Dissertations / Theses: 'Atherosclerosis – Risk factors'

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Persson, Jerker. "Ultrasound and atherosclerosis evaluation of methods, risk factors and intervention /." Malmö : Lund : Malmö University Hospital ; Lund University, 1997. http://catalog.hathitrust.org/api/volumes/oclc/68945104.html.

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Pöykkö, S. (Seppo). "Ghrelin, metabolic risk factors and carotid artery atherosclerosis." Doctoral thesis, University of Oulu, 2005. http://urn.fi/urn:isbn:9514276566.

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Abstract The increasing prevalence of metabolic syndrome and the consequent cardiovascular diseases, including atherosclerotic diseases and type 2 diabetes, are a cause of public concern worldwide. This development has stimulated an active search for novel risk factors and new candidate genes. The hormones regulating energy balance and the polymorphisms associated with them are of special interest as potential risk factors for metabolic syndrome. Ghrelin is a novel peptide hormone from stomach with strong growth hormone releasing activity. It is also able to modify glucose and insulin metabolism, blood pressure levels, cardiac function, adipogenesis and inflammatory processes in experimental conditions. Whether ghrelin and ghrelin gene variations have a role in the development of metabolic syndrome and the associated diseases, is not known. In the present study, the associations between fasting plasma ghrelin concentrations, ghrelin gene mutations (Arg51Gln and Leu72Met), features of metabolic syndrome, type 2 diabetes and carotid artery atherosclerosis were analysed. In addition, the relationship between ghrelin and insulin-like growth factor I (IGF-I) concentrations was studied. The study population consisted of 1045 middle-aged subjects of the hypertensive and the control cohorts of the OPERA project from the City of Oulu, Finland. Low ghrelin concentrations were found to be associated with several components of metabolic syndrome: adiposity, low HDL cholesterol levels, high insulin concentrations and high blood pressure levels. The prevalence of insulin resistance and type 2 diabetes was increased amongst the subjects with low ghrelin concentrations. Out of the individual factors tested, IGF-I concentration was the most significant predictor of ghrelin concentrations. This negative association was strongest in the subjects with insulin resistance and type 2 diabetes, which suggests that changes in ghrelin/IGF-I interactions might be involved in the development of these conditions. The subjects with the Gln51 allele of the ghrelin gene had lower ghrelin concentrations and, consistent with the findings mentioned above, higher prevalence of type 2 diabetes and hypertension compared with the subjects homozygous for the Arg51 allele. No correlation between ghrelin and C-reactive protein concentrations was seen. However, there was a positive association between ghrelin concentrations and carotid artery intima-media thickness. This association was independent of the commonly recognised risk factors of atherosclerosis and was only seen in men, who also had more advanced atherosclerosis than women. These observations call for further studies to clarify the potential causative role of ghrelin in the etiology of metabolic syndrome, type 2 diabetes and atherosclerotic cardiovascular diseases Tiivistelmä Metaboliseen oireyhtymään liittyy kohonnut riski sairastua sydän- ja verisuonisairauksiin kuten tyypin 2 diabetekseen ja sepelvaltimotautiin. Metabolisen oireyhtymän nopea esiintyvyyden kasvu on johtanut aktiiviseen uusien riskitekijöiden etsintään. Erityisen kiinnostuksen kohteena ovat olleet energia-aineenvaihduntaa säätelevät hormonit ja niihin liittyvät polymorfiat. Greliini on ensisijaisesti vatsalaukusta erittyvä hormoni, joka lisää voimakkaasti kasvuhormonin eritystä. Koeolosuhteissa sillä on myös vaikutuksia sokeriaineenvaihduntaan, verenpaineeseen, sydämen toimintaan, rasvakudoksen kehittymiseen ja tulehduksellisiin tapahtumiin, minkä perusteella on syytä epäillä greliinillä olevan osuutta metabolisen oireyhtymän ja siihen liittyvien sairauksien synnyssä. Tässä tutkimuksessa selviteltiin greliinin paastoplasmapitoisuuksien ja greliinipolymorfioiden (Arg51Gln ja Leu72Met) yhteyksiä metabolisen oireyhtymän piirteisiin, tyypin 2 diabetekseen ja kaulavaltimoiden ateroskleroosiin. Lisäksi tutkittiin greliinin ja insuliinin kaltaisen kasvutekijän (IGF-I) pitoisuuksien yhteyksiä. Tutkimusväestö koostui 1045 oululaisesta keski-ikäisestä OPERA tutkimukseen kuuluvasta henkilöstä. Tutkimuksessa matalien greliinipitoisuuksien havaittiin olevan yhteydessä useisiin metabolisen oireyhtymän piirteisiin: lihavuuteen, alhaisiin HDL kolesterolin pitoisuuksiin, korkeisiin insuliinipitoisuuksiin ja kohonneeseen verenpaineeseen. Matala greliinipitoisuus yhdistyi myös tyypin 2 diabeteksen ja verenpainetaudin esiintyvyyteen. Tutkituista tekijöistä IGF-I -pitoisuudet selittivät parhaiten greliinipitoisuuksia. Tämä käänteinen yhteys oli erityisen vahva tyypin 2 diabeetikoilla ja insuliiniresistenteillä henkilöillä viitaten greliinin ja IGF-I:n mahdollisen vuorovaikutukseen liittyvän näiden tilojen kehittymiseen. Lisäksi havaittiin, että greliinigeenin Gln51-alleelia kantavien henkilöiden greliinipitoisuudet olivat alhaiset, ja että he sairastivat enemmän diabetesta ja verenpainetautia kuin henkilöt jotka olivat homotsygootteja Arg51-alleelin suhteen. Greliinipitoisuudet ja C-reaktiivisen proteiinin pitoisuudet eivät korreloineet keskenään. Kaulavaltimon seinämäpaksuus korreloi positiivisesti greliinipitoisuuksien kanssa miehillä riippumatta perinteisistä ateroskleroosin riskitekijöistä. Tutkimustulokset tukevat olettamusta, että greliinillä saattaa olla merkitystä metabolisen oireyhtymän, tyypin 2 diabeteksen ja ateroskleroosin kehittymisessä. Jatkotutkimukset ovat tarpeen tämän yhteyden osoittamiseksi

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Rerkasem, Kittipan. "The risk factors associated with carotid artery disease." Thesis, University of Southampton, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271581.

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Xu, Lin, and 徐琳. "Subclinical atherosclerosis, cardiovascular risk factors and metabolicsyndrome in older Chinese people." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B4451430X.

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Rantala, M. (Maire). "Dietary modification and genetic variability of atherosclerosis risk factors." Doctoral thesis, University of Oulu, 2000. http://urn.fi/urn:isbn:9514256522.

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Abstract The risk factors for atherosclerosis and coronary heart disease (CHD) are multiple and may interact with each other. Diet has a significant role among the main risk factors for atherosclerosis, as it regulates the levels of plasma lipids and lipoproteins, their oxidative modification or protection from oxidation, blood pressure, energy balance, and thrombogenesis. Nutrients can transfer their effects directly through plasma concentrations or modify the cell transduction or gene expression of important regulatory genes. The response to dietary modification varies between individuals. The plasma cholesterol response induced by dietary modification is at least partly regulated genetically and some of the variation is explained by other environmental factors. Apolipoprotein E (apo E) and apolipoprotein B (apo B) are the key regulatory proteins in cholesterol and lipoprotein metabolism. The genetic variation of apo E is associated with the plasma lipid levels and the CHD risk. The polymorphic variation of the apo B gene is also associated with increased plasma cholesterol and CHD risk. Obesity is associated with increased morbidity and mortality. Plasma lipid abnormalities, impaired glucose metabolism and increased blood pressure caused by obesity are the main reasons for increased CHD mortality among obese subjects. To study the magnitude of the response to dietary modification, genetically selected groups were investigated. Dietary modification had a significant impact on plasma total, LDL, and HDL cholesterol concentrations, and the individual response in plasma LDL cholesterol varied from 3 to 100%. The role of genetic variation in the apo E gene was not significant in the lipid response, but the blood pressure response was more distinct among subjects with the ε 4 allele than those with the ε 3 allele. The determination of apo B EcoRI and MspI gene polymorphisms revealed subjects with a greater response to diet, a finding which may have clinical importance in the future for the attempt to identify subjects for effective dietary counselling. The effect of caloric restriction on gene expression was studied in obese gallstone patients. Moderate weight reduction during caloric restriction was associated with reduced lipoprotein lipase gene expression, while the cholesteryl ester transfer protein gene expression remained unchanged. Some of the beneficial changes in plasma lipids and lipoproteins during and after weight reduction may be followed by altered transcription of their modifying genes. Meta-analysis is a modern and generally accepted method. Many clinical uncertainties can be solved by combining all the data available to a quantitative and objective analysis. However, the use of meta-analysis do not resolve the problem of the effect of publication bias.

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Karvonen, J. (Jarkko). "Genetic and immunological risk factors and carotid artery atherosclerosis." Doctoral thesis, University of Oulu, 2004. http://urn.fi/urn:isbn:9514272609.

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Abstract Atherosclerosis is a multifactorial disease with numerous genes and environmental factors affecting its intiation and progression. During the past years many candidate genes for atherosclerosis have been suggested, and it has also become evident that the immune system plays a part in atherogenesis. Early atherosclerotic changes can be effectively detected by measuring carotid artery intima-media thickness (IMT). In the present study the associations between IMT and polymorphisms of three candidate genes for atherosclerosis were studied: endothelial nitric oxide synthase (eNOS), apolipoprotein E (apoE) and paraoxonase-1 (PON1). To assess the role of immunological factors determining carotid atherosclerosis, CRP and circulating autoantibodies to oxidised LDL were studied in relation to IMT. The study population consisted of 519 hypertensive and 526 control subjects from a middle-aged population in Oulu, Finland. The results showed that the investigated polymorphisms of eNOS and PON1 genes were not associated with IMT, suggesting that these polymorphisms are not major risk factors for atherosclerosis in the general Caucasian population. A significant interaction between the apoE polymorphism and smoking in relation to IMT was observed among men, indicating that carriers of the ε4 allele may be particularly prone to the atherogenic effects of smoking. This interaction was especially clear in hypertensive subjects. CRP was strongly associated with IMT before adjusting for confounding factors. After the adjustment, this association diasppeared. The finding suggests that instead of early atherosclerosis CRP may be related to the later phases of the disease. This may partly explain the strong correlation between CRP and future cardiovascular events. IgM type of autoantibodies binding to oxidised LDL were inversely associated with IMT, and this finding remained after adjusting for previously known risk factors for atherosclerosis, implying a possible protective role for these antibodies in atherogenesis.

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Hietaniemi, M. (Mirella). "Studies on novel and traditional risk factors of atherosclerosis." Doctoral thesis, University of Oulu, 2009. http://urn.fi/urn:isbn:9789514291296.

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Abstract The atherosclerotic plaques develop with the adhesion of inflammatory cells and lipids onto the innermost layer of the vessel. They may eventually occlude the vessel impairing blood flow. A severe complication is the rupture of a plaque resulting in the formation of a thrombus that can cause myocardial infarction or stroke. Though a large number of risk factors for atherosclerosis have been identified, the pathogenesis of atherosclerosis is far from unravelled. The aim of the present work was to study both traditional as well as potential novel risk factors of atherosclerosis. The first study examined the relationship between IGF-I concentrations and carotid artery atherosclerosis and its metabolic risk factors. Low IGF-I concentrations were associated with several cardiovascular risk factors. A positive association was observed between IGF-I concentrations and carotid artery intima-media thickness in women. The results suggest that IGF-I may be involved in the pathogenesis of atherosclerosis. Interestingly, the effect may manifest differentially in men and women. The second study focused upon the effects of obesity and weight loss on liver gene expression. A global decrease in gene expression was observed. The down-regulated genes included genes involved in the ubiquitin cycle, which may point to a reduction in oxidative stress due to the hypocaloric diet. The down-regulation of peroxisome proliferator-activated receptor gamma cofactor 1 alpha (PGC-1α) may be related to improved insulin sensitivity. Several novel genes not previously linked to obesity and weight loss were also discovered. In the third and fourth studies, the developmental origins of atherosclerosis hypothesis was studied in a rat model of fetal undernutrition. Unfavourable changes in the obesity-related peptide hormones adiponectin and resistin were observed which could predispose to insulin resistance in later life. In addition, total cholesterol levels were elevated in the undernourished offspring. The gene expression changes in the rat pups suggest that the development of pancreas was affected, which might further contribute to disturbances in insulin and glucose metabolism Tiivistelmä Ateroskleroosi eli valtimonkovettumatauti on sairaus, joka saa alkunsa verisuonen sisäseinämään kiinnittyvistä tulehdussoluista ja veren rasvapartikkeleista, joista muodostuu pitkän ajan kuluessa ateroskleroottisia plakkeja. Plakit voivat kasvaessaan heikentää veren virtausta valtimoissa ja pahimmillaan jopa tukkia suonen kokonaan. Mikäli plakki repeää, voi muodostua verihyytymä joka sydämessä aiheuttaa sydäninfarktin ja aivoissa aivoinfarktin. Vaikka useita ateroskleroosille altistavia tekijöitä tunnetaan, taudin syntymekanismit ovat vielä suurelta osin selvittämättä. Tämän väitöskirjatyön tarkoituksena oli tutkia sekä ateroskleroosin perinteisiä että mahdollisia uusia riskitekijöitä. Ensimmäisessä osatyössä tutkittiin insuliininkaltaisen kasvutekijä I:n (IGF-I) yhteyttä kaulavaltimon ateroskleroosiin sekä perinteisiin ateroskleroosin riskitekijöihin. Matalat IGF-I pitoisuudet liittyivät moniin ateroskleroosin riskitekijöihin. Naisissa korkeammat IGF-I pitoisuudet kuitenkin yhdistyivät paksumpaan kaulavaltimoon, mikä viittaa ateroskleroosiin. Tulosten perusteella IGF-I saattaa liittyä ateroskleroosin kehitykseen ja mahdollisesti sen vaikutukset ilmenevät naisissa ja miehissa eri tavoin. Toisessa osatyössä tutkittiin maksan geenien ilmentymistä lihavuudessa ja laihdutusjakson jälkeen. Laihduttaneessa ryhmässä 142:n geenin ilmentyminen oli vähentynyt ja vain yhden lisääntynyt suhteessa kontrolliryhmään. Ubikitiini-syklin geenien ilmentymisen väheneminen voi viitata vähentyneeseen oksidatiiviseen stressiin elimistössä dieetin seurauksena. Muun muassa diabetekseen liittyvän geenin, peroxisome proliferator-activated receptor gamma cofactor 1 alpha, väheneminen puolestaan voi liittyä parantuneeseen insuliiniherkkyyteen laihduttaneissa. Lisäksi tässä työssä tuli esiin monia uusia, mielenkiintoisia geenejä, joita ei aiemmin ole yhdistetty lihavuuteen tai ateroskleroosiin. Kolmannessa ja neljännessä osatyössä selvitettiin ns. Barkerin hypoteesia, eli sitä, voisiko sairastumisalttius määräytyä jo sikiökauden ja varhaiskehityksen aikana. Rottakokeemme osoittivat, että sikiöaikaisen aliravitsemuksen seurauksena kolesteroliarvot olivat korkeammat ja että lihavuuteen liittyvien peptidihormonien, adiponektiinin ja resistiinin, pitoisuuksissa oli tapahtunut epäsuotuisia muutoksia, jotka voivat altistaa insuliiniresistenssille Tulokset viittasivat myös siihen, että aliravitsemus oli mahdollisesti vaikuttanut haiman kehitykseen, mikä voi myös osaltaan vaikuttaa mm. insuliini- ja sokeriaineenvaihduntaan. Tämänkaltaiset muutokset saattavat altistaa ateroskleroosille myöhemmällä iällä

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Rantala, A. (Asko). "Risk factors and carotid atherosclerosis in hypertensive and control subjects." Doctoral thesis, University of Oulu, 2001. http://urn.fi/urn:isbn:9514264657.

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Abstract Different metabolic and environmental factors affect the blood pressure level, constituting a cluster, especially in hypertensives, that leads to an increased risk of cardiovascular diseases. The present research was designed to determine the prevalence and the predictors of the metabolic syndrome and the role of insulin and blood pressure in carotid atherosclerosis in 600 treated male and female hypertensives aged 40-59 years and 600 age- and sex-matched controls. The prevalence of the metabolic syndrome in different population-based cohorts varied, depending on the definition, from 0.8% to 35.3%, being lowest in control men and women and highest in hypertensive men. 73.8% of a random, middle-aged, urban population showed at least one cardiovascular risk factor, and 91.3% of all hypertensive subjects showed at least one cardiovascular risk factor in addition to hypertension itself. The independent predictors of the metabolic syndrome were waist circumference, uric acid, total cholesterol and gamma-glutamyl transpeptidase. Hypertension had a significant effect on carotid intima-media thickness and the prevalence of plaques in men, but its effect in women was not significant. A long duration of hypertension resulted in greater intima-media thickness and a higher prevalence of plaques, particularly in men. There were significant associations between gamma-glutamyl transpeptidase and the components of the metabolic syndrome after adjustment for alcohol consumption and also in teetotallers. There were inconsistent associations between the different insulin measures and the intima-media thickness as a measure of carotid atherosclerosis. The exclusion of diabetic subjects did not change the results. In conclusion, a cluster of metabolic abnormalities related to hypertension is frequent among both controls and treated hypertensive subjects. Hypertensive subjects have higher prevalences of carbohydrate and lipoprotein aberrations and structural and functional cardiovascular complications than age- and sex-matched controls.

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Nicoll, Rachel. "Insights into the relationship between coronary calcification and atherosclerosis risk factors." Doctoral thesis, Umeå universitet, Institutionen för folkhälsa och klinisk medicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-124909.

