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1
Appannah, Geeta. "Dietary patterns, obesity and cardiovascular risk factors in young people." Thesis, University of Cambridge, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648138.
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Khan, Hassan. "Markers of glycaemia and risk of cardiovascular disease." Thesis, University of Cambridge, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648585.
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Heydon, Emma Elizabeth. "Telomere length and cardiovascular disease risk factors in South Asians." Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708496.
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Black, James Alexander. "Optimising cardiovascular risk management early in the diabetes disease trajectory." Thesis, University of Cambridge, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.709489.
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Ng, Kuen-to, and 伍權韜. "The gender difference and association between social position and cardiovascular risk factors in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B45012775.
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Kwape, Lemogang Daniel. "Diet and cardiovascular disease risk factors in Botswana." Thesis, University of Aberdeen, 2012. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=211324.
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Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide. In Sub-Saharan Africa, rates of CVD are increasing rapidly, but there is little evidence about the potential determinants of CVD risk in this population. This thesis investigated CVD risk factors in Gaborone, capital city of Botswana, by (i) documenting CVD risk factors in this population, (ii) investigating the association between diet and CVD risk factors and (iii) assessing the association between diet and risk of CVD. 787 adults were recruited. Of these 566 were generally “healthy” with no history of CVD, while 221 (“diseased”) had at least one reported CVD condition, hypertension or diabetes. The median (interquartile range) age was 27 (23, 32) and 52 (42, 62) years for healthy and diseased participants respectively. All participants completed an interview administered questionnaire, including a food frequency questionnaire. Height, weight, waist circumference and blood pressure were measured, and a non-fasting blood sample was obtained for analysis of lipids, lipoproteins and glucose. A high prevalence of overweight and obesity (36.8%), particularly in women (50.0%), and low HDL cholesterol (<1.0 mmol/L men and <1.3 mmol/L women) (62.6%) was found. High levels of triglycerides, LDL cholesterol, glucose and high blood pressure were also found in this population of young adults in Gaborone. Total fat and/or saturated fat intake (as percentage energy) was significantly linearly associated with increased LDL cholesterol (p=0.017), triglycerides (p=0.048), glucose (p=0.044) and with decreased HDL cholesterol (p=0.021). However, fibre, polyunsaturated fatty acids and dietary patterns were not independently associated with CVD risk factors. Carbohydrates intake was significantly associated with increased risk of disease. Unexpectedly, saturated fat intake was associated with reduced disease risk, but weakened after nutrients adjustment. CVD risk factors are relatively high in this population. These results suggest a need for further research on CVD in Botswana.
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Johns, David James. "Dietary patterns and cardiovascular disease in severe obesity." Thesis, University of Cambridge, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.610554.
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Kavikondala, Sushma. "Intergenerational and life course influences on cardiovascular risk factors from a developing country perspective, and implications foraetiology." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B4633211X.
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Pennells, Lisa. "Assessing predictive ability using individual participant time to event data from multiple prospective studies : application to cardiovascular disease risk prediction." Thesis, University of Cambridge, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.609800.
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Moore, Vivienne M. "Fetal growth and cardiovascular risk factors in an Australian cohort /." Title page, contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09PH/09phm824.pdf.
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Awotedu, Kofoworola Olajire. "Functional changes of the vasculature leading to some cardiovascular risk factors in HIV/AIDS patients." Thesis, Walter Sisulu University, 2013. http://hdl.handle.net/11260/d1015712.
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The present study sought to explore the functional changes that occur in the vasculature of HIV positive participants of African origin in Mthatha district of South africa which might lead to increased risk in their cardiovascular system. Available literature shows that arterial stiffness plays an important role in cardiovascular events such as stroke, vasculitis and myocardial infarction. Measurement of (aortic pulse wave velocity; PWV) provides some of the strongest evidence concerning the prognostic significance of large artery stiffening. This study was aimed at investigating the relationship between anthropometry, age, E-Selectin level, cytokine levels, haemodynamic variables, blood counts and blood lipid profile with pulse wave velocity. Some traditional cardiovascular risk factors such as alcohol, and smoking were also taken into account. This was a cross-sectional study comprising of 169 participants (62 males and 107 females). 63 were HIV negative (group A), 54 HIV positive on treatment (group B), and 52 were HIV positive not on treatment (group C). Pulse wave velocity (PWV) was assessed using the Sphygmocor Vx. Statistically, ANOVA was used for variables with normal distribution and non parametric tests were used for variables with skewed distribution. Notable significant differences were seen in the means of the following variables across all the 3 groups. The mean PWV value for group C (7.21±2.17) was greater than that for group B (6.84± 1.17) which in turn was more than group A (6.38±1.67); P=0.037. In participants who are HIV negative, In univariate analysis PWV correlated significantly with the following: Augmentation index; AIx (75): (r=0.850,p=0.004): Systolic aortic blood pressure; Spa: (r=0.635, p<.000); diastolic blood pressure; dbp: (r=0.436, p<0.000); aortic pulse pressure; Ppa: (r=0.472, p=0.000); Mean arterial pressure; MP: (r=0.446 p=<0.00) and age (r=0.606, p<0.000). In participants who are on HAART the following variables were positively correlated with PWV: Ppa: (r=0.338,p=0.012), MP: (r=0.400,p=0.400), monocytes (r=0.320,p=0.047). Neutrophils: (r=0.341,p=0.034), CD4: (r=-0.446,p=0.009). In participants who are HAART naïve and HIV positive the following correlated with PWV Spa: (r=0.369, p=0.012), MP: (r=0.400, r=0.003) Ppa: (r=0.338,p=0.012), waist to hip ratio: (r=0.319, p=0.037), platelets: (r=0.037, p=0.019), triglycerides: (r=0.490, p=0.002). With multiple linear regression Spa, age and triglycerides as the only independent and significant determinants of PWV among HIV negatives R2= 56.9% (adjusted R2=54.7%), model adjusted for gender, anthropometric parameters, HDL-C, TC, LDL-C, haematologic data, haemodynamic data, cytokines, smoking and alcohol. Only MP and waist circumference were identified as the most important and significant independent determinants of PWV in HIV positive participants not on treatment. Age, MP, HDL-C, and triglycerides were identified as the significant independent determinants of the variations of PWV in HIV positive participants on HAART. R2 =57 %(adjusted R2 =53.5%). Model adjusted for gender, anthropometric data, smoking, alcohol, cytokines, adhesion molecules, total cholesterol, LDL-C. Haematological data, CD4 count, and other haemodynamic parameters. For Aix(75) In HIV negatives the multiple linear regression model identified age (positive correlation), height (negative correlation), CD4 (positive correlation) and MP (positive correlation) as the independent and significant determinants of AIx (75) among HIV negatives. Spa and Age were independently and significantly associated with the variations of Aix(75) among HIV positives not on HAART. On the other hand height was negatively and significantly associated with Aix(75) amongst HIV positives not on HAART. After excluding confounding factors, height (negative correlation) age (positive correlation), MP (positive correlation, HDL-C (negative correlation), platelets (positive correlation) alcohol intake (excessive consummation associated with positive correlation) and TNFα (negative correlation) were identified as the independent and significant variables associated with increase in AIx(75) among HIV positive participants on HAART. Conclusion: This study showed that HIV infected patients with or without antiretroviral therapy have increase arterial stiffness which is associated with an increased cardiovascular risk. The sphygmocor is an accurate, non invassive and useful tool in the evaluation of arterial stiffness and its use in clinical practice should be encouraged. PWV and the augmentation index (AIx) are the two major non-invasive methods of assessing arterial stiffness. Life style modification should be incorporated into the management of HIV patients so as the continuous monitoring of their haematological and lipid profile.
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Tan, Jennifer Sue Ling. "Cardiovascular risk factors and nutrition and the incidence of macular degeneration and cataract." Phd thesis, Sydney Medical School, 2010. http://hdl.handle.net/2123/14170.
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Masoud, Mohamed Abdulsalam. "Validation of a recently proposed equation for the estimation of small, dense LDL particles from routine lipid measures in a population of mixed ancestry South Africans." Thesis, Cape Peninsula University of Technology, 2016. http://hdl.handle.net/20.500.11838/2490.
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Thesis (MSc (Biomedical Technology))--Cape Peninsula University of Technology, 2016.Cardiovascular diseases (CVD) are the leading cause of global mortality, of which over 75% occurred in low- and middle-income countries such as South Africa. The lipid profile, specifically decreased levels of high density lipoprotein cholesterol (HDL-C), elevated triglyceride levels and the presence of small-dense low density lipoprotein (sdLDL) has been reported associated with CVD. An increased number of sdLDL is also common in metabolic syndrome (MetS), visceral obesity and diabetes mellitus, the last a known risk factor for CVD. The modification of low density lipoprotein (LDL) size, or number of sdLDL particles, has been reported to significantly reduce CVD risk, but not conclusively so and needs further investigation. In this regard, sdLDL particles are seldom estimated routinely for clinical use because of financial and other limitations. Currently, an alternative approach for estimating sdLDL is to use equations derived from routine lipid measures, as has been proposed by several groups. However, there is a need for extensive evaluation of this equation across different ethnic and disease groups, especially since reports showed an inadequate performance of the equation in a Korean population. The aim of this study was to assess the performance of a recently proposed equation for the estimation of sdLDL in healthy and diabetic mixed ancestry South Africans. Furthermore, we also investigated the role of sdLDL as a cardiometabolic risk factor, as measured against known risk factors such as the glycemic and lipid profiles.
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Martin, Luci A. "Negative affect, introversion and physiological markers of cardiovascular disease." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9063/.
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Cardiovascular risk factors have expanded to include personality and other psychological characteristics. Negative affect (NA) has a longstanding history in cardiovascular health, but the path by which NA leads to cardiovascular disease (CVD) is yet to be defined. The following study examined the relationship of high NA and low extroversion (EX) with physiological cardiovascular markers in a sample of non-medical, professional adults. Our results indicated that individuals high in NA and low in EX displayed a significantly lower platelet count and a significantly higher mean platelet volume. Individuals high in NA displayed a significantly lower cholesterol risk ratio, while individuals high in EX displayed significantly higher platelet counts. Personality was not significantly related to blood pressure, high or low density lipoproteins. Understanding the relationships among psychological variables and physiological markers will help clinical researchers design interventions that reduce the likelihood of CVD.
