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Dissertations / Theses on the topic 'Cardiovascular outcome'

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Published: 9 March 2023
Last updated: 10 March 2023

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1

Daragjati, Julia. "Gender differences in therapies and outcome in cardiovascular disease." Doctoral thesis, Università degli studi di Padova, 2014. http://hdl.handle.net/11577/3424552.

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The purpose of this analysis was to explore, by using an administrative database, gender and age differences in drug prescriptions of ordinarily residents, entitled to either free or subsidised approved prescribed drugs and medicines and and surgical interventions provided from the Local Health Service. Further analysis was performed in the cohort of patients that experienced an ACS during 2008. Methods: All residents of the Local Health Service Area 16 of the Veneto Region (Italy) ages 15-44, 45-64, 65-79 and >=80 years in the period 1st of January until 31st of December 2010, were included in the study. The Local Health Service system, covering this area, keeps record of all drug prescriptions dispensed by public or private pharmacies. All medications dispensed during 2010 were considered and classified according to Anatomical Therapeutic Chemical (ATC) classification system. Results were reported as odds ratios (OR) of prescriptions dispensed to males and females with 95% confidence intervals (CI) to analyse the number of subjects that received at least one medication. A detailed analysis was conducted for Cardiovascular drugs (ATC: C) in the cohort of 1,204 ACS patients (760 men and 444 women) being admitted in Saint’Anthony Hospital. Data of therapies and interventions were collected from the hospital and local medical distribution database. Results: Of the 491,261 included subjects, 255,026 were females and 236,235 males. Females were medicine dispensed in most of ATC subgroups as with antiulcer drugs (OR=0.80, 95% confidence interval [CI] 0.74-0.86), antibiotics(39% M vs. 46% F, p<0.001) as for tetracyclines (OR=0.91 95% CI 0.85-0.93), penicillins (OR=0.90 in the 95% CI 0.83-0.94), antimigraine preparations (OR 0.34 95% CI 0.0.31-0.36), antipsychotics (OR=0.86, 95% CI 0.81-0.90), antidepressants (3.74%M vs. 8.09% F, OR=0.44, 95% CI 0.40-0.52) diuretics (OR=0.72, 95% CI 0.66-0.80). On the other hand, males were dispensed more with antidiabetic drugs, insulin therapy (OR= 1.24 95% CI 1.21-1.30) and with oral hypoglycaemic (OR=1.37 95% CI 1.33-1.40), more exposed to treatment for cardiovascular disease with antithrombotic agents (12.11% M vs. 11.33%F, OR=1.16 95% CI 1.14-1.20), betablockers (OR=1.15 95% CI 1.10-1.20), ACE-inhibitors (OR=1.25 95% CI 1.20-1.30). Males were generally more prescribed with cardiovascular medications than their female counterparts. An obvious gender difference in drug utilisation was noticed during the 15-44 years of age, this difference decreased with aging, but still the medication use difference remained statistically significant. The prevalence of ACS was 2.5 ‰ (3.26‰ in male patients and 0.92‰ in female patients, OR=1.7 95% CI 1.4-2.0). Of the ACS patients, 142 (11.8%) died in hospital without any gender and age difference. Thus, for further investigations a cohort of 1,062 ACS patients (688 male and 374 female patients) was considered. Of these patients 40.12% underwent a revascularization intervention and 48.1% were not revascularised. Male patients over 65 years of age (73.4%) were significantly more likely to have a revascularization than the female patients (26.6%) of the same age (age group: 65-79, OR=1.7 95%CI 1.2-2.5; age group >=80, OR=4.1 95%CI 2.2-7.6). Six months after hospital discharge antiaggregation therapy was analysed. In the ACS population 82% received at least one antiaggregant. The remaining population 18% did not receive any antiaggregant at all, generally those were female patients (OR=2.8 95%CI 2.1-3.8). Aspirin was used in 35% of the non- revascularized vs. 28 % of the revascularized patient especially in non-revascularized female patients; Thienopyridines were dispensed in 8% of the non-revascularized vs. 5% of the revascularized patients especially in revascularized female patients, dual antiplateletes therapy was more dispensed in revascularized patients (61% vs. 29%), especially in male non-revascularized patients. For the other non mentioned therapies male and female patients were treated equally. Regarding to therapy adherence, male patients were in general more adherent to Aspirin (92%M vs. 82%F, OR=2.4 95%CI 1.2-4.6) on the other hand, to Thienopyridines (87%M vs. 84%F, OR=1.3 95%CI 0.3-5.0) and to Dual-antiplateletes therapy (76%M vs.74%F, OR=1.1 95%CI 0.7-1.8) both male and female patients were adherent without gender differences. Conclusions: As women are more exposed to chronic and acute conditions, especially in the reproductive years 15 to 44 and in pre- and post-menopausal age, according to the literature, our results support the suggestion that females are dispensed more medicines than males in general. On the contrary, men were more exposed to cardiovascular drugs than women. ACS occured more frequently in men than in women. In general men were more revascularized than women. On discharge, female patients were not usually treated with antiaggregant therapy, more often than their male counterparts. Revascularized patients compared to non-revascularized patients did not have any gender difference in terms of therapy, but an evaluation between non-revascularized patients indicated an inequity between male-female patients use of antiaggregants. On the whole, both female and male ACS patients were adherent to therapy. In general, men had a better survival than women
L’obbiettivo iniziale della ricerca è stato quello di descrivere la storia prescrittiva di tutti i farmaci nell’anno 2010. Tramite l’analisi dei dati di prescrizione provenienti dall’Assistenza Farmaceutica Territoriale di Padova è stato possibile descrivere l’utilizzo di questi farmaci nella popolazione generale. Sono risultati maggiormente utilizzati: gli antibiotici (con 39% M vs 46 % F con almeno un antibiotico prescritto, p<0,001), gli antiulcera( 13,20% M vs 16,68 % F, p<0,001), gli antireumatici (10,84% M vs 16,70 % F, p<0,001), gli antidepressivi (con 3,74% M vs 8,09 % F, p<0,001) etc., con una prevalenza di trattati del genere femminile. Una prevalenza di trattati del genere maschile è stata osservata invece per gli antitrombotici (con 12,11% M vs 11,33% F, p<0,025), gli antidiabetici di cui insulino-trattati 1,26% M vs 1,03 % F, p<0,05 ed i trattati con ipoglicemizzanti 3,73% M vs 2,83 % F, p<0,05) ed i dislipidemici (8,93%M vs 8,08%F, p<0,025) etc. Tutti questi dati riportati sono statisticamente significativi. Questa analisi indica anche che il genere femminile è in assoluto il maggior consumatore di farmaci antidolorifici, risultato che porta a dedurre che le donne soffrono maggiormente di dolore acuto e cronico, ma può essere anche un indicatore di una maggiore propensione della donna alla ricerca di una visita medica rispetto all’uomo, il quale forse preferisce rimedi autogestibili (OTC oppure a fumo e alcool). L’alto numero di donne fra i trattati con farmaci del sistema nervoso (antipsicotici, antidepressivi) fa pensare a questi “giorni moderni” in cui la donna è ancora vittima di violenza non solo fisica, ma anche psichica, e si trova spesso sottoposta a stress, come risultato dell’emancipazione. La moglie-madre-donna in carriera è esposta ad una vita frenetica e le tante responsabilità accumulate negli anni tendono a portarla alla parità col genere maschile. Una analisi più approfondita è stata fatta nello specifico per i farmaci cardiovascolari. La maggior parte dei farmaci cardiovascolari è stato dispensato prevalentemente al genere maschile, ma bisogna sottolineare che le malattie cardiovascolari erano la causa principale di morte in entrambi i sessi. Non si è verificata alcuna differenza di genere nella prevalenza di trattati per i sottogruppi dei betabloccanti non associati, calcio antagonisti con effetto cardio-diretto e antagonisti dell’angiotensina II, mentre per gli antitrombotici, gli antiaritmici di classe sia I che III, gli ipocolesterolemizzanti e ipotrigliceridemizzanti si è osservato un utilizzo maggiore nel genere maschile. Per quanto riguarda le malattie trombotiche, le femmine risultavano meno trattate dei maschi, in accordo con il fatto che il maschio adulto, a parità di età, è più propenso alla trombosi rispetto alla femmina adulta, perché con l’avanzare dell’età ha una maggiore aggregazione piastrinica rispetto alla femmina. Infine, l’attenzione è stata focalizzata sull’evento della sindrome coronarica acuta (SCA) per analizzare la presenza di eventuali differenze di genere in pazienti ospedalizzati per SCA in relazione ai seguenti indicatori: prevalenza di ricoveri per SCA, mortalità intra- ed extra-ospedaliera, tipologia di interventi di rivascolarizzazione, trattamento farmacologico alla dimissione, aderenza alla terapia e sopravivvenza. Nel corso dell’anno 2008, sono stati ricoverati per SCA 1.204 pazienti (760 maschi e 444 femmine). La prevalenza dei ricoveri è stata significativamente superiore negli uomini (3,26‰ ) rispetto alle donne (0,92‰) con OR = 1,7 (IC 95% = 1,4-2,0). Dei 1.204 pazienti arruolati 142, ovvero 11,8%, sono andati incontro a decesso intraospedaliero. Sono state analizzate le recidive a breve e lungo termine. Le donne in entrambi i casi andavano in contro a recidive più frequentemente degli uomini (nel 2009 il 17,9% delle donne vs. 12,6% degli uomini e nel 2012 32% donne vs. 24% degli uomini, p<0,05). Una fotografia della terapia nei 12 mesi precedenti l’evento evidenziava un trattamento con antiipertensivi e antidepressivi maggiore nelle donne. Per quanto riguarda il trattamento del diabete e delle dislipidemie non si evidenzia nessuna differenza di genere nell’utilizzo dei farmaci riguardanti queste patologie. E‘ stata fatta una analisi degli interventi di rivascolarizzazione per rilevare eventuali differenze di genere e differenze di età. Il 40,12% della popolazione è andata incontro a rivascolarizzazione invece il 48,1% non è stata rivascolarizzata. Nella fascia di età 65-79 anni il 73,4% dei maschi ha subito un intervento di rivascolarizzazione contro il 26,6% delle donne (OR=1,7 con IC 95% =1,2-2,5). Negli over 80, gli uomini sono sempre maggiormente rivascolarizzati (71,2%M vs 28,8F OR= 4,1 con IC 95% = 2,2-7,6). Questi dati hanno confermato che in generale gli uomini vengono sottoposti a questo tipo di interventi più delle donne. Per quanto riguarda l'aderenza alla terapia, i pazienti di sesso maschile sono stati più aderenti alla terapia limitatamente all’aspirina (92% M vs 82% F, OR = 2,4 IC 95% 1,2-4,6). L'analisi di sopravvivenza ha mostrato una prognosi migliore del genere maschile, con una mortalità più alta del genere femminile
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2

Mahendru, Amita. "A prospective study of implantation, maternal cardiovascular function and pregnancy outcome." Thesis, University of East Anglia, 2012. https://ueaeprints.uea.ac.uk/47385/.

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Events at embryonic implantation play a key role in the establishment of successful pregnancy. Not only is delayed implantation associated with an increased incidence of early pregnancy loss, but may also be associated with impaired trophoblastic invasion and uteroplacental insufficiency. Furthermore, uteroplacental vascular mal-adaptation may also be affected by pre-existing maternal cardiovascular function and associated with maternal cardiovascular maladaptation during pregnancy. There is limited understanding of events surrounding human implantation because of the difficulties in conducting prospective studies from prior to pregnancy and an inability to study events at the trophoblast-decidual interface in vivo. The primary objective of this study was to test the feasibility of being able to conduct and complete a prospective study from prior to pregnancy to the postpartum period combining measures of ovulation, implantation, ultrasound measurements of fetal size and cardiovascular changes during pregnancy. The secondary objective was to investigate ovulation and implantation timing using digital home ovulation and pregnancy test kits along with cardiovascular changes in relation to various pregnancy complications and fetal growth to determine the power for a future prospective study. This was a prospective cohort feasibility study of 143 women planning to conceive. Pre-pregnancy cardiovascular function was investigated in all women. We observed ovulation, implantation timing in 101 pregnancies and investigated the relationship between implantation timing, embryonic and fetal growth, birthweight and length of gestation in the 69 viable pregnancies. Longitudinal cardiovascular changes in viable pregnancies were examined in relation both to previous obstetric history and index pregnancy outcome. Normal pregnancy was associated with profound cardiovascular changes, beginning from 6 weeks of gestation. Delayed implantation was associated with early pregnancy loss and a smaller first trimester fetal size. The incremental rise in cardiac output from before pregnancy to its peak in the second trimester was associated with birthweight. It is feasible to conduct and complete a prospective study from prior to pregnancy to the postpartum period. Larger prospective studies of this nature will enable an understanding of the events surrounding implantation including the ‘cause and effect’ relationship of cardiovascular function with pregnancy complications such as preeclampsia and fetal growth restriction.
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3

Cruz, Lemini Mónica Cristina. "Fetal cardiovascular dysfunction in intrauterine growth restriction as a predictive marker of perinatal outcome and cardiovascular disease in childhood." Doctoral thesis, Universitat de Barcelona, 2013. http://hdl.handle.net/10803/134221.

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Most risk factors leading to cardiovascular disease are already present in childhood and the importance of early identification of pediatric cardiovascular risk factors is now well recognized. Hypertension in the child has been associated with substantial long-term health risks and considered an indication for lifestyle modifications. Current clinical guidelines contemplate screening for hypertension in children over 3 years of age, in order to provide strategies for promoting cardiovascular health, which can be integrated into comprehensive pediatric care. Interventions in the IUGR group could go from blood pressure monitoring before 3 years of age, recommending lack of exposure to other risk factors (secondary smoking, obesity), surveillance of catch-up growth or administration of hypotensors and specially, promoting exercise and physical activity. A recent randomized trial in a large cohort of children suggest that the inverse association of fetal growth with arterial wall thickness in childhood can be prevented by dietary ω-3 fatty acid supplementation over the first 5 years of life. IUGR is not listed among those conditions presumed to increase cardiovascular risk, in current guidelines. Considering IUGR affects 5-10% of all newborns, the findings of this study would affect thousands of children per year. Currently, there are no prenatal parameters described that may aid in selecting those fetuses with later hypertension and arterial remodeling that may benefit for early screening in infancy and other preventive measures or interventions. Both fetal and child cardiovascular evaluations have proven to be reliable techniques for describing changes in IUGR; cardiovascular dysfunction has been found subclinically and may have implications for cardiovascular risk in future life. The main aim of this work was to evaluate cardiovascular function parameters in IUGR fetuses as predictors of perinatal and postnatal cardiovascular outcome. In order to do this, we looked to validate the reproducibility of measurements and techniques not previously described in IUGR fetuses (studies 1 and 2), to evaluate whether fetal cardiovascular parameters could help us predict perinatal outcome (study 3) and finally to assess the value of fetal echocardiography for prediction of postnatal cardiovascular risk factors, specifically hypertension and arterial remodeling (study 4). This thesis confirms previous studies showing fetal cardiac dysfunction can be documented by fetal echocardiography; it validates different methods for evaluating cardiac function in the fetus and demonstrates the predictive value of these parameters for perinatal and postnatal cardiovascular outcome. Our first study demonstrates for the first time the validity of M-mode to assess longitudinal axis motion in IUGR. It further confirms previous research that IUGR fetuses have a significant decrease in longitudinal myocardial motion, as part of the fetal cardiovascular adaptation to placental insufficiency. In our second study, both TDI and 2D-derived strain analysis demonstrated to be feasible and reproducible to evaluate deformation parameters in the fetal heart. Our third study evaluated the independent and combined contribution of fetal cardiovascular parameters to the prediction of early-onset IUGR perinatal mortality. The study suggests an algorithm illustrating the chances of perinatal death against gestational age and DV, which might help clinical decisions in the management of early-onset IUGR fetuses. The fourth study provides, for the first time, evidence that fetal echocardiographic parameters are strongly associated to postnatal hypertension and arterial remodeling, which are recognized cardiovascular risk factors and surrogates for early-onset cardiovascular disease. It supports that a fetal cardiovascular score is strongly associated with the presence of postnatal hypertension and arterial remodeling at 6 months of age in IUGR. Echocardiographic parameters demonstrated a far better performance than perinatal factors and fetoplacental Doppler used for establishing the severity of IUGR.
Los fetos con restricción del crecimiento intrauterino (RCIU) presentan remodelamiento cardiovascular el cual persiste en la infancia y se ha asociado a enfermedades cardiovasculares en el adulto. La hipertensión en la infancia se ha demostrado como un factor de riesgo cardiovascular para la enfermedad adulta. Un seguimiento estricto junto con intervenciones en la dieta se ha demostrado mejora la salud cardiovascular en estos niños, sin embargo no todas las restricciones del crecimiento tienen hipertensión en la infancia. El objetivo principal de esta tesis es definir los parámetros con mayor utilidad de la ecocardiografía fetal para predecir hipertensión y remodelamiento arterial en infantes de 6 meses de edad con restricción del crecimiento intrauterino. Para esto, se realizó un estudio de cohorte incluyendo fetos con RCIU y controles, seguidos desde vida prenatal hasta los 6 meses de edad. La evaluación prenatal consistió en una ecocardiografía funcional completa. A los 6 meses de edad estos niños fueron evaluados para hipertensión y remodelamiento arterial. Posteriormente se realizó la construcción de un score cardiovascular para determinar desde vida prenatal aquellos niños con mayor riesgo a presentar hipertensión en vida postnatal y que pudieran requerir vigilancia o intervenciones.
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4

Berry, Karen L. (Karen Louise) 1972. "The structural basis of arterial stiffness and its relationship to cardiovascular outcome." Monash University, Dept. of Medicine, 2003. http://arrow.monash.edu.au/hdl/1959.1/7919.

