Dissertations / Theses on the topic 'Cardiovascular disease risk factors'
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Kaffashian, Sara. "Cognitive Aging : Role of Cardiovascular Disease Risk Factors." Phd thesis, Université Paris Sud - Paris XI, 2013. http://tel.archives-ouvertes.fr/tel-00940586.
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Several cardiovascular disease risk factors including, dyslipidemia, high blood pressure, and diabetes have been proposed as important modifiable risk factors for cognitive decline and dementia. These risk factors often co-occur and their aggregation is associated with increased risk of cardiovascular disease and dementia. However, studies of composite measures of cardiovascular disease risk in relation to cognitive outcomes in non-elderly populations are scarce. The aim of this thesis was to examine composite measures of risk in relation to cognition and longitudinal cognitive change amongmiddle-aged adults. Data from the Whitehall II study were used to study the associations between the metabolic syndrome, two Framingham risk scores; the Framingham stroke and general cardiovascular disease risk scores, and cognition, based on three cognitive assessments over 10 years. In addition, these two (cardio)vascular risk scores were compared with the CAIDE dementia risk score. Of all composite measures of risk examined, the two Framingham risk scores were the best predictors of 10-year cognitive decline. Higher cardiovascular risk was associated with faster 10-year decline inmultiple cognitive tests including verbal fluency, vocabulary and global cognition. These results suggest that multiple cardiovascular disease risk factors contribute to cognitive decline starting in midlife and that multi-risk factor models such as cardiovascular risk scores may be better suited to assessing risk of cognitive decline. Early identification and treatment of cardiovascular disease risk factors may offer the possibility of markedly delaying or preventing cognitive decline.
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SAKAMOTO, JUNICHI, KAZBEK TULEBAYEV, YOSHITOKU YOSHIDA, MD HARUN-OR-RASHID, and GULNARA KULKAYEVA. "CARDIOVASCULAR DISEASE RISK FACTORS AMONG RURAL KAZAKH POPULATION." Nagoya University School of Medicine, 2012. http://hdl.handle.net/2237/16022.
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Kwape, Lemogang Daniel. "Diet and cardiovascular disease risk factors in Botswana." Thesis, University of Aberdeen, 2012. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=211324.
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Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide. In Sub-Saharan Africa, rates of CVD are increasing rapidly, but there is little evidence about the potential determinants of CVD risk in this population. This thesis investigated CVD risk factors in Gaborone, capital city of Botswana, by (i) documenting CVD risk factors in this population, (ii) investigating the association between diet and CVD risk factors and (iii) assessing the association between diet and risk of CVD. 787 adults were recruited. Of these 566 were generally “healthy” with no history of CVD, while 221 (“diseased”) had at least one reported CVD condition, hypertension or diabetes. The median (interquartile range) age was 27 (23, 32) and 52 (42, 62) years for healthy and diseased participants respectively. All participants completed an interview administered questionnaire, including a food frequency questionnaire. Height, weight, waist circumference and blood pressure were measured, and a non-fasting blood sample was obtained for analysis of lipids, lipoproteins and glucose. A high prevalence of overweight and obesity (36.8%), particularly in women (50.0%), and low HDL cholesterol (<1.0 mmol/L men and <1.3 mmol/L women) (62.6%) was found. High levels of triglycerides, LDL cholesterol, glucose and high blood pressure were also found in this population of young adults in Gaborone. Total fat and/or saturated fat intake (as percentage energy) was significantly linearly associated with increased LDL cholesterol (p=0.017), triglycerides (p=0.048), glucose (p=0.044) and with decreased HDL cholesterol (p=0.021). However, fibre, polyunsaturated fatty acids and dietary patterns were not independently associated with CVD risk factors. Carbohydrates intake was significantly associated with increased risk of disease. Unexpectedly, saturated fat intake was associated with reduced disease risk, but weakened after nutrients adjustment. CVD risk factors are relatively high in this population. These results suggest a need for further research on CVD in Botswana.
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Minh, Hoang Van. "Epidemiology of cardiovascular disease in rural Vietnam." Doctoral thesis, Umeå : Public Health and Clinical Medicine Folkhälsa och klinisk medicin, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-779.
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Lindberg, Gunnar. "Serum sialic acid and cardiovascular disease risk." Malmö : Dept. of Community Health Sciences, Lund University, 1992. http://books.google.com/books?id=YPxqAAAAMAAJ.
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Guo, Xiaohui. "Effects of Total Polyphenol Intakes on Cardiovascular Disease Risk Factors in an Elderly Population at High Cardiovascular Risk." Doctoral thesis, Universitat de Barcelona, 2016. http://hdl.handle.net/10803/399542.
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There is a consensus that CVD has been the leading cause of death worldwide in recent decades, and it is predicted that will raise from 17.5 million in 2012 to 22.2 million in 2030. Besides, CVD is a heavy economic burden on the health care system at both global and national scales. For the primary prevention, prediction models based on established risk factors are useful tools in the prevention of CVD. In this study, the cardiovascular risk factors among the elderly population have been assessed, which used to set up associations between total polyphenol intakes from a Mediterranean diet and prevention of CVD.
The Mediterranean diet is a nutritional recommendation that has recently shown beneficial effects on human health. Numerous studies have demonstrated there is a negative association between consumption of the Mediterranean diet and the prevalence of CVD. The evidence concerning the potential mechanisms of action which underlie the cardio-protective effects may be attributed to a high amount of dietary fiber, vitamins, folic acid, natural antioxidants, monounsaturated fat; moderate amounts of animal protein, moderate amount of alcohol mainly in the form of wine; and low amount of saturated and trans fat. However, only limited studies have focused on the observed protection from the most abundant antioxidants in nature, polyphenol. Therefore, in this study, we hypothesized that a high dietary polyphenol intakes, recorded by urinary polyphenol excretion, could be associated with low CVD risk parameters, diabetes, and obesity in an elderly population with high cardiovascular risk.
Traditional methods of obtaining information on polyphenol intakes, such as from dietary recalls, FFQs, and databases on the polyphenol content of foods, are not accurate enough to reflect polyphenol concentration after metabolism. To solve this problem, we used excretion of urine as a reliable and effective biomarker to track polyphenol after digestion.
High glucose levels, TG concentration, DBP are classic cardiovascular risk factors for developing of CVD. In this thesis, we found significant inverse correlations between changes in TPE and plasma TG concentration, glucose concentration, and DBP after adjustment for potential confounders after a 5-year of intervention.
Overweight and obesity are also important risk factors for developing of CVD. Inverse correlations were observed between TPE at 5 years of follow-up and BW, BMI, WC and WHtR after adjustment for potential confounders, indicating higher polyphenol intakes improve body weight managements.
Prevalence of T2D is positively associated with incidence of CVD. We found a high intake of total polyphenols, calculated by FFQs and the Phenol-Explorer database, was associated with a reduced risk of diabetes in elderly people at high risk of CVD.
To conclude, we suggest that a high consumption of polyphenol-rich foods in the frame of a Mediterranean diet could potentially help to reduce multiple risk factors of CVD.Las enfermedades cardiovasculares (CVD) representan la principal causa de mortalidad en el mundo. Numerosos estudios han demostrado una asociación negativa entre el consumo de la dieta mediterránea y la prevalencia de las CVD. Sin embargo, sólo algunos estudios se han centrado en evaluar la protección que pueden ejercer los polifenoles. En este trabajo se propuso la siguiente hipótesis de que una ingesta elevada de polifenoles a través de la dieta, podría estar asociada a una disminución de parámetros de bajo riesgo de CVD, diabetes y obesidad en una población de edad avanzada con alto riesgo de enfermedades cardiovasculares. Se observó que una alta ingesta de polifenoles totales, calculado por las encuestas de frecuencia de consumo (FFQ) y la base de datos de Phenol-Explorer, se asoció con un menor riesgo de diabetes en personas de edad avanzada con alto riesgo de CVD. Los métodos tradicionales para obtener las informaciones de la ingesta de polifenoles, como los recordatorios de la dieta, las encuestas de frecuencia de consumo y bases de datos, no son suficientemente precisos. Para resolver este problema, se utilizó la además la excreción de los polifenoles en la orina (TPE) como un biomarcador fiable, robusto y eficaz para realizar un seguimiento del consumo de polifenoles. Hemos observado correlaciones inversas significativas entre los cambios en la concentración plasmática de TPE a los 5 años de seguimiento y triglicéridos plasmáticos, la concentración de glucosa y la presión sanguínea diastólica después de ajustar por posibles factores de confusión. El sobrepeso y la obesidad también son importantes factores de riesgo cardiovascular. Se observaron correlaciones inversas entre TPE a los 5 años de seguimiento y peso corporal (BW), índice de masa corporal (BMI), circunferencia de la cintura (WC) y cintura a la altura (WHtR) después del ajuste por posibles factores de confusión. Para concluir, se sugiere que un alto consumo de alimentos con alto contenido en polifenoles en el marco de una dieta mediterránea podría reducir múltiples factores de riesgo de CVD.
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Dedkhard, Saowapa. "Risk Factors of Cardiovascular Disease in Rural Thai Women." Diss., The University of Arizona, 2006. http://hdl.handle.net/10150/195629.