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Xu, Lin, and 徐琳. "Subclinical atherosclerosis, cardiovascular risk factors and metabolicsyndrome in older Chinese people." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B4451430X.
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Zilkens, Renate Ruth. "The effect of alcohol and beverage type on cardiovascular disease risk factors." University of Western Australia. School of Medicine and Pharmacology, 2004. http://theses.library.uwa.edu.au/adt-WU2004.0053.
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[Formulae and special characters can only be approximated here. Please see the pdf version of the abstract for an accurate reproduction.] Two randomised controlled trials were conducted to explore the relationship between the consumption of alcoholic beverages and cardiovascular disease risk factors. Study 1 was primarily designed to test the hypothesis that the cardio-protective effect of light alcohol could be mediated, in part, via improvements in endothelial function. Study 1 was also designed to explore the effect of alcohol on both traditional risk factors for cardiovascular disease, such as changes in lipid profile, haemostatic factors and blood pressure, and novel risk factors such as homocysteine, markers of inflammation and oxidative stress. The experimental design of this study also allowed us to determine whether reducing alcohol intake in these moderate-to-heavy drinkers could improvement insulin sensitivity, a component of the metabolic syndrome. In this group of sixteen healthy middle-aged men with a history of moderate to heavy alcohol intake of seven standard drinks per day, reducing intake down to approximately one standard drink per day for four weeks had no beneficial effects on conduit vessel endothelial function as assessed by post-ischaemic brachial artery flow-mediated dilatation, nor were there any detectable changes in soluble E-selectin, endothelin-1 and von Willebrand Factor, which are considered biomarkers of endothelial activation. As this study did not investigate the effect of alcohol on endothelial function in resistance vessels, it cannot exclude the possibility that alcohol may affect endothelial cells resident in that vascular bed. This study does show and confirm, however, that the relationship between alcohol and risk factors for cardiovascular disease is an extremely complex one. On the one hand it demonstrated that alcohol was potentially harmful, increasing blood pressure, plasma F2-isoprostane (oxidative stress), and homocysteine. On the other hand it showed that increasing alcohol intake led to significant reductions in two (i.e. fibrinogen and IL-6) of five inflammatory markers, in addition to improving the HDL-cholesterol profile of these subjects. Although the effects of alcohol on blood pressure, fibrinogen and HDL-cholesterol are not in themselves new, they support our choice of study design and strengthen the argument in favour of accepting the more novel findings of this study, specifically, the lack of effect on endothelial function and insulin sensitivity, and the harmful effect of alcohol in increasing oxidative stress and homocysteine. Study 2 was primarily designed to test the hypothesis that the consumption of red wine may confer greater cardio-protection than beer via improvements in endothelial function. Simultaneously, the study was also designed to determine whether drinking red wine for 4-weeks would have different effects than beer on either traditional risk factors for cardiovascular disease (i.e. blood pressure and lipid profile) or the more novel risk factors, homocysteine and oxidative stress. Using a randomised controlled cross-over study design, Study 2 provides evidence that the regular daily consumption of 4 standard drinks of either beer or red wine does not alter endothelial function, as measured by post-ischaemic flow-mediated vasodilatation of the brachial artery in healthy middle-aged men, nor was there evidence of any beneficial effect of de-alcoholised red wine on brachial artery response. As compliance with drinking protocol was confirmed with increased serum γ-GT and HDL during red wine and beer periods, and increased 24-hr urinary excretion of 4OMGA during red wine and de-alcoholised red wine periods, we are confident that there was excellent compliance with the beverage treatments. Study 2 also provides the first evidence from a carefully controlled intervention study that both red wine and beer elevate blood pressure to a similar degree, with no detectable difference in the magnitude of either treatment. As with endothelial function, there was also no evidence of any beneficial effect of de-alcoholised red wine on blood pressure. In addition, although post hoc analysis found evidence that alcohol increased both plasma homocysteine and urinary excretion of F2-isoprostane and endothelin-1, there was no apparent protective effect conferred from either red wine or de-alcoholised red wine on these cardiovascular risk markers. The results from this study cannot disprove the hypothesis that red wine is more beneficial for cardiovascular health; however, they suggest that if red wine has properties beyond those of beer to confer protection, they are not via any interactions with the nitric oxide regulatory function of the endothelium in conduit vessels nor are they via moderation of the vasopressor, homocysteine-raising, and oxidative stress effects of alcohol. The interpretation of the findings from both intervention studies and their place in the context of our current understanding of the role that alcoholic beverages play in the development and/or prevention of cardiovascular disease are explored in this thesis.
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Cheung, Yiu-fai, and 張耀輝. "An analysis of the determinants of peripheral conduit arterial stiffness in children and teenagers in health and disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B29761815.
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Lipoeto, Nur Indrawaty 1963. "Minangkabau traditional diet and cardiovascular disease risk in West Sumatra, Indonesia." Monash University, Monash Asia Institute, 2001. http://arrow.monash.edu.au/hdl/1959.1/8508.
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Kettle, Susan M. "Prevalence of cardiovascular disease risk factors in young Newfoundland and Labrador adults living in rural and urban communities." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0017/MQ54927.pdf.
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Wat, Chi Ling Elaine. "Dietary milk phospholipids and their effects on cardiovascular risk factors / Chi Ling Elaine Wat." Thesis, The University of Sydney, 2009. https://hdl.handle.net/2123/28853.
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Cardiovascular disease is responsible for a significant portion of morbidity and mortality in Australia. The metabolic syndrome, which is the clustering of cardiometabolic risk factors, is well known to be associated with increased risk of CVD. There is thus great interest in treating and preventing this metabolic disease. Pharmaceutical approaches
to the treatment of the metabolic syndrome to this date have been inadequate. Increasing evidence suggests that dietary PLs may be potentially cardioprotective. The aim of this thesis is therefore to investigate the possibility that PLs can be extracted from dairy milk, and to identify and characterise the potent ability of dairy milk PLs to
be used to treat and/or prevent CVD.
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MacIntyre, Iain McGregor. "Modification of cardiovascular and renal risk factors using antagonists of the endothelin system." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/10032.
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Chronic kidney disease (CKD) is an important independent risk factor in the development of cardiovascular disease (CVD). Indeed, patients with CKD are far more likely to die from CVD than reach end stage renal disease. Conventional cardiovascular risk factors and co-morbidity contribute to this increased risk of CVD. However, emerging evidence suggests other novel factors including inflammation, oxidative stress, and a shift in the balance of the vasodilator nitric oxide and vasoconstrictor endothelin system, are also important contributors. Despite increasing evidence that the endothelin system plays an important role in the development of CKD and CVD, there has been little research examining possible therapeutic benefits of its modification in patients with CKD. The overall aims of the work presented within this thesis were to examine CVD risk in patients with renal impairment and then to see what impact chronic inhibition of the endothelin system would have on risk factors for CVD and CKD progression. In the first two studies I examined markers of arterial stiffness (AS) and endothelial function in a cohort of patients with immune-mediated renal disease. I was able to show in the acute setting that improvement in renal function following treatment for these conditions leads to significant improvements in AS. Interestingly, in patients who were in remission from their renal disease, only classical cardiovascular risk factors appear to be linked to AS. In the next study I was able to prove that sitaxsentan, a selective oral ETA antagonist, did not cause functional blockade of the ETB receptor in man. This was the first study of its kind to confirm that a “selective” endothelin antagonist truly is selective in vivo: a finding that will allow more accurate mechanistic investigation of the ET system. In the final studies, I showed that in subjects with stable non-diabetic proteinuric CKD, chronic selective ETA receptor antagonism reduces blood pressure and AS, and that these systemic benefits are associated with an increase in renal blood flow and reduction in proteinuria. The reduction in proteinuria is most likely haemodynamic and linked to a fall in GFR and filtration fraction, similar to what is seen with ACE inhibitors. Importantly, these benefits were seen in patients already taking maximally tolerated renin-angiotensin aldosterone system blockade, suggesting that chronic endothelin antagonism could be an important future therapy in the management of CKD. In summary, I have shown that renal impairment can directly affect markers of arterial function and by inference increase the risk of CVD. Chronic antagonism of the endothelin system with ETA receptor blockers would appear to improve many of these biomarkers, including reductions in BP, AS and proteinuria. There were no adverse effects reported in these studies, suggesting that selective ETA antagonism may be safe enough for clinical development in CKD patients. Further larger clinical trials are warranted.
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Henning, Andrea L. "Monitoring Monocyte Oxldl Phagocytosis As a Cardiovascular Disease Risk Factor Following a High-fat Meal." Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc700101/.
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Macrophage-derived foam cells play a predominant role in the deposition of arterial plaques during the early stages of atherosclerosis. The deposition of arterial plaques is known to be effected by several factors, including a person’s dietary habits. The consumption of a high-fat (>60% of calories from fat) meal is known to elevate serum LDL and triglycerides, which have been previously implicated in the formation pf foam cells. One limitation of current research models is that it is not possible to directly measure foam cells in vivo. Thus, the purpose of the present study was to validate the use of blood derived monocytes as a proxy measure of foam cells. In order to complete this objective, we evaluated monocyte oxLDL phagocytosis capacity following consumption of a high-fat meal. Eight men and women participated in the present study and venous blood samples were collected prior to the meal, 1-h, 3-h, and 5-h post-meal. Monocytes (CD14+/16- and CD14+/16+) were evaluated for adhesion molecule expression (CD11a, CD11b, and CD18), scavenger R (CD36) expression, and oxLDL phagocytosis using an image-based flow cytometry method developed in our laboratory for this purpose. Data was statistically analyzed for significance using a single-factor ANOVA with repeated measures and a p < 0.05. Consumption of a high-fat meal caused an increase significant increase in the proportion of pro-inflammatory monocytes (CD14+/16+) and a decrease in classic monocytes (CD14+/16-), with the greatest difference occurring at 5 h post prandial (p = 0.038). We also found that pro-inflammatory monocyte expression of adhesion molecules and CD36 increased in a manner that would promote in vivo movement of monocytes into the subendothelial space. Finally, over the course of the 5 h postprandial period, the majority of oxLDL uptake occurred in pro-inflammatory compared to classic monocytes. These results suggest that consuming a high-fat meal increases the potential of monocytes to become foam cells for at least 5 h postprandial.