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Foley, Paul William Xavier. "Cardiovascular magnetic resonance in the prediction of outcome after cardiac resynchronisation therapy." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/2852/.

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Contemporary management of patients with heart failure (HF) includes treatment with cardiac resynchronisation therapy (CRT). The benefit of CRT results from several mechanisms, predominantly correction of dyssynchrony. The development of a novel method of measuring left ventricular global dyssynchrony using cardiovascular magnetic resonance (CMR), termed CMR-tissue synchronisation index (CMR-TSI) is described. A study of 225 patients with HF who underwent CMR-TSI found that HF appears synonymous with dyssynchrony. The importance of myocardial scar is illustrated in a study of 95 patients which revealed a significantly higher mortality in patients undergoing CRT who had postero-lateral (PL) scar on CMR. A study into the effects of a combination of CMR-TSI and scar imaging found that presence of either CMR-TSI >110ms or PL scar resulted in a worse outcome, whilst the presence of both was associated with the highest mortality. A final study in 148 patients allowed the development of a risk score to predict mortality from CRT on the basis of 16 candidate variables. PL scar, dyssynchrony and creatine discriminated between survivors and non-survivors and were used to derive the score. The score is discussed in the context of data derived from echocardiography and clinical studies.
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Boyne, Pierce. "Aerobic Deconditioning after Stroke: Optimizing Outcome Measures and Interventions." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1511867874726817.

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7

Junttila, E. (Eija). "Cardiovascular abnormalities after non-traumatic intracranial hemorrhage." Doctoral thesis, Oulun yliopisto, 2012. http://urn.fi/urn:isbn:9789526200200.

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Abstract Cardiovascular abnormalities are frequent after non-traumatic intracranial hemorrhage (NT-IH). They have mainly been studied in patients with subarachnoid hemorrhage (SAH), in which they have been reported to be associated with a poorer outcome. The aim of this observational clinical study was to evaluate cardiovascular abnormalities in patients with NT-IH requiring intensive care: clinical picture, predisposing factors and impact on outcome were examined. Additionally, the validity of cardiac output (CO) monitoring via uncalibrated arterial pressure waveform analysis (APCO, FloTrac/Vigileo™) was evaluated. The thesis was comprised of retrospective (n=229) and prospective (n=108) studies. The cardiovascular abnormalities evaluated were repolarization abnormalities (RAs) in electrocardiography (ECG), myocardial injury and dysfunction, and neurogenic pulmonary edema (NPE). Cardiovascular dysfunction severity was assessed using the Sequential Organ Failure Assessment cardiovascular (SOFAcv) score. Predisposing factors for RAs and NPE were examined. The one-year mortality and functional outcome were assessed. APCO was compared with the intermittent bolus thermodilution technique (TDCO). Cardiovascular abnormalities were almost universal after NT-IH and comparable after intracerebral hemorrhage (ICH) and SAH. Each RAs (QT interval prolongation, ischemic-like ECG changes and morphological end-repolarization abnormalities) had characteristic predisposing factors. The Acute Physiology And Chronic Health Evaluation (APACHE) II score ≥20 and systemic interleukin 6 concentration >40 pg/mL were independent predictors for NPE. In the retrospective study the mortality rate was 32% after SAH and 44% after ICH. In the prospective study the rates for mortality were 18% vs. 29% and for a poor functional outcome 41% vs. 69%, respectively. Ischemic-like ECG changes were associated with a poorer functional outcome. APCO underestimated CO compared to TDCO and was biased by low systemic vascular resistance (SVR). In conclusion, cardiovascular abnormalities after NT-IH are comparable after SAH and ICH. Predisposing factors for each RAs vary. Inflammatory mechanisms play an important role in NPE development. Ischemic-like ECG changes are associated with a poorer one-year functional outcome. The validity of APCO is insufficient and biased by low SVR in patients with NT-IH
Tiivistelmä Sydämen ja verenkierron toimintahäiriöt ovat yleisiä ei-traumaattisen aivoverenvuodon (NT-IH) jälkeen. Niitä on tutkittu lähinnä lukinkalvonalaisvuotopotilailla (SAV), joilla niiden on todettu olevan yhteydessä huonompaan ennusteeseen. Tässä havainnoivassa kliinisessä tutkimuksessa selvitettiin tehohoidettujen NT-IH -potilaiden sydämen ja verenkierron toimintahäiriöiden kliinistä oirekuvaa, altistavia tekijöitä ja vaikutusta ennusteeseen. Tutkimuksessa arvioitiin myös valtimopainekäyräanalyysiin perustuvan monitorointimenetelmän (APCO, FloTrac/Vigileo™) luotettavuutta mitattaessa sydämen minuuttitilavuutta. Väitöskirjatyö koostui retrospektiivisesta (n=229) ja prospektiivisesta (n=108) tutkimuksesta. Tutkittavia toimintahäiriöitä olivat elektrokardiografiassa (EKG) nähtävät repolarisaatiohäiriöt (RAs), sydänlihaksen vaurio ja supistumishäiriö sekä keuhkopöhö. Sydämen ja verenkierron toimintahäiriön yleistä vaikeusastetta arvioitiin SOFAcv -pisteytyksellä. RAs:lle ja keuhkopöhölle altistavia tekijöitä määritettiin. Potilaiden kuolleisuus ja toiminnallinen ennuste selvitettiin vuoden seuranta-aikana. APCO:a verrattiin lämpölaimennusmenetelmään (TDCO). Sydämen ja verenkierron toimintahäiriöitä esiintyi lähes kaikilla, eivätkä ne oirekuvaltaan eronneet aivokudoksen sisäistä vuotoa (ICH) ja SAV:a sairastavilla potilailla. Eri RAs:llä (QT-ajan pidentyminen, iskeemistyyppiset EKG-muutokset ja loppurepolarisaation morfologiset poikkeavuudet) oli kullekin ominaiset altistavat tekijät. APACHE II –pisteet ≥20 ja veren interleukiini 6 –pitoisuus >40 pg/ml ennustivat keuhkopöhön kehittymistä. Retrospektiivisessä aineistossa kuolleisuus oli 32 % SAV-potilailla ja 44 % ICH-potilailla. Prospektiivisessa aineistossa kuolleisuus ja huono toiminnallinen ennuste olivat vastaavasti 18 % vs. 29 % ja 41 % vs. 69 %. Iskeemistyypiset EKG-muutokset olivat yhteydessä huonompaan toiminnalliseen ennusteeseen. APCO aliarvioi TDCO:a matalan systeemiverenkierron vastuksen (SVR) kasvattaessa harhaa. Yhteenvetona todettakoon, että sydämen ja verenkierron toimintahäiriöt eivät eroa SAV- ja ICH-potilailla. Eri RAs:lle altistavat kullekin ominaiset tekijät. Tulehdukselliset mekanismit ovat keskeisiä keuhkopöhön kehittymisessä. Iskeemistyyppiset EKG-muutokset ovat yhteydessä huonompaan toiminnalliseen ennusteeseen. APCO:n luotettavuus NT-IH -potilailla on riittämätön, ja harhaa lisää matala SVR
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Marks, Edward Charles Arthur. "Potential use of sFlt-1 and pterin to predict the clinical outcome of cardiovascular disease." Thesis, University of Canterbury. Biological sciences, 2015. http://hdl.handle.net/10092/10851.

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Formation of functional collateral circulation, to repair blocked or damaged arterial blood flow, is an important process in amending adverse outcomes after acute coronary occlusion events. Inadequate capillary growth during pressure overloads impairs myocardial perfusion, often contributing to the progression of coronary heart disease and ischaemia. Considered to be the critical rate-limiting step in physiological angiogenesis, the binding of VEGF (vascular endothelial growth factor) to VEGFR (vascular endothelial growth factor receptors) is essential for the growth and repair of arteries. Conversely, VEGF mediated angiogenesis has also been shown to promote atherosclerosis through arterial wall thickening. However, an alternatively spliced soluble form of VEGFR-1 (sFlt-1) has been shown to inhibit VEGF activity. sFlt-1 binds and sequesters free extracellular VEGF and/or heterodimerizes with VEGFR preventing the angiogenic pathway occurring. As a result, the primary pathway of angiogenesis does not occur. In recent years this has led to debate over the nature of sFlt-1 in the VEGF system. However, the level of sFlt-1 found in cardiovascular disease (CVD) patients, as well as its stability in plasma, has allowed for current research into its involvement with ischemic disorders to take place. Enhanced T-cell activity that results in increased production of interferon-γ has been shown to have involvement in the pathogenesis of CVD. 7,8-dihydroneopterin (7,8 NP) production by monocytes and macrophages is primarily in response to stimulation by interferon-γ (IFN-γ) released by activated T-lymphocytes. When combined with neopterin, the oxidised product of 7,8 NP, the total neopterin is accounted for which is a measure of the total macrophage activation by interferon-γ. Therefore, the levels of total neopterin observed may reflect the level of cell-mediated immunity within individuals which could contribute to mortality post CVD event. Progression of coronary heart disease is often clinically silent, without signs or symptoms. For this reason, the ability of markers to monitor progression is a powerful tool for predicting cardiovascular risk and the level of preventative treatment required. This study shows, that in 514 stable post-ACS (MI or unstable angina) patients, above median baseline sFlt-1, total neopterin and 7,8 NP levels, were strong predictors of mortality over a median 5 year period. Furthermore, above median sFlt-1 levels were specifically predictive of CVD death (p=0.001). This suggests that sFlt-1, total neopterin and 7,8 NP may be useful markers for risk prediction in CVD patients, post-acute event, with potential to aid prognosis in previously diagnosed patients. In support of these findings, levels of sFlt-1 measured in plasma taken from patients, immediately prior to undergoing carotid endarterectomy procedures (n=27), were significantly raised in comparison to age and gender matched healthy controls (p<0.001). Furthermore, levels of sFlt-1 in patient and control groups were shown to be independent of both age and gender. Another aspect of the study, analysis of excised live plaque tissue from carotid endarterectomy patients, showed the presence of live inflammatory cell populations. Macrophages, in the plaque sections, could be stimulated in the presence of IFN-γ to produce significantly elevated (p<0.01) levels of the antioxidant 7,8 NP. Since bivariate analysis of 7,8 NP and sFlt-1, in plasma from the endarterectomy patients, yields a positive correlation (r=0.323, p<0.01), further analysis of live plaque may give insight into the association between inflammation and hypoxic up-regulation of sFlt-1. It is now generally accepted, in diseases with complex pathogenesis, that particular biomarkers are predominantly indicative of only a single variable in a wide range of contributing factors. The data generated in this study highlights the potential for sFlt-1, neopterin and 7,8 NP to be used as contributing biomarkers in the prognosis of patients suffering from CVD, which if confirmed, may have important clinical implications in the medical community.
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9

George, Anish. "Prevalence of glucometabolic disorders in acute coronary syndrome and their prognostic influence in long term cardiovascular outcome." Thesis, University of Hull, 2016. http://hydra.hull.ac.uk/resources/hull:14392.

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10

Zen, Monica. "Pre-Eclampsia: Prediction, Prevention And Long-Term Sequelae." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29566.

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Preeclampsia is a multi-system disorder that affects approximately 3-5% of all pregnancies and is one of the leading causes of maternal and neonatal morbidity and mortality globally. At present, there remain many facets of preeclampsia lacking data and comprehensive understanding. This thesis presents a number of studies investigating various aspects of prediction, prevention and long-term sequelae of preeclampsia. Women with pre-existing diabetes mellitus (DM) form a unique cohort of women with significantly increased risk of developing preeclampsia in pregnancy compared to the general population. Despite this, there is minimal data on serum predictive markers and no data on urinary predictive markers for the development of preeclampsia in this cohort. This thesis explored both urinary and serum predictive markers for preeclampsia throughout pregnancy, in women with pre-existing DM. We described urinary protein excretion as pregnancy progresses in women with pre-existing DM. For total protein excretion measured via spot urine protein-to-creatinine ratio (uPCR), results were in keeping with the literature within the general obstetric population, with increments as pregnancy progressed. However, unlike the general population, in our population of women with pre-existing DM, spot urinary albumin-to-creatinine ratio (uACR) remained stable until late trimester 3. We additionally found that for our population, in each trimester of pregnancy, spot uACR outperformed spot uPCR with respect to its association with the outcome of preeclampsia. Additionally, placental growth factor (PlGF) is known to play a key role in placental angiogenesis in pregnancy - we found that preeclampsia is associated with an anti-angiogenic state, with reduced levels of serum PlGF and increased levels of soluble fms-like protein kinase 1 (sFlt1). We demonstrated correlation between urinary and serum levels of PlGF throughout pregnancy and in contrast to the literature within the general obstetric population, we found that for our women with DM, serum PlGF alone performed as a better predictor of preeclampsia than the serum sFlt1-to-PlGF ratio, at all gestations sampled throughout pregnancy. Due to their increased preeclampsia risk, there is clear consensus that women with pre-existing DM would benefit from aspirin prophylaxis for preeclampsia risk reduction. These recommendations appear to stem from data obtained in the general population. However, there is evidence suggesting potentially reduced aspirin effectiveness in those with pre-existing DM. We reviewed the current literature of preeclampsia risk reduction with aspirin prophylaxis within women with pre-existing DM. Our systematic review is the first published review exploring the available data around the use of antenatal aspirin for the prevention of preeclampsia specifically in women with pre-existing DM. Our findings revealed a great void of available data surrounding aspirin prophylaxis for preeclampsia risk reduction in this cohort, with results suggesting no difference in preeclampsia outcome with aspirin use, a finding likely a consequence of lack of power due to insufficient data available for our cohort of interest. Preeclampsia not only poses immediate risk to the mother and neonate during the peripartum period, but it is now understood that it has long-term implications for both the mother and offspring. A wealth of evidence now exists demonstrating women with a history of preeclampsia have increased long term risk of cardiovascular morbidity and mortality. It appears that preeclampsia history may be a gender specific cardiovascular risk factor akin to traditional cardiovascular risk factors such as hypertension or obesity. It is known that those with increased cardiovascular risk are also at increased cardiovascular morbidity and mortality post-surgery. However, no data exists regarding postoperative cardiovascular risk in women with a history of preeclampsia. We aimed to explore this association in the PREECLAMPSIA-VISION study, a sub-study including all female participants with a positive pregnancy history from the original Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) study, a large international prospective cohort study of a representative sample of adults aged 45 years and older who underwent non-cardiac surgery. Our primary outcome was Myocardial Injury after Non-cardiac Surgery (MINS) within 30 days after surgery. We found that a positive preeclampsia history was an independent risk factor for MINS, with 26% relative increase in the hazard of MINS in the first 30 post-operative days when compared to women whose previous pregnancies were not complicated by preeclampsia. In addition to long-term implications for the woman, epidemiological evidence also supports an association between maternal preeclampsia and long-term neurocognitive function in the offspring. However, the available literature is conflicting and there is often incomplete consideration of confounding factors. We explored this association, taking into account important confounding and mediating factors, via a population-based cohort study using record-linkage of New South Wales birth, hospitalization and education data. Our outcome of measure for neurocognitive function was offspring school performance as assessed by the Grade 3 National Assessment Program–Literacy and Numeracy (NAPLAN), a standardised national test, which assesses children in 5 domains: reading, writing, spelling, grammar and punctuation, and numeracy. Our outcome of interest was a score below the national minimal standard (BNMS) in any of the 5 NAPLAN domains. In children exposed to preeclampsia in utero, crude univariate analysis demonstrated an increased risk of scoring BNMS in all 5 NAPLAN domains compared to children of unaffected pregnancies. Interestingly, once perinatal and child factors were accounted for, these differences were completely attenuated. The perinatal factors had a greater mediating effect than child factors, with gestational age at birth being the primary contributor, accounting for up to 21% of the association between preeclampsia and scoring BNMS. All the studies presented within this thesis have either direct clinical implication or translational potential to clinical practice and have laid the foundation for further research. We suggest that women with pre-existing DM form a unique high-risk cohort of women with respect to the outcome of preeclampsia, and screening with uACR instead of the current clinically used uPCR would provide improved risk stratification for this cohort. Our results also suggest that the implementation of current clinically used algorithm-based screening, particularly those that include serum sFlt1-to-PlGF ratio may not be appropriate for women with pre-existing DM and screening within this cohort cannot be based on extrapolation of data obtained from the general obstetric population. Additionally, urinary PlGF holds promise for preeclampsia screening within this cohort and possibly the general obstetric population, however more sensitive commercially available kits are required. Further, we suggest caution before extrapolating currently available data for preeclampsia risk reduction with aspirin prophylaxis to women with pre-existing DM. Our PREECLAMPSIA-VISION study underscores the distinct requirement for enhancement in our overall understanding of gender differences in perioperative cardiovascular outcomes and overall long-term cardiovascular risk and suggests benefit in the incorporation of preeclampsia history into current perioperative risk predictive models for female patients. Lastly, to reduce the risk of poorer long-term offspring educational outcomes associated with preeclampsia, we support the implementation of strategies to safely prolong pregnancy and increase gestational age at birth in women whose pregnancies are complicated by preeclampsia.
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11

Björnådal, Lena. "Long-term outcome of patients with rheumatoid arthritis and systemic lupus erythematosus with special reference to cardiovascular disease /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-787-8/.

