAMPLE EXAM ANSWERS 307
development of heart disease in an individual. The graph need to obtain a numerical answer to the question, showing
below shows the results of a survey in America on the relevant working. If the answer has a unit, this must be
incidence of heart disease in adults aged 18 and older. included.
500 Key Finding the numbers requires you to read the graph really
carefully, paying close attention to the increments on the
Incidence of heart disease
Female
400
y-axis, as well as choosing the correct set of bars.
per 100 population
Male
300
200
100
0
18–44 45–64 65–74 75 and
older
Calculate the increased risk that a man who is 75 or older has
of developing heart disease, compared to a man aged between
18 and 44 years old. (2)
Question analysis
• The important thing with calculations is that you must
show your working clearly and fully. The correct answer
on the line will gain all the available marks. However,
an incorrect answer can gain all but one of the available
marks if the correct working is shown.
• Show the calculation that you are performing at each
stage and not just the result. When you have finished,
look at your result and see if it is sensible.
• At some point during your answer, you will need to do
some kind of sum, and the skills are to decide
which numbers you need The student has not read the graph correctly. Five of the
small sections on the y-axis equal 100, so each small
which operation you need. section of the y-axis corresponds to 20. Therefore, the
calculation of difference is actually 420 − 35, which is
Average student answer 385.
395
410 – 15 = 395. ____
= 26.3, so 26.3 times. To work out the increased risk, you divide the difference by
15 the risk for 18–44-year-old men.
It’s a good idea when you finish the question to check
COMMENTARY whether you need to put in the units. In this question, there
are none as it’s simply a case of ‘multiples of risk’.
This is an average answer because:
zz The student has misread the graph so has used incorrect
figures in the calculation.
zz However, the correct technique has been used to work
out the increased risk, so a mark would be awarded for
using the correct method.