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林文健 and Man-kin Lam. "A cross-sectional study of leisure-time physical activity prevalence and its association with cardiovascular biochemical risk factors inHong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31970631.
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Mashinya, Felistats. "Cardiovascular risk factors in an HIV infected rural population of Limpopo Province, South Africa." Thesis, University of Limpopo, 2016. http://hdl.handle.net/10386/1717.
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Thesis (Ph. D. (Medical Sciences)) -- University of Limpopo, 2016Refer to document
The Belgium Development Co-operation through VLIR-UOS, The University of Limpopo,and The Flemish Universities
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Turnbull, Fiona. "Effects of different blood pressure-lowering regimens on major cardiovascular events in major patient subgroups." Thesis, The University of Sydney, 2007. https://hdl.handle.net/2123/28142.
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Background
Cardiovascular disease is a leading cause of mortality and morbidity worldwide.
Blood pressure is the single, most important risk factor for cardiovascular disease;
nearly two-thirds of all strokes and approximately half of all ischaemic heart disease
events are attributable to non-optimal blood pressure. The evidence from individual
randomised trials of blood pressure lowering regimens suggests that that protection
from major cardiovascular events can be achieved by lowering blood pressure, even
among those with so-called ‘normal’ blood pressures. However, many trials are not
sufficiently powered to demonstrate modest but clinically important differences in
the effects of different classes of drug on the risk of cardiovascular disease. As a
result, there is considerable uncertainty about the relative effectiveness of different
drug classes. Reliable and precise information about the effects of treatment is
central to the management of cardiovascular risk in millions of people worldwide.
The aim of the research contributing to this thesis was to generate high quality
evidence about the effects of a range of blood pressure lowering regimens on major
cardiovascular outcomes in important patient subgroups.
Methods
The research uses prospectively-planned overviews (meta-analyses) of large
randomised trials to generate precise estimates of treatment effect. The trials
contributing to the overviews were those participating in the Blood Pressure
Lowering Treatment Trialists’ Collaboration. Data from all relevant trials were
submitted to the Collaboration Secretariat based at the George Institute for
International Health in Sydney, Australia for inclusion in analyses. Data were
combined using standard meta-analytic techniques and reported as pooled point
estimates and 95% confidence intervals for the six pre-specified primary outcomes of
stroke, coronary heart disease, heart failure, cardiovascular death and total mortality.
The analyses comprised three main components: (1) one main set of overview
analyses to examine treatment effects in the overall study population; (2) three sets of
overview analyses to examine treatment effects in subgroups of younger and older
patients, men and women and patients with and without diabetes; and (3) a series of
post-hoc analyses (meta-analysis and meta-regression analysis) to examine the
relative contributions of blood pressure-dependent and independent effects of two
main classes of blood pressure drugs, ACE-I inhibitors and angiotensin receptor
blockers.
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Link-Malcolm, Jessica. "Health message framing : motivating cardiovascular risk factor screening in young adults." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9066/.
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As the leading cause of death in the United States, coronary heart disease (CHD) is a growing public health problem, despite the fact that many risk factors for the disease are preventable, especially if addressed early in life. The purpose of the current study was to examine the effects of loss-framed versus gain-framed versus information-only health messages on both intention to attend and actual attendance at an appointment to get screened for CHD risk factors (i.e., hypertension, diabetes, and dyslipidemia). It was hypothesized that a population of young adults would be more likely to view screening for CHD risk factors as a low-risk, health-affirming behavior as opposed to a risky, illness-detecting behavior and would thus be more strongly influenced by gain-framed messages than loss-framed messages. Additional goals included the exploration of the extensively researched individual health beliefs of perceived threat (as defined by the health belief model) and health locus of control as they relate to message frames. One hundred forty-three undergraduate students were randomly assigned to either the loss-framed, gain-framed, or information-only control conditions. Framing manipulation checks revealed that participants failed to discern differences in the tone and emphasis of the experimental pamphlets. As a result, no tests of framing effects could be conducted. Sixteen (11.2%) of the 143 participants who participated in Part 1 of the experiment participated in Part 2 (i.e., attended a risk factor screening appointment). Multiple regression analysis revealed risk index, age, and powerful others health locus of control as significant predictors of screening intention. Gender was the only demographic or health related variable that was significantly related to screening outcome, such that women were more likely to get screened than men. Limitations and recommendations are discussed.
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Smith, Jessica 1980. "Elevated waist to hip ratio and cardiovascular disease risk, assessed by the apoBapoA1 ratio, in Asian Indian immigrants." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=98800.
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Traditional indicators of cardiovascular disease (CVD) risk may not be appropriate for Asian Indians. We designed a cross-sectional study of body fat distribution, apoB/apoA1 ratio and adipokines of Northern Indians compared to Caucasians to determine if there is a different relationship between these parameters. Indian (men: n = 54; women n = 28) and Caucasian (men: n= 32; women, n = 51) subjects were recruited who were between the ages of 20 and 60 years. Subjects were excluded if they had a history of CVD or were taking lipid lowering medications. Body fat percentage (BF%) was measured using bioelectrical impedance analysis. Indian subjects had a substantially higher waist-to-hip ratio (WHR) ratio than Caucasian subjects (men: 0.93 +/- 0.01 vs. 0.86 +/- 0.01, p < 0.001; women: 0.88 +/- 0.01 vs. 0.76 +/- 0.01, p < 0.0001). Interestingly, while WHR correlated strongly with BF% in Caucasians (men: r = 0.63 p = 0.0002; women: r = 0.74, p < 0.0001, respectively) there was no correlation in Indians (men: r = 0.22, ns; women: r = 0.23, ns). The regression lines for WHR vs. BF% of Indians compared to Caucasians was significantly different (men p = 0.02, women p = 0.002). A similar pattern of correlation was seen with WHR and BMI. In addition, Indian men and women had a higher apoB/A1 ratio than Caucasians: the most powerful lipoprotein measure of CVD risk (men: 0.84+/-0.04 vs. 0.66+/-0.04, p=0.001; women: 0.70+/-0.04 vs. 0.56+/-0.03, p = 0.003, respectively). Leptin levels were higher and adiponectin levels in lower in the Indian men and women. Hypothetically, these alterations in body composition, apoB/apoA1 and adipokines could be due to alterations in adipocyte number.
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Maloney, Kelly Veronica. "Awareness, reported behaviour, and dietary intake of fat and fiber as risk factors for cardiovascular disease." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0020/MQ54935.pdf.
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Vu, Manh Tuan. "Feasibility, acceptability and utilization of a moblie cardiovascular risk factor profile e-platform amongst physicians and patients in HongKong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B47869823.
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Study methods: Mixed-method study design was used to investigate feasibility of implementing a mobile-phone based behavioural intervention to reduce CVD risk factors among the Chinese population. Patients, who were 45-79 years old, fair English literacy, had access to a JAVA enabled mobile phone and had no mental health problems, cognitive impairment or severe illness, were eligible to the study.
Intervention: Patients recruited from three settings (1 GP, 1 specialist and 1 public clinics) had the study software installed to their phone. The software enabled patients to access their CVD risk profiles (including weight, BP, HbA1c, and lipoprotein profile), 10-year CVD risk prediction (based on Framingham Cardiac Risk Score), and pre-set behavioural recommendations. Patients’ CVD risk profiles were updated at 1-month and 3-month follow-up when their test results were available. Patients were alerted with healthy behaviours recommendations.
Outcomes: Outcomes were measured at baseline and 3-month follow-up. Clinical outcomes included Cardiac Risk Factor Score and its components (BMI, Systolic & Diastolic BP, total cholesterol, HDL and HbA1c). Two sets of questionnaires were used to measure knowledge, risk reduction behaviour and attitude toward usefulness of medical records (pre-intervention) and perceived ease of use, usefulness, satisfaction and utilisation of the software (post-intervention).
Results and Discussion: 19 patients were recruited at baseline. 75% (14) aged 45-55 years, 58% (11) were male, 79% (15) had secondary or lower education, 63% (12) were married, and 95% (18) never smoked. Patients’ understanding about CVD risk factors and risk reduction behaviour was moderate. Patients’ attitude toward electronic medical record was positive. Overall patients’ perception of usefulness, ease of use and satisfaction with the software was satisfactory. Post-intervention, a decreasing trend was observed in patients’ CVD risk profiles i.e. weight, BMI, SBP&DBP, HbA1c and Lipoprotein profile.
Focus group discussions revealed that there was a mismatch between physicians and patients perspectives about the use of mobile phone in a behavioural intervention. Physicians tended to express their concern about the quality of records, security of technology, and patients’ actual benefit, while patients showed little concern about security and great excitement about further use of mobile phone technology in assisting their disease self-management. The public sector physicians admitted that their patients were passive in term of seeking information about their health. Patients were willing to use this software for future care if it could provide more real-time data, tailored recommendations for behavioural change, and an interactive communication tool with their physicians. Physicians would like to try the software if it could ease patient-management process, especially enhance patient-physician communication, and be a decision support system to help them keep track with changes that their patients made.
Conclusion: This pilot study has provided preliminary evidence of the feasibility, acceptability, and utility of an e-platform in primary interventions for CVD in Hong Kong.published_or_final_version
Community Medicine
Master
Master of Philosophy
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Zhou, Haiyun, and 周海韵. "Risk factors driving ambulatory care sensitive conditions hospitalisation among elderly with chronic obstructive pulmonarydisease or heart disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B47055819.
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黃佩儀 and Pui-yi Wong. "The relationships among habitual physical activity, daily eating habits, aerobic fitness and cardiovascular risk factors in Hong Kongmales." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B3125732X.
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Kuinchtner, Gabriela Castro. "ASSOCIAÇÃO ENTRE RISCO CARDIOVASCULAR E CONTROLE AUTONÔMICO CARDÍACO EM PORTADORES DE HIV." Universidade Federal de Santa Maria, 2015. http://repositorio.ufsm.br/handle/1/5855.