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Cardiovascular disease (CVD) is a major health problem among women worldwide. In Thailand, risk factors of CVD in rural Thai women have not yet been examined. The purpose of this predictive correlational study was to examine risk factors of CVD in rural Thai women. Non-modifiable risk factors, modifiable risk factors (physiological, behavioral, and psychological risk factors), contextual risk factors, as well as, coping were conceptualized as major variables in this study.The sample consisted of 149 rural Thai women who had been diagnosed with CVD and resided in rural northern Thailand. A set of questionnaires and physiological measures were used to obtain data. The Chi-square test and the Pearson correlation technique, as well as the Multiple regression were used for data analysis.The results revealed that age, hypertension, cigarette smoking, stress, depression, and poverty had positive relationships with the severity of CVD. BMI, physical activity, education level, and family income were inversely related to the severity of CVD. However, total cholesterol, diabetes mellitus, menopause status, alcohol consumption, distance to hospital, transportation to health care, and coping had no relationship to the severity of CVD. A few of the physiological and behavioral risk factors were significant predictors of the severity of CVD in rural Thai women. These included high blood pressure, cigarette smoking, and physical inactivity. Notably, psychological stress and the contextual risk factors of income and poverty were also significant predictors of the severity of CVD in these women. Moreover, there were the significant moderator effects in predicting to the severity of CVD: total serum cholesterol and family income, diabetes and distance to a hospital, BMI and transportation, menopause and income, cigarette smoking and transportation, and depression and poverty.In conclusion, the findings from this study suggested that few of traditional risk factors of CVD were significant risk factors for CVD. Noteworthy findings demonstrated that psychological stress and contextual risk factors played an important role in contributing to CVD in rural Thai women. It is suggested that specific and effective interventions are needed for these women in order to reduce their morbidity and mortality rates of CVD.
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Khan, Hassan. "Markers of glycaemia and risk of cardiovascular disease." Thesis, University of Cambridge, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648585.
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Abshire, Demetrius A. "CARDIOVASCULAR DISEASE RISK FACTORS AMONG EMERGING ADULTS IN COLLEGE." UKnowledge, 2014. http://uknowledge.uky.edu/nursing_etds/12.
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The purpose of this dissertation was to examine factors associated with cardiovascular disease (CVD) risk among emerging adults in college aged 18-25 years. CVD risks that develop during this period often persist into adulthood making it an ideal time to target CVD prevention. The specific aims of this dissertation were to 1) explore perceptions of cardiovascular risk among emerging adult men in college; 2) compare differences in unhealthy behaviors and obesity between emerging adults in college living in rural, Appalachian Kentucky and urban Fayette County, Kentucky; and 3) compare measures of general and abdominal obesity in predicting blood pressure among emerging adults in college.
Specific Aim One was addressed by a qualitative study of perceptions of cardiovascular risk in 10 emerging adult males in college. Specific Aims Two and Three were addressed by a study of emerging adult college students living in rural, Appalachian and urban Fayette County, Kentucky. We hypothesized that students in rural, Appalachian Kentucky would engage in more unhealthy behaviors and be obese due to living in an austere environment with barriers to healthy behaviors. Although obesity and hypertension are known to be related, researchers have not determined whether body fat distribution, general vs. abdominal, is predictive of blood pressure in emerging adults. Knowing which body fat distribution is the strongest predictor of blood pressure may help in evaluating cardiovascular risk in emerging adults.
Emerging adult men emphasized difficulty engaging in CVD health behaviors while attending college and choose to ignore long-term CVD risk. Overcoming college-specific and developmental barriers to engaging in healthy behaviors is critical to reducing cardiovascular risk in this population. Students living in rural, Appalachian Kentucky had more CVD risk behaviors and more were obese compared to those in urban Fayette County, Kentucky. Reducing CVD risk behaviors and obesity among students in rural Appalachian Kentucky may help decrease the high burden of CVD in this region. Findings suggest that waist circumference was the best predictor of systolic blood pressure among emerging adults in college.
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Appannah, Geeta. "Dietary patterns, obesity and cardiovascular risk factors in young people." Thesis, University of Cambridge, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648138.
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Wilson, Johanna. "Cardiovascular Disease Risk Scores and Novel Risk Factors in Relation to Race and Gender." Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6434.
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The use of cardiovascular risk scores remains the foundation for risk stratification to guide clinical management. Clinicians have access to several cardiovascular risk scores in practice settings. While having several risk scores with different risk factors may provide more information, it does not imply accuracy of the cardiovascular risk score used to calculate individual patient cardiovascular risk. The objective of this study was to compare the Framingham Risk score, Reynolds Risk scores, and the Pooled Cohort Risk Equation (3 commonly used equations) scores with respect to ability to predict cardiovascular events in a diverse ethnic population. Additionally, the potential predictive utility of three novel risk factors (carotid intima media thickness, peripheral arterial tonometry and vasa vasorum) was examined in relation to ability to improve 10-year cardiovascular risk prediction.
A secondary analysis of the longitudinal prospective study cohort known as Heart Strategies Concentrating On Risk Evaluation (Heart SCORE) was conducted. The cardiovascular risk scores of study participants who did and did not experience a cardiovascular event composite index consisting of myocardial infarction, death, stroke, acute ischemic stroke, or revascularization were assessed using methods of calibration and discrimination overall and by race and gender. When examining performance of the 3 risk scores, the overall 10-year absolute predicted cardiovascular risk varied substantially (e.g. approximately 2-fold) and this wide variation in predicted 10-year cardiovascular risk was present across race and gender. Nonetheless, despite the wide variation in estimates of absolute risk, the 3 cardiovascular risk score equations were strongly associated with future cardiovascular risk overall and by race and gender. There was some indication that the Reynolds risk score was the most accurate measure of future cardiovascular risk. The 3 novel risk factors examined did not significantly improve 10-year cardiovascular risk prediction above and beyond the standard demographic and clinical variables used in these well-known equations.
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Heydon, Emma Elizabeth. "Telomere length and cardiovascular disease risk factors in South Asians." Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708496.
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Preston, Emma Chevallier. "Cardiovascular risk factors in mild to moderate chronic kidney disease." Thesis, Imperial College London, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.497669.
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Woodhouse, Peter Robert. "Seasonal variation of cardiovascular disease risk factors in older adults." Thesis, University of Southampton, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295672.
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Lund, Adam John Svenn. "Physical activity, chronic inflammation and risk factors for cardiovascular disease." Thesis, University of Bath, 2009. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.519920.
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The purpose of this thesis was to examine the interaction between cardiovascular risk factors (particularly novel inflammatory measures) and short-term changes in physical activity. This is important as it is necessary to establish whether the changes that occur to these markers over the longer-term might be a consequence of short-term changes in physical activity. Chapter 4 investigated the challenges in handling the large volume of minute-by-minute data obtained from the use of a novel device for estimating physical activity energy expenditure from synchronous heart rate and accelerometer data. This chapter describes the development of specific software to enable efficient data-processing and evaluated the advantages and disadvantages of this new method of physical activity measurement. Chapter 5 sought to understand the reproducibility of various measures that were central to progress in this field in order to justify their inclusion in future intervention-based studies. This work showed that the inflammatory markers C-Reactive Protein and interleukin-6 and the lipid markers total cholesterol, high-density lipoprotein, low-density lipoprotein and triglycerides were all reproducible measures. The measurement of physical activity energy expenditure, when demarked into common categories, was also mostly reproducible. The circulating marker oxidised-low-density lipoprotein, an in-house adhesion assay and in-house mononuclear cell cytokine secretion assay were determined to be not reproducible and were not used further in this thesis. In Chapter 6 a group of highly active middle-aged men undertook one week of detraining where all structured exercise was removed but activities of daily living were allowed. It was shown that this short-term period of detraining did not elicit any changes in any of the inflammatory, lipid or glucose/insulin markers measured including a commercial, externally-validated whole-blood cytokine secretion assay. In Chapter 7 a sedentary group of middle-aged men performed daily brisk walking for 30 minutes over one week. This period of training did not elicit any change in any of the inflammatory, lipid or glucose/insulin markers measured; including no changes in glucose measures with an oral glucose tolerance test either one day after the last training session or three days later. The differences between the highly-active (Chapter 6) and sedentary (Chapter 7) participants in inflammatory markers were large with substantially higher concentrations for C-Reactive Protein and interleukin-6 in the sedentary middle-aged men. Because these do not change in response to relatively short-term detraining (Chapter 6) or training (Chapter 7) it appears that these differences represent long-term changes and adaptations. Therefore, in addition to being reproducible, fasting inflammatory and lipid markers are very stable with no changes after positive or negative short-term alterations in physical activity level. One immediate implication of this stability is improved ease of follow-up measures after interventions (e.g., training studies) since differences appear to reflect chronic changes in response to the regular training/detraining undertaken and not to recent exercise per se. In the future it will be important to establish better demarcations of acceptable physical activity behaviour. It will also be important to establish whether recently-trained individuals also exhibit stability in their inflammatory markers after a short-period of detraining and whether sedentary individuals are ever capable of achieving the blood profiles of their highly-active counterparts.