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Introduction Coronary artery disease (CAD) is the most common cause of death in Europe and North America and early detection of atherosclerosis is a clinical priority. Diagnosis of CAD remains conventional angiography, although recent technology has introduced non-invasive imaging of coronary arteries using computed tomographic coronary angiography (CTCA), which enables the detection and quantification of coronary artery calcification (CAC). CAC forms within the arterial wall and is usually found in or adjacent to atherosclerotic plaques and is consequently known as sub-clinical atherosclerosis. The conventional cardiovascular (CV) risk factors used to quantify the estimated 10-year coronary event risk comprise dyslipidaemia, hypertension, diabetes mellitus, obesity, smoking and family history of CAD. Nevertheless, their relationship with significant (>50%) stenosis, their interaction with the CAC score and their predictive ability for CAC presence and extent has not been fully determined in symptomatic patients. Methods For Papers 1-4 we took patients from the Euro-CCAD cohort, an international study established in 2009 in Umeå, Sweden. The study data gave us the CAC score and the CV risk factor profile in 6309 patients, together with angiography results for a reduced cohort of 5515 patients. In Papers 1 and 2 we assessed the risk factors for significant stenosis, including CAC as a risk factor. Paper 2 carried out this analysis by geographical region: Europe vs USA and northern vs southern Europe. Paper 3 investigated the CV risk factors for CAC presence, stratified by age and gender, while Paper 4 assessed the CV risk factors for CAC extent, stratified by gender. In paper 5 we carried out a systematic review and meta-analysis of all studies of the risk factor predictors of CAC presence, extent and progression in symptomatic patients. From a total of 884 studies, we identified 10 which fitted our inclusion criteria, providing us with a total of 15,769 symptomatic patients. All 10 were entered in the systematic review and 7 were also eligible for the meta-analysis. Results Paper 1: Among risk factors alone, the most powerful predictors of significant coronary stenosis were male gender followed by diabetes, smoking, hypercholesterolaemia, hypertension, family history of CAD and age; only obesity was not predictive. When including the log transformed CAC score as a risk factor, this proved the most powerful predictor of >50% stenosis, but hypercholesterolaemia and hypertension lost their predictive ability. The conventional risk factors alone were 70% accurate in predicting significant stenosis, the log transformed CAC score alone was 82% accurate but the combination was 84% accurate and improved both sensitivity and specificity. Paper 2: Despite some striking differences in profiles between Europe and the USA, the most important risk factors for >50% stenosis in both groups were male gender followed by diabetes. When the log CAC score was included as a risk factor, it became by far the most important predictor of >50% stenosis in both continents, followed by male gender. In the northern vs southern Europe comparison the result was similar, with the log CAC score being the most important predictor of >50% stenosis in both regions, followed by male gender. Paper 3: Independent predictors of CAC presence in males and females were age, dyslipidaemia, hypertension, diabetes and smoking, with the addition of family history of CAD in males; obesity was not predictive in either gender. The most important predictors of CAC presence in males were dyslipidaemia and diabetes, while among females the most important predictors of CAC presence were diabetes followed by smoking. When analysed by age groups, in both males and females aged <70 years, diabetes, hypertension and dyslipidaemia were predictive, with diabetes being the strongest; in females aged <70 years, smoking was also predictive. Among those aged ≥70 years, the results are completely different, with only dyslipidaemia being predictive in males but smoking and diabetes were predictive in females. Paper 4: In the total cohort, age, male gender, diabetes, obesity, family history of CAD and number of risk factors predicted an increasing CAC score, with the most important being male gender and diabetes. In males, hypertension and dyslipidaemia were also predictive, although diabetes was the most important predictor. Diabetes was similarly the most important risk factor in females, followed by age and number of risk factors. Among patients with CAC, hypertension, dyslipidaemia and diabetes predicted CAC extent in both males and females, with diabetes being the strongest predictor in males followed by dyslipidaemia, while diabetes was also the strongest predictor in females, followed by hypertension. Quantile regression confirmed the consistent predictive ability of diabetes. Paper 5: In the systematic review, age was strongly predictive of both CAC presence and extent but not of CAC progression. The results for CAC presence were overwhelmed by data from one study of almost 10,000 patients, which found that white ethnicity, diabetes, hypertension and obesity were predictive of CAC presence but not male gender, dyslipidaemia, family history or smoking. With respect to CAC extent, only male gender and hypertension were clearly predictive, while in the one study of CAC progression, only diabetes and hypertension were predictive. In the meta-analysis, hypertension followed by male gender, diabetes and age were predictive of CAC presence, while for CAC extent mild-moderate CAC was predicted by hypertension alone, whereas severe CAC was predicted by hypertension followed by diabetes. Conclusion Our investigation of the Euro-CCAD cohort showed that the CAC score is far more predictive of significant stenosis than risk factors alone, followed by male gender and diabetes, and there was little benefit to risk factor assessment over and above the CAC score for >50% stenosis prediction. Regional variations made little difference to this result. Independent predictors of CAC presence were dyslipidaemia and diabetes in males and diabetes followed by smoking in females. The risk factor predictors alter at age 70. The most important risk factor predictors of CAC extent were male gender and diabetes; when analysed by gender, diabetes was the most important in both males and females. Our studies have consistently shown the strong predictive ability of male gender in the total cohort and diabetes in males and females and this is reflected in the meta-analysis, which also found hypertension to be independently predictive. Interestingly, dyslipidaemia does not appear to be a strong risk factor.

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Sjögren, Per. "Cardiovascular risk factors, diet and the metabolic syndrome /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-894-0/.

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Zhang, Xiaohua. "Investigations of effects of garlic materials upon risk factors of atherosclerosis." Thesis, University of Wolverhampton, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.323146.

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A brief review was provided of lipid metabolism, mechanisms of lipid lowering and coronary heart disease risk factors (including the role of antioxidants). In addition, studies of lipid-lowering and other anti-atherosclerotic effects of garlic materials were also reviewed. Evaluation and development of techniques required to perform studies of the anti-atherosclerotic effects of garlic were implemented, including evaluation of methods for measuring total antioxidant capacity and the development of methods for the rapid isolation of low density lipoprotein (LDL). The main objective of this project was to investigate the effects of garlic upon plasma lipids in rats and healthy human subjects and the effects upon antioxidant status in healthy human subjects. In a long-term study with old male rats, a low dose of garlic oil (c. O.5mg/Kg body weight/day) for 12.5 weeks provided in a high fat diet produced no significant reduction in plasma lipids or glucose. Upward trends in plasma lipids early in the treatment period were similar to those reported from several previous studies in which eventual reductions in plasma lipids were observed suggesting the possibility of a small effect of garlic oil upon lipid metabolism. Two randomised, double-blind, placebo-controlled human studies were carried out to investigate the effects of capsules containing garlic oil dissolved in vegetable oil upon coronary heart disease risk factors in normal subjects. In the first study, 8.2 mg/day of garlic oil (or placebo) capsules were given to 51 subjects over an I 1- week period. 95% confidence intervals were calculated for differences between garlic oil and placebo groups of changes in plasma lipids, glucose and total antioxidant capacity between baseline and end-oftreatment. No significant effects were observed, but it was found that plasma lipids and glucose trends were more favourable with garlic oil treatment. Effects of garlic oil over placebo for cholesterol-related variables and glucose were in opposite directions for males and females and this interaction between genders reached significance for high density lipoprotein cholesterol, total cholesterol/high density lipoprotein cholesterol ratio, calculated low density lipoprotein cholesterol and glucose of plasma. The strong gender effect of garlic oil evidenced for plasma lipids and glucose implies potent effects of garlic oil and suggests future garlic studies should include gender analyses. In the second human study, 12 mg/day garlic oil (or placebo) capsules were given to 27 trained young male athletes for 16 weeks. 95% confidence intervals were calculated for differences between garlic oil and placebo groups of changes in plasma lipids, total antioxidant capacity and LDL composition between baseline and end-of-treatment. It was found that the reduction in plasma triglycerides (p=O.09) of the garlic oil group in comparison with the placebo group was accompanied by increases in density, a significant reduction in triglycerides / protein and a trend towards reduction of cholesterol/protein of the LDL fraction. A trend towards reduced total antioxidant capacity / protein of LDL appear to reflect garlic oil effects upon lipid composition of LDL rather than directly upon antioxidants. Non-significant trends towards small improvements in maximal oxygen intake test-duration and less plasma glucose depletion with garlic oil were observed. Overall, the results from the human studies provide some encouragement to the view that garlic oil could reduce coronary heart disease risk in normal persons and that this possibility deserves further investigation.

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McKeown, Barry Hugh. "Determinants of atherosclerosis in elderly post-menopausal women : effects of endogenous estrogen, estrogen-related genes and established cardiovascular risk factors." University of Western Australia. School of Medicine and Pharmacology, 2005. http://theses.library.uwa.edu.au/adt-WU2005.0100.

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[Truncated thesis] Background & Aims- The determinants of atherosclerosis in elderly postmenopausal women are poorly understood. We do not know if the traditional coronary heart disease (CHD) risk factors remain important in this group. Despite the growing body of data relating to exogenous estrogen, we know very little about the relationship of endogenous estrogen with inflammation, CHD risk factors and subclinical atherosclerosis in elderly women. Genes that may play a role in post-menopausal cardiovascular disease (CVD)(ER-α and Apo E gene polymorphisms) have not been examined in this population for their effect on sub-clinical atherosclerosis and whether this effect is modified by the level of endogenous estrogen. We have examined the effect of established cardiovascular risk factors, endogenous estrogen and Apo E genotype on carotid artery atherosclerosis in a large group of women over the age of 70 years. In smaller sub-groups, we have examined the relationship between ER-α gene polymorphisms and atherosclerosis and the relationship between endogenous estrogen and CRP. Methods- We studied 1149 ambulatory elderly women who were recruited from the electoral role in Perth, Western Australia in 1998 and subsequently underwent carotid ultrasound assessment in 2001 according to a standardised protocol (for detection of focal plaque and measurement of intimal-medial thickness). The subjects had a mean age of 75 years (range 70 to 82 years) at baseline. We assessed the following variables in almost all subjects at baseline; time from menopause, FEI (molar ratio of plasma estradiol to sex hormone binding globulin (SHBG) x 1000), systolic and diastolic blood pressure, total cholesterol, LDL and HDL cholesterol, triglycerides, body mass index, glycated haemoglobin, homocysteine, apolipoprotein E (ApoE) genotype, history of smoking, diabetes, cardiovascular disease and medication use. Four hundred and thirty three women were analysed for estrogen receptor alpha (ERα) genotype and 100 underwent measurement of high sensitivity C-reactive protein.

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Mamudu, Hadii M., Arsham Alamian, Timir Paul, et al. "Diabetes, Subclinical Atherosclerosis and Multiple Cardiovascular Risk Factors in Hard-to-Reach Asymptomatic Patients." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/2778.

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Aim: To examine the association of cardiovascular disease risk factors with and their cumulative effect on coronary artery calcium in hard-to-reach asymptomatic patients with diabetes. Methods: : A total of 2563 community-dwelling asymptomatic subjects from Central Appalachia participated in coronary artery calcium screening at a heart centre. Binary variable was used to indicate that coronary artery calcium was either present or absent. Independent variables consisted of demographic and modifiable risk factors and medical conditions. Descriptive statistics and multinomial logistic regression analyses were conducted. Results: : In total, 55.8% and 13.7% of study participants had subclinical atherosclerosis (coronary artery calcium ⩾1) and diabetes, respectively. The presence of coronary artery calcium was higher in subjects with diabetes (68.5%) than those without (53.8%). Compared to subjects without diabetes with coronary artery calcium = 0, obesity, hypertension, hypercholesterolaemia and smoking increased the odds of the presence of coronary artery calcium (coronary artery calcium score ⩾1) regardless of diabetes status; however, with larger odds ratios in subjects with diabetes. Compared to subjects without diabetes with coronary artery calcium score = 0, having 3, 4 and ⩾5 risk factors increased the odds of presence of coronary artery calcium in subjects with diabetes by 14.06 (confidence interval = 3.26–62.69), 32.30 (confidence interval = 7.41–140.82) and 47.12 (confidence interval = 10.35–214.66) times, respectively. Conclusion: : There is a need for awareness about subclinical atherosclerosis in patients with diabetes and more research about coronary artery calcium in subpopulations of patients.

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Jenner, Kris Harlan. "The study of inherited diseases using recombinant DNA technology." Thesis, University of Oxford, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.670385.

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Clarke, S. C. "The effect of oestrogens and anti-oestrogens on plasma risk factors for coronary atherosclerosis and arterial flow-mediated vasodilation in patients with coronary atherosclerosis." Thesis, University of Cambridge, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.597727.

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Helmersson, Johanna. "Prostaglandins and Isoprostanes in Relation to Risk Factors for Atherosclerosis : Role of Inflammation and Oxidative Stress." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4803.

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Byers, Constance S. (Constance Susan). "Transactional Risk Factors and Coronary Atherosclerosis: The Impact of Type A Behavior, Hostility, and Defense Style." Thesis, University of North Texas, 1990. https://digital.library.unt.edu/ark:/67531/metadc935809/.

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The relationship of coronary-prone behavior, hostility, and defense style to atherosclerosis was examined. Subjects were 1,271 patients who underwent coronary angiography at Duke University Medical Center between 1974 and 1980. Type A behavior was assessed using both the Structured Interview and Jenkins Activity Survey. The Cook and Medley Hostility scale and Byrne's Repression-Sensitization scale, both subscales of the Minnesota Multiphasic Personality Inventory, were employed to measure hostility and defense style. The results revealed no significant association between the disease end-points CADSEV, history of myocardial infarction, and history of angina pectoris and either the Structured Interview Type A, hostility, or repression-sensitization, Jenkins Activity Survey defined Type B's, however, were found to more frequently complain of angina. It was suggested future research employ longitudinal or process designs to focus on adaptive functioning from a transactional and developmental perspective which may serve to promote coronary resistance.

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Kuek, Conchita Maria. "Hereditary haemochromatosis and the C282Y genotype : implications in diagnosis and disease." University of Western Australia. School of Surgery and Pathology, 2003. http://theses.library.uwa.edu.au/adt-WU2004.0024.

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[Truncated abstract. Please see the pdf format for the complete text.] The discovery of the C282Y mutation and its role in the development of hereditary haemochromatosis has allowed a greater understanding into the effects of iron overload and its involvement in other conditions such as diabetes and heart disease. It has also allowed the better classification of heterozygotes, who were previously only diagnosed through the use of family studies. There are however, areas of conflict between phenotyping and genotyping methods. My research involved examining the relationship between Haemochromatosis and certain diseases such as diabetes and heart disease; genotyping versus phenotyping discrepancies and the possible interaction of secondary mutations. In Chapter 3 a population study was undertaken with the aim of comparing genotyping versus phenotyping methods as well as increasing general practitioner awareness regarding hereditary haemochromatosis and its diagnosis. It was determined that a minimum of 5000 subjects would be required to give the study sufficient power. Individuals were to be between the ages of 20—40 years, and thus presumably presymptomatic. Participation was entirely voluntary and a consent form was to be signed. Recruitment of subjects proved to be difficult and there was a selective bias towards individuals already displaying symptoms of haemochromatosis. In total less than a 100 subjects were recruited for the study. There were several issues encountered in the implementation of this study. Firstly the number of GPs participating was probably insufficient to recruit the subjects required. A more extensive campaign was probably required to enroll more GPs. Secondly it is very difficult for a busy GP to find the time necessary to explain the study to each of his patients and to get them to sign the consent form. Finally a bias developed in some of the requests. The subjects participating in this study were supposed to be random but in many cases the GPs had enrolled them in the study because they had symptoms of iron overload. In effect the biggest obstacle this study faced was the recruitment of subjects. Due to the small number of subjects little statistical data could be obtained from this study. It was noted, however, that genotyping methods detected two individuals who were homozygous for the C282Y mutation. Both also had increased transferrin saturation levels. Phenotyping detected 5 individuals with increased transferrin saturation. The three others detected via phenotyping were C282Y heterozygotes. Haemochromatosis has long been though to be related to the development of diabetes due to the effect of iron overload on the pancreas. If this is so it would be logical to assume that the prevalence of haemochromatosis would be higher in a diabetic population. Chapter 4 examined the possibility that diabetics have a higher frequency of the C282Y mutation. A population group consisting of 1355 diabetics was genotyped for the C282Y mutation and iron studies were performed on all heterozygotes and C282Y homozygotes. Initial findings indicated that there was a significant difference between the diabetic and control population. However, this finding was the opposite of what was expected, there seemed to be a decreased frequency of the Y allele in the diabetic population rather than an increased one. The control and diabetic populations were not matched in terms of ethnicity. The removal of the ethnic bias in the diabetic population altered the statistics so there was no longer a significant difference between the two groups. This study highlighted the importance of using appropriate control populations as comparison groups. The final results of the study indicated that there was no significant difference between the diabetic population and the control population. This would seem to indicate that there is not an increased occurrence of the C282Y mutation in the diabetic population when compared to the control group. Chapter 5 considered the possible association between C282Y heterozygosity and cardiovascular disease as well as the potential for early mortality. Several recent studies have indicated that C282Y heterozygosity may be a risk factor for the development of atherosclerosis, possibly on the basis of increased iron loading. Using a control population and a population of individuals with known coronary events the incidence of the C282Y mutation was compared against other risk factors. C282Y heterozygosity did not appear to be a risk factor for atherosclerosis. There was however, a statistically significant link between increased ferritin in women and carotid plaques. A population of elderly women was genotyped in order to examine the effects of C282Y heterozygosity on longevity. The first hypothesis addressed in chapter 5 was that C282Y heterozygosity was a risk factor for the development of coronary heart disease.

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Ljungberg, Liza. "Angiotensin-Converting Enzyme : Effects of Smoking and Other Risk Factors for Cardiovascular Diseases." Licentiate thesis, Linköping : Department of Medical and Health Sciences, Linköping University, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-16704.

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Mamudu, Hadii M., Timir K. Paul, Liang Wang, et al. "The Effects of Multiple Coronary Artery Disease Risk Factors on Subclinical Atherosclerosis in a Rural Population in the United States." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/1372.

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INTRODUCTION: The risk factors for cardiovascular disease (CVD) are associated with coronary atherosclerosis and having multiple risk factors potentiates atherosclerosis. This study examined the prevalence of multiple biological and lifestyle/behavioral risk factors and their association with coronary artery calcium (CAC), a marker for subclinical coronary atherosclerosis. METHODS: This is a cross-sectional study of 1607 community-dwelling asymptomatic individuals from central Appalachia who participated in CAC screening between January 2011 and December 2012. Data on demographics (sex and age) and 7 traditional risk factors for coronary artery disease (CAD) were collected and categorized into 5 groups (0-1, 2, 3, 4, and ≥5). Prevalence of these risk factors and CAC scores (0, 1-99, 100-399, ≥400) were assessed, and the impact of the number of risk factors on CAC scores were delineated using multiple logistic regression. RESULTS: Over 98% of participants had ≥1 risk factor. While obesity, diabetes, hypertension, and family history of CAD significantly increased the odds of having CAC, CAC scores significantly increased with number of risk factors. After adjusting for demographic factors, having 3, 4, and ≥5 risk factors was significantly associated with increased odds of having higher CAC scores when compared to zero CAC score by more than one and half times [OR=1.65, CI (1.20-2.25)], two times [OR=2.32, CI (1.67-3.23)] and three times [OR=3.45, CI (2.42-4.92)], respectively. CONCLUSION: The high prevalence of multiple risk factors in the study population suggests the need for aggressive multiple risk factors interventions for primary prevention of CAD, which could address CVD health disparities.

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Vardhan, Anand. "The role of biochemical risk markers, cytokines and growth factors in atherosclerosis and adverse cardiovascular outcome in dialysis patients." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.509782.

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Rodríguez, García Marina. "Estudio de propiedades fisicoquímicas de las lipoproteínas para una mejor predicción del riesgo residual." Doctoral thesis, Universitat Rovira i Virgili, 2018. http://hdl.handle.net/10803/663664.