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Introduction: The increase of cardiovascular disease risk has been demonstrated in subjects with HIV infection. The dysfunction in the regulation of the autonomic system has been identified as a mechanism underlying to cardiac death in this group of patients. This study aimed to analyze the association between cardiovascular risk and cardiac autonomic control in patients with HIV. Methods: The sample consisted of 25 patients with HIV, of both genders, in use of antiretroviral therapy and with undetectable viral load, treated on the of Infectious Diseases Ambulatory, from the University Hospital of Santa Maria (HUSM), between August and December of 2014. Patients with cardiovascular disease, metabolic, respiratory, neurological or kidney were excluded. The cardiovascular risk was assessed by Framingham score, used to estimate the probability of cardiovascular events in ten years. The cardiac autonomic control was assessed by measuring the heart rate variability, analyzing the following variables: 1) in the time domain were measured SDNN, triangular index (overall variability) and rMSSD (parasympathetic activity); 2) in the frequency domain understood the low frequency components (LF; sympathetic activity) and high frequency (HF; parasympathetic activity), both normalized, and the LF/HF ratio (sympatho-vagal balance). Results: The sample (12 women and 13 men) had a mean age of 48.7±10.9 years, body mass index of 25.7±5.1 kg/m2, heart rate of 72.1±13.4 bpm, respiratory rate of 16.3±3.8 bpm, systolic blood pressure of 125.2±18.7 mmHg and diastolic 83.3±12.2 mmHg. The average time since diagnosis of the disease was 10.2±5.0 years, the medication time of 7.2±4.2 years and the CD4 count of 628.6±223.8 mm3 of blood. The score obtained in the Framingham score was 9.5±5.1 and the risk of cardiovascular events was 9.5±7.9%, with 7 patients classified as low risk, 14 as intermediate risk and 4 as high cardiovascular risk. The Framingham score presented a correlation with the medication time (r=0.53), with the LFnu component (r=0.45) and with the ratio LF/HF (r=0.44), but it was inversely correlated with SDNN (r=-0.43), rMSSD (r=-0.47) and with the triangular index (r=-0.49). The risk of cardiovascular events was positively correlated with the medication time (r=0.54), with the LFnu component (r=0.45) and with the ratio LF/HF (r=0.45), but had negative correlation with SDNN (r=-0.40), rMSSD (r=-0.43) and the triangular index (r=-0.48). Conclusion: Patients with HIV classified into different bands of Framingham score, presented association between cardiovascular risk and increased sympathetic activity, decreased parasympathetic activity and sympatho-vagal balance. This demonstrates that even in patients with undetectable viral load, cardiovascular autonomic dysfunctions may be associated with cardiovascular risk in ten years. These findings point to the importance of routine assessments of cardiovascular autonomic nervous system in this population.Introdução: o aumento do risco de doença cardiovascular tem sido demonstrado em sujeitos com infecção por HIV. A disfunção na regulação do sistema autônomo tem sido apontada como mecanismo subjacente a morte cardíaca nesse grupo de pacientes. Este estudo objetivou analisar a associação entre risco cardiovascular e controle autonômico cardíaco em portadores de HIV. Métodos: a amostra foi composta por 25 pacientes com HIV, de ambos os sexos, em uso de antirretrovirais e com carga viral não detectável, oriundos do Ambulatório de Doenças Infecciosas do Hospital Universitário de Santa Maria (HUSM), entre agosto e dezembro de 2014. Pacientes com doença cardiovascular, metabólica, respiratória, neurológica ou renal foram excluídos. O risco cardiovascular foi avaliado pelo Escore de Framingham, utilizado para estimar a probabilidade de eventos cardiovasculares em dez anos. O controle autonômico cardíaco foi avaliado pela medida da variabilidade da frequência cardíaca, analisando-se as seguintes variáveis: 1) no domínio do tempo foram mensurados o SDNN, índice triangular (variabilidade global) e rMSSD (atividade parassimpática); 2) o domínio da frequência compreendeu os componentes de baixa frequência (LF; atividade simpática) e de alta frequência (HF; atividade parassimpática), ambos normalizados, e a relação LF/HF (balanço simpato-vagal). Resultados: a amostra (12 mulheres e 13 homens) apresentavam idade média de 48,7±10,9 anos, índice de massa corporal de 25,7±5,1 kg/m2, frequência cardíaca de 72,1±13,4 bpm, frequência respiratória de 16,3±3,8 rpm, pressão arterial sistólica de 125,2±18,7 mmHg e diastólica de 83,3±12,2 mmHg. O tempo médio de diagnóstico da doença foi de 10,2±5,0 anos, o tempo de medicação de 7,2±4,2 anos e a contagem de CD4 de 628,6±223,8 mm3 de sangue. A pontuação obtida no Escore de Framingham foi de 9,5±5,1 e o risco de eventos cardiovasculares foi de 9,5±7,9%, sendo 7 pacientes classificados como baixo risco, 14 como risco intermediário e 4 como alto risco cardiovascular. A pontuação do Escore de Framingham apresentou correlação com o tempo de medicação (r= 0,53), com o componente LFnu (r=0,45) e com a relação LF/HF (r=0,44), mas correlacionou-se inversamente com o SDNN (r=-0,43), rMSSD (r=-0,47) e com o índice triangular (r=-0,49). O risco de eventos cardiovasculares esteve correlacionado positivamente com o tempo de medicação (r=0,54), com o componente LFnu (r=0,45) e com a relação LF/HF (r=0,45), porém, apresentou correlação negativa com o SDNN (r=-0,40), rMSSD (r=-0,43) e com o índice triangular (r=-0,48). Conclusão: Pacientes portadores de HIV, classificados em diferentes faixas do Escore de Framingham, apresentam associação entre o risco cardiovascular e o aumento da atividade simpática, redução da atividade parassimpática e do balanço simpato-vagal. Isso demonstra que, mesmo em pacientes com carga viral não detectável, as disfunções autonômicas cardiovasculares podem estar associadas ao risco cardiovascular em dez anos. Estes achados apontam para a importância de avaliações rotineiras do sistema nervoso autonômico cardiovascular nesta população.
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Almeida, Raitany Costa de 1977. "Hipertensão arterial sistêmica e outros fatores de risco cardiovascular em uma amostra da população de Porto Velho - RO = comparação urbana versus ribeirinha = Hypertesion and other cardiovascular risk factors in a sample of the population of Porto Velho - RO : urban area versus riverside area." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311543.
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Orientador: Otávio Rizzi CoelhoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Hipertensão arterial sistêmica (HAS) é uma importante causa evitável de morbidade e mortalidade cardiovascular. Vários estudos apontam para o aumento de sua prevalência no mundo e baixo controle pressórico, mas existem poucos dados referentes as comunidades ribeirinhas. Esta pesquisa compara a prevalência, consciência, tratamento e controle de HAS entre população urbana e ribeirinha em Porto Velho, região Amazônica, assim como avalia outros fatores de risco cardiovascular. Foi conduzido um estudo transversal, fundamentado em inquérito domiciliar em indivíduos de 35 a 80 anos, recrutados entre julho e dezembro de 2013. Realizado entrevista com questionário padronizado, medidas de pressão arterial (PA), peso, altura e circunferência abdominal (CA). HAS foi definido através de indivíduos que relataram ter a doença, ou prescritos para uso de medicações anti-hipertensivas ou aqueles que tinham PA sistólica ? 140 mmHg ou PA diastólica ? 90 mmHg, na média de duas medidas usando dispositivo digital automático. Consciência foi baseada em autorrelatos, tratamento no uso de medicamento anti-hipertensivo, e controle foi definido quando indivíduos apresentavam PA menor do que 140/90 mmHg. Foi calculado índice de massa corpórea (IMC) e CA para avaliação de obesidade e obesidade abdominal. Também foi avaliado, através de autorrelatos, a taxa de diabetes, dislipidemia, tabagismo. Entre 1410 participantes, 750 (53,19%) tinham HAS e 473 (63,06%) eram cientes do diagnóstico. Daqueles que tinham consciência do diagnóstico, a maioria 404 (85.41%) recebia tratamento farmacológico, mas a taxa de controle foi baixa. As percentagens de prevalência e tratamento foram maiores na área urbana, respectivamente, (55,48% vs. 48,87%)(p=0,02) e (61,25% vs. 52,30%)(p<0,01). A consciência de HAS foi maior na área ribeirinha (61,05% vs. - 67,36%)(p<0,01), mas as taxas de controle, tanto entre todos os hipertensos quanto naqueles que faziam tratamento farmacológico, foram similares, respectivamente, (22,11% vs. 23,43%)(p=0,69) e (33,88% vs. 34,32%) (p=0,77). Não houve diferença significativa no sobrepeso (40,93% vs. 40,28%)(p=0,73); obesidade (19,10% vs 19,63%)(p=0,68) e tabagismo (18,56% vs. 16,76%)(p=0,09). Cerca de metade dos participantes apresentavam HAS. A prevalência foi mais alta nos urbanos, mas a diferença para os ribeirinhos foi pequena. Dos indivíduos hipertensos, tanto na área urbana quanto ribeirinha, menos de um quarto tinham HAS controlada
Abstract: High blood pressure (hypertension) is a major preventable cause of cardiovascular morbidity and mortality. Several studies indicate to the increase its prevalence in the world and low control rate, but there are few data on the riverside communities. This research compares the prevalence, awareness, treatment and control of hypertension between urban and riverside population in Porto Velho, the Amazon region, as well as evaluating other cardiovascular risk factors. A cross-sectional study was conducted, based on a household survey in individuals 35-80 years recruited between July and December 2013. Directed interview with standardized questionnaire, blood pressure measurements (PA), weight, height and waist circumference (WC). Hypertension was defined by individuals who reported having the disease, or prescribed for use of antihypertensive medications or those who had systolic blood pressure ? 140 mmHg or diastolic BP ? 90 mmHg, the mean of two measurements using automatic digital device. Awareness was based on self-reports, treatment in the use of antihypertensive medication, and control was defined as a BP ? 140/90 mm Hg. We calculated body mass index (BMI) and WC for assessing obesity and abdominal obesity. We also assessed through self-report, the rate of diabetes, dyslipidemia, smoking. Among 1410 participants, 750 (53.19%) had hypertension and 473 (63.06%) were aware of their diagnosis. Of those who were aware of the diagnosis, 404 (85.41%) received pharmacological treatment, but the control rate was low. The percentages of prevalence and treatment were higher in urban areas, respectively (55.48% vs. 48.87%) (p = 0:02) and (61.25% vs. 52.30%) (p <0.01). Awareness was higher in the riverside area (61.05% vs. 67.36%) (p <0.01), but control rates, both among all hypertensive patients and in those who were pharmacological treatment were similar, respectively, (22.11% vs . 23.43%) (p = 0.69) and (33.88% vs. 34.32%) (p = 0.77). - There was no significant difference in the overweight (40.93% vs. 40.28%) (p = 0.73); obesity (19.10% vs. 19.63%) (p = 0.68) and smoking (18.56% vs. 16.76%) (p = 0.09). Hypertension prevalence was higher in the urban population than in the riverside population. Of the hypertensive individuals in both areas, < 25% had controlled blood pressure
Doutorado
Clinica Medica
Doutor em Clínica Médica
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Odebunmi, Olufeyisayo, Sylvester Olubolu Orimaye, Moboni Tosin Mokikan, Adeola Olubukola Awujoola, Adekunle Olumide Oke, Amy Poole, Timir Kumar Paul, et al. "Identifying Multiple Risk Factors of Hypertension for Reducing the Prevalence of Peripheral Arterial Disease in Rural Central Appalachia." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/22.