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Yanouri, Lamia L. "Racial/Ethnic Discrimination: Relationship to Risk Factors for Cardiovascular Disease." Thesis, University of North Texas, 2020. https://digital.library.unt.edu/ark:/67531/metadc1707296/.
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The current project used data from the Health & Retirement Study (HRS) 2016 wave and assesses the relationship between everyday racial/ethnic discrimination and risk factors for cardiovascular disease. The role of acculturation and social support on this relationship was also considered. The sample size consisted of 3,994 non-Hispanic White, 1,140 non-Hispanic Black, and 842 Hispanic older adults. The results suggest that non-Hispanic Black and Hispanic individuals endorse higher perceived everyday racial/ethnic discrimination (p < .001) in comparison to non-Hispanic White individuals. Additionally, non-Hispanic Black adults have higher systolic and diastolic blood pressure readings (p < .001) than non-Hispanic White and Hispanic adults. Support for the direct and moderating role of certain aspects of social support and acculturation on health outcomes/behaviors related to cardiovascular disease risk among non-Hispanic Black (R2 = .07, F(15, 415) = 2.06, p= .011) and Hispanic (R2 = .30, F(5, 34) = 2.97, p = .025) older adults, respectively, were found. The limitations and clinical implications of the study are further discussed.
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Cooper, Chadrick. "The Influence of Cardiovascular Disease Risk Factors on Exercise Participation." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3520.
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The study's purpose was to analyze whether the control (sustained healthy level) of independent cardiovascular disease risk factors could be used to significantly predict aerobic exercise status. The health belief and ecological model helped describe health awareness, autonomy, and ecological influences that could also influence the control of each risk factor. Multiple logistic regression analysis of behaviors and demographics was utilized to assess relationships of met aerobic recommendations to hypertension, diabetes, obesity, tobacco/alcohol use, diet, physical activity limitations, mood, and socio-economic status. The study consisted of 340 African American participants (37% male 63% female), between the ages of 30-64 who, lived in the state of Texas. With a 95% confidence internal, p < .05, and effect size of .15, results indicated that participants controlling the risk factor poor diet (P = .011; OR 3.3 [CI 95%]) were three times more likely to meet aerobic recommendations than those who did not. Participants controlling risk factors education status (P = .002; OR 2.4 [CL 95%]), sex (P = .012; OR 1.9 [CI 95%]), and high blood pressure diagnosis (P = .044; OR 1.7 [CI 95%]) were also more likely to meet exercise recommendations than those who did not. Findings showed that by initiating and sustaining changes in modifiable factors, participants were likely to meet aerobic recommendations and reduce their risk for cardiovascular disease. Policy makers, educators, health professionals, and employers are recommended to implement the study's results in communities, workplaces, and schools to target health promotion at persons with poor diet, hypertension, and less than a college education.
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Hurtig, Wennlöf Anita. "Cardiovascular risk factors in children /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-179-2/.
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Black, James Alexander. "Optimising cardiovascular risk management early in the diabetes disease trajectory." Thesis, University of Cambridge, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.709489.
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Eriksson, Maria. "Adipocyte-derived hormones and cardiovascular disease." Doctoral thesis, Umeå universitet, Institutionen för folkhälsa och klinisk medicin, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-36679.
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Obesity is increasing globally and related to major changes in lifestyle. This increase is associated with an increased risk of cardiovascular disease (CVD). Knowledge about adipose tissue as a metabolic-endocrine organ has increased during the last few decades. Adipose tissue produces a number of proteins with increased body weight, many of which are important for food intake and satiety, insulin sensitivity, and vessel integrity, and aberrations have been related to atherosclerosis. Notably, the risk for developing CVD over the course of a lifetime differs between men and women. In Northern Sweden, men have a higher risk for myocardial infarction (MI). However, the incidence is declining in men but not in women. These sex differences could be due to functional and anatomical differences in the fat mass and its functions. The primary aim of this thesis was to evaluate associations between the adipocyte-derived hormones leptin and adiponectin, and fibrinolysis and other variables associated with the metabolic syndrome, and particularly whether these associations differ between men and women. Another aim was to evaluate these associations during physical exercise and pharmacological intervention (i.e. enalapril). Finally, whether leptin and adiponectin predict a first MI or sudden cardiac death with putative sex differences was also investigated. The first study used a cross-sectional design and included 72 men and women recruited from the WHO MONICA project. We found pronounced sex differences in the associations with fibrinolytic variables. Leptin was associated with fibrinolytic factors in men, whereas insulin resistance was strongly associated with all fibrinolytic factors in women. The second study was an experimental observational study with 20 men exposed to strenuous physical exercise. During exercise, leptin levels decreased and adiponectin levels increased, and both were strongly associated with an improved fibrinolytic capacity measured as decreased PAI-1 activity. Changes in insulin sensitivity were not associated with changing adiponectin levels. The third study was a randomised, double-blind, single centre clinical trial including 46 men and 37 women who had an earlier MI. The study duration was one year, and participating subjects were randomised to either placebo or ACE inhibitor (i.e. enalapril). Circulating leptin levels were not associated with enalapril treatment. During the one-year study, changes in leptin levels were associated with changes in circulating levels of tPA mass, PAI-1 mass, and tPA-PAI complex in men, but not vWF. These associations were found in all men and men on placebo treatment. In women on enalapril treatment there was an association between changes in leptin and changes in vWF. In the fourth study, the impact of leptin, adiponectin, and their ratio on future MI risk or sudden cardiac death was tested in a prospective nested casecontrol study within the framework of the WHO MONICA, Västerbotten Intervention Project (VIP), and Västerbotten Mammary Screening Program (MSP). A total 564 cases (first-ever MI or sudden cardiac death) and 1082 matched controls were selected. High leptin, low adiponectin, and a high leptin/adiponectin ratio independently predicted a first-ever MI, possibly with higher risk in men in regards to leptin. The association was found for non-fatal cases with ST-elevation MI. Subjects with low adiponectin levels had their MI earlier than those with high levels. In conclusion, the adipocyte-derived hormones leptin and adiponectin are related to the development of CVD with a sex difference, and fibrinolytic mechanisms could be possible contributors to CVD risk.
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Patel, Vyoma. "Monocyte subset functional alterations with increased cardiovascular risk factors." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20501.
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Atherogenesis is dependent upon monocyte influx into the vessel wall. In humans, three monocyte subsets exist, classical, intermediate and non-classical. Of these monocyte subsets, clinically, the intermediate monocytes are considered to be a potential treatment target in cardiovascular disease (CVD), due their significant elevation and inflammatory nature. However, whether their elevation in CVD would translate to a functional contribution to atherogenesis is currently unknown. In addition, intermediates are also known to adhere more to endothelium than the classical subset as described in murine models. However, adhesion does not necessarily equate to migration as classical subset migrates at a greater rate to the plaque (in response to chemokines such as CCL2/MCP-1) than other subsets. Further research in understanding the contribution of each monocyte subset in CVD is needed. Here we aimed to determine the phenotype of monocyte subsets in individuals (who were generally healthy) relative to their lipid levels, as monocytes displaying an atherogenic phenotype in those with perturbed lipid levels would indicate whether the monocyte functional changes are occurring in the circulation, prior to entry into the vessel wall. First, we determined the inflammatory nature of monocyte subsets by assessing the monocyte subset cytokine production and expression of inflammatory/anti-inflammatory markers (Chapter 4). The findings from cytokine production (upon LPS stimulation) and surface marker expression combined suggest that intermediates and non-classicals are more inflammatory than the classical subset. This is consistent with the literature but we extend the understanding to show that this remains the case even when including individuals with an altered lipid profile. However, for the intermediates and non-classicals, being more inflammatory than classicals does not mean that they will have the greatest contribution to atherosclerotic plaque development as their level of recruitment into the plaque is also a factor. Recruitment depends on two key steps, adhesion and migration – that are regulated by adhesion molecules and chemokine receptors. Therefore, we next assessed monocyte subset adhesive and migratory nature by the expression of various adhesion molecules and chemokine receptors. From assessment of expression of adhesion molecules (Chapter 5) and chemokine receptors (Chapter 6) on monocyte subsets, we found that they differentially express various adhesion molecules and chemokine receptors which ultimately, would result in their distinct trafficking patterns and thus differential functional consequences. This suggests that all monocyte subsets possess a potential to adhere or migrate into the plaque and thus, raises a question whether targeting intermediates alone would sufficiently reduce CVD risk. Further, we assessed whether the changes in cytokine production and surface marker (inflammatory, adhesion molecule and chemokine receptor) expression occurs in a gradual or distinct manner at the subset level by flow cytometry. Our findings indicate that the changes in cytokine production and surface marker expression levels varied incrementally from one subset to another. We also assessed monocytes at the cellular level by flow cytometry, where we suggest that the monocytes in some individuals are likely to be entering the circulation in a pro-atherogenic state as differences were evident in the classical monocytes of one individual compared to another. This finding adds to the growing body of evidence that challenges the paradigm that monocytes are just precursors to macrophages and dendritic cells. Importantly, we found that monocyte expression of pro-atherogenic markers varies between the participants with the degree of spread (coefficient of variance) for the monocytes being comparable. This suggests that no one particular monocyte subset displays an increased proatherogenic phenotype but instead, all do, and this acquisition of a pro-atherogenic phenotype by monocytes occurs even before they differentiate into the intermediate subset. We further explored the relationship between the pro-atherogenic marker expression by the monocyte subsets and we found that participants’ pro-atherogenic marker expression by one subset correlated with that of the next. This indicates that the pro-atherogenic state acquired throughout differentiation (from classical to non-classical) is dictated by the pro-atherogenic profile of the emerging classical subset. This finding suggests that no particular subset is proatherogenic but rather all, as they recapitulate the pro- therogenic phenotype of a precursor, the classical subset or perhaps, bone marrow cells. The monocyte subset pro-atherogenic state (increased monocyte inflammation, adhesion or migration) was related to the participants’ lipid levels. The key result was that not only the cytokines, but also the expression of most of the pro-atherogenic markers (M1 markers, adhesion molecules, chemokine receptors) on monocyte subsets, were inversely associated with participants’ Apo A1 (or HDL-C) levels and, importantly, this was evident for all monocyte subsets. This finding suggests that altered lipid levels may be a key factor promoting monocyte pro-atherogenic changes. Lastly, we assessed whether the relationship between the monocyte pro-atherogenic state (chemokine receptor expression) and participants’ lipid levels could be seen functionally by in vitro static migration assay in response to chemokines, as a preliminary study (Chapter 6). Interestingly, we observed an inverse relationship (trend only) with monocyte subset migration and participants’ cholesterol and LDL-C levels suggesting that the higher levels of cholesterol and LDL-C negatively impact on the degree of monocyte migration in these participants. Thus, overall it is noteworthy that the changes in expression of chemokine receptors on monocyte subsets may not necessarily translate to direct changes in theirmigration in vitro. Taken together, the findings from the present study provide a fundamental change in the understanding of the importance of monocytes in atherosclerosis (particularly, their role and functional contribution i.e. adoption of pro-atherogenic phenotype) as we have shifted the paradigm from the need to target the intermediate monocyte subset, to targeting specific functions of monocytes overall. Importantly, with the changes evident in individuals that have perturbed lipids, but no diagnosed CVD, this study has drawn attention to proatherogenic changes that are occurring quite early sub-clinically in association with an altered lipid profile. This could be contributing to plaque development as monocytes would enter the vessel wall primed to become pro-atherogenic macrophages.