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12

Bergh, Cecilia. "Life-course influences on occurrence and outcome for stroke and coronary heart disease." Doctoral thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-54254.

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Although typical clinical onset does not occur until adulthood, cardiovascular disease (CVD) may have a long natural history with accumulation of risks beginning in early life and continuing through childhood and into adolescence and adulthood. Therefore, it is important to adopt a life-course approach to explore accumulation of risks, as well as identifying age-defined windows of susceptibility, from early life to disease onset. This thesis examines characteristics in adolescence and adulthood linked with subsequent risk of CVD. One area is concerned with physical and psychological characteristics in adolescence, which reflects inherited and acquired elements from childhood, and their association with occurrence and outcome of subsequent stroke and coronary heart disease many years later. The second area focuses on severe infections and subsequent delayed risk of CVD. Data from several Swedish registers were used to provide information on a general population-based cohort of men. Some 284 198 males, born in Sweden from 1952 to 1956 and included in the Swedish Military Conscription Register, form the basis of the study cohort for this thesis. Our results indicate that characteristics already present in adolescence may have an important role in determining long-term cardiovascular health. Stress resilience in adolescence was associated with an increased risk of stroke and CHD, working in part through other CVD factors, in particular physical fitness. Stress resilience, unhealthy BMI and elevated blood pressure in adolescence were also associated with aspects of stroke severity among survivors of a first stroke. We demonstrated an association for severe infections (hospital admission for sepsis and pneumonia) in adulthood with subsequent delayed risk of CVD, independent of risk factors from adolescence. Persistent systemic inflammatory activity which could follow infection, and that might persist long after infections resolve, represents a possible mechanism. Interventions to protect against CVD should begin by adolescence; and there may be a period of heightened susceptibility in the years following severe infection when additional monitoring and interventions for CVD may be of value.
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13

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

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14

Harb, Nidal Mahmoud. "The Effect of Success Stories on Exercise Adherence to Newly Enrolled Cardiovascular Patients in Cardiac Rehabilitation Program." Kent State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=kent1542377729977464.

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15

Ralovich, Kristof [Verfasser], Nassir [Akademischer Betreuer] Navab, Nassir [Gutachter] Navab, and Franjo [Gutachter] Pernus. "Image-based Treatment Outcome Prediction and Intervention Guidance for Cardiovascular Diseases / Kristof Ralovich ; Gutachter: Nassir Navab, Franjo Pernus ; Betreuer: Nassir Navab." München : Universitätsbibliothek der TU München, 2018. http://d-nb.info/1177241439/34.

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16

Ren, Cizao. "Evaluation of interactive effects between temperature and air pollution on health outcomes." Thesis, Queensland University of Technology, 2007. https://eprints.qut.edu.au/16384/1/Cizao_Ren_Thesis.pdf.

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A large number of studies have shown that both temperature and air pollution (eg, particulate matter and ozone) are associated with health outcomes. So far, it has received limited attention whether air pollution and temperature interact to affect health outcomes. A few studies have examined interactive effects between temperature and air pollution, but produced conflicting results. This thesis aimed to examine whether air pollution (including ozone and particulate matter) and temperature interacted to affect health outcomes in Brisbane, Australia and 95 large US communities. In order to examine the consistency across different cities and different countries, we used two datasets to examine interactive effects of temperature and air pollution. One dataset was collected in Brisbane City, Australia, during 1996-2000. The dataset included air pollution (PM10, ozone and nitrogen dioxide), weather conditions (minimum temperature, maximum temperature, relative humidity and rainfall) and different health outcomes. Another dataset was collected from the 95 large US communities, which included air pollution (ozone was used in the thesis), weather conditions (maximum temperature and dew point temperature) and mortality (all non-external cause mortality and cardiorespiratory mortality). Firstly, we used three parallel time-series models to examine whether maximum temperature modified PM10 effects on cardiovascular hospital admissions (CHA), respiratory hospital admissions (RHA), cardiovascular emergency visits (CEV), respiratory emergency visits (REV), cardiovascular mortality (CM) and non-external cause mortality (NECM), at lags of 0-2 days in Brisbane. We used a Poisson generalized additive model (GAM) to fit a bivariate model to explore joint response surfaces of both maximum temperature and particulate matter less than 10 μm in diameter (PM10) on individual health outcomes at each lag. Results show that temperature and PM10 interacted to affect different health outcomes at various lags. Then, we separately fitted non-stratification and stratification GAM models to quantify the interactive effects. In the non-stratification model, we examined the interactive effects by including a pointwise product for both temperature and the pollutant. In the stratification model, we categorized temperature into two levels using different cut-offs and then included an interactive term for both pollutant and temperature. Results show that maximum temperature significantly and positively modified the associations of PM10 with RHA, CEV, REV, CM and NECM at various lags, but not for CHA. Then, we used the above Poisson regression models to examine whether PM10 modified the associations of minimum temperature with CHA, RHA, CEV, REV, CM and NECM at lags of 0-2 days. In this part, we categorized PM10 into two levels using the mean as cut-off to fit the stratification model. The results show that PM10 significantly modified the effects of temperature on CHA, RHA, CM and NECM at various lags. The enhanced adverse temperature effects were found at higher levels of PM10, but there was no clear evidence for synergistic effects on CEV and REV at various lags. Three parallel models produced similar results, which strengthened the validity of these findings. Thirdly, we examined whether there were the interactive effects between maximum temperature and ozone on NECM in individual communities between April and October, 1987-2000, using the data of 60 eastern US communities from the National Morbidity, Mortality, and Air Pollution Study (NMMAPS). We divided these communities into two regions (northeast and southeast) according to the NMMAPS study. We first used the bivariate model to examine the joint effects between temperature and ozone on NECM in each community, and then fit a stratification model in each community by categorizing temperature into three levels. After that, we used Bayesian meta-analysis to estimate overall effects across regions and temperature levels from the stratification model. The bivariate model shows that temperature obviously modified ozone effects in most of the northeast communities, but the trend was not obviously in the southeast region. Bayesian meta-analysis shows that in the northeast region, a 10-ppb increment in ozone was associated with 2.2% (95% posterior interval [PI]: 1.2%, 3.1 %), 3.1% (95% PI: 2.2%, 3.8 %) and 6.2 % (95% PI: 4.8%, 7.6 %) increase in mortality for low, moderate and high temperature levels, respectively, while in the southeast region, a 10-ppb increment in ozone was associated with 1.1% (95% PI: -1.1%, 3.2 %), 1.5% (95% PI: 0.2%, 2.8%) and 1.3% (95% PI: -0.3%, 3.0 %) increase in mortality. In addition, we examined whether temperature modified ozone effects on cardiovascular mortality in 95 large US communities between May and October, 1987-2000 using the same models as the above. We divided the communities into 7 regions according to the NMMAPS study (Northeast, Industrial Midwest, Upper Midwest, Northwest, Southeast, Southwest and Southern California). The bivariate model shows that temperature modified ozone effects in most of the communities in the northern regions (Northeast, Industrial Midwest, Upper Midwest, Northwest), but such modification was not obvious in the southern regions (Southeast, Southwest and Southern California). Bayesian meta-analysis shows that temperature significantly modified ozone effects in the Northeast, Industrial Midwest and Northwest regions, but not significant in Upper Midwest, Southeast, Southwest and Southern California. Nationally, temperature marginally positively modified ozone effects on cardiovascular mortality. A 10-ppb increment in ozone was associated with 0.4% (95% posterior interval [PI]: -0.2, 0.9 %), 0.3% (95% PI: -0.3%, 1.0%) and 1.6% (95% PI: 4.8%, 7.6%) increase in mortality for low, moderate and high temperature levels, respectively. The difference of overall effects between high and low temperature levels was 1.3% (95% PI: - 0.4%, 2.9%) in the 95 communities. Finally, we examined whether ozone modified the association between maximum temperature and cardiovascular mortality in 60 large eastern US communities during the warmer days, 1987-2000. The communities were divided into the northeast and southeast regions. We restricted the analyses to the warmer days when temperature was equal to or higher than the median in each community throughout the study period. We fitted a bivariate model to explore the joint effects between temperature and ozone on cardiovascular mortality in individual communities and results show that in general, ozone positively modified the association between temperature and mortality in the northeast region, but such modification was not obvious in the southeast region. Because temperature effects on mortality might partly intermediate by ozone, we divided the dataset into four equal subsets using quartiles as cut-offs. Then, we fitted a parametric model to examine the associations between temperature and mortality across different levels of ozone using the subsets. Results show that the higher the ozone concentrations, the stronger the temperature-mortality associations in the northeast region. However, such a trend was not obvious in the southeast region. Overall, this study found strong evidence that temperature and air pollution interacted to affect health outcomes. PM10 and temperature interacted to affect different health outcomes at various lags in Brisbane, Australia. Temperature and ozone also interacted to affect NECM and CM in US communities and such modification varied considerably across different regions. The symmetric modification between temperature and air pollution was observed in the study. This implies that it is considerably important to evaluate the interactive effect while estimating temperature or air pollution effects and further investigate reasons behind the regional variability.
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17

Ren, Cizao. "Evaluation of interactive effects between temperature and air pollution on health outcomes." Queensland University of Technology, 2007. http://eprints.qut.edu.au/16384/.

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Abstract:
A large number of studies have shown that both temperature and air pollution (eg, particulate matter and ozone) are associated with health outcomes. So far, it has received limited attention whether air pollution and temperature interact to affect health outcomes. A few studies have examined interactive effects between temperature and air pollution, but produced conflicting results. This thesis aimed to examine whether air pollution (including ozone and particulate matter) and temperature interacted to affect health outcomes in Brisbane, Australia and 95 large US communities. In order to examine the consistency across different cities and different countries, we used two datasets to examine interactive effects of temperature and air pollution. One dataset was collected in Brisbane City, Australia, during 1996-2000. The dataset included air pollution (PM10, ozone and nitrogen dioxide), weather conditions (minimum temperature, maximum temperature, relative humidity and rainfall) and different health outcomes. Another dataset was collected from the 95 large US communities, which included air pollution (ozone was used in the thesis), weather conditions (maximum temperature and dew point temperature) and mortality (all non-external cause mortality and cardiorespiratory mortality). Firstly, we used three parallel time-series models to examine whether maximum temperature modified PM10 effects on cardiovascular hospital admissions (CHA), respiratory hospital admissions (RHA), cardiovascular emergency visits (CEV), respiratory emergency visits (REV), cardiovascular mortality (CM) and non-external cause mortality (NECM), at lags of 0-2 days in Brisbane. We used a Poisson generalized additive model (GAM) to fit a bivariate model to explore joint response surfaces of both maximum temperature and particulate matter less than 10 μm in diameter (PM10) on individual health outcomes at each lag. Results show that temperature and PM10 interacted to affect different health outcomes at various lags. Then, we separately fitted non-stratification and stratification GAM models to quantify the interactive effects. In the non-stratification model, we examined the interactive effects by including a pointwise product for both temperature and the pollutant. In the stratification model, we categorized temperature into two levels using different cut-offs and then included an interactive term for both pollutant and temperature. Results show that maximum temperature significantly and positively modified the associations of PM10 with RHA, CEV, REV, CM and NECM at various lags, but not for CHA. Then, we used the above Poisson regression models to examine whether PM10 modified the associations of minimum temperature with CHA, RHA, CEV, REV, CM and NECM at lags of 0-2 days. In this part, we categorized PM10 into two levels using the mean as cut-off to fit the stratification model. The results show that PM10 significantly modified the effects of temperature on CHA, RHA, CM and NECM at various lags. The enhanced adverse temperature effects were found at higher levels of PM10, but there was no clear evidence for synergistic effects on CEV and REV at various lags. Three parallel models produced similar results, which strengthened the validity of these findings. Thirdly, we examined whether there were the interactive effects between maximum temperature and ozone on NECM in individual communities between April and October, 1987-2000, using the data of 60 eastern US communities from the National Morbidity, Mortality, and Air Pollution Study (NMMAPS). We divided these communities into two regions (northeast and southeast) according to the NMMAPS study. We first used the bivariate model to examine the joint effects between temperature and ozone on NECM in each community, and then fit a stratification model in each community by categorizing temperature into three levels. After that, we used Bayesian meta-analysis to estimate overall effects across regions and temperature levels from the stratification model. The bivariate model shows that temperature obviously modified ozone effects in most of the northeast communities, but the trend was not obviously in the southeast region. Bayesian meta-analysis shows that in the northeast region, a 10-ppb increment in ozone was associated with 2.2% (95% posterior interval [PI]: 1.2%, 3.1 %), 3.1% (95% PI: 2.2%, 3.8 %) and 6.2 % (95% PI: 4.8%, 7.6 %) increase in mortality for low, moderate and high temperature levels, respectively, while in the southeast region, a 10-ppb increment in ozone was associated with 1.1% (95% PI: -1.1%, 3.2 %), 1.5% (95% PI: 0.2%, 2.8%) and 1.3% (95% PI: -0.3%, 3.0 %) increase in mortality. In addition, we examined whether temperature modified ozone effects on cardiovascular mortality in 95 large US communities between May and October, 1987-2000 using the same models as the above. We divided the communities into 7 regions according to the NMMAPS study (Northeast, Industrial Midwest, Upper Midwest, Northwest, Southeast, Southwest and Southern California). The bivariate model shows that temperature modified ozone effects in most of the communities in the northern regions (Northeast, Industrial Midwest, Upper Midwest, Northwest), but such modification was not obvious in the southern regions (Southeast, Southwest and Southern California). Bayesian meta-analysis shows that temperature significantly modified ozone effects in the Northeast, Industrial Midwest and Northwest regions, but not significant in Upper Midwest, Southeast, Southwest and Southern California. Nationally, temperature marginally positively modified ozone effects on cardiovascular mortality. A 10-ppb increment in ozone was associated with 0.4% (95% posterior interval [PI]: -0.2, 0.9 %), 0.3% (95% PI: -0.3%, 1.0%) and 1.6% (95% PI: 4.8%, 7.6%) increase in mortality for low, moderate and high temperature levels, respectively. The difference of overall effects between high and low temperature levels was 1.3% (95% PI: - 0.4%, 2.9%) in the 95 communities. Finally, we examined whether ozone modified the association between maximum temperature and cardiovascular mortality in 60 large eastern US communities during the warmer days, 1987-2000. The communities were divided into the northeast and southeast regions. We restricted the analyses to the warmer days when temperature was equal to or higher than the median in each community throughout the study period. We fitted a bivariate model to explore the joint effects between temperature and ozone on cardiovascular mortality in individual communities and results show that in general, ozone positively modified the association between temperature and mortality in the northeast region, but such modification was not obvious in the southeast region. Because temperature effects on mortality might partly intermediate by ozone, we divided the dataset into four equal subsets using quartiles as cut-offs. Then, we fitted a parametric model to examine the associations between temperature and mortality across different levels of ozone using the subsets. Results show that the higher the ozone concentrations, the stronger the temperature-mortality associations in the northeast region. However, such a trend was not obvious in the southeast region. Overall, this study found strong evidence that temperature and air pollution interacted to affect health outcomes. PM10 and temperature interacted to affect different health outcomes at various lags in Brisbane, Australia. Temperature and ozone also interacted to affect NECM and CM in US communities and such modification varied considerably across different regions. The symmetric modification between temperature and air pollution was observed in the study. This implies that it is considerably important to evaluate the interactive effect while estimating temperature or air pollution effects and further investigate reasons behind the regional variability.
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18

Jaffer, Usman. "Endothelial function/dysfunction and oxidative stress during ischaemia reperfusion injury as a consequence of intermittent claudication : is good endothelial function a prognostic indicator for poor cardiovascular outcome in intermittent claudication?" Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/25015.