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Introduction
Hypertension occurs when there is persistent increase in the pressure of blood vessels in the body; this condition affects about 75 million people in the United States (U.S.). Hypertension is a major risk factor for Peripheral Artery Disease (PAD). PAD is a narrowing of the peripheral arteries in legs, stomach, arms and head regions of the body except the heart. Research has shown that hypertension can be life-threatening for patients with PAD. Moreover, research supports an evidence of a low threshold for blood pressure treatment in patients with PAD. Additionally, current American Heart Association guidelines recommend treating hypertension in patients with PAD to reduce the risk of other cardiovascular disease (CVD) comorbidities. In Central Appalachia, the rate of hypertension and the corresponding risk factors is higher than the national average. As such, this study examined the multiple risk factors of hypertension in patients with PAD within the Central Appalachian region.
Method
The study population consists of patients diagnosed with PAD in a large health system in Central Appalachia from 2008 to 2018. We extracted 13,455 patients with PAD from Electronic Medical Records (EMR) system using ICD- 9 and ICD-10 codes. The outcome variable of the study was hypertension in PAD patients. Explanatory variables included gender, age, and cardiovascular risk factors (myocardial infarction (MI), Body Mass Index (BMI), diabetes mellitus, smoking status, low-density lipoprotein, high-density lipoprotein, triglycerides, and hypercholesterolemia). Multivariable logistic regression was performed to assess the association between risk factors of hypertension in male and female PAD patients. All analyses were performed using SPSS version 24.
RESULTS
Of the total PAD patients in the study, 45.8% were females and 54.2% were males. Of these patients, 79.1%, 45.7% and 22.6% had hypertension, diabetes and a history of MI, respectively. Upon stratifying based on gender, the odds of hypertension in PAD female patients with a history of MI was approximately 5.4 times (OR: 5.4, CI : 1.80-16.21) and 2.6 times higher with diabetes (OR: 2.6, CI: 1.43-4.83). Whereas in PAD male patients, the odds of hypertension was 3.9 (OR: 2.6, CI: 1.61-9.21) and 2.6 times (OR: 2.6, CI: 1.43-4.83) higher in those with a history of MI and diabetes, respectively. Stratifying by MI, the odds of hypertension in PAD increased by 2.8 times in patients with diabetes (OR: 2.6, CI: 1.75-4.49). Stratifying by diabetes showed that the odds of hypertension in PAD increased by 4.7 times in patients with MI (OR: 4.7, CI: 1.32-17.07).
CONCLUSION
The study showed that odds of hypertension in PAD patients is increased in the presence of diabetes and history of MI in both genders. Therefore, controlling diabetes and myocardial infarction will have the greatest impact in reducing the likelihood of hypertension leading to decreased morbidity and mortality in patients with PAD.
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Martin, Nailú Angélica Sinicato 1989. "Síndrome metabólica e composição corporal nos pacientes com lúpus eritematoso sistêmico juvenil." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312095.
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Orientador: Simone AppenzellerDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Lupus Eritematoso Sistêmico (LES) e uma doença autoimune, crônica e mutissistemica, caracterizada por períodos de atividade e remissão. Anormalidades como leucopenia, anemia hemolítica, presença de auto-anticorpos como anti-DNA de fita dupla (anti-dsDNA), anti-Smith (anti-Sm) e fator antinuclear (FAN) podem ser encontradas. Quando diagnosticado ate os 16 anos de idade e denominado LESj. Devido ao elevado acometimeto cardíaco nesses pacientes e muito importante avaliar os fatores de risco para o desenvolvimento de doenças coronarianas. O presente estudo, de característica transversal, teve como objetivo avaliar a presença de SM nos pacientes com LESj e comparar com controles sem histórico de doença autoimune e cardiovasculares e avaliar a composição corporal e observar a associação com a atividade e dano da doença, uso de corticosteróides e TNF-?. Foram selecionados pacientes consecutivos com LESj acompanhados na Unidade de Reumatologia Pediátrica da UNICAMP entre 2010/2012. Manifestações clinicas, laboratoriais e medicação em uso foram avaliadas. A atividade da doença [SLE Disease Activity Index (SLEDAI)], dano cumulativo [Lupus International Collaborating Clinics (SLICC)] foi determinado para cada paciente no dia da coleta de sangue. A SM foi avaliada através do critério da IDF - International diabetes federation. A dosagem da citocina foi realizada por ELISA (Enzyme Linked Immuno Sorbent Assay). Observamos uma prevalência de SM de aproximadamente 20% dos pacientes incluídos. Observamos um numero similar de pacientes com LES <18 anos com síndrome metabólica quando comparada com ? 18 anos de idade (p = 0,202). Observamos que pacientes com LES <18 anos apresentaram mais hipertrigliceridemia e pacientes ? 18 anos apresentaram mais frequentemente hipercolesterolemia, altos níveis de LDL-C e hipertrigliceridemia, Observamos correlação do SLEDAI ajustado ao longo do tempo com a definição do IDF nos pacientes com LES ? 18 anos (r = 0,229, p = 0,033). Observamos também uma maior razão CA/CQ em pacientes com LESj quando comparado ao grupo controle (p <0,001). Observou-se correlação com o IMC e CA (r = 0,58, p <0,001) e CQ (r = 0,53, p <0,001) nos pacientes com LESj e entre IMC e peso (r = 0,86, p <0,001), altura (r = 0,26, p = 0,030), CA (r = 0,59, p <0,001) e CQ (r = 0,55, p <0,001) nos controles. Observamos uma correlação entre CA e IMC (r = 0,53, p <0,001) e o IAC (r = 0,39, p <0,001) nos pacientes com LESj. Observamos uma correlação entre o IAC e o IMC (r = 0,48, p <0,001). A analise da DXA mostrou que em pacientes com SLEj 36,8% de massa de corpo inteiro corresponde a gordura, e 42,3% esta localizada na região do tronco. Em nosso estudo observamos um aumento dos níveis séricos de TNF-? em pacientes com LESj, houve o aumento dos níveis de TNF-? em pacientes com doença ativa, alem de uma correlação positiva entre a pontuação de SLEDAI, níveis de TNF-? também se correlacionaram com a porcentagem de gordura e a massa gorda na região do tronco. De acordo com nossos resultados, os pacientes com LESj, possuem maior prevalência de SM e uma distribuição central de gordura corporal maior do que indivíduos controlem. Devido ao grande aumento do risco cardiovascular nesses pacientes e necessario a avaliacao rotineira da SM e da composição corporal
Abstract: Systemic lupus erythematosus (SLE) is a chronic, multisystemic, relapsing and remitting autoimmune disease. Abnormalities such as leukopenia, hemolytic anemia, presence of autoantibodies such as anti-double-stranded DNA (anti-dsDNA), anti-Smith (anti-Sm) and antinuclear antibodies (ANA) can be found. When the diagnosis was made until 16 years old the patients was called childhood-onset SLE. Because of the greatest rate of cardiac involvement of these patients is very important to evaluate the risk factors to coronary diseases development The present cross-sectional study aimed to evaluate the presence of MetS in SLE patients and to compare with controls without autoimmune disease history and to evaluate the body composition and observe its association with the activity disease, laboratory data and corticosteroid treatment and TNF-?. We selected consecutive pediatric SLE patients followed at the Pediatric Rheumatology Unit of UNICAMP between 2010/2012. Clinical, laboratory, disease activity [SLE Disease Activity Index (SLEDAI)], cumulative damage [Systemic Lupus International Collaborating Clinics / American College of Rheumatology Damage Index (SDI)] and current drug exposure were evaluated. The MetS was evaluated by IDF - International diabetes federation criteria. The measurement of cytokines was performed by ELISA (Enzyme Linked Immuno Sorbent Assay). The prevalence of MetS in approximately 20% of patients included. We observed a similar number of SLE patients <18 years with MetS compared with ? 18 years of age (p = 0.202). We found that SLE patients <18 years presented with hypertriglyceridemia and patients ? 18 years were more frequently hypercholesterolemia, high LDL-C and hypertriglyceridemia observed correlation of SLEDAI adjusted over time with the definition of the IDF in SLE patients ? 18 years (r = 0.229, p = 0.033). We also observed a higher ratio HC / WC procedures in patients with SLE compared to the control group (p <0.001). Correlation with BMI and WC (r = 0.58, p <0.001) and HC (r = 0.53, p <0.001) in patients with SLE and between BMI and weight (r = 0.86, p <0.001), height (r = 0.26, p = 0.030), WC (r = 0.59, p <0.001) and HC (r = 0.55, p <0.001) in controls. We observed a correlation between WC and BMI (r = 0.53, p <0.001) and BAI (r = 0.39, p <0.001) in patients with SLE. We observed a correlation between the BAI and BMI (r = 0.48, p <0.001). The DXA analysis showed that in patients with cSLE 36.8% by weight of the whole body matches the fat, and 42.3% is located in the trunk. In our study we observed an increase in serum levels of TNF-? in patients with cSLE, there were increased levels of TNF-? in patients with active disease, and a positive correlation between the SLEDAI score, levels of TNF-? also correlated with the percentage of fat and fat mass in the trunk region. According to our results, patients with cSLE, have a higher prevalence of MetS and a central distribution of body fat greater than control subjects. Due to the large involvement of CVD in these patients is necessary routine assessment of MetS and body composition
Mestrado
Pediatria
Mestra em Ciências
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Ollila, M. M. (Meri-Maija). "The role of polycystic ovary syndrome (PCOS) and overweight/obesity in women’s metabolic and cardiovascular risk factors and related morbidities." Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526222592.