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Les malalties cardiovasculars són la principal causa de mort a nivell mundial. Aproximadament entre el 30 i el 40 % dels infarts de miocardi succeeixen en situacions amb nivells normals de colesterol total i LDLc, per la qual cosa no es poden explicar pels factors de risc tradicionals. Aquesta situació crea la necessitat de buscar nous factors de risc a través d'anàlisis més exhaustives. Els factors analitzats són el diàmetre i nombre de partícules lipoproteiques, la càrrega elèctrica neta, el contingut i els components de LPS i les glicoformes de Apo CIII. Les poblacions utilitzades són pacients diagnosticats de LES, participants controls i dones i homes joves i sans. Els resultats obtinguts demostren la importància d'anàlisis exhaustives en la cerca de nous factors de risc, ja que afavoreixen el diagnòstic de perfils lipídics aterogènics. El diàmetre i nombre de partícules ajuden a identificar un perfil lipídic aterogènic en situacions d'estrès i ansietat. La càrrega elèctrica es veu influenciada en casos d'estrès i ansietat i en els pacients amb lupus, la càrrega elèctrica té un efecte sobre el gruix de l'íntima-mitjana carotídea independent a les característiques antropométriques, tabaquisme i perfil lipídic. Les glicoformes de Apo CIII es distribueixen de la mateixa forma en plasma i en lipoproteïnes; en canvi, el LPS i els seus components no. A més, s'obtenen una gran varietat de correlacions amb diferents comportaments entre aquests paràmetres i el perfil lipídic, en funció del paràmetre i de la lipoproteïna en la qual es trobi. Finalment, les glicoformes de Apo CIII afecten sobre la quantitat de LPS i dels components que es troben units a les lipoproteïnes. Tot això porta a la conclusió de la importància de realitzar anàlisis exhaustives de les propietats fisicoquímiques de les lipoproteïnes, a més de l'estudi de les interaccions entre elles. Las enfermedades cardiovasculares son la principal causa de muerte a nivel mundial. Aproximadamente entre el 30 y el 40 % de los infartos de miocardio suceden en situaciones con niveles normales de colesterol total y LDLc, por lo que no se pueden explicar por los factores de riesgo tradicionales. Esta situación crea la necesidad de buscar nuevos factores de riesgo a través de análisis más exhaustivos. Los factores analizados son el diámetro y número de partículas lipoproteicas, la carga eléctrica neta, el contenido y los componentes del LPS y las glicoformas de Apo CIII. Las poblaciones utilizadas son pacientes diagnosticados de LES, participantes controles y mujeres y hombres jóvenes y sanos. Los resultados obtenidos demuestran la importancia de análisis exhaustivos en la búsqueda de nuevos factores de riesgo, ya que favorecen el diagnóstico de perfiles lipídicos aterogénicos. El diámetro y número de partículas ayudan a identificar un perfil lipídico aterogénico en situaciones de estrés y ansiedad. La carga eléctrica se ve influenciada en casos de estrés y ansiedad, y en los pacientes con lupus tiene un efecto sobre el grosor de la íntima-media carotídea independiente a las características antropométricas, tabaquismo y perfil lipídico. Las glicoformas de Apo CIII se distribuyen de la misma forma en plasma y en las lipoproteínas; en cambio, el LPS y sus componentes no. Además, se obtienen una gran variedad de correlaciones con distintos comportamientos entre dichos parámetros y el perfil lipídico, en función del parámetro y de la lipoproteína en la que se encuentre. Por último, las glicoformas de Apo CIII afectan sobre la cantidad de LPS y de sus componentes que se encuentran unidos a las lipoproteínas. Todo esto lleva a la conclusión de la importancia de realizar análisis exhaustivos de las propiedades fisicoquímicas de las lipoproteínas, además del estudio de las interacciones entre ellas. Cardiovascular diseases are the main cause of death worldwide. Approximately, 30 - 40% of myocardial infarctions occur in situations with normal levels of total cholesterol and LDLc, so they cannot be explained by traditional risk factors. This situation creates the need to look for new risk factors through more exhaustive analysis. The factors analyzed are the diameter and particles number of lipoproteins, the net electric charge, the content and the components of LPS and the glycoforms of Apo CIII. The populations used are patients diagnosed with SLE, control participants and young, healthy women and men. The results obtained demonstrate the importance of exhaustive analysis in the search for new risk factors, since they favor the diagnosis of atherogenic lipid profiles. The diameter and particles number of lipoproteins help to identify an atherogenic lipid profile in situations of stress and anxiety. The net electric charge is influenced by stress and anxiety and, in patients with lupus, the net electric charge has an effect on the thickness of the carotid intima-media independent of the anthropometric characteristics, smoking and lipid profile. The Apo CIII glycoforms are also distributed in plasma and in lipoproteins; however, the LPS and its components do not. In addition, a great variety of correlations are obtained with different behaviors between these parameters and the lipid profile, as a function of the parameter and the lipoprotein where it is focated. Finally, Apo CIII glycoforms affect the amount of LPS and its components that are bound to lipoproteins. All this leads to the conclusion of the importance of carrying out exhaustive analyzes of the physical-chemical properties of lipoproteins, and the study of the interactions between them.

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Bergman, Per. "Atherosclerosis of the ascending aorta as a risk factor for stroke after cardiac surgery : a study based on epiaortic ultrasound /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-928-5/.

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24

Schöffauer, Mark [Verfasser]. "Das metabolische Syndrom bei Frauen mit koronarer Herzkrankheit : Daten der coronary risk factors for Atherosclerosis in women studie (CORA) / Mark Schöffauer." Hamburg : Staats- und Universitätsbibliothek Hamburg, 2011. http://d-nb.info/1010757652/34.

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25

Wideman, Laurie. "Postprandial lipemia in abdominally obese and non-obese males." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/845959.

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Recent research has shown that the combination of high triglyceride (TG) levels and low high density lipoprotein (HDL) levels, significantly increases the incidence of coronary artery disease (CAD). The incidence of CAD is also increased in abdominally obese individuals. To assess differences in postprandial TG clearance patterns between abdominally obese (AO) and controls (C), fourteen healthy, normolipidemic males (seven controls and seven abdominally obese) completed an oral fat loading test (78 grams of fat). Blood samples were collected every hour for eight hours. Abdominally obese individuals had significantly greater TG values, significantly lower total HDL and HDL2 values and significantly greater area under the TG curve (p = 0.03). Time to reach peak TG and time to reach baseline TG values did not differ between the two groups, even though fewer AO individuals reached baseline within eight hours. The data from the present investigation indicate that increased time to clear TG in AO individuals may be one pathway that increases the incidence of CAD in this group. School of Physical Education

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Stephens, Amanda Mae. "Reduction of Cardiovascular Disease Risk Factors and Atherosclerosis in Male Syrian Golden Hamsters by Peanuts, Peanut Oil and Fat Free Peanut Flour." NCSU, 2008. http://www.lib.ncsu.edu/theses/available/etd-05222008-160514/.

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Studies have demonstrated the cardiovascular protective properties of peanuts and peanut oil through the reduction of low density lipoprotein cholesterol (LDL-C) while maintaining healthy levels of high density lipoprotein cholesterol (HDL-C). The cardiovascular protective effects of fat free peanut flour have never been evaluated despite the fact flour contains arginine, flavonoids, folates and other compounds beneficial to cardiovascular health. In addition, there is a growing body of evidence suggesting unsaturated fatty acids and arginine may promote bone strength. The objective of this study was to evaluate the effects of fat free peanut flour and other peanut components on plasma cholesterol risk factors for cardiovascular disease, atherosclerosis and bone strength in male Syrian golden hamsters. Seventy-six hamsters were randomly divided into four groups and each group was fed a different isocaloric diet for twenty-four weeks. Each experimental diet was a modification of the high fat and high cholesterol control diet. Modifications to the control diet were made by substituting fat free peanut flour (<0.5% oil), peanut oil or whole peanuts for similar metabolic components. Randomly selected hamsters from each diet group were euthanized at 0, 12, 18 and 24 weeks at which point blood plasma, aortas and femurs were collected. Plasma was analyzed for total plasma cholesterol (TPC) and lipoprotein distribution by high-performance gel chromatography. Aortic total cholesterol (TC), free cholesterol (FC) and cholesteryl ester (CE), a metabolic atherosclerosis indicator, were determined as mg/g protein. Hamsters consuming diets containing fat free peanut flour, peanut oil or whole peanuts had significantly lower TPC and LDL-C than the control group. There were no significant differences in HDL-C among any of the diet groups. Aortic TC, FC and CE were significantly lower in the fat free flour, peanut oil and peanut diet group hamsters compared to those in the control group. Results indicated peanuts, peanut oil and fat free peanut flour in diets reduced blood chemistry risk factors and slowed the development of atherosclerosis, as indicated by low levels of CE, in male Syrian golden hamsters fed a high fat and high cholesterol diet. The results for bone strength were variable and overall the effects of fat free peanut flour, peanut oil and whole peanuts on bone strength were inconclusive.

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Wang, Jiaqiu. "Image-based patient-specific computational biomechanical analysis of the interaction between blood flow and atherosclerosis." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/202017/1/Jiaqiu_Wang_Thesis.pdf.

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This research focuses on the development of a biomechanical strategy for risk assessment of atherosclerotic plaque rupture, which is a leading cause of acute cardiovascular events, such as heart attack and stroke. Image-based three-dimensional coronary and carotid arterial models were developed, and computational biomechanical analysis was performed to evaluate the mechanical interaction between blood flow and atherosclerosis. This study uncovered the biomechanical risk factors that are associated with high-risk atherosclerosis and provided a biomechanical tool for detecting high-risk plaques. It will help with future clinical diagnosis and treatment of cardiovascular diseases.

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Ferreira, Carla Susana Mendes. "Prognostic markers in 980 patients with ACS hospitalized in CHBV." Master's thesis, Universidade de Aveiro, 2014. http://hdl.handle.net/10773/12944.

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Mestrado em Biomedicina Molecular Acute coronary syndrome consists in a state of clinical symptoms compatible with acute myocardial ischaemia that may result from various thrombotic coronary artery diseases: unstable angina, non–ST-segment elevation acute myocardial infarction and STsegment elevation myocardial infarction. This disease normally occurs due to atherosclerosis, through the rupture of an unstable atherosclerotic plaque or through superficial endothelial erosion. Eventually the activation of the coagulation cascade and platelet adhesion, activation and aggregation ends up leading to acute thrombosis. Risk stratification in patients with acute coronary syndrome is very important in the determination of the proper treatment strategy. Various clinical features are known to be associated with an increased risk of a worse outcome in the event of an acute coronary syndrome and are taken into account in various risk scores. The main aim of this work is the determination of clinical characteristics that are associated with a worse outcome in a group of patients with acute coronary syndrome admitted to the Cardiac Intensive Care Unit of Hospital Infante D. Pedro, in Centro Hospitalar do Baixo Vouga, in order to identify potential prognostic markers in these patients, and the assessment of the association of these markers with other clinical characteristics, in order to determine their influence in the physiology of patients with acute coronary syndrome. A prospective observational study was conducted in 980 patients with acute coronary syndrome admitted to the cardiac intensive care unit of Hospital Infante D. Pedro, in Centro Hospitalar do Baixo Vouga, between January 2008 and June 2012. Data collected was analysed using Student's T-test, One-way Anova, Kruskal-Wallis test, Pearson’s X2 test, Fisher's Exact test, Cox Proportional Hazards Model e Kaplan-Meyer estimate, and included general clinical information and information regarding cardiac risk factors, general blood test, serum cardiac markers, left ventricular ejection fraction, provided revascularization therapy and previous and posterior cardiac events The results obtained indicate that female gender, advanced age, anemia, low left ventricular ejection fraction, the presence of a previous event, hypertension, dyslipidemia and obesity are associated with a poorer prognosis in patients with acute coronary syndrome. O síndrome coronário agudo consiste num estado de sintomas físicos compatíveis com isquemia miocárdica aguda, podendo resultar de várias doenças arteriais coronárias: angina instável, enfarte agudo do miocárdio sem elevação do segmento-ST e enfarte agudo do miocárdio com elevação do segmento-ST. Esta doença ocorre normalmente devido a aterosclerose, através da rutura de uma placa aterosclerótica instável ou através de erosão endotelial. Eventualmente a ativação da cascata de coagulação e a adesão, ativação e agregação de plaquetas levam a trombose aguda. A estratificação do risco em pacientes com síndrome coronário agudo é muito importante na determinação da estratégia terapêutica adequada. Várias características clínicas estão associadas com um risco aumentado de um prognóstico adverso aquando de um síndrome coronário agudo, sendo tidos em conta em várias tabelas de previsão de risco. O principal objetivo deste trabalho é a determinação de características clínicas associadas com pior um prognóstico num grupo de doentes com síndrome coronário agudo internados na unidade de cuidados intensivos cardíacos do Hospital Infante D. Pedro, no Centro Hospitalar do Baixo Vouga, de forma a identificar potenciais marcadores de prognóstico nestes doentes, e a determinação da sua associação com outras características clínicas, de forma a determinar a sua influência na fisiologia de doentes com síndrome coronário agudo. Levou-se a cabo um estudo prospetivo observacional em 980 doentes com síndrome coronário agudo internados na unidade de cuidados intensivos cardíacos do Hospital Infante D. Pedro, no Centro Hospitalar do Baixo Vouga, entre Janeiro de 2008 e Junho de 2012. A informação recolhida foi analisada usando Student's T-test, One-way Anova, Kruskal-Wallis test, Pearson’s X2 test, Fisher's Exact test, Cox Proportional Hazards Model e Kaplan-Meyer estimate, e incluiu informação clínica geral e informação sobre fatores de risco cardíacos, análise sanguínea geral, marcadores cardíacos séricos, fração de ejeção ventricular esquerda, terapia de revascularização e eventos cardíacos prévios e posteriores. Os resultados obtidos indicam que sexo feminino, idade avançada, baixa fração de ejeção ventricular esquerda, a presença de um evento prévio, hipertensão, dislipidémia e obesidade estão associados com um prognóstico adverso em pacientes com síndrome coronário agudo.

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Barros, Isly Maria Lucena de. "Prevalência de aterosclerose de carótida e fatores associados em mulheres a partir do climatério." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-01122014-142018/.

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Introdução: As doenças cardiovasculares permanecem como a principal causa de morbimortalidade entre as mulheres no Brasil e no mundo. Estratégias de prevenção primária baseadas na detecção dos fatores de risco tradicionais para aterosclerose, têm sido pouco eficazes para reduzir as altas taxas de mortalidade nessa população. O presente estudo tem como objetivo primário detectar e quantificar a presença de aterosclerose na sua fase subclínica, em mulheres climatéricas e pós-menopausadas. Métodos: Foram estudadas 823 mulheres de 45 a 65 anos de idade (idade média 54,3 ± 5,3 anos), no período peri e pós-menopausa, sem doença cardiovascular conhecida, ou em uso de terapia de reposição hormonal, residentes em Recife, Nordeste do Brasil. Todas foram submetidas a avaliação clínica e dosagens bioquímicas, que incluíram os níveis de glicose, lipídios, proteína C-reativa, hormônio folículo-estimulante, adiponectina e aldosterona. Ultrassonografia modo B foi utilizada na avaliação carotídea; medidas da espessura íntima média carotídea (EIMC) foram determinadas na parede posterior da artéria carótida comum (ACC) utilizando-se um \"software\" de leitura automatizada; aterosclerose carotídea foi definida quando da presença de placa carotídea e/ou EIMC > 1mm. Resultados: De 823 mulheres, 10,2% eram fumantes, 58% tinham hipertensão e 9,9% eram diabéticas. A prevalência de doença aterosclerótica subclínica entre a população analisada foi de 12,7%, e a média da EIMC foi de 0,645 ± 0,124 milímetros. Na análise univariada, foram detectadas associações significativas entre presença de aterosclerose carotídea e: a idade (p < 0,001), o fumo (p=0,014), a hipertensão (p=0,002), a pressão arterial sistólica (p=0,003), o colesterol total (p=0,001) e o LDL-colesterol (p=0,001). No modelo ajustado, a idade (p < 0,001), o fumo (p=0,001), a pressão arterial sistólica (p=0,030) e o colesterol total (p=0,008) se correlacionaram de forma significativa e independente com a aterosclerose carotídea. Conclusão: O presente estudo revelou uma alta prevalência de aterosclerose carotídea entre as mulheres brasileiras a partir do climatério. Assim como a idade, os fatores de risco clássicos se correlacionaram de forma independente com aterosclerose carotídea. Esses resultados são de particular relevância, visto que as estratégias para redução do risco cardiovascular são baseadas em modelos de predição de risco onde as mulheres são frequentemente classificadas no grupo de baixo risco cardiovascular. Consequentemente, as oportunidades de envolvê-las mais cedo na prevenção da doença aterosclerótica são muitas vezes perdidas Aims: Cardiovascular diseases continue to be the main cause of morbidity and mortality among women in Brazil and worldwide. Strategies of primary prevention, based on the detection of traditional risk factors for atherosclerosis, have had a small impact in reducing the high rates of mortality in this population. Therefore, the main purpose of this study was to analyse the prevalence of subclinical carotid atherosclerosis in peri- and postmenopausal women. Methods: We studied 823 peri- and postmenopausal women, 45 to 65 years-old (mean age 54.3±5.3 years), from Recife city, without known cardiovascular disease and hormone therapy utilization. All of them were submitted to a careful medical evaluation, and biochemical analyses that included glucose and lipids levels, C-reactive protein, follicle-stimulating hormone, adiponectin and aldosterone. B-mode ultrasound was utilized for carotid evaluations; intima-media thickness (IMT) measures were determined on the far wall common carotid artery (CCA) with automated reading software; presence of carotid atherosclerosis was defined as either the presence of plaque and/or IMT >= 1.00mm. Results: Of the 823 women, 10.2% were current smokers, 58% had hypertension and 9.9% were diabetics. The prevalence of subclinical atherosclerotic disease among the analyzed population was 12.7%, and the mean CCA-IMT was 0.645±0.124 mm. By univariate analyses, a positive and statistically significant correlation was found between carotid atherosclerosis and age (p < 0.001), current smoker (p=0.014), hypertension (p=0.002), systolic blood pressure (p=0.003), total cholesterol (p=0.001) and LDL cholesterol (p=0.001). In the adjusted model, age (p < 0.001), current smoker (p=0.001), systolic blood pressure (p=0.030) and total cholesterol (p=0.008), remained correlating significantly and independently with carotid atherosclerosis. Conclusion: Our study showed a high prevalence of carotid atherosclerosis among asymptomatic pre- and post-menopausal Brazilian women. As well as age, classic risk factors correlated independently with carotid atherosclerosis. These findings are of particular relevance as strategies for reducing cardiovascular risk are based on risk prediction models in which women are often classified as having low cardiovascular risk, and opportunities for engaging them in prevention at a younger age are very often missed

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Henning, Andrea L. "Monitoring Monocyte Oxldl Phagocytosis As a Cardiovascular Disease Risk Factor Following a High-fat Meal." Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc700101/.