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Peripheral Vascular Disease (PVD) has a major morbidity and mortality in the general population. The spectrum of PVD ranges from intermittent claudication to critical limb ischaemia. There is a high prevalence of intermittent claudication in the general population, however only five to ten percent will progress to more severe disease. The progression of disease is at present unpredictable. There is a growing awareness that patients with intermittent claudication may have differing propensities for developing cardiovascular morbidity and mortality. This study aims to investigate the relationship between the endothelial response to exercise in the macro and microcirculation and correlate this with plasma inflammatory cytokine levels, plasma oxidative state and a marker of acute kidney injury in patients with peripheral vascular disease and healthy controls. This information may lead to a new screening test for patients with an increased risk of disease progression who once identified could be better managed to reduce their risk. Furthermore potential new cytokine targets for halting disease progression and potential treatment will be investigated.
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19

Nascimento, Zeus Peron Barbosa do. "RepercussÃes Maternas e Perinatais de Gestantes com Cardiopatias em Hospital TerciÃrio no CearÃ." Universidade Federal do CearÃ, 2010. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=5628.

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Objetivos. Avaliar as repercussÃes maternas e perinatais das gestantes com cardiopatia, comparando os dados sociodemogrÃficos, obstÃtricos e resultados perinatais pelo tipo de cardiopatia (congÃnita versus adquirida) e pela via de parto (parto vaginal versus abdominal). Metodologia. Trata-se de estudo transversal, retrospectivo, descritivo e analÃtico, realizado por meio da pesquisa de 70 prontuÃrios de pacientes que tiveram o parto no Hospital Geral CÃsar Cals nos anos de 2007 (26 casos) e 2008 (44 casos) por meio do preenchimento de questionÃrios. Foram usados os testes estatÃsticos Qui-quadrado de Yates e de Pearson e Exato de Fisher para anÃlise bivariada dos dados. Foi considerado nÃvel de significÃncia p < 0,05. Resultados. A idade das pacientes variou de 15 a 42 (mÃdia de 25,8Â6,5) anos; 25 (35,7%) eram primigestas, 22 (31,4%) secundigestas e 23 (32,9%) delas eram multigestas, dezesseis pacientes (22,9 %) tinham cardiopatia congÃnita e 45 cardiopatia adquirida (64,3%). Houve 15 partos prematuros (21,7%); 24 (34,3%) delas teve parto vaginal e 46 (65,7%) parto abdominal. A taxa de prematuridade foi de 21,7%. Verificou-se a presenÃa de 27,1% de RN com baixo peso ao nascer, 8,6% de restriÃÃo do crescimento fetal, 17,1% de Apgar < 7 no primeiro e 11,4% no quinto minuto de vida. Houve um Ãbito materno e cinco Ãbitos perinatais. NÃo houve diferenÃa estatÃstica entre as cardiopatias congÃnitas e as adquiridas, exceto pela maior presenÃa de patologias clÃnicas prÃvias à gestaÃÃo no grupo das cardiopatias congÃnitas. As pacientes que tiveram parto vaginal apresentaram maior paridade e menor escolaridade, maior taxa de prematuridade, de RN com baixo peso ao nascer e menores Ãndices de Apgar no primeiro minuto quando comparadas Ãquelas submetidas a parto abdominal. A frequÃncia de descompensaÃÃo clÃnica durante o trabalho de parto e/ou parto foi de 5,7%, sem diferenÃa estatÃstica entre os partos vaginais ou abdominais. ConclusÃes. Houve frequÃncia elevada de cesariana, parto prematuro, baixo peso ao nascer, Apgar < 7 no primeiro minuto de vida e necessidade de internamento em UTI neonatal. NÃo houve diferenÃa clara entre os tipos de cardiopatias. O piores resultados neonatais encontrados para o parto vaginal podem ser atribuÃdos à prÃpria prematuridade; ou seja, nÃo necessariamente à via de parto.
Aims. To evaluate maternal and peri-natal outcomes of pregnant women with heart disease, comparing the socio - demographic, obstetric data and peri-natal results by the type of heart disease (congenital versus acquired) and the route of delivery (vaginal versus abdominal). Methodology. This is a cross sectional, retrospective, descriptive and analytical research carried out by the records of 70 patients who delivered at Hospital Geral Cesar Cals in the years 2007 ( 26 cases) and 2008 (44 cases) by completing questionnaires. We used the Yates chi-square test, Pearson and Fisher Exact test for bi-varied analysis of data. We considered the level of significance p < 0.05. Results. The age of patients ranged from 15 to 42 (mean 25.8 + 6.5) years; on twenty five (35.7%) were first pregnancy, 22 (31.4%) second pregnancy and 23 (32.9%) were multi â pregnancy. Sixteen patients (22.9%) had congenital heart disease and 45 had acquired heart disease (64.3%). There were 15 premature births (21.7%). Twenty four (34.3%) of the women had vaginal deliveries and 46 (65.7%) cesarean section. The rate of pre term births was 21.7%. There was 27.1% of infants with low birth weight, 8.6% of fetal growth restriction, 17.1% of Apgar score < 7 in the first and 11.4% in the fifth minute of life. There was one maternal death and 5 peri-natal deaths. There was no statistical difference between congenital and acquired heart disease except for a greater presence of clinical pathologies previous to the pregnancy in the group of congenital heart disease. Patients who had vaginal deliveries presented higher parity and lower education, higher rates of prematurity in infants with low birth weight and lower Apgar scores in the first minute when compared to those who were submitted to cesarean section. The frequency of clinical discompensation during labor and / or delivery was 5.7% without statistical difference between the vaginal or abdominal. Conclusions. There was a high frequency of cesarean section, premature birth, low birth weight, Apgar score < 7 in the first minute of life and need to be admitted in the neonatal UTI. There was no clear differencebetween the types of heart disease. The worst neonatal results found for the vaginal delivery can be attributed to the very pre-term birth, that is, not necessarily the mode of delivery. .
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20

Fisher, Kimberly A. "Impact of COPD on the Mortality and Treatment of Patients Hospitalized with Acute Decompensated Heart Failure (The Worcester Heart Failure Study): A Masters Thesis." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/717.

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Objective: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with heart failure, yet little is known about the impact of this condition in patients with acute decompensated heart failure (ADHF), especially from a more generalizable, community-based perspective. The primary objective of this study was to describe the in-hospital and post discharge mortality and treatment of patients hospitalized with ADHF according to COPD status. Methods: The study population consisted of patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 4 study years: 1995, 2000, 2002, and 2004. Results: Of the 9,748 patients hospitalized with ADHF during the years under study, 35.9% had a history of COPD. The average age of this population was 76.1 years, 43.9% were men, and 93.3% were white. At the time of hospital discharge, patients with COPD were less likely to have received evidence-based heart failure medications, including beta-blockers and ACE inhibitors/angiotensin receptor blockers, than patients without COPD. Multivariable adjusted in-hospital death rates were similar for patients with and without COPD. However, among patients who survived to hospital discharge, patients with COPD had a significantly higher risk of dying at 1 (adjusted RR 1.10; 95% CI 1.06, 1.14) and 5-years (adjusted RR 1.40; 95% CI 1.28, 1.42) after hospital discharge than patients who were not previously diagnosed with COPD. Conclusions: COPD is a common co-morbidity in patients hospitalized with ADHF and is associated with a worse long-term prognosis. Further research is required to understand the complex interactions of these diseases and to ensure that patients with ADHF and COPD receive optimal treatment modalities.
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21

Fisher, Kimberly A. "Impact of COPD on the Mortality and Treatment of Patients Hospitalized with Acute Decompensated Heart Failure (The Worcester Heart Failure Study): A Masters Thesis." eScholarship@UMMS, 2007. http://escholarship.umassmed.edu/gsbs_diss/717.

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Objective: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with heart failure, yet little is known about the impact of this condition in patients with acute decompensated heart failure (ADHF), especially from a more generalizable, community-based perspective. The primary objective of this study was to describe the in-hospital and post discharge mortality and treatment of patients hospitalized with ADHF according to COPD status. Methods: The study population consisted of patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 4 study years: 1995, 2000, 2002, and 2004. Results: Of the 9,748 patients hospitalized with ADHF during the years under study, 35.9% had a history of COPD. The average age of this population was 76.1 years, 43.9% were men, and 93.3% were white. At the time of hospital discharge, patients with COPD were less likely to have received evidence-based heart failure medications, including beta-blockers and ACE inhibitors/angiotensin receptor blockers, than patients without COPD. Multivariable adjusted in-hospital death rates were similar for patients with and without COPD. However, among patients who survived to hospital discharge, patients with COPD had a significantly higher risk of dying at 1 (adjusted RR 1.10; 95% CI 1.06, 1.14) and 5-years (adjusted RR 1.40; 95% CI 1.28, 1.42) after hospital discharge than patients who were not previously diagnosed with COPD. Conclusions: COPD is a common co-morbidity in patients hospitalized with ADHF and is associated with a worse long-term prognosis. Further research is required to understand the complex interactions of these diseases and to ensure that patients with ADHF and COPD receive optimal treatment modalities.
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22

Bruno, Maria Lucia Mendes. ""Três formas de intervenção para a adesão ao tratamento dietético da obesidade em cardiologia: estudo comparativo"." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-16102006-145427/.

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Trata-se de pesquisa realizada em hospital da rede pública estadual de São Paulo, especializado em cardiologia com pacientes obesos em acompanhamento ambulatorial pelo Serviço de Nutrição e Dietética (SND) dessa instituição. As formas de intervenção nutricional investigadas foram: atendimento individual, em grupo (controle) e grupo multiprofissional (com nutricionista e psicóloga). Na fase preliminar do estudo, realizou-se pesquisa de opinião que possibilitou o embasamento das variáveis analisadas. Na fase principal, os participantes foram divididos em grupos, sendo realizadas duas entrevistas individuais no intervalo de seis meses. Foram investigados apenas os pacientes de alta. Compararam-se os resultados obtidos quanto ao peso corporal, índice de massa corpórea, circunferência do abdome; o acompanhamento dos fatores de risco cardiovascular (hipertensão arterial, diabetes melito, dislipidemias) foi feito através da variação das medidas de pressão arterial e níveis sanguíneos de glicose, triglicérides, colesterol total e frações. Analisaram-se as opiniões sobre as facilidades e dificuldades para seguir as orientações recebidas por meio de instrumento próprio, não validado. No atendimento em grupo, foram obtidos resultados satisfatórios, porém não ideais, e verificou-se que os participantes passaram a valorizar o apoio familiar. No atendimento individual, os participantes conseguiram maior redução da glicemia e triglicérides, porém isso não pode ser atribuído exclusivamente à dieta. No atendimento em grupo multiprofissional, houve mudança de comportamento com valorização desse tipo de atendimento.
The study was performed in a cardiology specialty hospital of Sao Paulo state public system with obese outpatients followed up by the Sector of Nutrition and Dietetics of the institution. Nutritional intervention actions that were assessed include: individual visit, group approach (control) and multiprofessional group (including dietitian and psychologist). In the preliminary phase of the study, an opinion survey was performed, which supported many of the studied variables. In the main phase of the study, the participants were divided into groups, and 2 individual interviews were conducted within a 6-month interval. Only patients who had been discharged were assessed. The results concerning body weight, body mass index, abdominal circumference, and follow up of cardiovascular risks (arterial hypertension, diabetes mellitus, dyslipidemia) were compared using variation of blood pressure measures and blood levels of glucose, triglycerides and total and fractioned cholesterol. We also checked whether patients found it easy or difficult to follow the received instructions, using our own non-validated instrument. In the group activities, results were satisfactory but not optimal and participants started to value family support. In the individual approach, participants reached higher reduction of glucose and triglyceride levels, but they could not be explained exclusively by the diet. In the multiprofessional group, there was change in behavior and recognition of multiprofessional approach.
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23

Chen, Han-Yang. "Hospital Treatment Practices, 30-Day Hospital Readmissions, and Long-Term Prognosis in Patients Hospitalized with Acute Myocardial Infarction: A Dissertation." eScholarship@UMMS, 2015. http://escholarship.umassmed.edu/gsbs_diss/771.

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Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the U.S. Acute myocardial infarction (AMI), with or without ST-segment elevation, is a common presentation of coronary heart disease and affected more than 800,000 American adults in 2010. The overall goal of this dissertation was to examine decade-long trends in the extent of delay in the receipt of a primary percutaneous coronary intervention (PCI) among patients hospitalized with ST-segment elevation myocardial infarction (STEMI), 30-day hospital readmission rates in patients having survived an AMI, and multiple decade long trends in 1-year post-hospital all-cause mortality, as well as factors associated with these outcomes, among patients hospitalized with AMI. Methods: Data from the Worcester Heart Attack Study, a population-based chronic disease surveillance project that has been carried out among adult residents of the Worcester, MA, metropolitan area, hospitalized with AMI on a biennial basis from 1975 through 2009 at all medical centers in central MA, were used for this dissertation. Results: Between 1999 and 2009, among patients hospitalized with STEMI, the likelihood of receiving a primary PCI within 90 minutes after emergency department arrival increased dramatically from 1999/2001 (11.6%) to 2007/2009 (70.5%). Between 1999 and 2009, among hospital survivors of an AMI, the 30-day all-cause rehospitalization rates decreased from 1999/2001 (20.3%) to 2007/2009 (16.7%). The overall cause-specific 30-day rehospitalization rates due to CVD, non-CVD, and AMI were 10.1%, 7.1%, and 1.8%, respectively, during the years under study. Between 1975 and 2009, among hospital survivors for a first AMI, the 1-year post-discharge mortality rates remained relatively stable from 1975-1984 (12.9%) to 1986-1997 (12.5%), but increased during 1999-2009 (15.8%). We identified several demographic, clinical and in-hospital treatment factors associated with an increased risk of failing to receive a primary PCI within 90 minutes after emergency department arrival, 30-day readmissions, and 1-year post-discharge mortality. Conclusions: Our findings can hopefully lead to the enhanced development of innovative, patient-centered, intervention strategies which can further improve the treatment and transitions of care, as well as short and long-term prognosis, of men and women hospitalized with AMI.
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24

Olsson, Christian. "Thoracic Aortic Surgery : Epidemiology, Outcomes, and Prevention of Cerebral Complications." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6899.

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25

Mazlan-Kepli, Wardati. "Antiplatelet therapy and clinical outcomes in cardiovascular diseases." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7831/.