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Abstract Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting reproductive aged women, with reproductive, metabolic and cardiovascular implications across the life span. The typical features of PCOS include irregular menstruation, androgen excess and polycystic ovaries in ultrasonography. The majority of women with PCOS are overweight or obese, and, at least partly, obesity-driven metabolic abnormalities often coexist with PCOS. Despite intensive research, it has remained unclear whether PCOS per se is a risk factor of metabolic abnormalities, and cardiovascular disease and events. The main aim of the current work was to investigate whether PCOS is an independent risk factor of metabolic abnormalities and cardiovascular diseases. The study population consisted of the prospective population-based Northern Finland Birth Cohort 1966, and we used data collected at ages 14, 31 and 46. The definition of PCOS was based on self-reported PCOS symptoms at age 31 and/or PCOS diagnosis by age 46. The results revealed that weight gain in early life was a risk factor for the development of PCOS. As for metabolic outcomes, at age 46, normal-weight women with PCOS did not display increased odds of abnormal glucose metabolism. However, weight gain during early adulthood was significantly associated with abnormal glucose metabolism in women with PCOS by age 46. Interestingly, PCOS per se was already associated with elevated blood pressure at age 31 and hypertension at age 46, independently of obesity. Women with PCOS also displayed reduced cardiac vagal activity, which was associated with metabolic abnormalities and hypertension. Furthermore, even though no major anatomical or functional impairments were observed in echocardiography, women with PCOS displayed a significantly greater prevalence of myocardial infarction and a two-fold higher prevalence of cardiovascular events than controls. In conclusion, our findings indicate that even though PCOS is an independent risk factor of metabolic derangements, related obesity is a major metabolic risk factor in these women. The role of PCOS in cardiovascular events per se remains controversial and requires follow-up of this cohort. Given all this, maintaining normal weight and preventing weight gain, especially during early adulthood, should be the main priority in the prevention of adverse metabolic changes in women with PCOSTiivistelmä Munasarjojen monirakkulaoireyhtymä (polycystic ovary syndrome, PCOS) on lisääntymisikäisten naisten yleisin hormonaalinen häiriö aiheuttaen runsaasti sairastavuutta ja terveydenhuollon kustannuksia. PCOS:n diagnostisiin kriteereihin kuuluvat epäsäännöllinen kuukautiskierto, lisääntynyt miessukupuoli-hormonivaikutus sekä monirakkulaiset munasarjat. Merkittävä osa oireyhtymää sairastavista naisista on ylipainoisia tai lihavia ja oireyhtymän kanssa yhtä aikaa esiintyykin useita, ainakin osittain ylipainosta johtuvia, metabolisia häiriöitä. Lukuisista tutkimuksista huolimatta on kuitenkin epäselvää, altistaako PCOS itsessään metabolisille häiriöille sekä sydän- ja verisuonisairauksille. Väitöskirjatutkimuksen tavoitteena oli selvittää, onko PCOS itsenäinen metabolisten ja sydän- ja verisuonisairauksien riskiä lisäävä tekijä. Tutkimus pohjautui Pohjois-Suomen syntymäkohortti 1966 tutkimuksen 14-, 31- ja 46-vuotisseurantoihin. PCOS luokittelu perustui 31- ja 46-vuotiskyselyissä itse ilmoitettuihin tyypillisiin PCOS oireisiin ja/tai diagnoosiin. Tutkimuksessa havaittiin, että 14- ja 31-ikävuoden välillä tapahtuva painonnousu oli yhteydessä PCOS diagnoosiin myöhemmällä iällä. 46-vuotiaana normaalipainoisilla PCOS naisilla ei ollut suurentunut tyypin 2 diabetes riski, mutta painonnousu varhaisaikuisuudessa oli merkittävästi yhteydessä sokeriaineenvaihdunnan häiriöön PCOS naisilla. PCOS oli yhteydessä kohonneeseen verenpaineeseen 31-vuotiaana ja hypertensioon 46-vuotiaana ylipainosta riippumatta. Oireyhtymään liittyvät metaboliset häiriöt olivat tärkein sydämen autonomisen hermoston säätelyyn vaikuttava tekijää, kun taas PCOS itsessään ei vaikuttanut autonomisen hermoston toimintaan. PCOS:ään sairastavien naisten sydämen rakenne ja funktio eivät merkitsevästi poikenneet kontrolloiden vastaavista muuttujista. Kuitenkin suhteellisen nuoresta iästä huolimatta PCOS naisilla esiintyi enemmän sydäninfarkteja ja kaksi kertaa enemmän sydän- ja verisuonitapahtumia, kuin kontrolleilla. Tutkimuksen tulokset osoittavat, että vaikkakin PCOS on itsenäinen riskitekijä metabolisille häiriöille, oireyhtymään liittyvä ylipaino vaikuttaa merkittävästi metabolisten häiriöiden esiintymiseen. PCOS:n ja sydän- ja verisuonitautitapahtumien yhteyden tarkempi tutkiminen vaatii kohortin jatkoseurantaa. Painonhallinnan tukemisen tulisi olla PCOS:ää sairastavien naisten hoidon kulmakivi
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Lewandowski, Adam J. "The impact of preterm birth on the cardiovascular system in young adulthood." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:f39dbabd-9f4f-439e-9c25-1989402a263a.
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Advancements in clinical care have led to a growing cohort of preterm-born individuals now entering adulthood. Before birth, such adults were often exposed to a suboptimal intrauterine environment, and after delivery, key developmental stages that would normally occur in utero during the third trimester had to take place under ex utero physiological conditions. Through detailed cardiovascular phenotyping, this thesis investigates the cardiovascular changes in preterm-born young adults, utilising a cohort of individuals with data collection since recruitment at birth. The detailed perinatal information was first used to design nested case-control studies to investigate the effects of early lipid and glucocorticoid exposure on long-term cardiovascular physiology in individuals born preterm. It was demonstrated that intravenous lipid administration leads to an artificial elevation of total cholesterol levels in immediate postnatal life, which is associated with long-term changes in aortic and left ventricular function proportional to the degree of cholesterol elevation. Additionally, exposure to antenatal glucocorticoids relates to a regional increase in aortic arch stiffness in young adulthood, as well as changes in glucose metabolism. It was then shown that young adults born preterm have increased left ventricular mass, out of proportion to blood pressure, and a unique three-dimensional left ventricular geometry, with reduced systolic and diastolic function compared to term-born controls. Similarly, they also show distinct differences in the right ventricle, with increased right ventricular mass and a proportion having clinically impaired right ventricular systolic function. Finally, it was demonstrated that preterm-born individuals have increased circulating levels of antiangiogenic factors in young adulthood, which relate to capillary rarefaction and blood pressure elevation. These findings are of considerable public health relevance given that nearly 10% of births are now preterm. Understanding whether modification of these variations in cardiovascular structure and function prevent the development of cardiovascular disease in this growing subgroup of the population will be of future interest.
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Carr, Lucas J. "Short and long-term efficacy of an Internet-delivered physical activity behavior change program on physical activity and cardiometabolic disease risk factors in sedentary, overweight adults." Laramie, Wyo. : University of Wyoming, 2008. http://proquest.umi.com/pqdweb?did=1663060191&sid=1&Fmt=2&clientId=18949&RQT=309&VName=PQD.
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Leboeuf, Charlotte. "Potential predictors and outcomes of physical activity : comparisons between physically active and inactive adolescent boys." Title page, table of contents and abstract only, 1991. http://web4.library.adelaide.edu.au/theses/09MPM/09mpml447.pdf.
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Al-Lage, Jéssica Guimarães. "Perfil epidemiológico, modulação autonômica cardíaca e escores de risco cirúrgico de indivíduos eletivos para cirurgia de revascularização do miocárdio /." Rio Claro, 2019. http://hdl.handle.net/11449/190800.
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Orientador: Robison José QuitérioResumo: Introdução: Em decorrência do número elevado de comorbidades associadas à Doença Arterial Coronariana (DAC), os modelos de previsão de risco para cirurgia cardíaca foram desenvolvidos com a finalidade de melhor caracterizar os fatores que influenciam os resultados deste procedimento. Além dos escores de risco utilizados mundialmente “European System for Cardiac Operative Risk Evaluation” (EUROSCORE II) e “Society of Thoracic Surgeons” (STS), a Variabilidade da Frequência Cardíaca (VFC) tem surgido como um novo instrumento de previsão do risco cardiovascular e cirúrgico. Objetivo: Caracterizar os pacientes eletivos para cirurgia de revascularização do miocárdio na região de Marília-SP-Brasil, quanto aos fatores de risco e controle neural do coração; Verificar se existe correlação entre os índices da VFC e os escores de risco cirúrgico EUROSCORE II e STS. Amostra: Foi composta por indivíduos de ambos os sexos, acima de 50 anos, eletivos para cirurgia de revascularização do miocárdio (Hospital Santa Casa de Misericórdia de Marília). O Grupo Controle (GC) foi composto por indivíduos de ambos os sexos, acima de 50 anos, saudáveis. Procedimentos do Estudo: Foi realizada a anamnese na qual foram avaliados os fatores de risco para doença cardiovascular. O registro do intervalos RR foi obtido na postura decúbito dorsal, por 20 minutos, em respiração espontânea. Os índices da VFC (lineares e não lineares) foram analisados, comparados com um grupo controle e correlacionados com valores ... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Introduction: Due to the high number of comorbidities associated with Coronary Artery Disease (CAD), risk prediction models for cardiac surgery were developed with the purpose of better characterizing the factors that influence the results of this procedure. In addition to the European System for Cardiac Operative Risk Evaluation (EUROSCORE II) and Society of Thoracic Surgeons (STS) worldwide, Heart Rate Variability (HRV) has emerged as a new tool for predicting cardiovascular risk and surgical. Objective: To characterize elective patients for myocardial revascularization surgery in the Marília-SP-Brazil region, regarding risk factors and neural control of the heart; To verify if there is a correlation between the HRV indices and the surgical risk scores EUROSCORE II and STS. Sample: It was composed of individuals of both sexes, over 50 years old, elective for myocardial revascularization surgery (Santa Casa de Misericórdia Hospital of Marília). The Control Group (CG) was composed of individuals of both genders, over 50 years, healthy. Study Procedures: An anamnesis was performed in which the risk factors for cardiovascular disease were evaluated. RR interval recording was obtained in the dorsal decubitus position for 20 minutes in spontaneous breathing. The HRV indices (linear and non-linear) were analyzed, compared to a control group and correlated with values obtained from EUROSCORE II and STS. The data were organized as descriptive statistics, with values of mean and stan... (Complete abstract click electronic access below)
Mestre
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Rodrigues, Sara. "Avaliação da rigidez arterial e da resistência vascular periférica em pacientes recém-diagnosticados com síndrome metabólica." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-24102016-115125/.