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Jamee, Shahwan Amal. "Epidemiology of Cardiovascular disease and associated risk factors in Gaza Strip- Palestine." Thesis, Limoges, 2019. http://www.theses.fr/2019LIMO0011.
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Introduction : Les pays arabes du Moyen-Orient qui ont une prédominance de population jeune ont connu des changements socio-économiques rapides, une instabilité et une transition épidémiologique. Dans ces pays, la mortalité due aux maladies cardiovasculaires (MCV) représente 45% des décès, en Palestine, elle est estimée à 30,3% en 2018. De plus, le fardeau des facteurs de risque est inquiétant : un quart de la population Arabe adulte est hypertendue, le tabagisme dépasse 30 % chez les hommes, l'obésité est particulièrement alarmante chez les femmes et 9,2 % des adultes sont atteints du diabète. Très peu d'études en population général sur les MCV ont été menées dans ces pays. Méthodes : En 2017, une étude transversale utilisant un échantillon de grappes stratifiées a été menée conformément à l'approche STEP de l'OMS. Un échantillon de 2240 participants âgés de ≥25 ans ont participé à l'étude. Résultats : La prévalence de la maladie coronarienne est de 8,3 %, AVC est de 3,0 %, l'hypertension artérielle est retrouvée avec une prévalence de 28,4 %, le diabète 19,1 % et l'obésité 47,8 % (60% chez les femmes). L’artériopathie oblitérante des membres inférieurs (AOMI) est observé avec une prévalence de 13,7 %. La prévalence augmente avec l'âge. Elle est plus élevée chez les femmes que chez les hommes (15,6% vs 11,6% respectivement). L'hypertension artérielle et le diabète sont les facteurs associés les plus importants. Le syndrome métabolique est présent avec une prévalence de 41 % plus élevé chez les femmes que chez les hommes (50 % vs 39 %) et associé de façon significative à toutes les maladies cardiovasculaires. Conclusion : Selon ces données, la situation dans la bande de Gaza est alarmante, les efforts et la recherche de stratégies visant à réduire le risque cardiovasculaire sont souhaitablesIntroduction: Arab Middle East Countries which have a predominance of young population have undergone rapid socioeconomic changes, instability and epidemiologic transition. In these countries cardiovascular disease (CVD) mortality accounts for 45% of deaths, in Palestine it was estimated up to 30.3% in 2018. Also, the burden of risk factors is worrying; one quarter of adult population was hypertensives, tobacco smoking exceeds 30% in males, obesity is alarming mainly in females, and 9.2% of adults are living with diabetes. Very few community-based on CVD studies were conducted in these countries. Methods: In 2017 a cross-sectional study using stratified cluster sample, was conducted in accordance with WHO’s STEP wise. A sample of 2240 participants aged ≥25 years participated in the study. Results: The prevalence of CAD is 8.3%, stroke 3.0%, hypertension is found with a prevalence of 28.4%, diabetes19.1% and obesity 47.8% with higher rate in females (60%). Lower extremity artery disease (LEAD) is found with a prevalence of 13.7%. The prevalence increased with age and is higher in females than in males (respectively15.6% vs 11.6%). Hypertension and diabetes are the most significant associated factors with LEAD. Metabolic syndrome is present with a prevalence of 41% higher in females than males (50% vs 39%) and it is significantly associated with all cardiovascular conditions. Conclusion: According to these data the situation in Gaza strip is alarming, effort and research to monitor and improve strategies and policies for reducing cardiovascular risk are mandatory
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Johns, David James. "Dietary patterns and cardiovascular disease in severe obesity." Thesis, University of Cambridge, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.610554.
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Koutsos, Athanasios. "Effects of apples on cardiovascular disease risk factors and gut microbiota." Thesis, University of Reading, 2017. http://centaur.reading.ac.uk/75263/.
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Evidence suggests that apples or their bioactive components (polyphenols and/or fiber) may have beneficial effects on lipid metabolism and other markers of cardiovascular disease (CVD). However, further adequately powered randomized controlled trials are necessary to confirm this evidence. Moreover, it has been shown that proanthocyanidins, the highest polyphenolic class in apples, reach the colon almost intact where together with fiber they interact with the gut microbiota. Recently, gut microbiota profiles and their metabolic output have also been suggested to influence CVD risk. This thesis investigated the potential interaction between modulation of the gut microbiota and cardiometabolic benefit in response to daily apple consumption. An in vitro batch culture fermentation identified that Renetta Canada variety significantly increased bifidobacteria, Faecalibacterium prausnitzii, and influenced microbial production of short chain fatty acids and phenolic microbial metabolites. Renetta Canada was therefore chosen for a randomized, controlled, crossover, dietary intervention study to determine the effects of apple intake on circulating lipids, vascular function, other CVD risk indicators and gut microbiota composition and activity in healthy mildly hypercholesterolemic subjects. Volunteers (23 women, 17 men), with a mean BMI 25.2 kg/m2 and age 51 years, consumed 2 apples/day, or a sugar matched control apple beverage for 8 weeks separated by a 4-week washout period in a random order. Blood lipids, bile acids, endothelial and inflammatory biomarkers and microvascular reactivity using laser Doppler imaging with Iontophoresis were measured. Fecal microbial profiles were monitored by 16S rRNA gene ilium ina MiSeq sequencing (V3-V4 region) and targeted groups of important gut bacteria quantified using Fluorescence in Situ Hybridization (FISH). Putative polyphenol metabolites of apple intake were identified in urine using LC-HRMS based metabolomics approach. Apple intake decreased serum total cholesterol (P=O.OOB) and LDL cholesterol (P=O.016) and vascular cell adhesion molecule-1 (P=O.037) compared with the control beverage. Apples had no effect on vascular function or other markers of CVD. No changes were observed in gut microbiota measured by 16S rRNA sequencing but apple intake significantly decreased Enterobacteriaceae enumerated by FISH compared with the control beverage. Valerolactones, valeric and phenolic acids were identified as microbial polyphenol metabolites among the 33 urine biomarkers related to the apple intake. These data suggest that the daily consumption of 2 Renetta Canada apples may result in beneficial effects on cardiovascular health and modifies both microbiota community structure and metabolic output.
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Ruiz, Jonatan Ruiz. "Cardiorespiratory fitness and cardiovascular disease risk factors in children and adolescents /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-158-6/.
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Shah, S. H. "Discovery and application of genetic determinants of cardiovascular disease risk factors." Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1417181/.