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Cardiovascular diseases (CVD) is a leading cause of death in the world. Despite effective treatment regimens for ischaemic heart disease (IHD) and ischaemic stroke, mortality and recurrence rates remain high. Antiplatelet therapy is on effective treatment and reduces the risk of recurrent heart attack and stroke. Nevertheless, there are patients who stopped or interrupted their antiplatelet therapy for certain reasons or some patients may be resistant or poor responders to antiplatelet therapy. Furthermore, there is evidence of rebound effect in platelet activity after antiplatelet cessation and this may associate with increased risk of cardiovascular event. This thesis is divided into five main chapters (chapters 3 to 7) which attempt to provide data to help resolve the uncertainty. Chapter 1 highlights the background of cardiovascular diseases and the global burden of cardiovascular and cerebrovascular diseases. The metabolism of platelets, antiplatelet therapy and current antiplatelet therapy guidelines are described, followed by discussion of the risk of cardiovascular event and changes in antiplatelet therapy. Chapter 2 describes the data source from Virtual International Stroke Trial Archive (VISTA) and National Health Service Greater Glasgow and Clyde (NHSGGC) Safe Haven, followed by definition of outcome measures. In chapter 3, Virtual International Stroke Trial Archive (VISTA) data was examined to test whether continue with the same antiplatelet therapy or changing to a new antiplatelet regimen reduces the risk of subsequent events in patients who experience a stroke whilst taking antiplatelet therapy. The findings indicate that subjects who switch to a new antiplatelet regimen after stroke did not have a lower early recurrence rate than subjects who continued with the same antiplatelet therapy. Observations on bleeding complications were similar in both groups. However, changing antiplatelet regimen after stroke was associated with more favourable functional outcome across a full scale modified Rankin Scale (mRS) at 90 days. In chapter 4, association between early or later initiation of antiplatelet with a recurrent ischaemic stroke and bleeding complications was assessed using VISTA data. The findings indicate that there was no association between a recurrent ischaemic stroke and timing of initiation of antiplatelet drug after stroke. However, early initiation was associated with increased risk of bleeding. In terms of functional outcomes, this study demonstrated that the mid-time and late initiation of antiplatelet therapy after acute stroke are associated with better functional outcomes compared with early initiation. In chapter 5, a nested case-control study was performed to explore the rate of antiplatelet cessation and interruption in a sample of patients with recent ischaemic stroke and to assess the risk of cardiovascular events associated with cessation and interruption of antiplatelet. It was found that there was no increased risk of cardiovascular event among patients who had early cessation or interrupted/stopped antiplatelet therapy within 90 days following acute ischaemic stroke. In chapter 6, the incidence and predictors of cardiovascular events after DAPT cessation were evaluated. The incidence of cardiovascular event while taking DAPT and following discontinuation of DAPT was 15.7% and 16.7% respectively. This study found that increasing age was associated with an increased risk of cardiovascular event, whereas, revascularization-treated patients and longer duration of DAPT, were each associated with a decreased risk. The duration of DAPT six months and less was associated a significantly higher risk for cardiovascular event. In chapter 7, an untargeted metabolomics analysis was performed while on DAPT (aspirin plus ticagrelor) and once they stopped ticagrelor to identify metabolite changes associated with cardiovascular events after stopping DAPT. Ten ACS patients were recruited in this study and data were analysed for seven patients. Three hundred eleven putative metabolites were identified. This study found 16 putative metabolites significantly altered following ticagrelor cessation. Of these, seven metabolites were from lipid pathway and down-regulated some up to 3-fold. On the other hand, adenosine, from nucleotide metabolism was upregulated up to 2.6-fold. It concluded that there are changes in numerous pathways following DAPT discontinuation and whether these changes differ in patients who have cardiovascular event after stopping DAPT warrant further investigation. In chapter 8, a summary of the findings of this thesis are presented as well as the future directions of research in this area.
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26

Crabb, Jennifer A. "Physical activity maintenance trends, predictors, and cardiovascular outcomes /." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2006. https://www.mhsl.uab.edu/dt/2009r/crabb.pdf.

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27

Lord, Tanya. "Early Detection and Treatment of Acute Clinical Decline in Hospitalized Patients: An Observational Study of ICU Transfers and an Assessment of the Effectiveness of a Rapid Response Program: A Dissertation." eScholarship@UMMS, 2011. https://escholarship.umassmed.edu/gsbs_diss/561.

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The Institute for Healthcare Improvement (IHI) has promoted implementing a RRS to provide safer care for hospitalized patients. Additionally, the Joint Commission made implementing a RRS a 2008 National Patient Safety Goal. Although mandated, the evidence to support the effectiveness of a RRS to reduce cardiac arrests on hospital medical or surgical floors and un-anticipated ICU transfers remains inconclusive, partly because of weak study designs and partly due to a failure of published studies to report all critical aspects of their intervention. This study attempted to evaluate the effectiveness and the implementation of a RRS on the two campuses of the UMass Memorial Medical Center (UMMMC). The first study presented was an attempt to identify the preventability and timeliness of floor to ICU transfers. This was done using 3 chief residents who reviewed 100 randomly selected medical records. Using Cohen’s kappa to assess the inter-rater reliability it was determined that 13% of the cases could have possibly been preventable with earlier intervention. The second study was an evaluation of the effectiveness of the Rapid Response System. Outcomes were cardiac arrests, code calls and floor to ICU admissions. There were two study periods 24 months before the intervention and 24 months after. A Spline regression model was used to compare the two time periods. Though there was a consistent downward trend over all 4 years there were no statistically significant changes in the cardiac arrests and ICU transfers when comparing the before and after periods. There was a significant reduction in code calls to the floors on the University campus. The third study was a modified process evaluation of the Rapid Response intervention that will assess fidelity of RRS implementation, the proportion of the intended patient population that is reached by the RRS, the overall number of RRS calls implemented (dose delivered) and the perceptions of the hospital staff affected by the RRS with respect to acceptability and satisfaction with the RRS and barriers to utilization. The process evaluation showed that that the Rapid Response System was for the most part being used as it was designed, though the nurses were not using the specific triggers as a deciding factor in making the call. Staff satisfaction with the intervention was very high. Overall these studies demonstrated the difficulty in clearly defining outcomes and data collection in a large hospital system. Additionally the importance of different study designs and analysis methods are discussed.
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28

O’Lone, Emma. "Cardiovascular disease: priorities and outcomes in end stage kidney disease." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/22326.

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Introduction End stage kidney disease (ESKD) accounts for 5-10 million deaths annually worldwide. The current treatment modalities for ESKD include dialysis, transplant and supportive care. The leading cause of death for people with ESKD is cardiovascular disease (CVD). CVD is a collective term for disease affecting the heart and blood vessels including coronary, cerebral and peripheral blood vessels. CVD causes significant morbidity and has a substantial impact on quality of life for people with ESKD. Improving cardiovascular outcomes for people living with ESKD is a priority. The escalating incidence of chronic kidney disease, its progression to ESKD and the high burden of cardiovascular disease has generated an increasing amount of research in the ESKD population. The ESKD population have previously been under-represented in clinical trials and current trials in ESKD have infrequently and inconsistently reported CVD outcomes. It is important to standardise outcomes used in research. When outcome reporting is standardised it enables comparisons of findings across trials, populations and eras. It is important that the outcomes reflect patient priorities and are relevant to patients and clinicians for use in shared decision making. The Standardised Outcomes in Nephrology Group (SONG) is an international initiative to establish a set of core outcomes and outcome measures across the spectrum of kidney disease for trials and other forms of research. The SONG-Haemodialysis (SONG - HD) initiative is developing a core outcome set for use in haemodialysis. As part of SONG-HD, CVD (as well as fatigue, vascular access and mortality) has been identified as important to all stakeholders and included in the core outcome set for haemodialysis. This requires appropriate measures of CVD to be identified and used. The first aim of this thesis was to achieve consensus on a CVD outcome measure for use in haemodialysis trials. In approaching this goal I first needed to ascertain the current use of cardiovascular outcomes (Chapter 2) and then determine which ones were important to all stakeholders (Chapter 3). Consensus over which is the most appropriate measure of CVD for use in trials in people on haemodialysis (Chapter 4) will allow improved standardisation of cardiovascular outcome reporting, reducing research wastage and will propel forward cardiovascular research to improve morbidity and mortality in this high risk population. The second aim of this thesis was to further examine some of the prioritised outcomes and to review the patterns and risks of CVD in the ESKD population. The magnitude of risk for cardiac events and cardiac deaths in people with ESKD relative to the general population and the changes over time are not well described. I hypothesised that the magnitude of risk remained high in the ESKD population and that epidemiological improvements seen in CVD outcomes in the general population have not been mirrored in the ESKD population (Chapters 5 and 6). CVD and more specifically cerebrovascular disease can lead to significant cognitive impairment which has a substantial impact on the ability of ESKD patients to understand their disease, interpret education and be involved in shared decision making. The patterns of cognitive deficit in the ESKD population are not well understood and I hypothesised that cognitive deficits in the ESKD population may be different to those found in the general population and may differ by modality of renal replacement therapy. Standardising CVD outcomes, examining the epidemiology of CVD in ESKD and comparing the trends and patterns to the general population can drive hypotheses into potential causative mechanisms and new treatments. I present this thesis as a hybrid of published work, work currently under peer review for publication and work submitted for publication on the theme of priorities and outcomes in ESKD.
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29

Ardito, Sabrina Queiroz. "Impacto da Insuficiência renal crônica associada à insuficiência Cardíaca Crônica Sistólica em pacientes com Cardiomiopatia Chagásica: Prevalência e Prognóstico." Faculdade de Medicina de São José do Rio Preto, 2011. http://bdtd.famerp.br/handle/tede/116.

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Made available in DSpace on 2016-01-26T12:51:32Z (GMT). No. of bitstreams: 1 sabrinaqueirozardito_dissert.pdf: 404181 bytes, checksum: cc58335cbd6ac86952c065cd2a36213e (MD5) Previous issue date: 2011-12-16
This study aimed at determining the prevalence and the prognostic significance of chronic renal impairment in patients with chronic systolic heart failure secondary to Chagas cardiomyopathy. A total of 245 patients followed at the Cardiomyopathy Outpatient service from January, 2000 to December, 2008 with the diagnosis of chronic systolic heart failure secondary to Chagas cardiomyopathy were included. Chronic renal impairment was diagnosed in 42 (17%) patients. A Cox proportional hazards model was used to evaluate the role of chronic renal impairment as a prognostic index, and a Kaplan-Meier survival curve to study its association with all-cause mortality. Baseline characteristics of patients with and without chronic renal impairment were similar. Beta-Blocker therapy (Hazard ratio=0,42; 95% Confidence Interval 0,27 to 0,63, p value <0,005), left ventricular ejection fraction (Hazard Ratio=0,97; 95% Confidence Interval 0,95 to 0,99; p value=0,005), serum sodium levels (Hazard ratio=0,94; 95% Confidence Interval 0,90 to 0,98; p value=0,004), inotropic support (Hazard Ratio= 1,85; 95% Confidence Interval 1,21 to 2,64; p value= 0,03), and digoxin use (Hazard ratio=2,35; 95% Confidence Interval 1,15 to 4,81; p value=0,02) were independent predictors of all- cause mortality. Survival probability at 12, 24, 36, and 60 months was 74%, 60%, 52%, and 37%, respectively, in patients with chronic renal impairment, and 84%, 70%, 70%, and 35% ,respectively, in patients without (p>0,05). Chronic renal impairment has a low prevalence and no prognostic significance in patients with chronic systolic heart failure secondary to Chagas Cardiomyopathy.
Este estudo tem por objetivo determinar a prevalência e a significância prognóstica da disfunção renal crônica em pacientes com insuficiência cardíaca crônica sistólica secundária à cardiomiopatia chagásica. Duzentos e quarenta e cinco pacientes seguidos no Ambulatório de Cardiomiopatia de Janeiro de 2000 a Dezembro de 2008 com o diagnóstico de insuficiência cardíaca crônica secundária a cardiomiopatia Chagásica foram incluídos no estudo. Disfunção renal crônica foi diagnósticada em 42 (17%) pacientes. Um modelo proporcional de Cox foi usado para avaliar a evolução da disfunção renal crônica como um indice prognóstico, e uma curva de sobrevida de Kaplan-Meier para estudar sua associação com todas as causas de mortalidade. As características basais dos pacientes com e sem disfunção renal crônica foram semelhantes. Terapia com betabloqueador (Razão de Risco=0,42; Intervalo de Confiança 95% de 0,27 a 0,63, p<0,005)], fração de ejeção ventricular esquerda(Razão de Risco=0,97; Intervalo de Confiança 95% de 0,95 a 0,99; p=0,005), nível sérico de sódio(Razão de Risco=0,94; Intervalo de Confiança 95% de 0,90 a 0,98; p=0,004), suporte inotrópico(Razão de risco = 1,85; Intervalo de Confiança 95% de 1,21 a 2,64; p= 0,03) e uso de digoxina(Razão de Risco =2,35; Intervalo de Confiança 95% de 1,15 a 4,81; p=0,02) foram fatores de predição independentes de mortalidade geral. A probabilidade de sobrevida em 12, 24, 36, e 60 meses foi 74%, 60%, 52%, e 37%, respectivamente, em pacientes com disfunção renal crônica e 84%, 70%, 70% e 35%, respectivamente, em pacientes sem disfunção renal crônica(p>0,05). A disfunção renal crônica tem baixa prevalência e não tem significância prognóstica em pacientes com insuficiência cardíaca crônica sistólica secundária a cardiomiopatia chagásica.
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30

Lloyd, Guy William Llewelyn. "Cardiovascular disease in women : treatment outcomes and hormonal factors." Thesis, King's College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.401029.

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31

Watson, Timothy J. "REVUP : Cardiovascular risk outcomes from a healthy lifestyle intervention." Master's thesis, Australian Catholic University, 2018. https://acuresearchbank.acu.edu.au/download/645ab255c8ad639cddce0fb9c82565a24ec53949f8e430fad7fea40ff7297352/23541627/Watson_2018_REVUP_cardiovascular_risk_outcomes_from_a.pdf.

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Introduction: Workplaces provide researchers and employers with an opportunity to engage in the health behaviours of employees. Despite the number of Australians in employment, many employers do not have meaningful programs to aid in the development of healthy behaviours. Internet delivered programs have advantages of reduced cost, ease of implementation over distance, and reliance on previously existing infrastructure. The Aim of REVUP is to assess the effectiveness of an online delivered, workplace health program on improving health risk factors. Method: The REVUP study was a single-blind, randomized controlled trial. Targeted participants were aged between 18 and 80 years and engaged in employment with the Uniting Church of Australia. A 12-week program was delivered via two emails per week, containing a video link and newsletter with activities. A range of topics was presented including physical activity, diet, goal setting, smoking cessation, and mental wellness. A comprehensive testing battery was utilised including objective measures of physical activity, blood testing, physical capacity assessments, and questionnaires. Results: Adoption and adherence to the program was low. Amongst the 36 individuals interested in the program 21 participants were randomised, with 15 completing the program. No significant differences were detected in any outcome measures. Adjusted effect sizes show promising results. Discussion: Significant barriers exist to the adoption and efficacy of internet delivered workplace health programs. Future programs may benefit from implementation of technology and structures that aids the development of intrinsic motivation and social support. Substantial integration of psychological theory, particularly in developing autonomous supportive environments is likely needed to support adherence and effective outcomes.
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32

Lopez, Marco Ana. "Low-flow low-gradient aortic stenosis: outcomes after aortic valve replacement." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/667817.