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Além das alterações autonômicas, a síndrome metabólica (SMet) causa disfunção vascular relacionada a eventos cardiovasculares e morte. Considerando que a resistência à insulina é associada à hiperativação simpática, testamos a hipótese de que a presença da glicemia de jejum alterada (GLI) é a principal causa das alterações estruturais e funcionais em grandes e pequenos vasos, via aumento do tônus simpático nesses pacientes. Foram avaliados pacientes com SMet recém diagnosticados (ATP-III) e não medicados, divididos em: glicemia de jejum alterada >=100mg/dL (SMet+GLI, n=35; 50±1 anos) e glicemia normal < 100mg/dL (SMet-GLI, n=24, 46 ± 1). Um grupo de indivíduos saudáveis foi estudado como controle (CS, n=17, 50±1 anos). Foram medidas rigidez arterial (velocidade de onda de pulso, VOP), atividade nervosa simpática muscular (ANSM, microneurografia) fluxo sanguíneo muscular (FSM, pletismografia), pressão arterial média (PAM, oscilométrico), resistência vascular periférica (RVP=PAM/FSM) e dimetilarginina assimétrica (ADMA). SMet+GLI apresentou maior VOP que SMet-GLI e CS (8,0[7,2-8,6], 7,3[6,9-7,9] e 6,9[6,6-7,2]m/s, respectivamente, P=0,001), não havendo diferença entre SMet-GLI e CS. Além disso, SMet+GLI foi similar ao SMet-GLI mas teve maior RVP que CS (P=0,008), não havendo diferença entre SMet-GLI e CS. Adicionalmente, SMet+GLI teve maior ANSM que SMet-GLI e CS; enquanto SMet-GLI teve maior ANSM que CS (31+-1; 26+-1; 19+-1 disparos /min, P < 0,001). ADMA foi similar entre os grupos (0,62 [0,56-0,71], 0,67 [0,59-0,92] e 0,60 [0,54-1,43] umol/L). Dentre os fatores de risco da SMet, GLI foi preditor do aumento da ANSM. ANSM foi associada à VOP (R=0.39; P=0,002) e à RVP (R=0,30, P=0,034). Em conclusão, a hiperativação simpática, que está aumentada na presença da glicemia alterada, é o mecanismo básico que pode explicar, pelo menos em parte, o aumento na VOP e na RVP. GLI parece ser o principal fator de risco no prejuízo da função e estrutura vascular nos pacientes com SMetBesides autonomic alterations, metabolic syndrome (MetS) causes vascular dysfunction related to cardiovascular events and death. Since insulin resistance is associated with sympathetic hyperactivation, we tested the hypothesis that the presence of impaired fasting glucose (IFG) is the main cause of structural and functional changes of large and small vessels via elevated sympathetic tonus in these patients. We evaluated never treated, newly diagnosed MetS (ATP-III) patients divided into: impaired fasting glucose >100mg/dL (MetS+IFG, n=35; 50±1 y) and normal fasting glucose <100mg/dL (MetS-IFG, n=24, 46±1 y). A healthy control group was also studied (C, n=17, 50±1 y). We measured the arterial stiffness (pulse wave velocity, PWV), muscle sympathetic nerve activity (MSNA, microneurography), forearm blood flow (FBF, plethysmography), mean blood pressure (MBP, oscillometric), peripheral vascular resistance (PVR=MBP/FBF) and asymmetric dimethylarginine (ADMA). MetS+IFG had higher PWV than MetS-IFG and C (8.0[7.2-8.6], 7.3[6.9-7.9] and 6.9[6.6-7.2]m/s, respectively, P=0.001), whereas SMet-GLI was similar to CS. Moreover, MetS+IFG was similar to MetS-IFG, but had higher PVR than C (P=0.008) and SMet-GLI was similar to CS. In addition, MetS+IFG had higher MSNA than MetS-IFG and C; whereas MetS-IFG had higher MSNA than C (31 +- 1; 26+- 1; 19+-1 bursts/min, P < 0.001). ADMA were similar among groups (0.62 [0.56-0.71] vs 0.67 [0.59-0.92] and 0.60 [0.54-1.43] umol/L). Among MetS risk factors, IFG was predictor of increased MSNA. Further, MSNA was associated with PWV (R=0.39; P=0.002) and PVR (R=0.30, P=0.034). In conclusion, sympathetic hyperactivation, which is enhanced in the presence of high blood glucose, is the basic mechanism that could explain, at least in part, the increase in PWV and PVR. IFG appears to be the main risk factor in the vascular function and structure damage in MetS patients
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DeAraugo, Jodi. "The effect of website, face-to-face, and combined programs on physiological, psychological, and lifestyle risk variables for cardio-vascular disease." Thesis, University of Ballarat, 2005. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/43348.
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Although a multitude of preventative programs have been utilised worldwide to modify cardiovascular risk factors, none have included internet based interventions. Study 1 aimed to compare internet based (n = 21), face-to-face (n = 27), and combined (n = 21) treatment groups with a naturally occurring control group (n = 24) on physiological, psychological, and lifestyle risk variables for cardiovascular disease across 6-months, and to determine if there were relationships between changes in the psychological and physiological variables over time. Results indicated that the internet based group had significantly greater social reciprocity than the face-to-face group. Significant time effects were noted for heart rate, stress, depression, anxiety, reciprocity, anger expression-out, anger expression-in, anger control-out, and anger control-in. Results also demonstrated that increases in reciprocity and anxiety, and decreases in anger expression-out, were related to increases in heart rate. "In contrast, less anger suppression was a significant predictor of greater systolic blood pressure. However, there were no significant results for group, time, or predictive value for the other psychological, physiological, and lifestyle risk variables. A follow-up study examined the effects of unstructured (n = 13) and highly structured (n =14) internet based programs on physiological, psychological, and lifestyle risk variables for coronary heart disease over 6-months. It also investigated if there were relationships between changes in the psychological and physiological variables over time. Participants stages of change were assessed in relation to psychological and lifestyle risk variables. Results showed that the unstructured group scored significantly higher on anger-expression-out than the highly structured group and that the unstructured groups alcohol usage significantly reduced over time. The remaining psychological, physiological and lifestyle risk variables did not produce significant group, time, or predictive changes. The stage of change results indicated no significant group or time effects. Results indicated that greater angry reaction scores were predictive of higher heart rate and increased stress scores were predictive of higher diastolic blood pressure. The critical psychological variables predictive of poorer cardiovascular functioning should be targeted in future interventions.Doctor of Psychology (Clinical)
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Gomes, Valeria Aguiar 1982. "Efeito do anticoncepcional oral sobre as alterações de metaloproteinases da matriz extracelular em pacientes com síndrome do ovário policístico : Effect of oral contraceptives on changes of extracellular matrix metalloproteinases in patients with polycystic ovary syndrome." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310020.