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Macrophage-derived foam cells play a predominant role in the deposition of arterial plaques during the early stages of atherosclerosis. The deposition of arterial plaques is known to be effected by several factors, including a person’s dietary habits. The consumption of a high-fat (>60% of calories from fat) meal is known to elevate serum LDL and triglycerides, which have been previously implicated in the formation pf foam cells. One limitation of current research models is that it is not possible to directly measure foam cells in vivo. Thus, the purpose of the present study was to validate the use of blood derived monocytes as a proxy measure of foam cells. In order to complete this objective, we evaluated monocyte oxLDL phagocytosis capacity following consumption of a high-fat meal. Eight men and women participated in the present study and venous blood samples were collected prior to the meal, 1-h, 3-h, and 5-h post-meal. Monocytes (CD14+/16- and CD14+/16+) were evaluated for adhesion molecule expression (CD11a, CD11b, and CD18), scavenger R (CD36) expression, and oxLDL phagocytosis using an image-based flow cytometry method developed in our laboratory for this purpose. Data was statistically analyzed for significance using a single-factor ANOVA with repeated measures and a p < 0.05. Consumption of a high-fat meal caused an increase significant increase in the proportion of pro-inflammatory monocytes (CD14+/16+) and a decrease in classic monocytes (CD14+/16-), with the greatest difference occurring at 5 h post prandial (p = 0.038). We also found that pro-inflammatory monocyte expression of adhesion molecules and CD36 increased in a manner that would promote in vivo movement of monocytes into the subendothelial space. Finally, over the course of the 5 h postprandial period, the majority of oxLDL uptake occurred in pro-inflammatory compared to classic monocytes. These results suggest that consuming a high-fat meal increases the potential of monocytes to become foam cells for at least 5 h postprandial.

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Andrade, Danieli Castro Oliveira de. "Avaliação não-invasiva das propriedades da parede arterial em pacientes com síndrome antifosfolípide primária." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5145/tde-10032008-152144/.

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Objetivo: A aterosclerose prematura e acelerada tem sido recentemente reconhecida como um fator adicional de dano vascular nos pacientes com Síndrome Antifosfolípide Primária (SAFP). Esses pacientes podem ser beneficiados com o emprego de métodos para detecção precoce de aterosclerose como a Velocidade de Onda de Pulso (VOP) e o Echo-tracking (ET). Esses métodos têm sido reconhecidos pela capacidade de avaliar de forma não-invasiva a progressão da aterosclerose na parede vascular. Portanto, nosso principal objetivo foi avaliar a aterosclerose prematura nesses pacientes com SAFP. Pacientes e Métodos: 27 pacientes do sexo feminino com SAFP definida pelos critérios de Sapporo e 27 pacientes controles pareadas por sexo, idade e índice de massa corpórea foram selecionadas de forma consecutiva. Todas as pacientes sofreram trombose e foram subdivididas de acordo com o sítio vascular: arterial (n=12) e venoso (n=11). Os critérios de exclusão foram: idade > 55 anos, raça negra, hipertensão descontrolada, uso de corticosteróides e estatinas, diabetes, dislipidemia prévia, gravidez, menopausa, outras trombofilias, colagenoses, doenças vasculares de outras etiologias, obesidade definido por Índice de massa corpórea (IMC) >30 m/kg2 e tabagismo. Todas as pacientes foram submetidas à VOP no leito fêmoro-carotídeo (Complior) e echo-tracking pelo Wall Track System no leito carotídeo para avaliação das propriedades funcionais dos vasos. Resultados: Ambos os grupos SAFP e controles não mostraram diferença em relação à idade (41.5 ± 9.3 vs. 41.2 ± 10.2 anos; p=0.92) e IMC (22.7 ± 3.4 vs. 22.6 ± 3.7 kg/m2; p=0.91). Todas as pacientes apresentaram VOP semelhante às controles (p=0.34), o espessamento íntima-média (EIM) foi semelhante nos dois grupos (p=0.29) assim como os demais parâmetros do echo-tracking como o diâmetro carotídeo (p=0.26), a distensibilidade (p=0.92), os coeficientes de complacência (p=0.36) e o módulo elástico (p=0.78). A pressão sistólica (PS) das pacientes estava aumentada em relação às controles (p=0.02). De acordo com o sítio de trombose, as pacientes com eventos arteriais demonstraram um aumento na VOP em relação àquelas com eventos venosos (p=0.01) mesmo com mesmo EIM (p=0.52). Ambos resultados não foram influenciados pela idade ou duração de doença. Os níveis de colesterol total (p=0.002), LDL (p=0.02) e apolipoproteína B (p=0.03) foram mais altos nas pacientes com SAFP com eventos arteriais exclusivos. Na análise multivariada, observamos correlação da VOP com a idade (r=0.584; p=0.001) e com o diâmetro do vaso (DV) (r=0.407; p=0.04). Foi observada uma correlação positiva da VOP com o colesterol total (r=0.507, p=0.01), LDL (r=0.402, p=0.05), e triglicérides (r=0.583, p=0.003). O EIM apresentou correlação direta com o DV (r=0.393; p=0.04) e com a distensibilidade (r=0.373, p=0.05). Conclusão: A aterosclerose na SAFP apresenta curso peculiar e de forma precoce. A VOP foi um método mais adequado para detectar a disfunção vascular secundária à rigidez arterial, visto que, não foram detectadas alterações vasculares funcionais pelo ET. Objective: Premature and accelerated atherosclerosis has been recently recognized as an additional vascular damage in Primary Antiphospholipid Syndrome (PAPS). These patients could benefit from non-invasive diagnostic methods to detect atherosclerosis as the Pulse Wave Velocity (PWV) and the Echo-Tracking (ET) device. By precise measurement of arterial stiffness, these methods output an indirect way to evaluate the vascular wall lesion progression. Our main objective was to evaluate premature atherosclerosis in PAPS.PATIENTS AND METHODS: 27 female patients with PAPS (Sapporo criteria) and 27 age-, body mass index- and sex-matched controls were consecutively selected. All PAPS patients had previous thrombosis and were subdivided according to the type of vascular exclusive event: arterial (n=12) and venous (n=11). Exclusion criteria were: age >55 years, black race, uncontrolled hypertension, smoking, diabetes, previous dyslipidemia, other thrombophilias, vascular and collagen diseases, corticosteroids and statins use, pregnancy, menopause, and obesity defined as body mass index (BMI)>30 m/kg2. All subjects underwent the PWV in femoral-carotidal bed (Complior) and echo-tracking by a Wall Track System in carotidal bed to analyze vascular wall functional properties. RESULTS: Both groups PAPS and controls did not show any difference regarding age (41.5 ± 9.3 vs. 41.2 ± 10.2 years; p=0.92) and BMI (22.7 ± 3.4 vs. 22.6 ± 3.7 kg/m2; p=0.91). All PAPS patients had PWV values similar to controls (p=0.34). Intima-media thickness (IMT) was also similar between groups (p=0.29) as well as all the other echo tracking parameters such as carotideal diameter (p=0.26), distensibility (p=0.92), compliance coefficients (p=0.36), and elastic modulus (p=0.78) were similar among groups. A higher systolic blood pressure was observed was observed in PAPS patients than controls (p=0.02). According to the site of thrombosis, PAPS patients with exclusive arterial events showed a higher PWV compared to those with venous (p=0.01) but had similar IMT (p=0.52). Both results were not influenced by age or disease duration. Total cholesterol (p=0.002), LDL (p=0.02), and apolipoprotein B (p=0.03) levels were higher in PAPS with exclusive arterial events compared to those with exclusive venous events. Multivariate analysis in PAPS showed that PWV was related to age (r=0.584; p=0.001) and blood vessel diameter (VD) (r=0.407; p=0.04). Moreover, PWV did also positively correlated with total cholesterol (r=0.507, p=0.01), LDL (r=0.402, p=0.05), and triglycerides (r=0.583, p=0.003). IMT also had a positive correlation with VD (r=0.393; p=0.04) and distensibility (r=0.373; p= 0.05). CONCLUSION: Atherosclerosis in PAPS has a peculiar course with an early onset, remarkably in those patients with arterial events. PWV was a sensible method to detect impaired functional vessel related to stiffness since no significant changes were observed in functional vascular properties by Echo- Tracking (ET) device.

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Željko, Živanović. "Korelacija ultrazvučnih karakteristika ateroskleroze karotidnih arterija i prisustva kardiometaboličkih faktora rizika kod bolesnika sa ishemijskim moždanim udarom." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2015. http://www.cris.uns.ac.rs/record.jsf?recordId=94884&source=NDLTD&language=en.

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UVOD: Ateroskleroza je najče&scaron;ća bolest karotidnih arterija i uzrok je oko 20% svih ishemijskih moždanih udara (IMU). Osim stepena stenoze i određene karakteristike karotidnog plaka označavaju povi&scaron;en rizik za IMU. Ultrazvukom je moguće pouzdano evaluirati aterosklerotske promene na karotidnim arterijama. Iako su faktori rizika (FR) za aterosklerozu istovremeno i FR za IMU, prisustvo identičnih FR kod pacijenata sa IMU, ne znači i prisustvo istog stepena ateroskleroze na karotidnim arterijama. CILJ: Utvrđivanje povezanosti pojedinih ultrazvučnih karakteristika karotidne ateroskleroze, sa prisustvom različitih kardiometaboličkih FR i njihovih biomarkera, kod pacijenata sa IMU. MATERIJAL I METODE: U istraživanje je uključeno 120 pacijenata sa nekardioembolijskim IMU u karotidnom slivu koji su podeljeni u dve grupe; 60 sa lakunarnim i 60 sa nelakunarnim infarktom mozga. Svim pacijentima je određivano prisustvo FR, kao &scaron;to su hipertenzija, dijabetes, hiperlipoproteinemija, pu&scaron;enje, gojaznost, metabolički sindrom, hiperhomocisteinemija i inflamacija. Beležene su vrednosti krvnog pritiska, glikemije, glikoliziranog hemoglobina, parametara lipidskog statusa, apolipoproteina (Apo) A-I i B, lipoproteina a, indeksa telesne mase (BMI), homocisteina, C reaktivnog proteina (CRP). Pomoću karotidnog dupleks ultrazvuka određivane su vrednosti intima-medijalnog zadebljanja (IMT), morfologija plaka, povr&scaron;ina plaka, stepen stenoze. Demografske karakteristike, FR i njihovi biomarkeri, te ultrazvučne karakteristike karotidne ateroskleroze, poređene su između dve grupe pacijenata. Kori&scaron;ćeni su hi-kvadrat test i t-test. Korelacije FR i vrednosti njihovih biomarkera sa različitim karakteristikama karotidnog plaka, određivane su upotrebom Pearsonovog koeficijenta korelacije r i Kramerovog V. Upotrebom regresionih analiza ispitivan je prediktivni značaj određenih FR i njihovih biomarkera u pojavi pojedinih karakteristika karotidnog plaka. REZULTATI: Vi&scaron;e pacijenata sa lakunarnim infarktom je imalo hipertenziju (98.3% naspram 85%; p=0.021). Pacijenti sa lakunarnim infarktom imali su veće vrednosti BMI (27.6 kg/m2 naspram 25.9 kg/m2; p=0.029), dok su pacijenti sa nelakunarnim infarktom imali veće vrednosti CRP (16.4 mg/l naspram 6.8 mg/l; p=0.001). Demografske karakteristike, ostali FR i njihovi biomarkeri, kao i vrednosti karotidnog IMT se nisu značajno razlikovali između dve grupe pacijenata. Pacijenti sa nelakunarnim infarktom su imali veći stepen karotidne stenoze (79.7% naspram 33.2%; p=0,0001), kao i če&scaron;će prisustvo heterogenog plaka (73.3% naspram 35%; p<0,001), hipoehogenog plaka (51.7% naspram 16.7%; p<0.001) i neravnog plaka (81.7% naspram 21.7%; p<0,001). Sa vrednostima IMT značajno (p<0.05) su korelirali životna dob pacijenata (r=0.276), dijabetes (Cramerovo V=0.236), metabolički sindrom (Cramerovo V=0.247), HDL holesterol (r=-0.254), LDL/HDL (r=0.306), ApoA-I (r=-0.386) i ApoB/ApoA-I (r=0.359). Sa prisustvom heterogenog plaka su korelirali metabolički sindrom (Cramerovo V=0.246), ApoB (r=0.213), ApoB/ApoA-I (r=0.207) i povi&scaron;en CRP (Cramerovo V=0.266). Sa neravnom povr&scaron;inom plaka značajno je korelirao povi&scaron;en CRP (Cramerovo V=0.283). Sa stepenom stenoze značajno su korelirali BMI (r=-0.180) i povi&scaron;en CRP (Cramerovo V=0.301). Nezavisni prediktori povi&scaron;enih vrednosti IMT bili su starija životna dob pacijenata (β=0.230; p=0.006), ApoA-I (β=-0.244; p=0.008) i ApoB/ApoA-I (β=0.247; p=0.007). Prediktori prisustva heterogenog plaka bili su mu&scaron;ki pol (p=0.011; OR=3.425), ApoB (p=0.007; OR=8.972), BMI (p=0.0001; OR=0.380), metabolički sindrom (p=0.003; OR=4.555) i povi&scaron;en CRP (p=0.018; OR=2.800). Prediktori prisustva hipoehogenog plaka bili su ApoB (p<0.001; OR=29.2), BMI (p=0.02; OR=0.514), metabolički sindrom (p<0.001; OR=9.224) i povi&scaron;en CRP (p=0.046; OR=2.659). Povi&scaron;en CRP bio je jedini prediktor prisustva neravnog plaka (p=0.002; OR=3.203), kao i prisustva većeg stepene karotidne stenoze (β=0.270; p=0.002). ZAKLJUČAK: Iako je karotidna stenoza znatno zastupljenija među pacijenatima sa nelakunarnim nego lakunarnim nekardioembolijskim IMU, prisustvo kardiometaboličkih FR, njihovih biomarkera i vrednosti IMT se bitno ne razlikuje između ove dve grupe pacijenata. Osim stenoze i prisustvo heterogenog, hipoehogenog i neravnog karotidnog plaka nosi povi&scaron;en rizik za IMU. Među FR i njihovim biomarkerima ApoA-I i ApoB su najbolji prediktori karotidne ateroskleroze. Apolipoprotein B i metabolički sindrom su najjače povezani sa prisustvom heterogenog i hipoehogenog plaka. Povi&scaron;en CRP kod pacijenata sa akutnim IMU može biti znak destabilizacije plaka i ukazivati na prisustvo signifikantne karotidne stenoze. INTRODUCTION: Atherosclerosis is the most common disease of carotid arteries, causing 20% of all ischemic strokes. Besides the degree of stenosis, certain characteristics of carotid plaques indicate an increased risk for stroke. Carotid ultrasound can reliably evaluate atherosclerotic changes in carotid arteries. Although the risk factors for atherosclerosis are the same as the risk factors for stroke, the presence of identical risk factors in patients with stroke does not necessarily mean the presence of the same degree of carotid atherosclerosis. AIM: To determine correlation of certain characteristics of carotid atherosclerosis detected by ultrasound with the presence of various cardiometabolic risk factors in patients with ischemic stroke. METHODS: The study included 120 patients with noncardioembolic ischemic stroke in the anterior circulation, who were divided into two groups; 60 with lacunar and 60 with nonlacunar brain infarction. The presence of cardiometabolic risk factors, such as hypertension, diabetes, hyperlipoproteinemia, smoking, obesity, metabolic syndrome, hyperhomocysteinemia, and inflammation, was evaluated in all patients. Data regarding blood pressure, glycemia, glycated hemoglobin, lipid status parameters, apolipoprotein (ApoAI and ApoB), lipoprotein a, body mass index (BMI), homocysteine, and C-reactive protein (CRP) were collected. Intima-media thickness (IMT), carotid plaque characteristics (morphology, surface) and the degree of stenosis were determined by carotid duplex ultrasound. Demographic characteristics, risk factors, biomarkers, as well as ultrasound characteristics of carotid atherosclerosis, were compared between patients with lacunar and nonlacunar stroke. Two-sample student t-test and χ2 test were used for comparisons. In order to assess the correlation of various risk factors and their biomarkers with different characteristics of carotid plaques, we used the Pearson correlation coefficient r and Cramer's V. Regression analysis was used to evaluate the association of risk factors and their biomarkers with various carotid atherosclerosis characteristics. RESULTS: More patients with lacunar stroke had hypertension (98.3% vs. 85%; p=0.021). Patients with lacunar stroke had higher BMI values (27.6 kg/m2 vs. 25.9 kg/m2; p=0.029), while patients with nonlacunar stroke had higher CRP values (16.4 mg/l vs. 6.8 mg/l; p=0.001). Demographic characteristics, other risk factors and their biomarkers, as well as carotid IMT were not significantly different between the two groups of patients. Patients with nonlacunar stroke had a higher degree of carotid stenosis (79.7% vs. 33.2%; p=0.0001) and a higher prevalence of heterogeneous plaques (73.3% vs. 35%; p<0.001), hypoechogenic plaques (51.7% vs. 16.7%; p<0.001), and plaques with irregular surface (81.7% vs. 21.7%; p<0,001). IMT was significantly (p<0.05) correlated with the age of patients (r=0.276), diabetes (Cramer’s V=0.236), metabolic syndrome (Cramer’s V=0.247), HDL cholesterol (r=-0.254), LDL/HDL (r=0.306), ApoA-I (r=-0.386) and ApoB/ApoA-I (r=0.359). The presence of a heterogeneous plaque was correlated with metabolic syndrome (Cramer’s V=0.246) ApoB (r=0.213), ApoB/ApoA-I (r=0.207) and elevated CRP (Cramer’s V=0.266). A plaque with irregular surface was correlated with elevated CRP (Cramer’s V=0.283). The degree of carotid stenosis was correlated with BMI (r=-0.180) and elevated CRP (Cramer’s V=0.301). The independent predictors of higher values of IMT were older age (β=0.230; p=0.006), ApoA-I (β=-0.244; p=0.008), and ApoB/ApoA-I (β=0.247; p=0.007). The predictors of the presence of a heterogeneous plaque were male gender (p=0.011; OR=3.425), ApoB (p=0.007; OR=8.972), BMI (p=0.0001; OR=0.380), metabolic syndrome (p=0.003; OR=4.555) and elevated CRP (p=0.018; OR=2.800). The predictors of the presence of a hypoechogenic plaque were ApoB (p<0.001; OR=29.2), BMI (p=0.02; OR=0.514), metabolic syndrome (p<0.001; OR=9.224) and elevated CRP (p=0.046; OR=2.659). Elevated CRP was the only independent predictor of a plaque with irregular surface (p=0.002; OR=3.203) and of a higher degree of carotid stenosis (β=0.270; p=0.002). CONCULSIONS: Although carotid stenosis is significantly more pronounced in patients with nonlacunar than those with lacunar noncardioembolic ischemic stroke, cardiometabolic risk factors, their biomarkers and carotid IMT do not differ significantly between the two groups of patients. In addition to stenosis, a presence of heterogeneous, hypoechogenic and irregular-surface carotid plaques indicates an increased risk for ischemic nonlacunar stroke. Among the cardiometabolic risk factors and their biomarkers, ApoAI and ApoB have the strongest association with carotid atherosclerosis. Apolipoprotein B and metabolic syndrome have the strongest association with a heterogeneous and hypoechogenic carotid plaque. Elevated CRP in patients with acute ischemic stroke may be a sign of carotid plaque destabilization and can indicate a significant carotid stenosis.