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Aortic stenosis is the commonest valve disorder in the Western World. The natural history of the disease is very well described; with a decreased survival once symptoms occur. There is currently, no medical therapy available to reduce the natural progression of the aortic stenosis, and therefore, aortic valve replacement has been recognised as the standard of care treatment for symptomatic aortic stenosis, with TAVI having merged as alternative for those cases with high/prohibitive surgical risk. All types of aortic stenosis have in common a reduced valve area (AVA <1.0cm2), but depending on the mean gradients and the stroke volume index, there are different types: Normal-Flow High-Gradient (NFHG AS) and Low-Flow Low-Gradient (LFLG AS) aortic stenosis. The latter is further subdivided into Classical and Paradoxical forms depending on the ejection fraction value. NFHG AS is the most common type. The left ventricle is capable of generating a normal flow through the stenotic valve, that it is translated onto high gradients. This type has been thoroughly studied and has an excellent prognostic with aortic valve replacement, with very low in-hospital mortality and long-term survival similar to the age-matched population. LFLG AS, on the other hand, is defined by a reduced stroke volume (SVi < 35 ml/min) and a low gradient (mean gradient < 40mmHg). The Classical form (CLFLG AS) has impaired ventricular function. These patients have dilated ventricles that are not able to generate enough flow through the stenotic valve and hence the low gradient. Dobutamine stress echocardiography is key for the diagnosis of this subtype, as it differentiates it from the Pseudo-Severe aortic stenosis (in which the problem is not in the aortic valve but in the left ventricle, and therefore there is no benefit from aortic valve replacement) and it has also prognostic value by determining the contractile reserve. These patients have been reported to have the highest mortality post aortic valve replacement and a reduced long-term survival; however, those who survive achieve excellent functional class. The other subtype of LFLG, the Paradoxical form (PLFLG AS) has a preserved ventricular function. These patients have a ventricular restrictive physiology, with reduced SVi due to a combination of mechanism such as subendocardial fibrosis, concentric remodeling, impaired diastolic filling and high afterload. It is paramount here to confirm the diagnosis by accurate echocardiography, ruling out measurement errors and other causes of reduced SVi. PLFLG AS patients have worse prognosis than NFHG AS but better prognosis than CLFLG AS patients. The primary hypothesis of our research project was that aortic valve replacement could be performed in patients with LFLG AS with low in-hospital mortality. Therefore, with the objectives of determining operative and mid-term outcomes of surgical intervention in LFLG AS compared to NFHG AS, we conducted a retrospective analysis of all patients who underwent isolated aortic valve replacement in our centre. Primary end-points were mortality (in-hospital, at one and five years) and the secondary end-points analysed were postoperative complications and clinical status at follow-up. Patients in the LFLG AS group were significantly older and had more cardiovascular risk factors and comorbidities than the NFHG AS group. Despite those differences, in-hospital mortality was equivalent and remarkably low in both groups. As expected, LFLG AS patients had a reduced mid-term survival but those who survived remained in an excellent functional class. With the separate analysis of the LFLG AS subgroups, we confirmed that CLFLG AS had higher in-hospital and mid-term mortality than PLFLG AS patients. In both groups, the in-hospital mortality was remarkably low compared to previous literature reports. Aortic valve replacement provided symptomatic relief and excellent functional class during the mid-term follow-up as well as recovery of the ventricular function in most of the patients. Based on our results, we concluded that aortic valve replacement should be recommended for symptomatic severe LFLG AS.
La estenosis aórtica es la enfermedad valvular más frecuente en el tercer mundo. La historia natural de la enfermedad es bien conocida desde hace décadas, siendo una enfermedad con mal pronóstico a medio-corto plazo que hace necesario someter a estos pacientes a recambio valvular aórtico tras la aparición de síntomas. La forma mas común de estenosis aórtica, con flujo normal y gradiente alto, tiene un pronóstico excelente tras el recambio valvular aórtico, con una supervivencia similar a la de la población normal. Sin embargo, la estenosis aórtica de bajo-flujo y bajo-gradiente, es una entidad menos conocida y de peor pronóstico. Estos pacientes tienen una mortalidad mucho mayor tras recambio valvular aórtico y menor supervivencia a largo plazo. El diagnóstico en el bajo-flujo bajo-gradiente es vital para seleccionar correctamente los pacientes con estenosis aórtica que se beneficiarán de tratamiento quirúrgico, teniendo también valor pronóstico, dependiendo de la categoría de bajo flujo (Clásica o Paradójica) y otros determinantes como la presencia/ausencia de reserva contráctil del ventrículo izquierdo. Nuestra hipótesis fue que la estenosis aórtica de bajo-flujo y bajo-gradiente, pueden ser tratada con recambio valvular aórtico con una mortalidad hospitalaria similar a aquellos con flujo normal y alto gradiente. Los objetivos del proyecto fueron el análisis de resultados hospitalarios y a medio plazo (mortalidad hospitalaria, a 1 y 5 años) así como la clase funcional y recuperación de la función ventricular, en pacientes con estenosis aórtica de bajo-flujo bajo-gradiente sometidos a recambio valvular aórtico comparado con flujo normal alto-gradiente. Nuestros resultados nos llevan a la conclusión de que el recambio valvular aórtico en pacientes con estenosis aórtica de bajo-flujo bajo-gradiente se puede lograr con baja mortalidad quirúrgica, comparable con pacientes con flujo normal y alto gradiente. A pesar de que tener una mayor mortalidad a medio-plazo, los supervivientes exhiben una excelente clase funcional y desaparición de síntomas, que apoyan la indicación quirúrgica en estos pacientes.
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33

Molloy, Eamonn S. "Cardiovascular outcomes and in-hospital mortality in fiant cell arteritis." Cleveland, Ohio : Case Western Reserve University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=case1212093974.

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34

Allard, Matthew. "Phenotypic characterization and cardiovascular outcomes of patients with familial hypercholesterolemia." Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/45312.

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Background: Familial hypercholesterolemia (FH) is a common autosomal dominant disorder caused by mutations in the low-density lipoprotein (LDL) receptor, apolipoprotein B-100 gene, or proprotein convertase subtilisin/kexin type 9, resulting in very high blood cholesterol levels and premature cardiovascular disease (CVD). Hypotheses/ Objectives: 1. FH patients who have developed CVD differ from those free of CVD by specific risk factors. 2. The specific risk factors differ in FH patients who develop CVD early and those resistant to CVD 3. These risk factors risk factors differ between men and women. 4. These risk factors differ between ethnic groups. Methods: A retrospective chart review of patients in the Prevention Clinic was carried out to find individuals with “definite” FH according to the Dutch Lipid Clinic Network Criteria (DLCNC) and to determine which patients developed CVD. Cox proportional hazard regression analysis was used to assess the association of risk factors to hard cardiovascular outcomes in univariate and multivariate analyses. Results: A total of 446 patients were identified as having “definite” FH based upon the DLCNC with 116 (26%) patients having hard evidence of CVD. Male sex, smoking, family history of premature CVD, diabetes mellitus, low HDL-C and high Lp(a) proved to be significant, independent risk factors for CVD in the entire FH cohort. The same risk factors remained significant when comparing FH patients susceptible to CVD to those resistant to CVD. Of note, LDL-C and hypertension were not important risk factors for CVD in this cohort. In men, family history, diabetes and low levels of HDL-C were significant risk factors for CVD while in women smoking, diabetes mellitus, low levels of HDL-C and high Lp(a) were significant risk factors for CVD. There were minimal detectable differences in risk factors between ethnicities. Conclusion: In our ethnically diverse cohort the significant risk factors for CVD in decreasing order of importance were, male sex, diabetes, high Lp(a), smoking, family history of pre-mature CVD, and low HDL-C in both the entire group as well as in the most susceptible subgroup. Men and women differed in the impact of the risk factors on the presence of CVD.
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Cruickshank, James. "Methodological issues and neuropsychological outcomes following vascular and cardiovascular surgery." Thesis, University of Leeds, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.399884.

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Molloy, Eamonn S. "Cardiovascular Outcomes and In-Hospital Mortality in Giant Cell Arteritis." Case Western Reserve University School of Graduate Studies / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=case1212093974.

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37

Poon, Chuen. "Cardiovascular outcomes of neonatal respiratory disease in infants and children." Thesis, Cardiff University, 2015. http://orca.cf.ac.uk/91302/.

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The aim of this thesis is to compare effects of respiratory distress syndrome (RDS) on the myocardial function of newborn preterm infants and the later effects of chronic lung disease of prematurity on pulmonary artery stiffness in school age children. The first study in this thesis compared global and regional myocardial function in preterm infants with respiratory distress syndrome (RDS) with preterm and term-born controls (30 with RDS, 30 preterm control ≤34 weeks, 60 term control) using conventional and tissue Doppler echocardiography at birth, at term, one month, and one year of age. The second study compared the pulmonary artery stiffness, an early preclinical marker of pulmonary hypertension, in children (aged 8-12 years) who had chronic lung disease of prematurity (CLD) with preterm and term-born controls. Pulmonary artery pulse wave velocity (PA PWV) was assessed in 59 children: 13 with CLD, 21 preterm (≤ 32 weeks gestation) and 25 term controls) using velocity encoded MRI technique while breathing room air and after 20 minutes of breathing 12% oxygen. At birth, infants with RDS had lower pulmonary artery AT:ET (p < 0.001), long axis shortening (p < 0.01), RV systolic velocity (p < 0.001) and higher TR (p < 0.01) compared to preterm and term control groups. The preterm groups was also noted to have diastolic dysfunction (lower mitral E:A) at birth (p < 0.001). At term corrected age, pulmonary artery AT:ET was still lower in the RDS group but no differences detected in TR between the groups. There were no differences in all parameters measured between the groups at one month and one year. 2 PA PWV was similar in all three groups at baseline when assessed at school age. However, following hypoxic challenge, PA PWV in children who had CLD increased significantly compared to preterm (p=0.025) and term controls (p=0.042). The findings in this thesis suggest that infants with RDS had mildly elevated pulmonary arterial pressure as a result of milder respiratory disease with improvement in antenatal and neonatal care. The RV global dysfunction in infants with RDS resolved with resolution of the respiratory condition. Both preterm groups underwent postnatal maturation of myocardial function and caught up with the term control group by one month corrected age. At school age, children who had CLD displayed increased pulmonary vascular reactivity to hypoxia and are at greater risk of developing pulmonary hypertension earlier.
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MARIANI, JACOPO. "AIR POLLUTION EXPOSURE IN PREGNANCY: NASAL MICROBIOTA AND EXTRACELLULAR VESICLE COMMUNICATION AS POTENTIAL MECHANISM TO EXPLAIN ADVERSE BIRTH OUTCOMES." Doctoral thesis, Università degli Studi di Milano, 2021. http://hdl.handle.net/2434/813004.

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ABSTRACT BACKGROUND: Particulate matter (PM) exposure has been linked to the exacerbation of respiratory and cardiovascular conditions as well as to adverse effects on fetal growth. To link the cross-talk that might occur between respiratory system and placenta after PM exposure, it has been proposed a novel mechanism of cell to cell communication mediated by extracellular vesicles (EVs). EVs are involved in both biological and pathological processes including pregnancy state. As PM interacts firstly with the nares, bacterial nasal microbiota (bNM) is one of the first compartments hit by PM exposure. This interaction might lead to structural and functional modifications within the bNM, which could cause variations within the EVs signaling network, which might lead to an improper immune response to PM stimuli. AIM: The main aim of the project was to identify how PM exposure might modify the homeostasis and composition of whole EV signaling network and bNM and the leading to a possible impact on newborn development. Subject recruitment: 518 volunteer pregnant women were enrolled during the 11th week of pregnancy at the ‘Clinica Mangiagalli’-Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy. Among them, a group of subjects composed by 65 pregnant women, who agreed to participate to a more complex study protocol, was also identified. Exposure assessment, EV and Microbiota measurement: Exposure to PM concentrations was assessed using data obtained from FARM models for the whole population. In addition, individual exposure to short-term PM levels was retrieved through a personal sampler worn by the subgroup of 65 pregnant women. Plasmatic concentration and cellular origin of EVs were characterized by Nanoparticle tracking analysis (NTA) and flow cytometry, respectively. We investigated the bNM structure and characteristics of 65 pregnant women both at the enrolment (T0) and the following Monday during the cardiovascular screening (T1) through metabarcoding analysis of the V3–V4 regions of the 16s rRNA gene. Statistical analysis: Multivariable linear regression models were applied to test the associations between PM exposure (retrieved from both FARM models and personal sampler) and the majority of the collected outcomes such as maternal, foetal/newborns, and cardiovascular parameters as well as for bNM data. On the other hand, to evaluate possible associations between PM concentrations and EV characteristics negative binomial regression models for count data with over-dispersion were performed. In addition, multiple comparison method based on Benjamini-Hochberg False Discovery Rate (FDR) were applied for high number of comparisons. RESULTS In the whole population, PM10 exposure (measured at different time windows) resulted in decreased release of total amount of EVs, with the strongest effect related to concentration measured 13 weeks before the enrolment (13wks), whereas an inverse tendency was observed for exposure to PM2.5, although these associations were not significant. More reliable data on the finest fractions (PM1, PM2.5 and PM4) are given by personal sampler worn by a subgroup of women for a very short time period preceding the blood drawing (1.5 hours). As we considered this extremely acute effect, we observed a generalized increment in the EV count. Noteworthy, among the different analyzed EV subtypes, the levels of HERV-w+ EVs were the only to be increased by each tested PM10 time-lag. The same models applied on bNM data showed a reduction in terms of diversity (Shannon/Faith_pd ratio) and relative abundance of the genera Corynebacterium spp. and Staphylococcus spp. In addition, when the possible role of bNM as effect modifier between PM exposure and EVs release was investigated, we observed for the pregnant women with a balanced bNM an increment in terms of circulating EVs after daily PM stimuli. Moreover, increments of the heart rate values were observed after exposure to both PM10 and PM2.5 levels measured the day before the cardiovascular screening (Day -1). Focusing on newborn’s outcomes, decrements of the gestational age at birth were associated to PM concentrations measured throughout the gestation or during the 2nd trimester. CONCLUSIONS: To our knowledge, this is the first exploring the role of bNM and the EV cross-talk in determining the effects of PM exposure levels on healthy pregnancies as well as on newborn outcomes. The results obtained so far might suggest a possible role exerted by both EV concentration and the bNM in pregnant women in mediating the effects of PM exposure.
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Larouche, Richard. "Assessing the Health-Related Outcomes and Correlates of Active Transportation in Children and Youth." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/26158.

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Active school transport (AST; e.g. the use of non-motorized modes such as walking and cycling to travel to/from school) is an inexpensive, accessible and environmentally-friendly source of physical activity (PA). This dissertation addresses two overarching objectives: 1) to measure the relationships of AST with PA and health-related outcomes; and 2) to examine the correlates of AST immediately before and after the transition from primary to secondary school (the “school transition”). First, a systematic review revealed increasing evidence showing that AST is associated with greater daily PA levels, and that cycling to/from school is associated with higher cardiovascular fitness. Cycling for transportation (not only for school trips) was also associated with lower values for total cholesterol and total cholesterol/HDL cholesterol ratio in the nationally-representative 2007-2009 Canadian Health Measures Survey. Moreover, the present dissertation provides preliminary evidence suggesting that AST may help attenuate the decline in PA across the school transition. However, the relationship between AST and body composition indicators remains unclear. With respect to the correlates of AST, distance was the strongest barrier to AST at both time points, but several road safety concerns, and the perception of having too much stuff to carry were also associated with engagement in motorized travel. At follow-up, AST was more common in children whose parents owned less than 2 cars. In contrast, children were more likely to engage in AST if their parents reported that they chose to live in their current neighbourhood so that their children could walk or bike to school. The associations of neighbourhood walkability (as measured with the Walk Score® application) with AST and PA were generally stronger after the school transition. While AST may improve health among children and youth, an ecological approach targeting multiple levels of influence will likely be needed to alleviate current barriers to AST.
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Hyun, Karice Kyonga. "Exploration of inequities in prevention and outcomes of cardiovascular disease in Australia." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/18249.