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The focus of my PhD has been two-‐fold: First, to improve the understanding of the biology behind a well-‐known cardiovascular disease (CVD) risk factor -‐ left ventricular mass, by identifying novel genetic loci associated with this risk factor. A large-‐scale association meta-‐analysis in over 10,000 individuals identified four novel loci associated with electrocardiographically-‐determined left ventricular mass. Second, to explore the application of known genetic determinants of the main blood lipid fractions, the latter being well-‐known CVD risk factors and therapeutic targets. I assess the use of genetic variants associated with total cholesterol, low-‐ density lipoprotein-‐cholesterol (LDL-‐C), high-‐density lipoprotein-‐cholesterol (HDL-‐C) and triglycerides for discriminating healthy individuals from those that have a high absolute risk of CVD, those that require lipid-‐lowering medication, and those that have a coronary event. The lipid genetic variants showed poor discriminatory ability for all three outcomes and provided no improvement over the widely-‐used, non-‐ genetic Framingham 10 year CVD risk score. Lipid-‐associated genetic variants were also used to generate genetic risk score instruments for LDL-‐C, HDL-‐C and triglycerides, which were applied in a Mendelian randomisation analysis to determine their causal relationship with carotid-‐intima media thickness (CIMT). CIMT has been a widely used surrogate outcome measure in clinical trials of CVD drugs. LDL-‐C-‐lowering drugs have shown to reduce CIMT progression and CHD risk in clinical trials. However, the extent of any causal association between HDL-‐C or triglycerides and CIMT is unclear. The results from this MR analysis support a casual relationship with LDL-‐C, but not with HDL-‐C and triglycerides, which may indicate that CIMT is a less useful surrogate end point in clinical trials of primarily HDL-‐C or triglyceride modifying therapies.
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Rees, Anwen Mair. "Prevalence and clustering of cardiovascular disease risk factors in Welsh adolescents." Thesis, Cardiff Metropolitan University, 2012. http://hdl.handle.net/10369/7264.
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The purpose of this study was to examine the prevalence and clustering of cardiovascular disease (CVD) risk factors in Welsh adolescents from different socioeconomic status (SES) and ethnicity. A cohort of 490 boys and 657 girls, aged 12.6 ± 0.7 years, were assessed for CVD risk factors. Socioeconomic status was determined by school attended, and ethnicity via self-reporting. Measurements included indices of obesity, blood pressure, diet, physical activity, aerobic fitness, blood lipids and lipoproteins, high sensitivity C-reactive protein (hs-CRP) and high-molecular weight (HMW) adiponectin. Two or more risk factors were present in 37.4% of the cohort, with 32.1% classed as overweight and 37.2% reported as unfit. Moreover, 75.5% consumed diets high in saturated fat and 13.3% had elevated total cholesterol (TC) levels. Low SES adolescents had higher levels of adiposity and higher blood pressure, lower fitness levels, a more atherogenic blood lipid profile and consumed diets lower in fibre content, compared to adolescents from a higher SES. Ethnic minority adolescents had significantly higher body fat and blood pressure levels, and significantly lower fitness levels compared to White adolescents. Overweight individuals had an increased clustering of risk factors. Adiposity was significantly associated with blood pressure and blood lipid measures. However, TC, hs-CRP and HMW-adiponectin were significantly associated with central skinfold measures. Fitness was found to be associated with blood lipids, hs-CRP and HMW-adiponectin. Fibre intake was significantly associated with a greater number of CVD risk factors compared to fat intake. Adolescents from a low SES and/or from an ethnic minority population exhibit a higher number of risk factors compared to White adolescents and those from a higher SES. Future interventions that are developed must target increasing physical activity and fitness levels and decreasing adiposity levels, with special consideration and attention given to those populations with increased prevalence of risk factors.
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Martin, Luci A. "Negative affect, introversion and physiological markers of cardiovascular disease." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9063/.
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Cardiovascular risk factors have expanded to include personality and other psychological characteristics. Negative affect (NA) has a longstanding history in cardiovascular health, but the path by which NA leads to cardiovascular disease (CVD) is yet to be defined. The following study examined the relationship of high NA and low extroversion (EX) with physiological cardiovascular markers in a sample of non-medical, professional adults. Our results indicated that individuals high in NA and low in EX displayed a significantly lower platelet count and a significantly higher mean platelet volume. Individuals high in NA displayed a significantly lower cholesterol risk ratio, while individuals high in EX displayed significantly higher platelet counts. Personality was not significantly related to blood pressure, high or low density lipoproteins. Understanding the relationships among psychological variables and physiological markers will help clinical researchers design interventions that reduce the likelihood of CVD.
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Simpson, Wendy M. "Psychological factors predicting health behaviour : the response to risk factor screening for cardiovascular disease." Thesis, University of St Andrews, 1996. http://hdl.handle.net/10023/13356.
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The two main aims of this thesis were first, to predict health behaviour and, second, to apply and test the existing psychological theories in this field. The health behaviours concerned were the responses to screening for risk factors for cardiovascular disease. Three empirical studies were carried out. The first response to screening is whether one attends or not. Results showed that uptake of screening in worksite settings (N=425) (Chapter 2) could be predicted by the health beliefs derived from social cognition models. Intention to attend was the best predictor of attendance. However, differences in predictive beliefs between worksites suggested communication factors were also an issue. Subsequently, communication factors were investigated in a study of uptake in general practice (N=210) (Chapter 4) finding that the method of offering screening affected uptake significantly. The second response to screening is the impact it has on the screenee. Results found that communication factors had little effect on screening impact in that there was little difference between three methods of offering screening in terms of their subsequent impact on patients' satisfaction, knowledge, intention or behaviour change (Chapter 4). Social cognitions, however, were found to predict impact in terms of behaviour change with a sample of attenders (N=59) at a screening clinic in general practice (Chapter 3). In the latter study, perceived threat was the best predictor of behaviour change. Four social cognition models were compared against each other in the classification of attenders and non-attenders in the Worksite study (Chapter 2). Apart from Social Learning Theory the other models performed adequately, but the Theory of Reasoned Action was the most successful. More recent theories were examined in the prediction of behaviour change following screening (Chapter 3). The data supported the stage model, the Precaution Adoption Process. The internal structure of the Health Action Process Approach was questioned, but the addition of an 'action phase' in tills model showed promise.
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Lipoeto, Nur Indrawaty 1963. "Minangkabau traditional diet and cardiovascular disease risk in West Sumatra, Indonesia." Monash University, Monash Asia Institute, 2001. http://arrow.monash.edu.au/hdl/1959.1/8508.
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Chen, Yang, Katie Callahan, David Blackley, Yan Cao, and Shimin Zheng. "Calcium Intake Associated with Risk Factors for Cardiovascular Disease among Obese Adults." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/85.
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Background: The incidence of cardiovascular disease (CVD) is high in obese people. The potential effects of inadequate calcium intake on CVD are receiving increased attention. We assessed the association between several risk factors for CVD and calcium intake among obese adults. Methods: We investigated 14,856 obese subjects age 20 years or older from the National Health and Nutrition Examination Survey, 1999-2010. ANOVA and Pearson correlation analyses were used to examine if any relationships existed. Simple and multiple linear and logistic regression analyses were conducted to determine the association between risk factors for CVD and calcium intake. Results: After adjusting for energy intake and other potential confounders, systolic blood pressure, diastolic blood pressure, C-reactive protein, glycosylated hemoglobin, and albuminuria were negatively associated with calcium intake at =0.05 level in both linear and logistic regression analyses. Adjusted regression coefficients and ORs did not show a significant relationship between high-density lipoprotein (HDL) and calcium intake. Total cholesterol was negatively associated with calcium intake in continuous form, but no relationshipwas seen between total cholesterol and the calcium intake quartiles form. When comparing low quartile to high quartile, total cholesterol had a weak negative association with calcium intake at =0.1 level. Conclusion: Our study provides evidence that adequate calcium intake could decrease the risks of CVD, such as high blood pressure and high glycosylated hemoglobin, among obese adults. However, calcium intake was not associated with HDL levels. More research is needed to assess the effect of total cholesterol by calcium intake.
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Feigl, Andrea B. "Managing Non-Communicable Disease Risk Factors in Developing Countries: Tobacco Control, Cardiovascular Disease Risk Surveillance, and Diabetes Prevention." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121160.
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Non-communicable diseases (cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and mental illnesses) and associated risk factors (unhealthy diets, physical inactivity, harmful use of alcohol, physical inactivity) are on the rise in developing countries, posing a threat to the health and financial systems of emerging economies.
In response, international organizations and Ministries of Health alike have started to tackle chronic diseases and associated risk factors with policies and treatment programs. Yet to this day, the body of evidence for best practices regarding the monitoring, prevention, and control of non-communicable diseases in low- and middle-income countries remains small.
This doctoral thesis adds to this body of evidence. The first paper of my thesis assesses the impact of a national tobacco control program in high schools in Chile. Specifically, it evaluates the effectiveness and makes several policy recommendations based on the findings. My second dissertation paper assesses the modifying effect of a change in anti-retroviral treatment among HIV-positive subjects in KwaZulu-Natal, South Africa on cardiovascular disease risk factors of high body mass index and high blood pressure. The third paper is based on a randomized controlled trial assessing the effectiveness of a social-network-based diabetes and weight management program in Jordan.Global Health and Population
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MacIntyre, Iain McGregor. "Modification of cardiovascular and renal risk factors using antagonists of the endothelin system." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/10032.