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AMARAL, Josefina Cláudia Zirpoli. "Sobrevida de indivíduos com HIV/AIDS e associação com fatores prognósticos." Universidade Federal de Pernambuco, 2013. https://repositorio.ufpe.br/handle/123456789/18660.

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Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-04-27T13:14:58Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE SOBREVIDA HIVAIDS Dra Josefina Cláudia Zirpoli (1).pdf: 4262333 bytes, checksum: 008823511dfd2b3edb2da710499cd03b (MD5) Made available in DSpace on 2017-04-27T13:14:58Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE SOBREVIDA HIVAIDS Dra Josefina Cláudia Zirpoli (1).pdf: 4262333 bytes, checksum: 008823511dfd2b3edb2da710499cd03b (MD5) Previous issue date: 2013-02-28 Introdução: A doença cardiovascular, especialmente a doença arterial coronariana,nos últimos tempos, tem sido marcadamente descrita, como associadas às mortes de indivíduos com HIV/AIDS, transformando-se em mais um grande desafio para a Saúde Pública. A presença de alguns hábitos de vida como fumar, fazer uso de bebidas alcoólicas ou drogas ilícitas; antecedentes familiares de doença arterial coronariana; um perfil aterogênico determinado pelos efeitos adversos das drogas antirretrovirais (dislipidemia, resistência à insulina); e,um processo de inflamação crônica e, persistente, induzida pelo próprio HIV,acelerando o processo de aterosclerose, são indicados como fatores preditivos de morte nesses indivíduos . Metodologia: Esta tese é apresentada em formato de três artigos, que tratam dos resultados de trêsgrandes estudos desenvolvidos ao longo de cinco anos,abordando a participação de diferentes fatores de risco, no desenvolvimento de doença arterial coronariana e, dessas com maior probabilidade de morte, em indivíduos com AIDS, participantes de uma grande coorte “Doença Cardiovascular em Pacientes com AIDS” em desenvolvimento em Pernambuco, objetivando contribuir para um maior conhecimento e avaliação dessa dinâmica e, possibilitar o planejamento de políticas adequadas e eficazes de intervenção. No primeiro artigo, constam os resultados do estudo caso-controle “Angina de peito e fatores de risco para doença arterial coronariana em indivíduos com AIDS em Pernambuco, Brasil”. Com o universo de 2279 indivíduos comAIDS foram encontradas, uma frequência deangina de peito, identificada pelo questionário de Rose, de 21,10% (10,8% angina definida e, 10,3% angina possível) e, associações independentes de diferentes fatores de risco, com o desenvolvimento da doença cardiocoronariana nesses indivíduos dos quais: baixa renda (OR= 2,06 IC 1,34 – 3,17), habito de fumar (OR=1,57 IC 1,09 – 2,26) antecedentes familiares de infarto do miocárdio ou morte súbita (OR=1,49 IC 1,06 – 2,08). No segundo artigo, constam os resultados da coorte desenvolvida entre junho de 2007 e abril de 2012, envolvendo 2273 indivíduos com o objetivo de conhecer a“Sobrevida de indivíduos com AIDS e angina de peito em Pernambuco, Brasil”. A análise de regressão multivariada de riscos proporcionais de Cox indicaram que os níveis de linfócitos TCD4 (+)<200 células/mm3 foi o principal fator prognóstico para a morte, em indivíduos expostos (Rose+) e, não expostos (Rose -) com uma taxa de risco de 5,22 (p=0,000) para o primeiro e, 6,31 ( p=0,000) para o segundo. O terceiro artigo trata dos resultados alcançados com o estudo exploratóriorealizado com o objetivo de identificar a participação da ”Doença cardiovascular como causa básica ou associada às mortes de indivíduos com HIV/AIDS em Pernambuco, Brasil” utilizando-se para tal os registros contidos no Sistema de Informação de Mortalidade do Ministério da Saúde do Brasil.Foram identificados que a AIDS ou doenças associadas a ela, foram a primeiras causas de óbitos na população estudada, com 47,07% de todas às menções de diagnóstico e, que a doença cardiovascular foi a 7ª causa com 34 menções. Foi encontrada ainda, uma taxa de mortalidade de 29/1.000/ano. Cerca de 70% dos óbitos ocorreram em homens, nas faixas de 30-49anos, com níveis de CD4 ≤ 200 cel/mm3. Conclusão: Os resultados dos diferentes estudos apontam no sentido de que a AIDS e as doenças ligadas a ela ainda são as maiores responsáveis pela morte de indivíduos infectados, sugerindo como principais responsáveis a busca tardia pelo tratamento e, a falta de aderência a terapia antirretroviral. Com isso, busca-se contribuir para o estabelecimento de estratégias para melhoria da assistência. Introduction:Cardiovascular disease especially coronary artery disease has been described in a more pointed way, as linked to the deaths of individuals with HIV/AIDS, in recent times, becoming major challenges for the health system. The presence of some life habits as smoking, use of alcohol or illicit drugs, the presence of a family history of coronary artery disease, an atherogenic profile determined by the adverse effects of antiretroviral drugs (dyslipidemia, insulin resistance), and a chronic and persistent inflammatory process, accelerating the process of atherosclerosis induced by HIV virus itself, are indicated as predictors of death in these individuals. Methodology: This thesis is presented in the format of four articles, which deal with the results of four studies developed over five years, addressing the participation of different risk factors in the development of disease, and greater likelihood of death by arterial coronary disease in patients with AIDS, a large cohort of participants "Cardiovascular Disease in Patients with AIDS" developing in Pernambuco, aiming to contribute to a better understanding and evaluation of this dynamic and allow planning of appropriate policies and effective intervention. The first article presents the results of case-control study involving 2273 individuals with HIV / AIDS where we propose to meet the " Angina Pectoris and its association with risk factors in individuals with AIDS in Pernambuco, Brazil." Was found a frequency of angina identified by Rose questionnaire of 21.10% (10.8% and definite angina, 10.3% possible angina) and pointed to independent associations of various risk factors with the development of cardiocoronary disease of these individuals: low income (OR = 2.06 CI 1.34 to 3.17), smoking habit (OR = 1.57 CI 1.09 to 2.26) a family history of myocardial infarction or sudden death (OR = 1.49 CI 1.06 to 2.08). The second article presents the results of a cohort developed between June 2007 and April 2012, with 2273 participants, in order to meet the "survival of people with AIDS and angina pectoris in Pernambuco, Brazil" in which the multivariate regression analysis of Cox proportional hazards indicated that the levels of TCD4 (+) <200 cells/mm3 was the main prognostic factor for death in exposed individuals (Rose +) and unexposed (Rose - ) with a hazard ratio of 5 , 22 (p = 0.000) for the first, and 6.31 (p = 0.000) for the second. The third article deals with the results of an exploratory study with the objective of identifying the participation of "Cardiovascular disease as underlying or associated cause to the deaths of individuals with HIV/AIDS in Pernambuco, Brazil. A cutout of 5 years" using the records contained in the Mortality Information System of the Ministry of Health of Brazil. We identified that AIDS or associated diseases were the leading causes of deaths in this population; accounting for 47.07% of all the mentions of diagnostic and cardiovascular disease was the 7th cause with 34 mentions. We also found a mortality rate of 29/1.000/year. About 70% of deaths occurred in men aged 30-49 years, and levels of CD4 ≤ 200 cells/mm3. Conclusion: The results of the different studies point towards AIDS and diseases linked to it are still mainly responsible for the death of the infected individuals, pointing towards delayed treatment and lack of adherence. We seek to contribute to the establishment of strategies for improving health care.

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Lima, Thais Pinheiro. "Avaliação prognóstica no seguimento de longo prazo dos pacientes submetidos a angiotomografia de coronárias: sub análise dos estudos CORE64 e CORE320." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-05122018-124528/.

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Introdução: os determinantes prognósticos da doença arterial coronária (DAC) incluem tanto a anatomia como a morfologia da placa, havendo uma forte correlação entre essas duas características. Pouco se sabe sobre os desfechos cardiovasculares nos pacientes com sintomas estáveis, assim como sobre o papel dos escores realizados através da angiotomografia das artérias coronárias (TCCor) no prognóstico de longo prazo. Objetivos: avaliar o prognóstico de longo prazo para eventos cardiovasculares nos pacientes sintomáticos com suspeita de DAC que realizaram TCCor em dois estudos prospectivos - CORE 64 e CORE 320. Métodos: foram incluídos 222 pacientes, com idades entre 45 e 85 anos, com indicação clínica de cateterismo por suspeita de doença arterial coronária, submetidos a TCCor no Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo e participantes dos estudos multicêntricos CORE64 e CORE 320. 23 (9,5%) pacientes foram excluídos por perda de seguimento. Foram avaliadas a presença e a extensão da DAC através dos escores tomográficos (SIS, SSS, Gensini e Leaman). Os pacientes foram classificados quanto à presença de DAC não obstrutiva (estenose < 50%) e DAC obstrutiva (estenose > 50%); presença ou ausência de eventos cardiovasculares maiores (MACE). MACE foi definido como evento composto por: IAM não fatal; revascularização miocárdica (realizada acima de 30 dias da inclusão do paciente); óbito cardiovascular; hospitalizações por insuficiência cardíaca (IC) e morte súbita revertida ou arritmias não fatais. Resultados: MACE ocorreu em 73 dos 199 pacientes. 9 (4,5%) apresentaram óbito cardiovascular, 14 (7,0%) IAM não fatal, 31 (15,5%) submeteram a revascularização miocárdica tardia, 11 (5,5%) hospitalizações por IC e 8 (4,0%) morte súbita revertida ou arritmias não fatais. Na análise multivariada, quando adicionados ao modelo clínico isolado, todos os escores tomográficos, com exceção de SIScalc, SISmista e Gensini, correlacionaram-se com a presença de MACE. O modelo que adicionou DAC obstrutiva foi o que apresentou a melhor performance diagnóstica, quando comparado ao modelo clínico isolado (?2 35,6 vs 21,2, p < 0,001). Após ajuste para a presença de DAC obstrutiva, o SISnãocalc permaneceu de forma independente associado a MACE, apresentando benefício incremental sobre o modelo clínico e a severidade da DAC (?2 39,5 vs 21,2, p < 0,001 comparado ao modelo clínico; e ?2 39,5 vs 35,6, p=0,04 comparado ao modelo clínico + severidade DAC). Pacientes com DAC não obstrutiva e SISnãocalc > 3 tiveram altas taxas de eventos (HR 4,27, 95% CI 2,17-4,40, p < 0,001). Conclusões: escores tomográficos predizem eventos cardiovasculares no seguimento de longo prazo nos pacientes sintomáticos com suspeita de DAC. Nossos achados sugerem que, entre os pacientes com DAC obstrutiva, a presença de mais de 3 segmentos com placas não calcificadas está associada ao aumento do risco cardiovascular no longo prazo Background: The prognostic determinants of coronary artery disease (CAD) include luminal obstruction severity, plaque burden and components, which can be assessed by coronary artery computed tomography angiography (CTA) scores. The role of CTA scores in the long-term prognosis of patients with stable symptoms is unknown. Aim: To evaluate the long-term prognosis value of CTA scores for cardiovascular events in symptomatic patients with suspected CAD referred for coronary CTA in two multicenter prospective studies - CORE 64 and CORE 320. Methods: Two hundred and twenty-two participants from Heart Institute (InCor) University of Sao Paulo Medical School of CORE64 and CORE320 studies, referred for clinically indicated invasive coronary angiography (ICA) for suspected or known CAD were enrolled. Coronary CTA were categorized as non-obstructive or obstructive CAD (greater than 50% stenosis), presence and extent of calcified, noncalcified and partially calcified plaques, using coronary CTA modified scores including all plaques or specific plaque types scores (Segmental Involvement Score - SIS, Segmental Stenosis Score - SSS, Gensini and CTA modified Leaman). The primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiovascular death, non-fatal acute coronary syndrome, hospitalization for heart failure, late revascularization (beyond 30 days of index conventional coronary angiography), non-fatal significant ventricular arrhythmia or cardiac arrest. Results: During a median follow-up of 6.8 (6.3-9.1) years, 73 patients met the composite end points of MACE. Cardiovascular death occurred in 9 (4.5%), non-fatal ACS in 14 (7.0%), revascularization in 31 (15.5%), hospitalization for heart failure in 11 (5.5%) and non-fatal significant VA or cardiac arrest in 8 (4.0%) patients. When individually added to clinical model on multivariate analysis, all CTA features remained significant, with the exception of SIS of calcified and mixed plaque (SISCalc, SICMixed) and Gensini score. Compared to the clinical model, the highest model improvement was observed when added obstructive CAD (?2 35.6 vs 21.2, p < 0.001). Moreover, CTA multivariate models demonstrated comparable incremental values for the prediction of MACE (X2 > 30), including the extent of non-calcified plaques (SISNoncalc). After further adjustment for the presence of obstructive CAD, SISNoncalc remained independently associated with MACE, presenting incremental prognostic value over clinical data and CAD severity (?2 39.5 vs 21.2, p < 0.001 for comparison with clinical model; and X2 39.5 vs 35.6, p=0.04 for comparison with clinical + CAD severity). Patients with obstructive CAD and SISNoncalc > 3 were likely to experience events (HR 4.27, 95% CI 2.17-4.40, p < 0.001). Conclusions: Coronary CTA scores predict cardiovascular events in long-term follow-up in symptomatic patients with suspected or known CAD. Among patients with obstructive CAD, the presence of more than 3 non-calcified plaques segments is associated with increased cardiovascular risk in the long term

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Neeb, Zachary P. "Diet-induced dyslipidemia drives store-operated Ca2+ entry, Ca2+ dysregulation, non-alcoholic steatohepatitis, and coronary atherogenesis in metabolic syndrome." Thesis, Connect to resource online, 2010. http://hdl.handle.net/1805/2209.

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Thesis (Ph.D.)--Indiana University, 2010. Title from screen (viewed on July 21, 2010). Department of Cellular and Integrative Physiology, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Michael Sturek, Jeffrey A. Breall, Robert V. Considine, Alexander Obukhov, Johnathan D. Tune. Includes vitae. Includes bibliographical references (leaves 212-240).

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Souza, Lara Vilela de. "Avaliação de aterosclerose carotídea através de ultra-sonografia e ressonância magnética." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-13102014-103252/.

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A aterosclerose é uma doença progressiva crônica. Embora segmentar, é generalizada e acomete as artérias carótidas, propiciando maior risco de acidente vascular cerebral. Utilizamos dois métodos diagnósticos, nesta avaliação, que foram a ultra-sonografia modo B em escala de cinza associada também a fluxo Doppler colorido, e a ressonância magnética (RM) com seqüências ponderadas em T1 e T2, ambas pelas técnicas \"black-blood\" (BB) e \"fat sat black-blood\" (FSBB), e angiografia por ressonância magnética \"time-of-flight\'\' tridimensional (3D TOF), com e sem a administração do contraste paramagnético. Objetivou-se a identificação de ateromas carotídeos em pacientes coronariopatas, comprovados por cateterismo cardíaco com indicação de terapia cirúrgica. Realizou-se a estimativa do grau de estenose das artérias carótidas internas, através de ultra-sonografia com fluxo Doppler colorido (UDC) e angiografia por ressonância magnética (ARM), comparando-se os métodos. Também foram feitas comparações entre a ecogenicidade das placas visualizadas através de ultra-sonografia (USG), com a intensidade de sinal adquirida pelos exames de ressonância magnética (RM). Foi realizada avaliação de qualidade de imagens e confiabilidade inter-observadores, nos exames de ressonância magnética. Houve alta incidência de aterosclerose carotídea, nos pacientes em estudo. Do total de 100 segmentos carotídeos analisados por ultra-sonografia, com fluxo Doppler colorido para estimativa do grau de estenose, 81% apresentaram algum tipo de estenose, sendo o grau leve (grau II) predominante, evidenciado em 59% dos casos. Avaliamos a associação entre o grau de estenose visualizado através de UDC e ARM, com e sem contraste, e houve reprodutibilidade marginal entre os métodos. Observaram-se alterações de intensidade de sinal das paredes vasculares nos exames de RM, nas seqüências ponderadas em T1-BB, T1-FSBB, T2-BB e T2-FSBB, entre 71% e 72%. O aumento da intensidade de sinal foi predominante. Nas 72 placas com ecogenicidade tipo 4, houve aumento da intensidade de sinal em 13,9% em 3D TOF, 59,7% em T1-BB, 65,3% em T1-FSBB, 62,5% em T2-BB e 66,7% em T2-FSBB. Nas placas com ecogenicidade tipo 2, houve aumento da intensidade de sinal em 42,9% em 3D TOF, 71,4% em T1-BB e T1-FSBB, 85,7% em T2-BB e 71,4% em T2-FSBB. Nas placas com ecogenicidade tipo 1, houve aumento da intensidade de sinal em 50,0%, nas seqüências ponderadas em 3D TOF, T1 e T2. Em 19 segmentos carotídeos, a USG foi considerada normal. Quando os mesmos segmentos foram avaliados através de RM, observou-se aumento da intensidade de sinal em 21,1% em 3D TOF, 47,4% em T1-BB, 57,9% em T1-FSBB, 52,6% em T2-BB e T2-FSBB. Não houve correlação entre os tipos de ecogenicidade das placas visualizadas através de USG, com as alterações de intensidade de sinal pela RM. A avaliação da qualidade de imagens dos exames de RM, com cortes no plano axial nas seqüências ponderadas em T1 e T2 (BB e FSBB), foi considerada ótima e, em 3D TOF, muito boa. A qualidade de imagem dos exames de ARM, com e sem contraste, foi considerada excelente. Notou-se ótima reprodutibilidade inter-observadores, com valores de índice Kappa acima de 0,71 Atherosclerosis is a chronic progressive disease. Although being segmental, atherosclerosis is systemic and attacks carotid arteries, propitiating a greater risk of cerebral vascular accident. In this assessment, we have applied two diagnostic imaging methods such as gray-scale B-mode ultrasound (US) in association with color flow Doppler (CFD-US) and T1 and T2-weighted magnetic resonance imaging (MRI) sequences, using black-blood (T1-BB and T2-BB) and black-blood with fat saturation (T1-FSBB and T2-FSBB) techniques, and magnetic resonance angiography (MRA) with and without paramagnetic contrast agent (three-dimensional time-of-flight, 3D TOF). Our objective was the identification of carotid atheromas in patients with coronary artery disease - as confirmed by cardiac catheterism, and referred to cardiac surgery. The degree of stenosis of the internal carotid arteries was estimated by CFD-US and by MRA, and the results from both methods were compared. The echogenicity of carotid plaques as seen by US and the signal intensity of MR images were also compared. Evaluation of image quality and inter-rater reliability of evaluation of MR images were also performed. There was a high incidence of carotid atherosclerosis in the patient population under study. From a total of one hundred (100) carotid artery segments analyzed by CFD-US for stenosis degree estimation, 81% showed some degree of stenosis, with a predominance of mild grade (grade II), which was detected in 59.0% of the cases. We have evaluated the association between the degree of stenosis visualized by CFD-US and by MRA with and without contrast agent and there was a marginal reproducibility between these methods. It was observed changes in artery wall signal intensity of 71% to 72%, in the T1-BB, T1-FSBB, T2-BB and T2-FSBB sequences of the MRI examinations. Increases in signal intensity were predominant. Among 72 plaques with echogenicity type 4, the signal intensity has increased 13.9% in 3D TOF, 59.7% inT1-BB, 65.3% in T1-FSBB, 62.5% in T2-BB and 66.7% in T2-FSBB. Among plaques with echogenicity type 2, the signal intensity has increased 42.9% in 3D TOF, 71.4% in T1-BB and T1-FSBB, 85.7% in T2-BB and 71.4% in T2-FSBB. Plaques with echogenicity type 1, showed signal intensity increase of 50.0% in the 3D TOF, T1 and T2 weighted MRI sequences. In 19 carotid artery segments, CFD-US was considered normal. When the same segments were evaluated by MRI, it was noted an increase of the image signal intensity in 21.1% in 3D TOF, 47.4% in T1-BB, 57.9% in T1-FSBB, 52.6% in T2-BB and T2-FSBB. There was no correlation between the types of plaque echogenicities seen by the CFD-US with the changes of signal intensity seen by MRI. The image quality and interobserver reliability of MR examinations were evaluated. The image quality of the T1 and T2-weighted axial MR images was considered excellent and for 3D TOF images, the quality was considered very good. The quality of the MRA images with and without paramagnetic contrast agent was considered excellent. It was noted an excellent interobserver reproducibility with values of Kappa index greater than 0.71

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Kormi, I. (Immi). "Translational perspectives on matrix metalloproteinase 8 and other inflammatory biomarkers in cardiovascular diseases." Doctoral thesis, Oulun yliopisto, 2017. http://urn.fi/urn:isbn:9789526215297.