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The prevention and treatment of cardiovascular disease (CVD), in particular, acute coronary syndrome (ACS), constitute a major economic and social burden globally and nationally. Furthermore, CVD continues to be the leading cause of death and affects patients as well as the healthcare system markedly. Despite the guidelines and policies available to reduce this burden, previous studies suggest that evidence-practice gaps in CVD care and management still exists; therefore, a greater understanding of inequities in healthcare and access to services is needed in order to close these gaps in CVD management. The World Health Organization (WHO) has reported that, across the globe, there are numerous social factors that are associated with health inequities. These inequities reportedly affect outcomes and impose problems for the individuals as well as the healthcare system. In Australia, inequity in the delivery of care has been documented in various chronic disease areas. Populations for whom inequity has been documented include women, those with lower socioeconomic status (SES) and limited English proficiency. Overall, there are a few studies, especially in Australia, describing how these subpopulations are managed in regard to the prevention and the treatment of CVD in primary healthcare, hospital and post-discharge. Therefore, the specific aims of this thesis are to [1] determine the effect of gender on the primary prevention of CVD, the receipt of CVD risk factor assessment and prescription of guideline-recommended medications in Australian primary healthcare; [2] determine the effect of socioeconomic status on ACS patients on the receipt of in-hospital care and clinical outcomes, including major adverse cardiovascular events or death; [3] determine if English proficiency of ACS patients admitted to Australian hospitals has an effect on the receipt of in-hospital care and major adverse cardiovascular events and death in hospital and from admission to follow-up; [4] identify the factors that contribute to household economic hardship following an ACS presentation, on the assumption that this may contribute to the lack of adherence to the appropriate care at post-discharge. For this thesis, two systematic reviews will be performed and the specific aims will be addressed by analysing three Australian datasets. First, the TORPEDO study (N=53,085) which extracted 53,085 patient data at baseline from 40 general practices and 20 Aboriginal community controlled health services. Second, the CONCORDANCE registry which is an ongoing registry which collected over 10,000 patients with suspected or confirmed ACS since 2009 from 42 public hospitals nationwide. Third, the SNAPSHOT ACS which was an observational audit that collected data on 4,387 patients with suspected or confirmed diagnosis of ACS admitted to 286 Australian and NZ hospitals between 14-27 May 2012. For Aim 1, a systematic review was performed to find the pooled effect of gender difference in the assessment of CVD risk factors. Further, TORPEDO data were used to compare the likelihood of primary prevention of CVD by evaluating the risk factor assessment, and further, for those at high-risk of CVD, prescription of medications at primary healthcare services between women and men. For Aim 2, the receipt of individual guideline-recommended medications in patients with ACS compared between the low and the high individual or area-level SES groups was explored through a systematic review. Moreover, CONCORDANCE dataset was used to compare in-hospital care (the receipt of coronary angiogram, revascularisation, a combination of the guideline-recommended medications and referral to cardiac rehabilitation) and clinical outcomes (major adverse cardiovascular event (MACE) and death) between four socioeconomic groups determined by their area of residence. For Aim 3, SNAPSHOT ACS data were used to compare limited English proficient and English proficient patients in regards to their in-hospital care, including the length of stay and the receipt of coronary angiogram, revascularisation, guideline-recommended medications, referral to cardiac rehabilitation smoking cessation advice, dietary advice and physical activity advice, and clinical outcomes, including MACE (myocardial infarction/heart failure/stroke) and death. For Aim 4, SNAPSHOT ACS health economic data were used to examine the factors associated with greater likelihood of experiencing economic hardship following their acute presentation. In terms of results, there was inequitable care for primary prevention of CVD but comparable care and clinical outcomes were observed during the acute presentation to Australian hospitals. For Aim 1, although the pooled international results showed no gender disparity in the assessment of CVD risk, in Australian primary healthcare, women were disadvantaged in receiving weaker primary prevention of CVD than men. In Australia, women had 12% lower odds of being assessed for CVD risk factors (odds ratio (95% confidence interval): 0.88 (0.81, 0.96)). Among patients with CVD or at high CVD risk, women aged 35-54 years were less likely to be prescribed the recommended medications for CVD management (0.63 (0.52, 0.77)), whereas women aged ≥65 years were more likely to be prescribed the medications (1.34 (1.17, 1.54)) compared to their male counterparts. For Aim 2 and Aim 3, the pooled international studies presented the difference in the prescription of guideline-recommended discharge medications, including beta blocker, statin and angiotensin-converting enzyme (ACE), between the lowest and the highest SES groups to patients with ACS in hospital. In Australian hospitals, equitable care was provided to patients with ACS despite their SES or English proficiency during an acute presentation. The likelihood of receiving coronary angiogram, revascularisation, four or more of the five guideline-recommended medication and referral to cardiac rehabilitation were similar across the SES groups. The group with the lowest SES status were found to have higher odds of MACE, driven by the odds of heart failure, however, no significant difference in the odds of short-term and long-term death was found between the groups. Similarly, patients’ proficiency in English did not affect the length of stay, and receipt of coronary angiogram, revascularisation, guideline-recommended medications, referral to cardiac rehabilitation and advice on smoking cessation, diet and physical activity. Further, the likelihood of short-term and long-term MACE and/or death were comparable. For Aim 4, post-discharge, more than 50% of patients who survived ACS reported having experienced economic hardship. Those who were more likely to experience household economic hardship included patients who were younger (18-59 vs ≥80 years: 1.89 (0.77, 4.63)), with no private health insurance (2.04 (1.37, 3.03)), with pensioner concession card (1.80 (1.03, 3.18)) and in low socioeconomic group (lowest vs. highest: 1.77 (0.91, 3.45)). Gender was not associated with experiencing hardship. Overall, this thesis suggests that, in Australia, inequities exist in primary healthcare regarding the prevention and care of CVD between genders, where women are disadvantaged compared to men, but equitable acute care is provided to patients who have presented to a hospital due to ACS, regardless of their SES or English proficiency. Post discharge, patients with low SES are more likely to experience economic hardship which may lead to further inequity in long-term secondary prevention. Although it is an encouraging affirmation that ACS patient care in hospital is not affected by patients’ SES or English proficiency, system-wide solutions are needed to resolve the issue of inequity in primary prevention of CVD and reduce the economic burden of managing ACS to, therefore, reduce the risk of a secondary event.
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41

Mooney, John Francis. "Prevention of Cardiovascular and Renal Outcomes in Patients undergoing Non Cardiac Surgery." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/16056.

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Background- Surgery is an essential component of heath care worldwide, however is increasingly associated with significant rates of adverse peri-operative myocardial infarction (PMI) and acute kidney injury (AKI), which are both potent post-operative complications associated with major morbidity and mortality. These events can be clinically silent and their diagnosis missed, yet whether clinically symptomatic or not they are strongly associated with worse post-operative outcomes. The goal of this work is to examine the opportunities to prevent PMI and AKI. Starting in the pre-operative setting, evaluation, management and implementation of current perioperative guidelines prior to surgery is likely to be key to this. In addition, understanding the application of risk prediction and the accuracy, role and contribution of biomarkers to predicting risk of perioperative adverse events is important. Here we focus on the more sensitive and novel biomarkers of renal function including the role of estimated Glomerular Filtration Rate (eGFR), cystatin c, urinary albumin: creatinine ratio (ACR) and Neutrophil Gelatinase Associated lipocalin (NGAL) and their association with adverse post-operative cardiac events, AKI and mortality. Thesis outline- The chapters and their objectives are detailed below: Chapter 2: Describes the methodology used. This incorporated a prospective cohort study of patients > 45 years old undergoing non cardiac surgery with at least one night in hospital and at least regional anaesthesia. Patients were recruited from Westmead hospital, a tertiary hospital in Western Sydney, NSW Australia. Data were collected on pre-, intra- and post-operative clinical factors as well as follow up at 30 days after surgery. Chapter 3: This chapter examines the pre-operative evaluation in terms of cardiovascular investigations and management of patients prior to surgery. It compares this to existing guidelines identifying a number of inconsistencies. It identifies both under and over utilisation of cardiac testing in disparate groups. It identifies in particular that those with known cardiovascular disease were undertreated with respect to preventative medications. Chapter 4: This was an analysis of the international VISION cohort recruited up till June 2011 and includes both patients recruited from Westmead hospital and participants from other sites. The aim of these analyses were to examine the prevalence of cardiovascular disease in this international cohort, the use of preventative medications and thus to document opportunities for prevention. From this it used modelling to determine predicted 5-year risk of cardio-vascular events with current medication adherence and compared this with optimization of adherence. Despite a history of either coronary, cerebro or peripheral vascular disease, only 1 in four patients were on optimal prevention, and one in 10 were on no secondary prevention. Chapter 5: In focussing on the role of renal biomarkers in predicting perioperative MI and AKI, this chapter describes a systematic review and meta-analysis of the literature, examining the strength of association between eGFR and post-operative events. The eGFR was strongly associated with post-operative outcomes, with a three-fold increase in risk of death within 30 days of surgery for patients with a pre-operative eGFR < 60 ml/min/1.73m2. Chapter 6: In the Westmead cohort, among those that provided urinary samples prior to surgery, these analyses examined the association of urinary ACR with PMI and AKI. It found that pre-operative urinary ACR was not predictive of cardiac or renal events, or mortality within 30 days after surgery. Chapter 7: In this chapter, the role of pre-operative cystatin c and creatinine based eGFR on mortality at long term follow up was examined. A separate cohort of patients undergoing cardiac surgery in Aberdeen, Scotland, was analysed. Cystatin c was found to be strongly associated with all-cause mortality at long term follow up. Its predictive utility did not improve on the EUROSCORE. Chapter 8: This chapter looks at association between post-operative NGAL levels and outcomes. It was based on the non-cardiac surgical cohort recruited at Westmead hospital who supplied post-operative urine samples. From this NGAL levels were analysed for association with post-operative AKI, and predictive utility. Elevated NGAL after surgery was not associated with cardiac or renal events, or all-cause mortality within 30 days of surgery. Conclusion- Despite improvements in surgical safety, a large number of patients are at risk of post-operative medical complications leading to organ injury and death. Pre-operative risk assessment is integral to prevention, though this is haphazard with implications for cost and delay to surgery. Furthermore, many patients presenting for surgery have cardiovascular disease, but lack adequate treatment and are at higher risk of future cardiovascular events. Finally, some alternative markers of renal function have stronger association with post-operative outcomes and have potential to improve risk stratification. Within this thesis it is suggested that outcomes can be improved by: Adherence to pre-operative assessment guidelines; optimizing vascular risk management for patients with cardio-vascular disease; and use of more sensitive renal biomarkers in risk predictive algorithms.
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Alonso-Ventura, Vanesa, Yangzhou Li, Vinay Pasupuleti, Yuani M. Roman, Adrian V. Hernandez, and Faustino R. Pérez-López. "Effects of preeclampsia and eclampsia on maternal metabolic and biochemical outcomes in later life: a systematic review and meta-analysis." W.B. Saunders, 2020. http://hdl.handle.net/10757/652437.

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Objective: To evaluate the association between preeclampsia (PE) and eclampsia (E) on subsequent metabolic and biochemical outcomes. Methods: Systematic review and meta-analysis of observational studies. We searched five engines until November 2018 for studies evaluating the effects of PE/E on metabolic and biochemical outcomes after delivery. PE was defined as presence of hypertension and proteinuria at >20 weeks of pregnancy; controls did not have PE/E. Primary outcomes were blood pressure (BP), body mass index (BMI), metabolic syndrome (MetS), blood lipids and glucose levels. Random effects models were used for meta-analyses, and effects reported as risk difference (RD) or mean difference (MD) and their 95% confidence interval (CI). Subgroup analyses by time of follow up, publication year, and confounder adjustment were performed. Results: We evaluated 41 cohorts including 3300 PE/E and 13,967 normotensive controls. Women were followed up from 3 months after delivery up to 32 years postpartum. In comparison to controls, PE/E significantly increased systolic BP (MD = 8.3 mmHg, 95%CI 6.8 to 9.7), diastolic BP (MD = 6.8 mmHg, 95%CI 5.6 to 8.0), BMI (MD = 2.0 kg/m2; 95%CI 1.6 to 2.4), waist (MD = 4.3 cm, 95%CI 3.1 to 5.5), waist-to-hip ratio (MD = 0.02, 95%CI 0.01 to 0.03), weight (MD = 5.1 kg, 95%CI 2.2 to 7.9), total cholesterol (MD = 4.6 mg/dL, CI 1.5 to 7.7), LDL (MD = 4.6 mg/dL; 95%CI 0.2 to 8.9), triglycerides (MD = 7.7 mg/dL, 95%CI 3.6 to 11.7), glucose (MD = 2.6 mg/dL, 95%CI 1.2 to 4.0), insulin (MD = 19.1 pmol/L, 95%CI 11.9 to 26.2), HOMA-IR index (MD = 0.7, 95%CI 0.2 to 1.2), C reactive protein (MD = 0.05 mg/dL, 95%CI 0.01 to 0.09), and the risks of hypertension (RD = 0.24, 95%CI 0.15 to 0.33) and MetS (RD = 0.11, 95%CI 0.08 to 0.15). Also, PE/E reduced HDL levels (MD = –2.15 mg/dL, 95%CI –3.46 to −0.85). Heterogeneity of effects was high for most outcomes. Risk of bias was moderate across studies. Subgroup analyses showed similar effects as main analyses. Conclusion: Women who had PE/E have worse metabolic and biochemical profile than those without PE/E in an intermediate to long term follow up period. ©
Revisión por pares
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43

Sukkar, Louisa. "Improving outcomes in chronic kidney disease and its associated comorbidities." Thesis, The University of Sydney, 2021. https://hdl.handle.net/2123/25667.

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Background: Chronic kidney disease (CKD) and its associated comorbidities such as diabetes and cardiovascular disease (CVD) are major drivers of death and disability around the world. Methods: This thesis by publication aims to examine the burden of CKD and diabetes in the community and explores the ways in which this burden can be ameliorated. These aims are achieved by various methodologies. A novel comprehensive population-based data linkage study is used to estimate CKD and diabetes incidence and associations as well as assesses health service delivery of proven cardioprotective treatments to mitigate the burden of CVD. An observational extension of a randomised controlled trial (RCT) cohort of people with CKD is used to investigate the legacy effect of statins on CVD. A narrative review examines the RCT evidence for the CV and kidney protection of novel glucose lowering agents for the treatment of diabetes. Systematic review and meta-analyses are used to examine treatment options to mitigate the effect of Acute kidney injury (AKI) a precursor of CKD. Results: This research program has demonstrated the high burden of CKD and diabetes in the community and identified risk factors that can be targeted to inform health service planning and resource allocation. New data is presented that demonstrates the significant missed opportunities in the use of cardioprotective therapies for CVD prevention. A literature review of glucose lowering agents showed CV and renal protection in people with and without pre-existing CVD. A systematic review of two currently used treatments for the management and prevention of AKI found no evidence for their continued use. Conclusions: Collectively the findings of this thesis have the potential to inform the design of strategies to target and readily implement solutions to improve health outcomes in CKD and diabetes.
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Doolan, Daniel M. "Age related differences in smoking cessation outcomes for women hospitalized with cardiovascular disease." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2007. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3261241.

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Saglimbene, Valeria. "Diet and health outcomes in adults with end stage kidney disease treated with haemodialysis." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20172.

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Adults with end-stage kidney disease (ESKD) treated with haemodialysis (HD) experience 15-20% mortality each year, mostly due to excess cardiovascular causes. Despite decades of research, the high rates of premature death remain largely unchanged. There is an unmet need for strategies to reduce this risk. Dietary modifications are important potential lifestyle intervention to improve health outcomes in HD and have been prioritized as an important area of research uncertainty by patients and healthcare professionals. The aim of this thesis is to investigate the association between diet at different levels (nutrients, food groups and dietary patterns) and survival in adults receiving HD. The “DIETary intake, death and hospitalization in adult with end-stage kidney disease treated with Haemodialysis (DIET-HD) study”, an international prospective cohort study of around 10000 patients treated with HD in Europe and South America, is the core of this work. The primary exposure of the study was informed by a systematic review of randomized controlled trials evaluating the benefits and harms of omega-3 fatty acids (n-3 PUFA) supplementation in chronic kidney disease. Low quality evidence suggested some cardiovascular benefit of omega-3 supplements in HD patients. However, this survival benefit was not seen in patients with higher consumption of dietary n-3 PUFA within the DIET-HD study. Overall, while the DIET-HD study found no association between n-3 PUFA dietary intake, existing dietary patterns considered healthy in the general population (such as Mediterranean and Dietary Approaches to Stop Hypertension diets) or data driven dietary patterns specific to the HD population and mortality, there was some evidence that higher fruit and vegetable intake may be associated with reduced all-cause death through non-cardiovascular pathways. Definitive answers on the role of diet on the health of HD patients will be provided only by large-scale, pragmatic interventions studies.
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Silva, Licera Humberto Rafael, and Yglesias María Antoinette Almeyda. "Effectiveness of bariatric surgery in morbidly obese adults for cardiovascular outcomes: a systematic review." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2021. http://hdl.handle.net/10757/656005.