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Chronic kidney disease (CKD) is an important independent risk factor in the development of cardiovascular disease (CVD). Indeed, patients with CKD are far more likely to die from CVD than reach end stage renal disease. Conventional cardiovascular risk factors and co-morbidity contribute to this increased risk of CVD. However, emerging evidence suggests other novel factors including inflammation, oxidative stress, and a shift in the balance of the vasodilator nitric oxide and vasoconstrictor endothelin system, are also important contributors. Despite increasing evidence that the endothelin system plays an important role in the development of CKD and CVD, there has been little research examining possible therapeutic benefits of its modification in patients with CKD. The overall aims of the work presented within this thesis were to examine CVD risk in patients with renal impairment and then to see what impact chronic inhibition of the endothelin system would have on risk factors for CVD and CKD progression. In the first two studies I examined markers of arterial stiffness (AS) and endothelial function in a cohort of patients with immune-mediated renal disease. I was able to show in the acute setting that improvement in renal function following treatment for these conditions leads to significant improvements in AS. Interestingly, in patients who were in remission from their renal disease, only classical cardiovascular risk factors appear to be linked to AS. In the next study I was able to prove that sitaxsentan, a selective oral ETA antagonist, did not cause functional blockade of the ETB receptor in man. This was the first study of its kind to confirm that a “selective” endothelin antagonist truly is selective in vivo: a finding that will allow more accurate mechanistic investigation of the ET system. In the final studies, I showed that in subjects with stable non-diabetic proteinuric CKD, chronic selective ETA receptor antagonism reduces blood pressure and AS, and that these systemic benefits are associated with an increase in renal blood flow and reduction in proteinuria. The reduction in proteinuria is most likely haemodynamic and linked to a fall in GFR and filtration fraction, similar to what is seen with ACE inhibitors. Importantly, these benefits were seen in patients already taking maximally tolerated renin-angiotensin aldosterone system blockade, suggesting that chronic endothelin antagonism could be an important future therapy in the management of CKD. In summary, I have shown that renal impairment can directly affect markers of arterial function and by inference increase the risk of CVD. Chronic antagonism of the endothelin system with ETA receptor blockers would appear to improve many of these biomarkers, including reductions in BP, AS and proteinuria. There were no adverse effects reported in these studies, suggesting that selective ETA antagonism may be safe enough for clinical development in CKD patients. Further larger clinical trials are warranted.
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Sigvant, Birgitta. "Epidemiological aspects of peripheral arterial disease." Stockholm : Department of Molecular Medicine and Surgery, Karolinska Institutet, 2009. http://diss.kib.ki.se/2009/978-91-7409-670-5/.
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Zilkens, Renate Ruth. "The effect of alcohol and beverage type on cardiovascular disease risk factors." University of Western Australia. School of Medicine and Pharmacology, 2004. http://theses.library.uwa.edu.au/adt-WU2004.0053.
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[Formulae and special characters can only be approximated here. Please see the pdf version of the abstract for an accurate reproduction.] Two randomised controlled trials were conducted to explore the relationship between the consumption of alcoholic beverages and cardiovascular disease risk factors. Study 1 was primarily designed to test the hypothesis that the cardio-protective effect of light alcohol could be mediated, in part, via improvements in endothelial function. Study 1 was also designed to explore the effect of alcohol on both traditional risk factors for cardiovascular disease, such as changes in lipid profile, haemostatic factors and blood pressure, and novel risk factors such as homocysteine, markers of inflammation and oxidative stress. The experimental design of this study also allowed us to determine whether reducing alcohol intake in these moderate-to-heavy drinkers could improvement insulin sensitivity, a component of the metabolic syndrome. In this group of sixteen healthy middle-aged men with a history of moderate to heavy alcohol intake of seven standard drinks per day, reducing intake down to approximately one standard drink per day for four weeks had no beneficial effects on conduit vessel endothelial function as assessed by post-ischaemic brachial artery flow-mediated dilatation, nor were there any detectable changes in soluble E-selectin, endothelin-1 and von Willebrand Factor, which are considered biomarkers of endothelial activation. As this study did not investigate the effect of alcohol on endothelial function in resistance vessels, it cannot exclude the possibility that alcohol may affect endothelial cells resident in that vascular bed. This study does show and confirm, however, that the relationship between alcohol and risk factors for cardiovascular disease is an extremely complex one. On the one hand it demonstrated that alcohol was potentially harmful, increasing blood pressure, plasma F2-isoprostane (oxidative stress), and homocysteine. On the other hand it showed that increasing alcohol intake led to significant reductions in two (i.e. fibrinogen and IL-6) of five inflammatory markers, in addition to improving the HDL-cholesterol profile of these subjects. Although the effects of alcohol on blood pressure, fibrinogen and HDL-cholesterol are not in themselves new, they support our choice of study design and strengthen the argument in favour of accepting the more novel findings of this study, specifically, the lack of effect on endothelial function and insulin sensitivity, and the harmful effect of alcohol in increasing oxidative stress and homocysteine. Study 2 was primarily designed to test the hypothesis that the consumption of red wine may confer greater cardio-protection than beer via improvements in endothelial function. Simultaneously, the study was also designed to determine whether drinking red wine for 4-weeks would have different effects than beer on either traditional risk factors for cardiovascular disease (i.e. blood pressure and lipid profile) or the more novel risk factors, homocysteine and oxidative stress. Using a randomised controlled cross-over study design, Study 2 provides evidence that the regular daily consumption of 4 standard drinks of either beer or red wine does not alter endothelial function, as measured by post-ischaemic flow-mediated vasodilatation of the brachial artery in healthy middle-aged men, nor was there evidence of any beneficial effect of de-alcoholised red wine on brachial artery response. As compliance with drinking protocol was confirmed with increased serum γ-GT and HDL during red wine and beer periods, and increased 24-hr urinary excretion of 4OMGA during red wine and de-alcoholised red wine periods, we are confident that there was excellent compliance with the beverage treatments. Study 2 also provides the first evidence from a carefully controlled intervention study that both red wine and beer elevate blood pressure to a similar degree, with no detectable difference in the magnitude of either treatment. As with endothelial function, there was also no evidence of any beneficial effect of de-alcoholised red wine on blood pressure. In addition, although post hoc analysis found evidence that alcohol increased both plasma homocysteine and urinary excretion of F2-isoprostane and endothelin-1, there was no apparent protective effect conferred from either red wine or de-alcoholised red wine on these cardiovascular risk markers. The results from this study cannot disprove the hypothesis that red wine is more beneficial for cardiovascular health; however, they suggest that if red wine has properties beyond those of beer to confer protection, they are not via any interactions with the nitric oxide regulatory function of the endothelium in conduit vessels nor are they via moderation of the vasopressor, homocysteine-raising, and oxidative stress effects of alcohol. The interpretation of the findings from both intervention studies and their place in the context of our current understanding of the role that alcoholic beverages play in the development and/or prevention of cardiovascular disease are explored in this thesis.
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Tesfaye, Fikru. "Epidemiology of cardiovascular disease risk factors in Ethiopia : the rural-ruban gradient." Doctoral thesis, Umeå : Univ, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1543.
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Lloyd, Berwyn Dargie. "Analysis of cardiovascular and inflammatory genes as risk factors for Alzheimer's disease." Thesis, Cardiff University, 2004. http://orca.cf.ac.uk/54098/.
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Four genes, connected to either the inflammatory or cardiovascular system or both, were investigated for association with late onset AD in up to 180 late onset cases and 180 age- and sex-matched controls. The I allele of DCP1 has previously been reported to be associated with AD although no associations was detected in this study. Six other polymorphisms within the gene were also studied but yielded no positive genotypic, allelic or haplotype associations. The other genes studied, TACR2, a peptide receptor that maps to a region of suggestive linkage on chromosome 10, ECE1, a potent vasoconstrictor which also maps to region of suggestive linage on chromosome 1 and PI12, a serine protease inhibitor that can form amyloidogenic fragments, were screened for polymorphisms. Fifteen polymorphisms were discovered (five coding) with only one two-marker haplotype in ECE1 (p= 0.001) and a polymorphism upstream of TACR2 (p = 0.05) showing statistically significant association. Neither association retained statistical significance after adjusting for multiple testing.
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Kearney, Thérèse. "Effects of brisk walking on cardiovascular disease risk factors in overweight individuals." Thesis, University of Ulster, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.587496.