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Abstract Cardiovascular diseases (CVD), and especially atherosclerotic vascular diseases (ASVD), are the largest cause of morbidity and premature death worldwide. Coronary heart disease (CHD) and cerebrovascular disease (stroke) are common and severe manifestations of ASVD. Atherosclerosis is a chronic inflammatory disease and lipoprotein metabolism disorder. If the regulation of inflammatory process is disturbed, the systemic release of pro-inflammatory mediators, including matrix metalloproteinases (MMPs), may lead to a low-grade systemic inflammation, which is a risk factor for CVDs. MMPs are enzymes that are responsible for the degradation of the extracellular matrix (ECM) during growth and tissue renewal but also in many pathological conditions. These ECM degrading proteases and their regulators play an important role in atherogenesis and subsequent plaque rupture, leading to acute cardiovascular manifestations. The pivotal role of MMPs in atherosclerosis has raised interest in the development of drug therapies targeting these proteases. Doxycycline has inhibitory effects on some MMPs in addition to its antimicrobial properties. The main objective of this thesis project was to investigate the potential of these inflammatory mediators as biomarkers, risk factors, and therapeutic targets in CVD. The special focus was on MMP-8 and its main regulator, tissue inhibitor of matrix metalloproteinase (TIMP)-1. The results of this study show that a high serum MMP-8 concentration indicates an acute cardiac condition and predicts a future CVD event. In addition to MMP-8, MMP-7 is a potential biomarker for incident CVD. The balance between these MMPs and their tissue inhibitor may indicate vulnerability to plaque rupture. Measurement of serum MMP-8 concentration is reliable, anti-invasive and inexpensive and can be done in hospital settings. We also show that regular-dose doxycycline decreases the systemic inflammatory burden in patients with earlier myocardial infarction and is a promising anti-inflammatory therapy in the prevention of CVDs with relatively minor side effects. In conclusion, MMP-8 and TIMP-1 can be considered inflammatory risk markers of CVD events and death, and they can be utilized both for diagnostic and screening purposes. The inhibition of MMP-8 by doxycycline may reduce the systemic inflammatory burden in patients with myocardial infarction Tiivistelmä Sydän- ja verisuonisairaudet, erityisesti ateroskleroottiset valtimosairaudet, ovat maailman yleisin sairastuvuuden ja ennenaikaisen kuoleman syy. Sepelvaltimotauti ja aivohaveri ovat ateroskleroottisen valtimosairauden yleisiä ja vakavia ilmenemismuotoja. Ateroskleroosi on krooninen tulehduksellinen sairaus ja lipoproteiiniaineenvaihdunnan häiriö. Jos tulehdustapahtuma häiriintyy, elimistöön vapautuvat tulehdusvälittäjäaineet, kuten matriksin metalloproteinaasit (MMP), voivat aiheuttaa elimistön matala-asteisen tulehduksen, joka on sydän- ja verisuonisairauksien riskitekijä. MMP:t ovat entsyymejä, jotka pilkkovat solunväliainetta kasvun ja kudosten uusiutumisen mutta myös monien tautitilojen yhteydessä. Nämä soluväliainetta hajottavat proteaasit ja niiden säätelijät ovat tärkeässä roolissa ateroskleroottisen plakin muodostumisessa ja repeämisessä, joka johtaa äkillisiin sydäntautitapahtumiin. Matriksin metalloproteinaasien keskeinen rooli ateroskleroosissa on herättänyt kiinnostusta niihin kohdistuvan lääkehoidon kehittämiseen. Doksisykliinillä on joidenkin MMP-entsyymien toimintaa estävä vaikutus antimikrobiaalisten ominaisuuksiensa lisäksi. Tämän väitöskirjatutkimuksen päätavoitteena oli tutkia näiden tulehdusvälittäjäaineiden mahdollisuuksia biomarkkereina, riskitekijöinä ja lääkehoidon kohteena sydän- ja verisuonisairauksissa. Erityinen kiinnostuksen kohde oli MMP-8 ja sen pääsäätelijä ja kudosestäjä, tissue inhibitor of matrix metalloproteinase (TIMP)-1. Tämän tutkimuksen tulokset osoittavat, että seerumin korkea MMP 8 pitoisuus viittaa akuuttiin sydäntautiin ja ennakoi tulevaa sydäntautitapahtumaa. MMP-8:n lisäksi MMP-7 on lupaava sydäntapahtuman biomarkkeri. Näiden matriksin metalloproteinaasien ja niiden kudossäätelijä TIMP-1:n välinen tasapaino voi liittyä ateroskleroottisen plakin haurauteen. Seerumin MMP-8:n mittaus on luotettavaa, kajoamatonta ja edullista, ja mahdollista toteuttaa myös sairaalaolosuhteissa. Näytämme myös, että doksisykliini vähentää elimistön tulehdustaakkaa sydäninfarktin sairastaneilla potilailla ja että se on sydäntautien ehkäisyssä lupaava anti-inflammatorinen lääke, jolla on suhteellisen vähän sivuvaikutuksia. Johtopäätöksenä on, että MMP-8:aa ja TIMP-1:tä voidaan pitää lupaavina sydän- ja verisuonitautien sekä kuoleman biomarkkereina sekä diagnostiikka- että seulontakäytössä. Lisäksi tutkimustulokset osoittavat, että MMP-8:n esto doksisykliinillä voi vähentää elimistön tulehdustaakkaa sydänkohtauksen sairastaneilla potilailla

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Prokopowitsch, Aleksander Snioka. "Avaliação não-invasiva das propriedades da parede arterial em pacientes portadoras de lúpus eritematoso sistêmico." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5145/tde-01062007-114759/.

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OBJETIVO: Avaliar a rigidez e distensibilidade arterial em mulheres não-menopausadas portadoras de lúpus eritematoso sistêmico (LES), bem como a influência da atividade de doença sobre esses parâmetros. MÉTODOS: 37 pacientes lúpicas do sexo feminino com idade menor ou igual a 40 anos e com até 10 anos de doença foram selecionadas para o estudo. Os critérios de exclusão utilizados foram: tabagismo atual ou prévio, hipertensão arterial sistêmica, diabetes mellitus, obesidade, insuficiência renal crônica, síndrome antifosfolípide secundária e gravidez ou menopausa no momento do estudo. As pacientes foram divididas em portadoras de doença ativa (SLEDAI maior ou igual a 4) e não-ativa (SLEDAI menor que 4) e comparadas a 25 mulheres saudáveis. Todos os indivíduos participantes foram submetidos à avaliação de rigidez e distensibilidade arterial por mensuração da velocidade de onda de pulso (VOP) carótido-femoral e echo-tracking da artéria carótida comum direita. RESULTADOS: Houve diferença significativa em relação à VOP entre os grupos estudados (p=0.01). Pacientes com LES em atividade apresentaram menor VOP que pacientes fora de atividade (6.89 ± 1.00 vs. 7.79 ± 1.10 m/s, p<0.05) e controles (6.89 ± 1.00 vs. 8.14 ± 1.07 m/s, p<0.05). Além disso, houve correlação negativa significativa entre VOP e SLEDAI (r=-0.354, p=0.03). Todos os parâmetros obtidos através do echo-tracking foram semelhantes entre os grupos: espessura íntima-média (EIM) (p=0.50), diâmetro diastólico (p=0.34), coeficiente de distensibilidade (p=0.98), coeficiente de complacência (p=0.74) e módulo elástico (p=0.87). A EIM correlacionou-se significativa e positivamente com a idade (r=0.328, p=0.04) e negativamente com os níveis de HDL-colesterol (r=-0.366, p=0.03) e apolipoproteína A1 (r=-0.407, p=0.01). Foi observada tendência de correlação positiva entre EIM e tempo de doença (r=0.306, p=0.06). CONCLUSÃO: Este estudo demonstra que a atividade lúpica é responsável por alterações na parede arterial compatíveis com processo aterosclerótico precoce, uma vez que a redução de rigidez arterial observada na doença ativa pode ser secundária a maior infiltração inflamatória e formação de células espumosas. OBJECTIVE: To evaluate arterial stiffness and distensibility in pre-menopausal female systemic lupus erythematosus (SLE) patients and assess the influence of disease activity on these parameters. METHODS: Thirty-seven female SLE patients aged less than 40 years old and with less than 10 years of disease duration were selected. Exclusion criteria were smoking, arterial hypertension, diabetes mellitus, obesity, chronic renal failure, secondary antiphospholipid syndrome, and pregnancy or menopause at the time of the study. Patients were divided into active (SLEDAI>4) or inactive (SLEDAI<4) disease, and compared to twenty-five healthy female controls. All subjects underwent arterial stiffness and distensibility evaluation by carotid-femoral pulse wave velocity (PWV) and common carotid echo-tracking. RESULTS: PWV was significantly different among the studied groups (p=0.01). Active SLE patients had lower PWV levels compared to inactive SLE patients (6.89 ± 1.00 vs. 7.79 ± 1.10 m/s, p<0.05) and also to controls (6.89 ± 1.00 vs. 8.14 ± 1.07 m/s, p<0.05). Moreover, there was a significant negative correlation between PWV and SLEDAI (r=-0.354, p=0.03). All carotid echo-tracking parameters were similar among groups (p>0.05): intima-media thickness (IMT) (p=0.50), diastolic diameter (p=0.34), distensibility coefficient (p=0.98), compliance coefficient (p=0.74), and elastic incremental modulus (p=0.87). IMT had a positive significant correlation with age (r=0.328, p=0.04) and a negative significant correlation with HDL (r=-0.366, p=0.03) and apolipoprotein A1 (r=-0.407, p=0.01). A trend of positive correlation between IMT and disease duration (r=0.306, p=0.06) was observed. CONCLUSION: This study demonstrates that SLE activity is responsible for alterations in arterial walls compatible with early atherosclerotic process, since the reduced arterial stiffness observed in active disease may be secondary to a greater inflammatory infiltration and foam cell formation.

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Almohmedhusain, Awal. "Lipid associated biomarkers in patients with systemic lupus erythematosus and rheumatoid arthritis." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/lipid-associated-biomarkers-in-patients-withsystemic-lupus-erythematosus-andrheumatoid-arthritis(e62f01eb-debe-4510-9489-13f05249dbc1).html.

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Patients with chronic inflammatory conditions such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) experience premature cardiovascular mortality and morbidity compared with the general population. The increased risk of cardiovascular disease (CVD) may in part, result from an interaction between traditional and non-traditional risk factors, modulated by chronic inflammation. The aim of this project was to look at lipid associated biomarkers in patients with SLE/RA and the association between these markers and cardiovascular disease outcomes. We also aimed to study the effect of inflammation reduction on vascular biomarkers. In the first study we examined 168 SLE patients median (IQR) age was 53 (46-61) years and median disease duration 13 (7, 23) years and 56 healthy controls median age 50 (39-60) years. We demonstrated elevated level of oxidised-LDLin SLE patients compared with healthy controls (76 (57, 99) U/l vs 56 (42, 88)U/l P= 0.02). We further explored the association between oxidant stress and premature atherosclerosis as measured by carotid intima media thickness (cIMT) and plaque. In addition to age and systolic blood pressure, oxidised-LDL and urinary 8-isoprostane were significantly and independently associated with cIMTin SLE patients _ coefficient 95%CI [0.00007 (5.29−6, 0.0001) and 0.003 (0.0008,0.004)], respectively. In healthy controls, age was the only independent variable. In the Norfolk Arthritis Register, 1266 patients with early inflammatory polyarthritis (IP) were studied. A linear regression analysis revealed a significant negative association between CRP and lipid profile namely TC, LDL, TG and ApoA-1. During a median (IQR) follow up = 5.5 (3.7-7.7) years 100 (7%) patients died (all causes) of which 33% (33) deaths were attributed to CVD. Forward stepwise regression analysis demonstrated that a low total cholesterol was independently associated with all cause mortality HR (95%CI) 0.75 (0.61, 0.91) and CVD mortality HR (95%CI) 0.49 (0.29, 0.85). In a small cohort 27 SLE patients and 15 healthy controls. We measured endothelial function using flow mediated dilatation of the brachial artery. At baseline we found a significant increase in TG level [1.36 (0.9, 1.87) mmol/l vs0.88 (0.64, 1) mmol/l P= 0.009] and a significant impaired endothelial function in SLE patients compared to the healthy controls [2.86 (0.6, 5.3) vs 6.81 (3.46,8.57), P= 0.03]. After treatment, there was a trend towards reduced TG level and improved endothelial function. Oxidised-LDL did not change significantly. In conclusion, oxidant stress is increased in SLE patients and relates to some measures of subclinical atherosclerosis. Control of inflammation may not be sufficient to completely control this in routine practice. In early RA, active inflammationmay mask any tendency to hyperlipidemia in this population. Low total cholesterol may be the best biomarker of the overall metabolic and inflammatory status of the patients as well as indicating a group with increased risk of future mortality.

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Accarini, Renata. "Doença periodontal como fator de risco coronariano São José do Rio Preto: Faculdade de Medicina de São José do Rio Preto, 2006." Faculdade de Medicina de São José do Rio Preto, 2006. http://bdtd.famerp.br/handle/tede/243.

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Made available in DSpace on 2016-01-26T12:51:55Z (GMT). No. of bitstreams: 1 renataaccarini_dissert.pdf: 311540 bytes, checksum: 6e73d654b99ae5ef0d517cb9c91c09bb (MD5) Previous issue date: 2006-10-16 Ainda permanecem controvérsias quanto à ligação causal e mecanismos fisiopatológicos que expliquem a associação entre Doença Periodontal e Doenças Cardiovasculares. Objetivo: Detectar a existência de associação entre doença periodontal ativa (DP) e ocorrência de Síndromes Coronárias Agudas (SCA). Casuística e Método: Foram avaliados 361 pacientes (57,3% do sexo masculino), com idades variando de 27 a 89 (médiaDP=60,512,2 anos) internados na Unidade de Tratamento Intensivo de um Hospital de Ensino com quadro clínico e complementar de SCA. Todos foram submetidos a exame periodontal completo, no próprio ambiente da UTI sendo que 325 (90,0%) realizaram cinecoronariografia para confirmação diagnóstica e/ou programação de conduta terapêutica. O exame periodontal consistiu na avaliação de todos os dentes presentes na cavidade oral e dos seguintes parâmetros: profundidade clínica de sondagem, nível de inserção clinica, índice de placa e índice gengival. Resultados: Dos 325 pacientes, 91 (28,0%) apresentavam artérias coronárias isentas de obstrução ou com obstruções discretas (<= 50% de perda de diâmetro), havendo obstruções importantes nos 72,0% restantes. O teste exato de Fisher mostrou valor de P de 0,0245 e ODDS Ratio de 2,571 (IC 95% 1,192 a 5,547), ou seja, documentou-se cerca de 2,5 vezes mais possibilidade de presença de DP ativa no grupo com SCA e coronariopatia obstrutiva significante. Conclusão: Constatou-se associação significante entre presença de doença periodontal ativa e doença coronária obstrutiva de grau importante em pacientes com Síndrome Coronária Aguda, reforçando a importância da prevenção e tratamento adequado da doença periodontal, que deve ser considerada como fator de risco potencial na etiologia e na instabilização da placa aterosclerótica. Abstract Positive association between periodontal disease and coronary diseases is unclear concerning physiopathologic mechanisms and causal relationship. The aim of this study was to assess the association between active periodontal disease active and obstructive coronary artery disease in patients with acute coronary syndromes. Method: 361 (57.3% males; mean age 60.5+12.2) patients referred for diagnostic coronary vessel disease were assessed for periodontal disease and also submitted to coronary angiography with diagnostic and prognostic purposes. Each patient underwent a full-mouth periodontal examination which included gingival bleeding, plaque index, periodontal pocket depths, attachment levels and missing teeth. For statistical analysis was used the Exact Fisher test and was accepted an Alfa error of 5%. Results: 28% patients haven t significant coronary vessel obstructions (<50% diameter obstruction) and 72.0% had significant obstructive disease (>50% diameter obstruction). The Exact Fisher Test showed p-value of 0.0245 and ODDS Ratio of 2.571 (95%CI from 1.192 to 5.547). So there was a 2.5 fold increase in the chance for active periodontal disease in patients with significant obstructive coronary artery disease. Conclusion: Our study indicates a positive and significant association between periodontal disease and obstructive coronary disease among patients with acute coronary syndromes becoming periodontal disease as a potential risk factor in etiology and outcome of atherosclerotic plaque. Results of this and other investigations should be taken into account in the future researches in order to validate this association. Ainda permanecem controvérsias quanto à ligação causal e mecanismos fisiopatológicos que expliquem a associação entre Doença Periodontal e Doenças Cardiovasculares. Objetivo: Detectar a existência de associação entre doença periodontal ativa (DP) e ocorrência de Síndromes Coronárias Agudas (SCA). Casuística e Método: Foram avaliados 361 pacientes (57,3% do sexo masculino), com idades variando de 27 a 89 (média DP=60,5 12,2 anos) internados na Unidade de Tratamento Intensivo de um Hospital de Ensino com quadro clínico e complementar de SCA. Todos foram submetidos a exame periodontal completo, no próprio ambiente da UTI sendo que 325 (90,0%) realizaram cinecoronariografia para confirmação diagnóstica e/ou programação de conduta terapêutica. O exame periodontal consistiu na avaliação de todos os dentes presentes na cavidade oral e dos seguintes parâmetros: profundidade clínica de sondagem, nível de inserção clinica, índice de placa e índice gengival. Resultados: Dos 325 pacientes, 91 (28,0%) apresentavam artérias coronárias isentas de obstrução ou com obstruções discretas (<= 50% de perda de diâmetro), havendo obstruções importantes nos 72,0% restantes. O teste exato de Fisher mostrou valor de P de 0,0245 e ODDS Ratio de 2,571 (IC 95% 1,192 a 5,547), ou seja, documentou-se cerca de 2,5 vezes mais possibilidade de presença de DP ativa no grupo com SCA e coronariopatia obstrutiva significante. Conclusão: Constatou-se associação significante entre presença de doença periodontal ativa e doença coronária obstrutiva de grau importante em pacientes com Síndrome Coronária Aguda, reforçando a importância da prevenção e tratamento adequado da doença periodontal, que deve ser considerada como fator de risco potencial na etiologia e na instabilização da placa aterosclerótica.