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Objectives: to determine the effectiveness of bariatric surgery to reduce the risk of cardiovascular events such as coronary heart disease, stroke, cardiovascular mortality, and total mortality in morbidly obese patients, compared with a non-surgical treatment and no intervention control group. Methods: a systematic review was carried out with cohort-type studies that evaluated, with a minimum follow-up of one year, morbidly obese adults who had undergone bariatric surgery compared to a control group of non-surgical treatment and without intervention in relation to the cardiovascular events such as coronary heart disease, stroke, cardiovascular mortality, and total mortality in morbidly obese patients. Results: 14 studies were selected that met our inclusion criteria. 44,912 patients who underwent bariatric surgery and 208,347 non-surgical controls were included. The high heterogeneity of the included studies did not allow the meta-analysis to be carried out. However, most of the individual results show decreased risk of the outcomes studied. A subgroup analysis was performed, where Bariatric Roux-en-Y surgery reduces the risk of coronary artery disease by approximately 60%. In morbidly obese diabetic patients, our calculations showed a risk reduction of 80% for cardiovascular mortality and 70% for total mortality. Finally, our calculations show a 58% decrease in cardiovascular mortality in studies with a follow-up of 2 or more years. Conclusions: Our study suggests that bariatric surgery is beneficial for morbidly obese adult patients at risk of presenting cardiovascular events.
Objetivos: determinar la efectividad de la cirugía bariátrica para disminuir el riesgo de eventos cardiovasculares como enfermedad coronaria, accidente cerebrovascular, mortalidad cardiovascular y mortalidad total en pacientes obesos mórbidos, comparado con un grupo control de tratamiento no quirúrgico y sin intervención. Métodos: se realizó una revisión sistemática con estudios de tipo cohortes que evalúen, con seguimiento mínimo de un año, a adultos obesos mórbidos que se hayan sometido a cirugía bariátrica en comparación a un grupo control de tratamiento no quirúrgico y sin intervención en relación con los eventos cardiovasculares como enfermedad coronaria, accidente cerebrovascular, mortalidad cardiovascular y mortalidad total en pacientes obesos mórbidos. Resultados: se seleccionaron 14 estudios que cumplieron nuestros criterios de inclusión. Se incluyeron 44 912 pacientes que se sometieron a cirugía bariátrica y 208 347 controles no quirúrgicos. La alta heterogeneidad de los estudios incluidos no permitió realizar el metaanálisis. Sin embargo, la mayoría de los resultados individuales muestran disminución del riesgo de los desenlaces estudiados. Se realizó un análisis por subgrupos, en donde la cirugía bariátrica en Y de Roux disminuye el riesgo de enfermedad coronaria en aproximadamente 60%. En pacientes obesos mórbidos diabéticos nuestros cálculos mostraron reducción del riesgo en 80% de mortalidad cardiovascular y 70% de mortalidad total. Por último, nuestros cálculos demuestran disminución del 58% de la mortalidad cardiovascular en los estudios con un seguimiento de 2 a más años. Conclusiones: Nuestro estudio sugiere que la cirugía bariátrica es beneficiosa para los pacientes adultos obesos mórbidos en riesgo de presentar eventos cardiovasculares
Tesis
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47

Helman, Tessa J. "The Systems Biology of Chronic Stress in Mice: Integrated Neurobiological, Behavioural and Cardiovascular Outcomes." Thesis, Griffith University, 2022. http://hdl.handle.net/10072/412435.

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The demands of modern life are often challenging and require psychological efforts in order to be effectively met. Conserved through evolution, acute psychological stress (in response to an acute threat) activates physiological systems that are advantageous, exerting appropriately timed responses to promote survival. However, the advantageous outcomes of the acute stress response are reversed under prolonged conditions (chronic stress), detrimentally influencing biological processes and/or behaviours and increasing disease risks. This disease risk is imposed on virtually all organ systems, and ranges from mood disorders (e.g., major depressive disorder; MDD) to cardiovascular (e.g., ischaemic heart disease; IHD) and metabolic (e.g., type 2 diabetes; T2D) diseases. Although the impact of chronic psychological stress on mood disorders has been well documented, its effects on other body systems (including cardiovascular, circulatory, and hepatic systems) are less detailed. Furthermore, chronic psychological stress outcomes vary between females and males, both in disease risk and presentation, yet we lack definitive understanding of the specific mechanistic differences. Our understanding of psychological stress has increased considerably since it’s early conception in 1915 by Walter Bradford Cannon, a view that would later be defined by Hans Selye in 1956. However, our knowledge regarding the systems biology of chronic stress, the neurobiological adaptations and underpinnings of aberrant behaviour, and the mechanistic basis of sex-dependent outcomes, remain relatively limited. The doctoral work presented in this thesis describes the establishment of models of chronic stress in mice and their application in addressing these issues. The first (and fundamental) step in this doctoral project consisted of the development and characterization of murine chronic stress models for further potential study. Three distinct categories of stress were initially trialled: homotypic physical (restraint stress; RS), heterotypic variable (chronic unpredictable mild stress; CUMS), and a novel model of heterotypic social stress (social stress; SS). Differential behavioural outcomes were apparent across these models, with heterotypic variable and social stress paradigms found to induce ‘stress’ behaviours and phenotypes. In contrast, homotypic RS induced hedonia while reducing anxiety behaviours (potentially reflecting habituation). Somewhat unexpectedly, stress-related shifts in circulating mediators were more pronounced with social vs. the other stressors, suggesting particular sensitivity to social forms of stress. Gene expression changes in the frontal cortex, including inflammation, neurotransmitter, and neurotrophic genes, were apparent in CUMS, and less so in SS and RS. In contrast, hippocampal gene transcripts remained largely unchanged under all stress conditions. Results indicate that SS may induce a more stable neurobiological state (associated with anxiety- and depressive-like behaviours) indicative of a later disease state vs. an earlier (unstable) disease state in CUMS. Critically, this study revealed that despite differing modes of stress, anxiety behaviours were consistently linked to CNS expression of inflammatory and monoamine signalling mediators. Thus, independent of stressor type or duration, behavioural outcomes are similarly governed by neuroinflammatory and monoamine signalling changes. Having established that a novel social stressor paradigm appeared to induce the greatest behavioural and endocrine disruption - consistent with the importance of social forms of stress in social mammals (including humans) - studies in Chapter 3 investigated the sex-specific impacts of chronic social stress. It is to be noted that sex differences of chronic stress-induced mood disorders (such as MDD) are well documented in humans. For example, women are twice as likely as men to develop MDD, in addition to presenting with more severe symptoms. However, controversy exists within the field regarding the relative resilience or susceptibility of male and female rodents to chronic stress, and whether this aligns with outcomes in humans. Aligning with clinical observations, female mice did exhibit a heightened ‘biological sensitivity’ to social stress (greater body weight loss, heightened peripheral inflammation) compared with male mice. Conversely, males presented with a more pronounced behavioural phenotype based on traditional markers (presenting with depressive-like behaviours), while females exhibited anxiety without anhedonia. These differing outcomes were matched by sex specific shifts in circulating and CNS mediators, including greater shifts in circulating catecholamines and adipokines in males; and greater stress-related shifts in CNS genes in females. The data support a role for autonomic and adipokine signalling in driving differing outcomes in males and females, yet also highlight the challenges in studying and interpreting sex dependent responses to chronic stress. While most research into chronic psychological stress addresses impacts on neurobiology (with links to mood disorders such as MDD), chronic stress is also strongly linked to cardiovascular disease (CVD). Moreover, when both MDD and CVD interact, they reciprocally increase the risk of the other thereby increasing the risk of worsened outcomes. Chapter 4 sought to examine the mechanisms linking chronic stress to cardiac phenotype (specifically, cardiac function and resistance to ischaemic or infarction), and how these responses are influenced by sex. Worsened myocardial outcomes were evident with heterotypical stressors (variable and social) vs. homotypic restraint stress. Data revealed that myocardial ischaemic tolerance across all experimental models correlated significantly with circulating noradrenaline, and CNS transcript for MAOA and key inflammatory markers. This supports key roles for the ANS in communicating stress response to the heart and confirms roles for monoamine and inflammatory signalling in the CNS. Sexually dimorphic cardiac outcomes were also apparent, with social stress inflicting greater cardiac detriment in male vs. female mice. This dimorphism paralleled shifts in catecholamines, together with transcription of key regulators of myocardial metabolism. Finally, work in Chapter 5 details the transcriptome wide response to chronic social stress in the frontal cortex of male mice. The frontal cortex plays an important role in regulating emotional responses to psychological stress. The 'un-biased' profile revealed by RNA-sequencing supported a dominant role for structural/remodelling adaptations to stress, coupled with involvement of mitochondrial dysfunction, rather than orchestrated shifts in neurotransmitter and inflammatory pathways. This data supports existence of adaptive changes in neurotrophic signalling, together with maladaptive changes in mitochondrial and other relevant paths (e.g., myelination). Coexistence of beneficial adaptive and detrimental maladaptive changes suggests these animals may exist in an unstable pre-disease state. The relevance of this array of observations, and broader issues regarding chronic stress experimentation and interpretation are considered in Chapter 6.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Pharmacy & Med Sci
Griffith Health
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48

Spivey, Justin, Heather Sirek, Robert Wood, Kalpit Devani, Billy Brooks, and Jonathan Moorman. "Retrospective Cohort Study of the Efficacy of Azithromycin Vs. Doxycycline as Part of Combination Therapy in Non-Intensive Care Unit Veterans Hospitalized with Community-Acquired Pneumonia." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/3177.

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The IDSA Community-Acquired Pneumonia (CAP) Guideline recommends ceftriaxone in combination with doxycycline as an alternative to combination therapy with ceftriaxone and azithromycin for non-intensive care unit (ICU) patients hospitalized with CAP. This is an attractive alternative regimen due to recent concerns of increased cardiovascular risk associated with azithromycin. The objective of this study was to compare the clinical outcomes of azithromycin and doxycycline each in combination with ceftriaxone for non-ICU Veterans hospitalized with CAP.
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49

Crispo, James Alexander George. "Pharmacotherapies in Parkinson Disease: Investigating Trends and Adverse Health Outcomes." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/35065.

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Parkinson disease (PD) is the second most common neurodegenerative disease worldwide, with estimates suggesting that PD prevalence and incidence will increase with aging populations. Therapeutic options and clinical guidelines for PD have significantly changed over the past 15 years; however, pharmacoepidemiology data in PD are lacking, especially regarding adverse effects of non-ergot dopamine agonists (DAs) and outcomes associated with anticholinergic burden. The objectives of this doctoral research are threefold: 1) examine patterns of antiparkinson drug use in relation to clinical guideline publication, drug availability, and emerging safety concerns; 2) determine whether PD patients treated with non-ergot DAs are at increased risk of adverse cardiovascular or cerebrovascular outcomes; and 3) determine whether anticholinergic burden is associated with adverse outcomes in PD. Specific research questions were investigated using epidemiological methods and electronic health data from Cerner Health Facts®, an electronic medical record database that stores time-stamped patient records for more than 300 Cerner subscribing facilities across the United States. Findings from this work are reported in a series of manuscripts, all of which have been published. Key findings include: 1) DA use began declining in 2007, from 34% to 27% in 2012. The decline followed publication of the American Academy of Neurology’s practice parameter refuting levodopa toxicity, pergolide withdrawal, and pramipexole label revisions; 2) heart failure was the only adverse cardiovascular or cerebrovascular outcome that demonstrated a significant association with non-ergot DA use, mainly pramipexole; and 3) anticholinergic burden in PD was associated with the diagnosis of fracture and delirium, and significantly increased the risk of emergency department visit and readmission post inpatient discharge. Reported antiparkinson prescribing trends suggest that safety and best practice information may be communicated effectively in PD. Although findings warrant replication, individuals with PD and independent risk factors for or a history of heart failure may benefit from limited use of pramipexole. Similarly, individuals with PD may benefit from substituting non-PD medications with anticholinergic effects for equally effective non-anticholinergic agents. Additional pharmacovigilance studies are needed to better understand health risks and the impact of population health interventions in PD.
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50

Galil, Arise Garcia de Siqueira. "Prevalência de anemia e doença renal crônica em portadores de insuficiência cardíaca sistólica num ambulatório de hipertensos e diabéticos." Universidade Federal de Juiz de Fora (UFJF), 2008. https://repositorio.ufjf.br/jspui/handle/ufjf/2837.

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Introdução: A insuficiência cardíaca (IC) tem alta morbimortalidade que decorre de fatores causais e refratariedade ao tratamento. A doença renal crônica (DRC) e a anemia têm se associado a pior prognóstico em pacientes com IC grave, especialmente os hospitalizados. Há, porém, poucos estudos que avaliem a prevalência e as conseqüências da DRC e da anemia em pacientes com IC acompanhados ambulatorialmente. Objetivos: Avaliar a prevalência da DRC e anemia e o impacto de desfechos cardiovasculares em portadores de IC sistólica estágios B e C. Pacientes e Métodos: Foram estudados pacientes adultos, com idade >18 anos e diagnóstico de IC sistólica e com fração de ejeção (EF) ≤45%, selecionados do ambulatório do Serviço de Hipertensão, Diabetes e Obesidade do SUS de Juiz de Fora e acompanhados por 12 meses. A anemia foi definida como hemoglobina <12,0g/dl nas mulheres e <13,0g/dl nos homens. A reserva de ferro foi considerada adequada quando índice de saturação da transferrina encontrava-se ≥20% e a ferritina ≥100ηg/dl. A filtração glomerular foi estimada pela fórmula do estudo MDRD e a DRC foi definida como proposto pelo K/DOQI da National Kidney Foundation americana. Considerou-se com desfechos cardiovasculares (CV) a ocorrência de hospitalização e/ou morte decorrente da IC. Os dados demográficos, de exame físico e laboratorial foram obtidos do prontuário dos pacientes. Resultados: Foram avaliados 83 pacientes, com idade média de 62,7±12 anos, sendo 56,6% do sexo feminino. A média da fração de ejeção (FE) foi de 37,8+7,9% e a maioria dos indivíduos (60,2%) estava no estágio C. A prevalência de anemia foi de 24,09%; 30,30% no estágio B e 20% no estágio C. A prevalência de DRC foi elevada, presente em 49,4% da amostra, 42,4% no estágio B da IC e 54% no estágio C. Todos os pacientes com anemia tinham reserva de ferro normal e 68,6% apresentavam DRC concomitante. Os desfechos CV ocorreram em 26,5% da amostra. Na estratificação dos pacientes nos estágios B e C da IC e presença ou não de DRC, evidenciou que 100% e 64,7% apresentaram desfechos, respectivamente. Na análise multivariada, após ajustes para fatores prognósticos no período basal, o diagnóstico de DRC aumentou em 3,6 vezes a possibilidade de desfechos (IC 95%1,04-12,67, p=0,04), enquanto os níveis mais elevados de sódio sérico (R 0,807, IC95%0,862-0,992, p=0,03) e da fração de ejeção (R 0,925, IC95% 0,862-0,942, p= 0,03) se mostraram protetores. Conclusão: Na coorte de pacientes estudada, composta de pacientes com IC estágios B e C, a ocorrência de anemia foi compatível com a observada em outros estudos e com tendência de se associar com menor filtração glomerular. A DRC foi prevalente e independentemente se associou a maior risco de hospitalizações e mortes secundárias à descompensação cardíaca, especialmente nos pacientes assintomáticos.
Introduction: Chronic heart failure (CHF) has a high morbidity and mortality which are consequent to etiologic factors and no response to treatment. Anemia and chronic kidney disease (CKD) have been associated to worse outcome in patients with severe hospitalized CHF. So far, there is few studies that assessed the prevalence and the consequences of anemia and CKD in outpatients with CHF. Aim: To study the prevalence of CKD and anemia and the impact of CV end points in patients with systolic CHF followed in an outpatient clinic. Methods: This is prospective cohort study, dealing with adult patients older than 18 years of age and diagnosis of systolic CHF and ejection fraction (EF) ≤45%, selected from the Hypertension, Diabetes and Obesity Outpatient Clinic of SUS of Juiz de Fora. Anemia was defined as hemoglobin <12,0g/dL in women and <13g/dL in men and women after the menopause. Normal iron store was defined when transferring saturation index was >20% and/or ferritin >100ηg/dL. The glomerular filtration rate was estimated from serum creatinine usinf the MDRD study formula, and CKD was defined as suggested by the K/DOQI of National Kidney Foundation. CV endpoints were defined as death or hospitalization due to CHF, in 12 months follow up. Demographic and clinical date were obtained from the patients’ charts. Results: Eight three patients were studied, the mean age was 62.7±12 years, and 56.6% were female. The EF was 37,8+7,9%, and the majority of the patients had stage C CHF (60,2%). The prevalence of anemia was 24,1%; 30,3% in stage B and 50% in stage C. CKD was diagnosed in 49.4% of the patients, 42,4% of the stage B and 54% in the stage C. All patients with anemia had normal iron storage, and 68,6% had concomitant CKD. Cardiovascular endpoints were observed in 26.5% of the patients. When the sample was stratified in stages B and C of CHF and presence or absence of CKD, it was found that 100% and 64.7% had CV endpoints, respectively. After adjustments for all other prognostic factors at baseline, it was observed that the diagnosis of CKD increased in 3.6 folds the hazard of CV endpoints (CI 95% 1,04-12,67, p=0,04), whereas higher ejection fraction (R 0,925, IC 95% 0,862-0,942, p= 0,03) and serum sodium (R 0,807, IC 95% 0,862-0,992, p=0,03) were protectors. Conclusion: In this cohort of outpatients with CHF stages B and C, the occurrence of anemia was low and frequently associated with concomitant CKD. On the other hand, CKD was prevalent and independently associated with heightened risk for hospitalization and death secondary of cardiovascular causes, mainly in asymptomatic patients.
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