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One of the main causes of death in the European Union (EU) is cardiovascular disease (CVD) which accounts for more than two million deaths every year. This equates to almost all half (42%) of all deaths within the region (Rayner et al. 2009). Although there are many contributing factors to CVD, inactivity has been shown to be one of the major risk factors (Howard et al. 2008; Owens et al. 2010). Arterial stiffness has also been shown to be an important CVD risk factor (Laurent et al. 2006) and, when measured via pulse wave velocity (PWV), has been shown to be a strong independent predictor of cardiovascular morbidity (Noor et al. 2009). To date there has been limited research investigating the effects of moderate activity on arterial stiffness, therefore, the aim of this thesis was to investigate the effects of brisk walking on CVD risk factors in overweight individuals, with particular reference to arterial stiffness. There were two studies carried out within the parameters of this thesis. An acute study (n17) investigated the effects of a single 30 minute walk on CVD risk factors. This was followed by a longer 6 month intervention (n77), investigating the effects of accumulated brisk walking (3 x 10 minutes) on the same risk factors. In the acute study, there were no significant changes (p > 0.05) to the CVD markers (blood pressure, PWV, lipid profiles, fasting glucose or fasting insulin.) It was concluded that a higher walking intensity may be required to elicit significant changes. The same set of CVD makers were measured in the 6 month walking study and although there were no significant changes to blood pressure, lipid profiles, fasting glucose or fasting insulin, the accumulated brisk walking did result in a significant decrease in arterial stiffness (p < 0.05). This decrease was maintained up to four months post intervention. NOx (a surrogate 'marker for the vasodilator Nitric oxide) was measured as possible mechanism for this decrease in PWV, with the result pointing to a possible relationship as a strong negative correlation between the two variables was found (r = -0.65, P < 0.001). Over the last number of years there has been much research which clearly proves that an active lifestyle is a major factor in achieving good health, and that a sedentary lifestyle is associated with ill health and a shorter life expectancy (Blair et al. 2004). The research within this thesis enhances the existing body of knowledge on the effects of walking on CVD risk factors, as it can be concluded that brisk walking can successfully reduce arterial stiffness in overweight individuals even without changes in other risk factors.
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Doulton, Timothy William Ronald. "The influence of sodium on cardiovascular risk factors in chronic kidney disease." Thesis, St George's, University of London, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.498320.
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Peer, Nasheeta. "Cardiovascular disease risk factors in the urban black population in Cape Town." Doctoral thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/3449.
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Lawrence, Catherine Wanjiru. "Modifiable Risk Factors For Cardiovascular Disease As Perceived By Women In Kenya." ScholarWorks @ UVM, 2015. http://scholarworks.uvm.edu/graddis/374.
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Cardiovascular disease (CVD) worldwide has grown exponentially in the last two decades and while sub-Saharan Africa (SSA) has been grappling with the crippling effects of epidemic infectious diseases such as HIV/AIDS and malaria, cardiovascular disease is now emerging as a grievous concern. Research and resources have largely been directed toward understanding and curtailing infectious diseases in the African continent. But as the risk of cardiovascular disease reaching endemic proportions in sub-Saharan Africa becomes more evident, research is critically needed in order to understand how to manage it and more importantly to direct the development and implementations of culturally relevant prevention strategies.
The risks and effects of CVD are present in both men and women across the globe, but there are differences in their occurrence based on gender that are worth considering. Women in sub-Saharan Africa, who are already burdened with the disadvantage of access to health care by virtue of their gender alone, are likely to be most adversely affected by CVD. Socioeconomic status (SES), epidemiologic transition and urbanization, lifestyle changes, and gender-based violence are all factors implicated in the compounded risk for CVD among women in this region.
To understand how women in a sub-Saharan region perceive CVD and its risk factors, this descriptive phenomenological study set out to answer the following research question: How do Kenyan women perceive the modifiable risk factors for CVD? Furthermore, how do they perceive its effects on their lives and their families? Two samples from central Kenya representing an urban and rural area were selected and interviewed in a focus group setting.
A number of themes were extrapolated from the interviews. The modifiable risk factors were perceived to be independent of CVD. Diet modification and physical activity were found to be helpful in controlling these diseases but clear understanding on their effects on overall cardiovascular health was lacking. Cigarette smoking generated the least discussion because none of the women were smokers. The effects of having either hypertension or type two diabetes included financial cost, emotional burden on the women and their families, and the concern of losing a breadwinner from disease or illness.
These results have implications in nursing practice, public health, primary care provision, and national and global policies. They also shed light on areas of potential consideration in prevention program design and implementation. Awareness, though felt by the women to be slowly gaining in Kenya, is key to disease prevention. There is limited research on this subject matter in SSA and more studies are needed to understand the scope and effects of CVD in this region.
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Choudhury, Khujesta. "Dietary enrichment by almond supplementation: effects on risk factors for cardiovascular disease." Thesis, Aston University, 2008. http://publications.aston.ac.uk/12618/.
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Cardiovascular disease (CVD) is the leading cause of death in Europe responsible for more than 4.3 million deaths annually. The World Health Organisation funded the Monica project (1980s-1990s) which monitored ten million subjects aged 22-65yrs, and demonstrated that coronary heart disease (CHD) mortality declined over 10 years, was due in two thirds of cases to reduced incidence of CHD (reduced risk behaviours e.g. poor diet and smoking) and one third by improved treatments. Epidemiological evidence suggests diets rich in antioxidants decrease incidence of CVD. Regular consumption of nuts, rich in vitamin E and polyphenols reduces atherosclerosis, an important risk for heart disease. Intervention studies to date using alpha tocopherol (an active component of vitamin E) have not consistently proved beneficial.
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Prue-Owens, Kathy Kay. "Risk Factors and Beliefs About Cardiovascular Disease Among Active Duty Service Members." Diss., The University of Arizona, 2007. http://hdl.handle.net/10150/194376.
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CVD remains the leading cause of morbidity and mortality in the United States. Nearly 17 million people die from CVD, particularly coronary heart disease (CHD) and stroke each year (AHA Heart Disease and Stroke Statistics-2006 Update, 2006), including members of the military. Unfortunately, no research has been conducted to describe CVD risk among the younger and lower ranking active duty service members, who constitute the majority of active duty personnel.The purpose of this study was to describe actual cardiovascular disease (CVD) risk factors and perceptions (beliefs) about CVD risk among active duty military men and women. Specific aims were to describe: 1) modifiable and non-modifiable cardiovascular risk factors specific to active duty service members; 2) perceived susceptibility of developing CVD among active duty service members; 3) perceived benefits and barriers to taking a health action to decrease the chance of developing CVD among active duty service members; 4) the differences between selected demographic variables (gender, race and rank) and modifiable cardiovascular risk factors among active duty service members; and 5) the relationship between modifiable cardiovascular risk factors and perceived susceptibility for developing CVD among active duty service members. A descriptive design was used to describe actual cardiovascular disease (CVD) risk factors and beliefs about CVD among active duty military men and women. Beliefs were measured by perceived susceptibility and perceived benefits and barriers to taking a health action to decrease the chance of developing CVD. The majority of the participants did not perceive themselves to be at risk for developing CVD and had a number of modifiable cardiovascular risk factors such as pre-hypertension, HTN, overweight, obese, and high cholesterol levels. Participants perceived themselves at risk of developing high blood pressure and high cholesterol levels. Based on reported modifiable risk factors for this sample, participants were at risk for overweight and pre-hypertension. Therefore, there was a significant relationship between pre-hypertension risk factor and perceived susceptibility for the development of high blood pressure. Participants perceive benefits to taking health actions to decrease the chance of developing CVD. However, there were a number of perceived barriers indicating a need for nutritional education.
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Nguyen-Duy, Thanh-Binh. "Aspects of cardiovascular risk in an Australian population study." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20101.
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Prevention of cardiovascular disease (CVD), a leading cause of death in men and women, is both a global and national public health priority. Prevention efforts have generally focused on well-known lifestyle (e.g., physical inactivity, unhealthy diet, smoking) and metabolic (e.g., overweight/obesity, hypertension, hyperlipidaemia) risk factors. It is also important for public health strategies to consider emerging risk factors, innovative approaches to risk factors, and evidence in middle-aged men and women, to develop effective prevention strategies. This thesis explored innovative aspects of cardiovascular risk in a large cohort of middle-aged and older Australian men and women (“the 45 and Up Study”) by examining: 1) emerging or lesser known risk factors such as raw vegetable intake (Chapter 3), sedentary behaviour (Chapter 4, Appendix 1) and psychological distress (Chapter 5); 2) the single versus joint influence of lifestyle risk factors on incident type 2 diabetes (Chapter 4, Appendix 1) and hypertension (Chapter 5); 3) potential gender differences (Chapters 3-5, Appendix 1), and female-specific behaviours such as breastfeeding (Chapters 6-7). Overall, findings support Australian recommendations for fruit and vegetable intake, physical activity, alcohol intake and infant breastfeeding. While the importance of reducing known risk factors for CVD prevention was evident, the role of raw vegetable intake, sedentary behaviour and psychological distress was inconclusive. Breastfeeding was associated with a lower maternal risk of CVD. Findings confirmed that adopting a cluster of healthy lifestyle behaviours can reduce CVD risk in the middle-aged and older population. Potential gender differences were explored and identified. This thesis contributes to the literature by exploring innovative aspects of cardiovascular risk that are relevant to middle-aged adults, particularly women, as well as informs health care providers, researchers and policy makers.
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Alamin, Ali E., Arsham Alamian, Hadii M. Mamudu, Timir K. Paul, Liang Wang, Pooja Subedi, and Matthew Budoff. "Associations Between Multiple Cardiovascular Disease Risk Factors and Diabetes Among Asymptomatic Individuals in a Hard To-Reach Population." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1386.