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Zeitouni, Michel. "Athérosclérose coronaire prématurée : facteurs de risque, pronostic, prévention et nouvelles approches mécanistiques." Thesis, Sorbonne université, 2021. http://www.theses.fr/2021SORUS526.

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Cette thèse s’est intéressée à la question de l’athérosclérose coronaire prématurée, du profil clinique et biologique des individus qui en sont touchés, avec une approche physiopathologique permettant d’évaluer la contribution de l’inflammation et l’âge vasculaire. Les études 1 et 2 ont décrit le profil cardiovasculaire à très haut risque de ces patients et les facteurs d’évolution péjorative sur le long-terme. Ces études ont démontré que l’athérosclérose coronaire est une maladie évolutive avec une atteinte multi artérielle rapide, menant à un taux de mortalité de 20 % sur 10 ans. L’étude 3 a démontré la contribution importante de l’inflammation infraclinique dans la genèse de l’athérosclérose coronaire chez les individus les plus jeunes, en comparaison avec les populations plus âgées. Cette observation a pu être effectuée grâce à l’utilisation d’un nouveau biomarqueur de l’inflammation chronique le GlycA, signal composite de la glycosylation des protéines de phase aiguë. L’étude 4 a mis en avant l’importante implication de l’ IL-1β dans la cascade inflammatoire post infarctus du myocarde, et son association avec la mortalité à court et long terme. L’étude 5 a évalué la rigidité de la racine de l’aorte mesurée en IRM comme nouveau marqueur de risque de la maladie coronaire prématurée, en ouvrant la voie vers une mesure intégrative du vieillissement vasculaire. Les études 6 et 7 ont mis en évidence la difficulté qu’ont les recommandations internationales américaines et européennes à détecter et traiter les individus à haut risque d’athérosclérose prématurés, et les opportunités manquées de traitement intensif après un premier infarctus du myocarde prématuré This thesis focused on premature coronary atherosclerosis, the clinical and biological profile of affected individuals, with a pathophysiological approach aiming to assess the contribution of inflammation and vascular age. Studies 1 and 2 described the very high-risk cardiovascular profile of these patients and the factors of poor long-term outcomes. These studies have demonstrated that premature coronary atherosclerosis is a progressive disease with a rapid multi-arterial involvement, leading to a mortality rate of 20% over 10 years. Study 3 demonstrated the significant contribution of subclinical inflammation to the genesis of coronary atherosclerosis in younger individuals, compared with older populations. This observation relied on the use of a new biomarker of chronic inflammation, GlycA, a composite signal of the glycosylation of proteins in the acute phase. Study 4 demonstrated the significant involvement of IL-1β in the post-myocardial infarction inflammatory cascade, and its association with short and long-term death. Study 5 evaluated the stiffness of the aortic root measured by MRI as a new risk marker for premature coronary artery disease, introduction a new tool for an integrative measure of vascular aging. Studies 6 and 7 have highlighted the lack of performance of American and European international guidelines in detecting and treating individuals at high risk of premature atherosclerosis, and the missed opportunities for intensive treatment after a first myocardial infarction. premature

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Bampi, Angela Teresa Bacelar Albuquerque. "Correlação dos dados clínicos e métodos não invasivos na detecção da aterosclerose humana." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-04082008-101044/.

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A doença cardiovascular aterosclerótica é a principal causa de morte no hemisfério ocidental, portanto também no Brasil. A detecção não invasiva da aterosclerose é fundamental para prevenção. Objetivos: Correlacionar os fatores de risco (escore de Framingham), o perfil lipídico, a PCR-us, a espessura da íntima-média da carótida, a função endotelial, o índice tornozelo-braquial e o escore de cálcio pela tomografia computadorizada, com a extensão da doença coronariana determinada pelo índice de Friesinger, na cinecoronariografia. Casuística e métodos: Foram estudados 100 pacientes de ambos os sexos, com idade de 55,1±10,7 sendo 55% homens e 45% mulheres. Não foram incluídos pacientes com síndrome coronariana aguda, insuficiência renal dialítica, doença do colágeno e câncer. Todos se submeteram a avaliação clínica, laboratorial (glicemia, perfil lipídico e PCR-us), função endotelial da artéria braquial e ultrasonografia da artéria carótida por ultra-som de alta resolução, índice tornozelo-braquial e tomografia computadorizada coronária para determinação do escore de cálcio. Foram calculados o colesterol não HDL-c e a relação TG/HDL-c. Todos os pacientes foram submetidos à cinecoronariografia por indicação do médico assistente. Foram considerados normais pacientes sem lesão obstrutiva na cinecoronariografia. Resultados: Pela análise univariada, escore de cálcio (529,5 ± 930,9) um HDL-c (45,9±15,5), relação TG/HDL (5,5±9,2) e IMT (0,77±0,22) mostraram correlação significativa com o índice de Friesinger. Já por análise multivariada somente o escore de cálcio, relação TG/HDL-c aumentada e HDL-c baixo correlacionaram-se significativamente com a extensão da DAC. A PCR-s (3,4±3,5), LDL-c (122,8±51,5) e DMF (4,8±5,7) não se correlacionaram com o índice de Friensinger. Conclusão: Assim, é possível ter uma idéia aproximada da presença/extensão da DAC usando métodos não invasivos, especialmente escore de cálcio, relação TG/HDL-c e HDL-c baixo. Background: Atherosclerotic cardiovascular disease is the leading cause of death in the western hemisphere including Brazil. Non-invasive detection of atherosclerosis is critical to prevention. Objectives: We correlated the risk factors (score of Framingham), lipid profile, PCR-us, carotid intima-media thickness, endothelial function, ankle-brachial index and calcium score by computed tomography with the extent of coronary disease determined by the Friesinger index, by coronary angiography. Methods: We studied 100 patients of both sexes, aged from 55.1 ± 10.7, 55% men and 45% women. Patients with acute coronary syndrome, renal dialitic, collagen disease and cancer were not included. All were submitted to clinical evaluation, laboratory (blood glucose, lipid profile and hs-CRP), endothelial function of brachial artery and ultra-sonography of carotid artery by high-resolution ultra-sound, ankle-brachial index and computed tomography for coronary determination of calcium score. We calculated the cholesterol not HDL-c and TG/HDL-c ratio. All patients were submitted to coronary angiography for indication by attending physician. We considered normal patients without obstructive lesion in coronary angiography. Results: By univariate analysis, calcium score, HDL-c, TG/HDL ratio and IMT showed significant correlation with Friesinger index. However, multivariate analysis only calcium score, increased TG/HDL-c and low HDL-c correlated significantly with the extension of the CAD. The hs-CRP, LDL-c and FMD, did not correlate Friensinger index. Conclusion: Thus, it is possible to have an approximate idea of the presence/extension of CAD by non-invasive methods, especially calcium score, TG/HDL-C ratio and HDL-c.

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Harbaoui, Brahim. "Rigidité Vasculaire en cardiologie interventionnelle." Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE1265/document.

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Le vieillissement vasculaire est un phénomène inéluctable. Il s'accompagne de modifications structurelles et fonctionnelles du système cardio-vasculaire constituant la rigidité vasculaire. Ce processus dégénératif affecte essentiellement la matrice extra cellulaire des artères élastiques. La perte de l'élasticité du système vasculaire va impacter la fonction ventriculaire gauche et la perfusion cardiaque, rénale et cérébrale par des mécanismes différents. La rigidité vasculaire est un puissant marqueur de risque cardio-vasculaire. Cette notion est peu répandue dans le domaine de la cardiologie interventionnelle alors qu'elle pourrait avoir des implications pronostiques et thérapeutiques importantes. Nous nous sommes intéressés à deux domaines de la cardiologie interventionnelle, pour lesquels la rigidité vasculaire pourrait ouvrir de nouvelles voies de recherche, la maladie coronaire et le traitement interventionnel du rétrécissement aortique. Concernant la maladie coronaire il existe un besoin de mieux comprendre la physiopathologie de la microcirculation et de l'ischémie myocardique. La survenue des accidents coronaires aigus reste également incomplètement comprise. Nous avons abordé la problématique par une approche épidémiologique en étudiant l'impact pronostique de la rigidité vasculaire sur la mortalité liée aux coronaropathies dans une cohorte de 1034 patients hypertendus avec 30 années de suivi. La rigidité vasculaire a été appréciée par la pression pulsée et un score d'athérosclérose de l'aorte abdominale. Un lien très fort a été mis en évidence entre la rigidité vasculaire et la survenue d'infarctus du myocarde. Nous avons ensuite développé un moyen d'étudier la rigidité vasculaire localement au niveau des artères coronaires. Nous avons mis au point une technique de mesure de la vitesse de l'onde de pouls coronaire. Cette technique repose sur l'utilisation d'un guide de pression ntra-coronaire et un algorithme breveté du traitement de signal. Nous sommes parvenus à mesurer une vitesse de l'onde de pouls sur 71 artères coronaires chez 49 patients. Nous avons observé une vitesse de l'onde de pouls plus lente témoignant d'artères plus compliantes chez les patients présentant un infarctus du myocarde en comparaison aux patients présentant un angor stable. Nous avons également constaté une augmentation de la vitesse de l'onde de pouls après implantation d'un stent endocoronaire témoignant d'une rigidification attendue de l'artère coronaire. Ces travaux pourraient ouvrir une nouvelle voie de recherche dans la compréhension de l'ischémie myocardique et de la survenue de l'accident coronaire aigu à savoir l'interaction rigidité vasculaire globale et rigidité locale coronaire. Concernant le traitement interventionnel du rétrécissement aortique, de nouveaux facteurs prédictifs du bénéfice de l'intervention sont nécessaires chez des patients souvent âgés et fragiles. Nous nous sommes intéressés à l'étude du volume de calcifications de l'aorte, reflet de la rigidité vasculaire. Ce paramètre a été mesuré par scanner chez des patients traités par remplacement valvulaire aortique par voie percutanée appelé TAVI pour transcatheter aortic valve implantation. Nous avons d'abord montré que le volume de calcifications de l'aorte ascendante était un puissant marqueur de risque indépendant de mortalité cardiaque et d'insuffisance cardiaque sur une série de 127 patients consécutifs traités par TAVI, avec un suivi médian de 907 jours. Ce travail a ensuite été complété en étudiant le volume de calcifications de l'aorte totale sur une série de 164 patients. Le volume de calcifications de l'aorte complète était prédicteur de mortalité totale et cardiaque. De plus, chaque segment d'aorte pris séparément (aorte ascendante, descendante et abdominale) prédisait la mortalité cardiaque. Enfin, seul le volume de calcifications du segment ascendant était prédicteur d'insuffisance cardiaque [etc…] Vascular aging is an inevitable phenomenon. It is accompanied by structural and functional modifications of the cardiovascular system mainly referred to as vascular stiffening. This degenerative process essentially affects the extracellular matrix of the elastic arteries. The loss of elasticity of the vascular tree affects left ventricular function as well as cardiac, renal and cerebral perfusions involving different mechanisms. Vascular stiffness is a powerful risk marker of cardiovascular disease. However, most interventional cardiologists are not familiar with this concept while it may have both important prognostic and therapeutic implications. We tackled two areas of interventional cardiology, where vascular stiffness may open new fields of research; coronary artery disease and interventional treatment of aortic stenosis namely, transcatheter aortic valve implantation (TAVI). With regards to coronary artery disease there is a need to better understand the pathophysiology of microcirculation and myocardial ischemia. Moreover, the occurrence of acute coronary events is also incompletely understood. Our first approach was epidemiological. We studied the prognostic impact of vascular stiffness on coronary artery disease mortality in a cohort of 1034 hypertensive patients after 30 years of follow-up. Vascular stiffness was assessed both by pulse pressure and by a score related to atherosclerosis of the abdominal aorta. A strong link was found between vascular stiffness and the occurrence of myocardial infarction and coronary artery disease related deaths. We then developed a way to study the local vascular stiffness at coronary artery level by measuring coronary pulse wave velocity. This technique relies on the use of an intracoronary pressure wire and a patented signal processing algorithm. We measured a coronary pulse wave velocity on 71 coronary arteries in 49 patients. Interestingly, patients with acute coronary syndromes had a lower coronary pulse wave velocity (which means more compliant arteries) when compared to patients with stable coronary artery disease. After an endocoronary stent implantation we noticed an increase of coronary pulse wave velocity in line with an expected stiffening. This work opens a new avenue of research regarding coronary perfusion physiology and plaque complications by studying the interaction of regional vascular stiffness and local coronary stiffness. Regarding TAVI, a procedure that often concerns elderly and frail patients, new factors predicting the benefit of the intervention are needed. We studied aortic calcifications as a surrogate of vascular stiffness. This parameter was measured by CT scan before TAVI. We first showed in 127 consecutive patients with a median follow-up of 907 days that ascending aorta calcifications were a powerful risk marker of cardiac mortality and heart failure after TAVI. This study was then completed by studying the volume of the whole aorta in 164 patients. The volume of calcifications of the whole aorta was a predictor of both all-cause and cardiac mortality. In addition, each segment of aorta taken separately (ascending, descending and abdominal aorta) predicted cardiac mortality. Finally, only ascending aorta calcifications predicted heart failure. These results support the hypothesis that ascending aorta calcifications are a marker of vascular stiffness and contribute to the left ventricular afterload. Moreover the volume of the whole aorta could mirror the global atherosclerosis burden of the patient. This easily measurable parameter could thus represent a new risk stratification tool in patients treated with TAVI. This work on vascular stiffness opens a new field of research in several areas of interventional cardiology. Regarding coronary artery disease, coronary pulse wave velocity could represent a way to better understand coronary perfusion, microcirculation, ischemia and the occurrence of coronary plaque rupture [etc...]

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Silva, Sara Maria Oliveira da. "Proteína C reativa e doença cardiovascular." Master's thesis, [s.n.], 2015. http://hdl.handle.net/10284/5318.

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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas As doenças cardiovasculares (DCV) são responsáveis por uma elevada taxa de mortalidade na sociedade portuguesa. Uma das causas mais comuns das DCV é a inflamação vascular que se associa à patogénese da aterosclerose. Como forma de auxiliar a deteção das DCV e acompanhar a sua evolução, são utilizados os biomarcadores inflamatórios, que constituem uma ferramenta valiosa na avaliação do prognóstico da patologia e na terapêutica a implementar. A proteína C reativa (PCR) é uma proteína de fase aguda (PFA), produzida essencialmente no fígado, pelos hepatócitos, após estimulação pelas citocinas proinflamatórias. A PCR é considerada um marcador significativo da reação inflamatória, cuja concentração não é afetada pela dieta ou variações circadianas. Esta PFA é também apontada como um importante mediador do processo de desenvolvimento da aterosclerose. A sua concentração é quantificada por métodos de alta sensibilidade (PCRas). Estes procedimentos possibilitam a identificação e diagnóstico de indivíduos com maior risco de adquirir problemas cardiovasculares, bem como o acompanhamento e a terapêutica associada à situação clínica de cada doente portador de DCV. Cardiovascular diseases (CVD) are responsible for a high rate of mortality in Portuguese society. One of the most common causes of CVD is vascular inflammation which is associated to the pathogenesis of atherosclerosis. As a way to assist the detection of CVD and monitor its evolution, are used inflammatory biomarkers, which constitute a valuable tool in evaluating the prognosis of pathology and therapy implement. The C-reactive protein (CRP) is an acute phase protein (APP), produced mainly in the liver by hepatocytes, after stimulation by cytokines pro-inflammatory. CRP is considered a significant marker of inflammatory reaction, since it is not affected by diet or circadian variations. This APP is also pointed as an important mediator of the atherosclerosis development. Its concentrations can be quantified by high sensitivity methods (hs-CRP). These procedures enable the identification and diagnosis of individuals with increased risk of acquiring cardiovascular problems, as well as monitoring and therapy associated with clinical situation of each patient bearer of CVD.

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Coll, Crespo Blai. "Influence of chemokine related polymorphisms in atherosclerosis and hiv-infections." Doctoral thesis, Universitat Rovira i Virgili, 2007. http://hdl.handle.net/10803/84026.

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Els malalts infectats pel Virus de la Immunodeficiència Humana (VIH) presenten major supervivència, degut a les teràpies altament efectives. De forma simultània però, també ha augmentat la incidència de malalties cardiovasculars , relacionada amb l’edat, els efectes secundaris de les medicacions i el mateix VIH. L’objectiu d’aquest treball és l’estudi de l’arteriosclerosi en malalts infectats pel VIH, de forma no invasiva (estudiant el intima-media thickness (IMT), mitjançant ecografia), i tenint en compte la dotació genètica (polimorfismes genètics), per identificar precoçment aquells individus més vulnerables a tenir events cardiovasculars. Contribucions i coneixements nous que aporta la tesi: l’estudi de l’arteriosclerosi en malalts amb una infecció crònica, s’hauria de complementar amb la utilització de la IMT i dels marcadors inflamatoris no convencionals (polimorfismes relacionats amb gens de les quimioquines). Metodologia emprada i conclusions més rellevants: disposem d’un “banc” d’imatges a partir de l’ecografia arterial per la mesura de la IMT així com una col•lecció de mostres biològiques (plasma, sèrum, ADN, limfòcits i ARN) per l’anàlisi dels polimorfismes (realitzats amb PCR) i per la determinació de les concentracions circulants d’algunes quimioquines (ELISA). D’acord amb els resultats obtinguts, podem concloure que determinats polimorfismes genètics tenen un impacte significatiu amb la promoció (MCP-1-2518G) o la preservació (SDF1-3’A) de l’arteriosclerosi dels malalts VIH, així com són determinants en la progressió de l’arteriosclerosi (CX3CR-1 249I). Així mateix, alguns d’aquests polimorfismes (MCP-1 i CCR-2) presenten una influència rellevant en l’evolució de la malaltia infecciosa (curs de limfòcits CD4 i càrrega viral del VIH). Resultats tangibles de la investigació: el desenvolupament d’aquesta tesi ha resultat en la publicació de quatre articles en revistes mèdiques especialitzades internacionals, i que representen referents en el camp cardiovascular (Circulation i Stroke) i en l’àrea de malalties infeccioses-VIH (AIDS i HIV Medicine). Així mateix s’han realitzat treballs complementaris (annexats a la tesi) publicats en revistes internacionals (Cytokine, Clinica Chimica Acta, European Journal of Pharmacology). Ens ha permès col•laborar amb d’altres grups de recerca (Rotterdam i Amsterdam) i presentar alguns dels resultats en el Congrés Nacional (La Corunya, 2005) i l’Internacional d’Arteriosclerosi (Roma, 2006).

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Petrulionienė, Žaneta. "Kardiovaskulinės rizikos įvertinimo ir modifikavimo įtaka aterosklerozės progresavimui ir sąsajos su arterijų sienelės pažeidimo žymenimis." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2009. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2009~D_20090526_151723-88838.

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Šiame darbe apžvelgėme Vilniaus Universiteto Širdies ir kraujagyslių ligų klinikos Prevencinės kardiologijos poskyryje nuo įkūrimo sukauptą patirtį (1997-2008). Apibendrinome tyrimų rezultatus 1624 pacientams, sergantiems koronarine širdies liga, 977 įvairios kardiovaskulinės rizikos asmenims (sergantiems metaboliniu sindromu, cukriniu diabetu, dislipidemija, arterine hipertenzija, sveikiems kontroliniams), genetiniame projekte ištyrėme 67 šeimų 236 asmenis. Gyvensenos, rizikos veiksnių ir kardioprotekcinių vaistų vartojimo tyrimas koronarine širdies liga sergantiems pacientams 22 Europos šalyse išryškino esminius Lietuvos ir kitų šalių pacientų priežiūros skirtumus. Nustatėme, kad dauguma Lietuvos pacientų nepasiekia kardiovaskulinės prevencijos tikslų, ypač gydant dislipidemijas. Tyrimas leido daryti išvadą, kad Lietuvoje būtina ženkliai pakelti kardiovaskulinės prevencijos lygį. Tyrėme tradicinių rizikos veiksnių paplitimą tarp pacientų, sergančių koronarine širdies liga, ir parodėme, kad šie rizikos veiksniai dažnesni, nei nurodoma literatūroje. Mūsų duomenimis net 98% koronarinių pacientų turi bent vieną iš keturių tradicinių rizikos veiksnių. Du trečdaliai (66,5%) koronarine širdies liga sergančių jaunesnių pacientų (<55 metų) turėjo du ir daugiau rizikos veiksnius. Nustatėme statistiškai reikšmingą ryšį tarp aterosklerozės progresavimo vainikinėse arterijose ir kai kurių rizikos veiksnių: padidėjusio kraujospūdžio, gliukozės, homocisteino, lipoproteino (a), mažo... [toliau žr. visą tekstą] This paper reviews the 1997−2008 experience gained by the Preventive Cardiology unit since its establishment in the department of Cardiovascular diseases of Vilnius University. We summarize the results of managing 1624 patients with coronary heart disease, 977 subjects with different cardiovascular risk (metabolic syndrome, diabetes, dyslipidaemia, arterial hypertension, healthy controls), evaluated 236 subjects from 67 families in the genetic project. A survey on the lifestyle, risk factors and use of cardioprotective drug therapies in patients with coronary heart disease from 22 European countries has showed major patient management differencies between Lithuania and other countries. The large proportion of patients in Lithuania do not achieve the targets for cardiovascular disease prevention, especially in lipid management. There is still considerable potential in Lithuania to raise standarts of cardiovascular prevention. We analyzed the prevalence of conventional risk factors among our patients with coronary heart disease and showed that they are more common than described in the literature. Our data revealed that 98% of coronary patients had at least one of four conventional risk factors. Two-thirds (66,5%) of younger patients (<55 years) with coronary heart disease had two and more risk factors. We have found statistically significant correlation between atherosclerosis progression rate in the coronary arteries and risk factors: elevated blood pressure, blood... [to full text]

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Ribeiro, Giovana Gomes. "Calcificação prematura de artérias coronárias no lúpus eritematoso sistêmico: associação com duração de doença e densidade mineral óssea." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5145/tde-16062009-164313/.

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Objetivo: Avaliar a relevância de fatores de risco tradicionais para doença cardiovascular (FRC), fatores relacionados ao lúpus e densidade mineral óssea (DMO) na calcificação prematura de artérias coronárias (CAC) em mulheres jovens com lúpus eritematoso sistêmico (LES). Métodos: Noventa e quatro pacientes lúpicas do sexo feminino com duração de doença 5 anos e idade menor que 45 anos foram selecionadas consecutivamente para este estudo. Os fatores de risco cardiovascular analisados foram: diabetes mellitus, hipertensão arterial sistêmica, dislipoproteinemia, fumo, índice de massa corpórea (IMC), insuficiência ovariana e renal. Fatores de risco relacionados ao LES estudados foram: duração de doença, critérios ACR, SLICC/ACR modificado (excluindo escores relacionados à aterosclerose), SLEDAI, tratamento com glicocorticóide e ciclofosfamida. A densidade mineral óssea de corpo inteiro, coluna lombar e colo do fêmur foram realizadas por densitometria de dupla emissão de fontes de raios-X (DXA). Calcificação de artérias coronárias foi determinada usando tomografia computadorizada com 16 multidetectores. Resultados: Calcificação prematura de artérias coronárias foi identificada em 12 (12,7%) dos pacientes, havendo associação com maior freqüência de pacientes com FRC (p=0,008), maior número de FCR (p=0,003), idade (p=0,025), duração de doença (p=0,011) e SLICC (p=0,011). A análise individual dos FRC demonstrou que a presença de menopausa (p=0,036), dislipidemia (p=0,003) e hipertensão (p=0,006) foram significativamente associados com calcificação coronariana. Análise de regressão logística múltipla usando FRC, idade, duração de doença, SLICC e DMO de corpo inteiro revelou que apenas duração de doença (p=0,042) e DMO de corpo inteiro (p=0,023) permaneceram fatores significantes para calcificação coronariana. Conclusão: Identificamos que duração de doença e DMO reduzida são preditores independentes para calcificação coronariana prematura em mulheres jovens com LES, sugerindo um mecanismo subjacente comum Objective: To evaluate the relevance of traditional cardiovascular risk factors (CVR), disease-related risk factors and bone mineral density (BMD) for premature coronary artery calcification (CAC) in young female systemic lupus erythematosus (SLE). Methods: Ninety-four female SLE patients 5 years disease duration and age <45 years were consecutively selected for this study. Cardiovascular risks (CVR) analyzed were: diabetes mellitus, arterial hypertension, dyslipoproteinemia, smoking, body mass index (BMI), ovarian and renal insufficiency. SLE-related risk factors evaluated were: disease duration, ACR criteria, modified SLICC/ACR (excluding atherosclerosis-related scores), SLEDAI, glucocorticoid and cyclophosphamide treatment. Bone mineral density (BMD) in whole body, lumbar spine and femoral neck was assessed by dual X ray absorptiometry (DXA). Coronary artery calcification was determined using the 16-slice multidetector computed tomography. Results: Premature coronary artery calcification was identified in 12 (12.7%) patients and was associated with a higher frequency of patients with CVR (p=0.008), a higher mean number of CVR (p=0.003), mean age (p= 0.025), mean disease duration (p=0.011) and mean SLICC (p=0.011). Individual analysis of CVR demonstrated that the presence of menopause (p= 0.036), dyslipidemia (p= 0.003) and hypertension (p=0.006) were significantly associated with coronary calcification. Additionally, premature calcification was associated with a lower whole body BMD (p=0.013). Multiple logistic regression analysis using CVR, age, disease duration, SLICC and whole body BMD revealed that only disease duration (p=0.042) and whole body BMD (p=0.023) remained significant factors for coronary calcification. Conclusion: We have identified that disease duration and decreased BMD are independent predictors for premature coronary calcification in young women with SLE, suggesting a common underlying mechanism

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Mangili, Leonardo Celeste. "Avaliação da associação da gordura pericárdica medida pela tomografia computadorizada com a presença de aterosclerose coronária subclínica em pacientes com hipercolesterolemia familiar." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-19122016-143332/.

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A hipercolesterolemia familiar (HF) é uma doença causada por um grupo de alterações genéticas que resultam em altas concentrações de colesterol no sangue e aumento na prevalência de aterosclerose subclínica e risco de eventos coronarianos precoces. Apesar da importância do colesterol como fator causal da aterosclerose na HF, o curso desta última é variável e influenciado por outros fatores de risco. A gordura pericárdica é um compartimento da gordura visceral e está associada à presença de aterosclerose coronária subclínica em populações sem HF. Este estudo avaliou a associação da gordura pericárdica com a presença e extensão da aterosclerose coronária subclínica em pacientes com HF. Noventa e sete pacientes com HF diagnosticada por critérios clínicos, confirmada geneticamente em 67% dos casos, foram submetidos a angiotomografia de coronárias e determinação do escore de cálcio (CAC). Foram analisadas a presença de placas, de estenose luminal > 50%, de CAC > 0 e do percentil de CAC > 75. Para se quantificar a extensão e gravidade da aterosclerose coronária subclínica foram avaliados de forma contínua a CAC, o Segment-Involvement Score (SIS) e o Segment-Stenosis Score (SSS). O volume de gordura pericárdica foi aferido por método semiautomático e dividido em dois compartimentos: gordura epicárdica (localizada dentre do saco pericárdico) e mediastinal (localizada fora do pericárdio). Para avaliar a associação dos volumes de gordura pericárdica com a aterosclerose subclínica foram ajustados modelos de regressão logística e linear. Os pacientes tinham idade média de 45 (±13) anos, com predomínio do sexo feminino. Foi encontrada presença de placas coronarianas e de CAC em 47,4% e 45,4% dos pacientes, respectivamente. Idade, colesterol total, LDL-C, HDL-C, apolipoproteína A-I, apolipoproteína B, presença de xantomas de tendão de Aquiles e clearance de creatinina foram associados a aterosclerose coronária subclínica na análise univariada. Os volumes de gordura pericárdica se associaram à presença de síndrome metabólica, hipertensão arterial, idade, IMC, a circunferência abdominal, o colesterol não-HDL, triglicerídeos e glicemia de jejum. Na análise multivariada em modelos ajustados para idade, sexo, tabagismo, HDL-C, LDL-C, circunferência abdominal, síndrome metabólica e uso prévio de estatinas, a gordura epicárdica foi associada independentemente com o percentil de CAC > 75 e foi diretamente proporcional a intensidade da CAC, SSS e SIS. Em conclusão, a gordura epicárdica associou-se independentemente à maior extensão e gravidade de aterosclerose coronária subclínica em pacientes com HF Familial hypercholesterolemia (FH) is a disease caused by a group of genetic mutations resulting in high blood cholesterol and elevated prevalence of subclinical atherosclerosis and early coronary events. Although high cholesterol is the driving cause of atherosclerosis in FH, the course of the latter is variable and is affected by other risk factors. Pericardial fat (PF) is a visceral fat compartment that is associated to the presence of subclinical atherosclerosis in non-FH populations. The present study sought to determine the association of PF with the presence and extent of subclinical coronary atherosclerosis in FH subjects. Ninety-seven patients with clinical diagnosis of FH, genetically confirmed in 67%, were submitted to coronary tomography angiography and coronary artery calcium (CAC) quantification. The presence of plaques, luminal stenosis > 50%, CAC > 0, CAC percentile above 75 were evaluated. In order to evaluate the extent and severity of subclinical atherosclerosis, the CAC scores, Segment-Involvement Score (SIS) and Segment-Stenosis Score (SSS) were also measured. Pericardial fat volumes were measured by semi automated method and divided in two compartments: epicardial fat (located inside the pericardial sac) and mediastinal fat (located outside pericardial sac). Logistic regression and linear models tested the association of PF volumes with subclinical coronary atherosclerosis. Patients were predominantly female, with mean age of 45 (± 13) years. Coronary plaques and CAC were found respectively in 47.4% and 45.4% of patients. Age, total cholesterol, LDL-C, HDL-C, apolipoproteins A-I and B, the presence of Achilles xanthomas and creatinine clearance were associated with subclinical coronary atherosclerosis in univariate analysis. PF volumes were associated with the presence of metabolic syndrome, hypertension age, BMI, abdominal circumference non-HDL-cholesterol triglycerides and fasting glucose. On multivariate analysis in models adjusted for age, sex, smoking, HDL-C, LDL-C, abdominal circumference, metabolic syndrome and previous statin use epicardial fat was independently associated with CAC > 75th percentile, and was directly proportional to the intensity of CAC, SSS and SIS. In conclusion, epicardial fat was independently associated with a greater extension and severity of subclinical atherosclerosis in FH patients

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Cao, Xiaojuan. "Effect of consuming ground beef of differing monounsaturated fatty acid content on atherosclerotic cardiovascular disease risk factors in healthy men." [College Station, Tex. : Texas A&M University, 2008. http://hdl.handle.net/1969.1/ETD-TAMU-3211.

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Sabbag, Cid Yazigi. "Psoríase e aterosclerose subclínica avaliada pela espessura médio-intimal nas artérias carótidas por meio da ultrassonografia." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5169/tde-05102016-131529/.

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Introdução: A psoríase é uma doença sistêmica crônica, inflamatória e imuno- mediada, que afeta a pele, vasos e sistema osteomuscular. A inflamação é um fator de risco importante para a aterosclerose, e a psoríase está associada com risco aumentado de dislipidemia, diabetes, hipertensão, obesidade e esteato-hepatite não alcoólica. No entanto, o impacto da inflamação crônica sistêmica sobre a saúde vascular e aterosclerose permanece mal compreendido. Objetivos: Analisar a associação entre psoríase e aterosclerose subclínica com uma medição não invasiva, avaliada no ramo das artérias carótidas, usando a espessura médio-intimal (IMTc). O objetivo secundário foi comparar a IMTc entre os subgrupos psoríase: leve, moderada à psoríase/grave e artropática, com o grupo controle. Métodos: Neste estudo caso-controle transversal, 221 pacientes com psoríase (31,2% psoríase leve, 41,6% psoríase moderada/grave e 31,2% psoríase artropática) foram comparados com um grupo de 5.061 controles existentes recrutados a partir de um inquérito anterior (ELSA-Brasil HU-USP). Os critérios de inclusão compreendem os seguintes fatores: acima de 40 anos de idade para mulheres e 35 anos para homens; psoríase diagnosticada e clinicamente ativa, pelo menos há dois anos. Os critérios de exclusão foram: gravidez, presença de neoplasia, gota, artrite reumatóide e lúpus eritematoso sistêmico. Todos os participantes foram submetidos a exame médico, exame clínico e dados antropométricos recolhidos, bem como amostras de sangue para análise laboratorial. Em seguida, foram realizados exame de ultrassonografia das artérias carótidas direita e esquerda a fim de determinar IMTc. Ambos os lados analisados com média dos valores; quando aumentados foram utilizadas como um indicador da aterosclerose subclínica. Resultados: No grupo psoríase, o tempo médio de doença foi de 16 (± 13) anos. Em relação ao IMT da carótida (média dos lados direito e esquerdo), não observamos valores aumentados no grupo de psoríase, em comparação com o grupo controle, com os dados crus (P = 0,24 e P = 0,83, IMT esquerda e IMT direita, respectivamente). No entanto, quando o ajuste por sexo e idade (P = 0,038 e P < 0,0001, IMT para a esquerda e direita, respectivamente) e um ajuste multivariado para o risco cardiovascular, uma diferença significativa é encontrada (P = 0,028 e P < 0,0001, IMT esquerda e IMT direita, respectivamente) com valores mais elevados da carótida IMT no grupo de psoríase do que no grupo controle. Em consonância com isso, não foram observadas diferenças na IMT entre ameno, sub-grupos artrite psoriática moderado-grave e grupo controle (P = 0,50 e P = 0,52, respectivamente). Hipertensão, Hs CRP, IMC, HDL e LDL foram maiores nos pacientes com psoríase, em comparação com os controles (ambos p < 0,001). Conclusões: Na coorte brasileira, pacientes com psoríase apresentaram um perfil mais grave de fatores de risco cardiovascular do que os controles, em função do aumento da espessura da parede da artéria carótida encontrada nesses pacientes. O papel preciso da inflamação sistêmica crônica e outros fatores sobre a progressão da doença e comorbidades devem ainda ser elucidados . Introduction: Psoriasis is a chronic systemic immune-mediated inflammatory disease affecting skin, vessels and osteomuscular system. Inflammation is an important risk-factor for atherosclerosis and psoriasis is associated with increased risk for dislipidemia, diabetes, hypertension, obesity and non-alcoholic steatohepatitis. However, the impact of chronic systemic inflammation on vascular health and atherosclerosis remains poorly understood. Objectives: To examine the association between psoriasis and subclinical atherosclerosis assessed at the carotid artery branch using a non-invasive measurement of the intima-media thickness (IMTc). The secondary objective was to compare the IMTc between psoriasis subgroups: mild, moderate / severe psoriasis and arthropathica with control group. Methods: In this cross-sectional case-control study, 221 psoriasis patients (31.2% mild psoriasis, 41.6% moderate-severe psoriasis and 31.2% arthritic psoriasis) were compared with a group of 5,061 existing controls recruited from a previous investigation (ELSA-Brasil HU-USP). Inclusion criteria were: 40 y of age for women and 35 y of age for men; psoriasis diagnosed and clinically active for at least 2 years. Exclusion criteria were: pregnancy, neoplasia, gout, rheumatic arthritis and systemic lupus erythematosus. All participants were submitted to medical screening, clinical examination and had anthropometric data collected as well as blood samples for laboratorial analysis. Then, they undertook an ultrasound scan of the right and left carotid arteries in order to determine IMTc. Both sides were averaged and increased values were used as an indicator of subclinical atherosclerosis. Results: The psoriasis group the mean disease time was 16±13 years. In relation to the carotid IMT (right and left sides averaged), we did not observe increased values in the psoriasis group as compared to the control group, with crude data (P = 0,24 and P = 0,83, IMT left and IMT right respectively). However, when adjusting by sex, age (P = 0,038 and P < 0,0001, IMT left and IMT right respectively) and a multivariate adjustment for cardiovascular risk, a significant difference is found (P = 0,028 and P < 0.0001, IMT left and IMT right respectively) with higher carotid IMT values in the psoriasis group than in the control group. In line with this, no differences were observed in the IMT between mild, moderate-severe, psoriatic arthritis sub-groups and control group (P = 0.50 e P = 0.52, respectively). Hypertension, Hs CRP, BMI, HDL and LDL were higher in psoriasis patients as compared to controls (both p < 0.001). Conclusions: In the Brazilian cohort, psoriasis patients presented a more severe profile of cardiovascular risk factors than controls, with increased carotid arterial wall thickness being found in these patients. The precise role of chronic systemic inflammation and other factors on disease progression and comorbidities are yet to be elucidated

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