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Background: Diabetes is the sixth leading cause of death in the United States (U.S), and a major risk factor for cardiovascular disease (CVD). The prevalence of diabetes in central Appalachian region is higher than the rest of the nation (14.4% versus 9.0%, respectively). Objectives: Examine the association between multiple risk factors for CVD and diabetes in asymptomatic adults in central Appalachia. Methods: Between January 2012 and July 2016, 3,000 community-dwelling asymptomatic individuals from central Appalachia participated in screening for sub-clinical atherosclerosis. Participants were asked to report their diabetes status (yes/no). In addition, data on coronary artery calcium (CAC), a marker for sub-clinical coronary atherosclerosis, in quartiles (0, 1-99, 100-399, ≥400), obesity (body mass index ≥30 kg/m2), hypercholesterolemia (yes/no), hypertension (yes/no), current smoking (yes/no), sedentary lifestyle (yes/no), and family history of coronary artery disease (CAD) (yes/no), were collected. Multivariable logistic regression analyses were conducted to assess association between CVD risk factors and diabetes. Results: Of the 3,000 participants, 2,509 subjects (mean age: 58.3 years; SD = 9.8 years) had complete data on variables of interest. Approximately, 14% of the study population reported having type 2 diabetes. Among subjects with diabetes, 58% had a CAC score ≥1, 22% were obese, 17% had hypercholesterolemia, 20% had hypertension, 16% were current smokers, 17% had a sedentary lifestyle, and 15% had a family history of CAD. After adjusting for sex and age, having a CAC score of 1-99, 100-399, and ≥400 increased the odds of having diabetes (Odds ratio (OR): 1.4, 95% Confidence interval (CI) = 1.02-1.9; OR: 2.0, 95% CI = 1.4-2.8; OR: 3.1, 95% CI = 2.1-4.7, respectively) in a linear fashion. Being obese (OR: 3.2; 95% CI = 2.5-4.0), having hypercholesterolemia (OR: 1.8; 95% CI=1.4-2.4), being hypertensive (OR: 3.0; 95% CI= 2.3-3.8), being a smoker (OR: 1.5; 95% CI = 1.1-2.1), and being sedentary (OR: 1.6; 95% CI = 1.3-2.0) were significantly associated with diabetes. Having three (OR: 3.0; 95% CI=1.3-6.6), four (OR: 4.4; 95% CI=2.0-9.7), five (OR: 7.0; 95% CI=3.1-16.1) or six (OR: 9.9; 95% CI= 3.5-27.7) CVD risk factors significantly increased the odds of diabetes. Subjects with any of the seven risk factors under study were 1.7 times (95% CI= 1.5-1.9) more likely to have diabetes. Conclusion. Odds of type 2 diabetes increase with higher number of risk factors for CVD. Results support the use of multifaceted CVD and diabetes prevention programs to lower the incidence of type 2 diabetes.
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Kitchen, Elizabeth A. "An Assessment of Cardiovascular Risk Factors and Dietary Intake in Firefighters." Kent State University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=kent1323791298.
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Banor, Chikaodi Priscilla Eziaha. "A Needs Assessment of African American Women's Risk for Cardiovascular Disease." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2469.
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Suboptimal cardiovascular health among African American (AA) women contributes to high costs of care related to acute illness, chronic illness, and disability. Using the health promotion model, this needs assessment project examined risk factors that predispose adult AA women between the ages of 21 to 64 years of age to higher incidence of cardiovascular disease (CVD). Seventy of the 300 charts that met the inclusion criteria (female AA patients, 21 to 64 years of age, receiving care in a community clinic in an urban city of Texas) were audited for this project. Descriptive analysis showed that 66% of the women did not have a diagnosis of CVD, 32% were noted as being at risk for CVD, and risk for diagnosis of CVD was not listed in 3% of the charts. The audit also showed that 7% of the AA women did not monitor their diet, 60% monitored their diet, and 33% lacked knowledge of heart healthy diet. Sixty-seven percent of charts audited noted a family history of CVD, 33% noted no family history of CVD, while 3% noted an unknown family history of CVD. The ages of the patients ranged from 21-64 (M = 24.9 years). Weight ranged from 104-225 lbs. (M = 172.5 lbs.) and height ranged between 52-73 inches (M = 61.13 inches). Body mass index (BMI) calculated showed 1.43% of the women were underweight, 11.4% showed normal BMI, 32.86% were overweight, and 54.29% were obese. Study recommendation included implementation of a patient education that will help increase awareness of CVD among the patient population at the clinic. Findings from this project could increase awareness on the importance of creating cultural congruent education program that will help educate minority populations more effectively in the management of cardiovascular disease.
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Weinstein, Patricia. "Awareness of Increased Risk for Heart Disease and Cardiovascular Risk Factors in Women with Systemic Lupus Erythematosus." Doctoral diss., University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2652.
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Women with systemic lupus erythematosus (SLE) develop cardiovascular disease (CVD) earlier and at a more accelerated rate compared to women without SLE. Many women with SLE are unaware of their increased risk despite years spent in the health care system, thus giving the atherogenic process time to accrue damage. Research has not explained fully why women with SLE are unaware of their increased risk for CVD or why awareness does not correspond to risk-educing behaviors. Stage theories of behavior like the Precaution Adoption Process Model (PAPM) propose that health behavior change proceeds through qualitatively different stages, and people at one stage face similar barriers before they can progress to the next. The Common Sense Model (CSM), a self-regulatory model of health behavior, explains the emotional and cognitive processes involved in progression from one stage to the next and the formation of a personal risk/illness representation. Combining the PAPM and CSM helps understand the relationship between risk perception and adoption of risk reducing behaviors. The specific aims of this study were to assess in women with SLE: (1) general knowledge of heart disease compared to women without SLE; (2) awareness of increased CVD risk and CVD risk factors; and (3) personal and healthcare system factors that influence awareness of increased CVD risk and adoption of risk reducing behaviors. Sixty women with SLE, 18 years of age or older, were recruited to participate in this descriptive study. Data included demographic information, self-report questionnaires (perceived CVD risk, CVD risk factors, depression, physical activity), body measures (height, weight, waist circumference, blood pressure), and blood samples for physiologic markers of traditional and novel CVD risk factors (glucose, insulin, lipoprotein lipids, creatinine, C-reactive protein, homocysteine, antiphospholipid antibodies). The Beck Depression Inventory-Primary Care and the Physical Activity Disability Survey were used to determine depression and activity level respectively. General knowledge of heart disease was assessed using the American Heart Association (AHA) National Survey on women's awareness of heart disease. Logistic regression was used to categorize participants into subgroups according to perceived risk and identify important factors that influenced their PAPM stage categorization. Women with SLE in this study were more aware of women's leading cause of death than United States women who responded to the 2006 AHA survey (73% v 57%), but fewer than 25% perceived themselves at increased CVD risk. Age was a significant predictor (p=0.05) for awareness of increased risk; younger age correlated with increased awareness. Most women received information about heart disease from public media. On average, women had 4 CVD risk factors, but they perceived they had only 2. The number of perceived risk factors predicted adoption of risk reducing behaviors (p=0.03). Women in this study with SLE underestimated their CVD risk factors and did not personalize their increased CVD risk. Healthcare providers' identification and discussion of CVD risk factors in women with SLE may enhance their risk awareness and the adoption of risk reducing behaviors. This information may contribute to the development of stage-matched interventions, a potentially more effective and efficient approach than a generic program of risk-reduction, especially in individuals with SLE who face the additional burden of a chronic illness.Ph.D.
School of Nursing
Other
Nursing PhD
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Friedemann, Claire. "Cardiovascular disease risk factors, weight, and the strategies to tackle future risk in school aged children." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:7612fe59-58c3-4d62-be55-c14c1dd7490e.
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Background: Cardiovascular disease (CVD) can have its beginnings in childhood, especially if the child is overweight. Without intervention, increased risk factors in childhood track in adulthood, putting the individual at increased risk for early cardiovascular morbidity and mortality. As a result, childhood health outcomes are an increasingly popular area for health research. However, little progress has been made on the most effective way to enable children to lead healthy lives. Methods: This thesis incorporated five studies. Firstly, a systematic review and meta-analysis of 63 papers involving nearly 50,000 school children examined the relationship between body mass index (BMI) categories and CVD risk factors. Secondly, a focus group study with 46 students to discuss their knowledge and attitudes towards health, health behaviours and health education. Thirdly, a focus group study with six mothers to discuss screening weight in childhood, and their perceptions of childhood health and health education. Fourthly, a component analysis to establish the characteristics of nine successful educational interventions on children’s health. Finally, a pilot intervention and feasibility study involving 314 students. Results: Overweight and obese BMI categories were associated with substantial increases in CVD risk factors measured and that the association with obesity was greater than that with being overweight. The focus group studies found that the depth of knowledge and the perceived depth of knowledge that participants had about CVD risk factors affected their attitudes and behaviours, although not in the same way. The pilot intervention was deemed feasible. A significant change was brought about in the students’ knowledge of cardiovascular disease and raised their self-efficacy towards ensuring the health of their hearts. Conclusion: The effect of obesity on cardiovascular risk factors is greater than that of being overweight. Additionally, studies in this area are hindered by inconsistent measurements and definitions of the BMI categories. Secondly, both parents and children need to be equipped with deep knowledge and understanding to facilitate attitude and behaviour change towards healthy living. Finally, the pilot intervention should be trialled in a randomised, controlled trial.
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MacLean, L. Michelle. "Functional social support and risk factors for cardiovascular disease among adult Nova Scotians." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape7/PQDD_0018/MQ49402.pdf.
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