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Orientador: José Eduardo Tanus dos SantosTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A síndrome do ovário policístico (SOP) é a endocrinopatia mais comum em mulheres na idade reprodutiva e está frequentemente associada a alguns fatores de risco cardiovascular. A grande maioria das doenças cardiovasculares (DCV) ocorre inicialmente com o remodelamento vascular, em que as metaloproteinases de matriz (MMPs) são os principais mediadores. Sendo assim, o objetivo do presente estudo foi comparar os níveis plasmáticos da MMP-2 e da MMP-9 e dos inibidores teciduais de MMPs (TIMPs) das pacientes com SOP com as controles saudáveis e examinar se os níveis desses biomarcadores estão associados com às características clínicas e bioquímicas da SOP. Além disso, avaliar o efeito do anticoncepcional oral sobre os níveis plasmáticos de MMPs e respectivos inibidores endógenos nas mulheres com SOP. Para isso, na primeira parte do estudo, avaliamos 65 controles ovulatórias e 80 pacientes com SOP. As concentrações plasmáticas de MMP-8, MMP-9, TIMP-1, TIMP-2 foram medidas por Elisa e, as de MMP-2, por zimografia. Os níveis de MMP-2, MMP-8, MMP-9 e TIMP-1 não foram significativamente diferentes entre os grupos (p? 0,05). Pacientes com SOP apresentaram menores níveis plasmáticos de TIMP-2 do que as controles saudáveis (182,30 ± 5,60 vs. 204,20 ± 7,28 ng/ml; p ?0,05). Além disso, a testosterona foi preditor independente dos níveis de TIMP-2 (estimativa = -0,35, p = 0,04) e da razão MMP-9/TIMP-1 (estimativa = 0,01, p = 0,04). Para avaliar se a redução do hiperandrogenismo iria promover alguma alteração no perfil das MMPs, foram analisadas 20 mulheres com SOP que queriam contracepção hormonal (grupo SOP- ACO), 20 mulheres ovulatórias que desejavam contracepção hormonal (grupo controle- ACO) e 15 mulheres ovulatórias que desejavam contracepção não-hormonal (grupo controle). O tratamento com ACO contendo 30 mcg de etinilestradiol/2mg de acetato de clormadinona durante 6 meses reduziu significativamente as concentrações plasmáticas de MMP-2 no grupo controle ( de 1,44 ± 0,11 unidades arbitrárias no tempo basal para 1,22 ± 0,07 unidades arbitrárias após 6 meses; p = 0,01), e no grupo SOP ( de 1,43 ± 0,08 unidades arbitrárias no tempo basal para 1,25 ± 0,09 unidades arbitrárias após 6 meses; p = 0,007). O ACO reduziu as concentrações de TIMP-2 e TIMP-1 no grupo controle (todos p ?0,05), mas não teve efeitos na MMP-9 plasmática e nas razões MMP-2/TIMP-2 e MMP-9/TIMP-1 (todos p? 0,05) nos grupos avaliados. Os achados do presente estudo indicam que as mulheres com SOP possuem um desequilíbrio nas razões MMP-2/TIMP-2 e MMP-9/TIMP-1, bem como níveis reduzidos de TIMP-2. Parte desses achados estão relacionados ao hiperandrogenismo presente nessas mulheres. Na segunda parte do estudo, observamos que a redução do hiperandrogenismo, promovido pelo tratamento em longo prazo com o ACO, reduziu as concentrações plasmáticas de MMP-2. Considerando o desequilíbrio no perfil das MMPs apresentado pelas mulheres com SOP e, as possíveis consequências decorrentes desse cenário, o tratamento com ACO se mostra benéfico nessas pacientes, podendo reduzir os riscos de futuras complicações cardiovasculares
Abstract: The polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age and it is often associated with some cardiovascular risk factors. The majority of cardiovascular disease (CVD) occurs initially with vascular remodeling in which matrix metalloproteinases (MMPs) are key mediators. Therefore, the aim of this study was to compare plasma levels of MMP-2 and MMP-9 and tissue inhibitors of MMPs (TIMPs) of PCOS patients with healthy controls and to examine whether the levels of these biomarkers are associated with clinical and biochemical characteristics of PCOS. In addition to it, our goal was to evaluate the effect of oral contraceptives on plasma levels of MMPs and their endogenous inhibitors in women with PCOS. In order to prove it, in the first part of the study we evaluated 65 controls and 80 patients with ovulatory PCOS. The plasma concentration of MMP-8, MMP-9, TIMP-1 and TIMP-2 were measured by Elisa, and MMP-2 by zymography. The levels of MMP-2, MMP-8, MMP-9 and TIMP-1 were not significantly different between groups (p? 0.05). PCOS patients had lower their plasma levels of TIMP-2 than healthy controls ones (182,30 ± 5,60 vs. 204,20 ± 7,28 ng/ml; p = 0,02). Furthermore, testosterone was an independent predictor of the levels of TIMP-2 (estimate = -0.35, p = 0.04) and the MMP-9/TIMP- 1 ratio (estimate = 0.01, p = 0.04). To assess whether the reduction of hyperandrogenism would promote a change in the profile of MMPs, we analyzed 20 women with PCOS who wanted to hormonal contraception (OC-PCOS group), 20 ovulatory women who required hormonal contraception (OC-control group) and 15 ovulatory women who wanted non-hormonal contraception wanted a nonhormonal contraception (non-OC control group). Treatment with OC containing 2 mg chlormadinone acetate/30 ?g ethinylestradiol for 6 months significantly reduced plasma MMP-2 concentrations in the OC-control (from 1.44 ± 0.11 arbitrary units at baseline to 1.22 ± 0.07 arbitrary units after 6 months; p = 0.01) and the PCOS groups (from 1.43 ± 0.08 arbitrary units at baseline to 1.25 ± 0.09 arbitrary units after 6 months; p = 0.007) and TIMP-2 and TIMP-1 levels (448.0 ± 66.3 ng/mL versus 349.0 ± 40.9 ng/mL; p = 0.009) in the OC-control group (all p ?0.05) but had no effects on MMP-9 concentrations or on MMP-2/TIMP-2 and MMP-9/TIMP- 1 ratios (all p? 0.05) in any group. The results of this study indicate that women with PCOS have an imbalance in the MMP-2/TIMP-2 and MMP-9/TIMP-1 ratios and reduced levels of TIMP-2. Parts of these findings are also related to hyperandrogenism presence in these women. In the second part of the study, we observed that the reduction of hyperandrogenism promoted by long-term treatment with the OC reduced plasma concentrations of MMP-2. Given the imbalance in the profile of MMPs presented by women with PCOS and the possible consequences of this scenario, treatment with OC shows beneficial in these patients may reduce the risk of future cardiovascular complications
Doutorado
Farmacologia
Doutora em Farmacologia
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Pretorius, Jakobus. "Investigation of the relationship between genetic and environmental risk factors associated with obesity and insulin resistance in South African patients with non-alcoholic fatty liver disease(NAFLD)." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71689.
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Thesis (MSCMedSc)--Stellenbosch University, 2012.Includes bibliography
ENGLISH ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in the world. The disease spectrum of NAFLD extends from steatosis (types 1,2) to non-alcoholic steatohepatitis (NASH) with inflammation (types 3,4). The aims of the study were 1) to analytically validate high-throughput real time polymerase chain reaction (RT-PCR) assays for three selected single nucleotide polymorphisms (SNPs), FTO rs9939609 (intron 1 T>A), TNF-α rs1800629 (-308 G>A) and PPARγ rs1801282 (Pro12Ala, 34 C>G), and 2) to perform genotype-phenotype association studies in relation to biochemical abnormalities, disease severity and age of onset. A total of 119 patients with fatty liver identified on ultrasound, including 88 histologically confirmed NAFLD patients, and 166 control individuals were genotyped for the three selected SNPs. RT-PCR validated against direct sequencing as the gold standard was used for detection of genetic variation. All three SNPs were in Hardy Weinberg equilibrium in the study population, except for a deviation in genotype distribution detected for PPARγ rs1801282 in the NAFLD patient subgroup (p<0.001). After adjustment for age and gender, the risk-associated FTO rs9939609 A-allele was detected at a significantly higher frequency in the Caucasian compared with Coloured patients (p=0.005). The opposite was detected for the risk-associated TNF-α rs1800629 A-allele, which occurred at a significantly higher frequency in the Coloured compared with Caucasian NAFLD patients (p=0.034). The onset of fatty liver disease symptoms was on average 5 years younger in the presence of each risk-associated TNF-α rs1800629 A-allele (p=0.028). When considered in the context of an inferred genotype risk score ranging from 0-6, disease onset occurred on average 3 years earlier (p=0.008) in the presence of each risk-associated FTO A-allele, TNF-α A-allele or PPARγ C-allele. After adjustment for age, gender and race, no differences in genotype distribution or allele frequencies were observed between histologically confirmed NAFLD (types 1,2) and NASH (types 3,4) patients, while the minor allele frequency for the TNF-α rs1800629 was significantly higher in the total NAFLD (types 1-4) (p=0.047) as well as NASH subgroup (NAFLD types 3,4) (p=0.030) compared with obese patients without a histologically confirmed NAFLD diagnosis. A significant correlation was furthermore observed between the number of TNF-α rs1800629 A-alleles and increasing CRP levels (p=0.029), with a favourable reduced effect in the presence of low- to moderate alcohol intake. The average waist circumference of physically active NAFLD patients was 12% lower than in physically inactive patients (p=0.004). In view of the results presented in this study, the inclusion of the selected SNPs, and in particular the pro-inflammatory TNF-α rs1800629 polymorphism, may be considered as part of a comprehensive cardiovascular risk evaluation of NAFLD patients. Ultimately, early detection of patients with fatty liver disease symptoms and effective intervention based on the underlying disease mechanism may prevent progression from NAFLD to NASH, shown to be an independent risk factor for cardiovascular diseases.
AFRIKAANSE OPSOMMING: Nie-alkoholiese lewervervetting (NALV) is die mees algemene kroniese lewersiekte in die wêreld. Die siektespektrum van NALV strek van steatose (vervette lewer tipes 1,2) tot steatohepatitis met inflammasie (NASH tipes 3,4). Die doel van die studie was 1) om analities die hoë omset polimerase kettingreaksie (RT-PKR) metode te valideer vir die geselekteerde enkel nukleotied polimorfismes (ENPs) FTO rs9939609 (intron 1 T>A), TNF-α rs1800629 (-308 G>A) en PPARγ rs1801282 (Pro12Ala, 34 C>G), en 2) om genotipe-fenotipe assosiasie studies uit te voer ten opsigte van relevante biochemiese abnormaliteite, graad van die siekte en aanvangsouderdom. ’n Totaal van 119 pasiënte met vervette lewers is geïdentifiseer met behulp van ultraklank, insluited 88 histologies-bevestigde NALV pasiënte, en 166 kontrole individue. Hierdie pasiënte is gegenotipeer vir die 3 geselekteerde ENP’s. RT-PKR gevalideer met direkte DNA volgorde bepaling as die goue standaard, is gebruik vir opsporing van genetiese variasie. Al die ENP’s was in Hardy Weinberg ekwilibrium in die studie populasie, behalwe vir ’n afwyking in genotipe verspreiding waargeneem vir PPARγ in die NALV subgroep (p<0.001). Nadat aanpassings gemaak is vir ouderdom en geslag, is die risiko-geassosieerde FTO rs9939609 A-alleel waargeneem teen ’n betekenisvol hoër frekwensie in die Kaukasiese pasiënte in vergelyking met Kleurling pasiënte (p=0.005). Die teenoorgestelde is waargeneem vir die risiko-geassosieerde TNF-α rs1800629 A-alleel wat voorgekom het teen ’n betekenisvol hoër frekwensie in die Kleurling NALV pasiënte, in vergelyking met Kaukasiese NALV pasiënte (p=0.034). Die aanvang van NALV was gemiddeld 5 jaar vroeër in die teenwoordigheid van elke risiko-geassosieerde TNF-α rs1800629 A-alleel (p=0.028). Met inagneming van ’n genotipe risiko telling tussen 0–6, het aanvang van siekte gemiddeld 3 jaar vroeër voorgekom (p=0.008) in die teenwoordigheid van elke toenemende risiko-geassosieerde FTO A-alleel, TNF-α A-alleel en PPARγ C-alleel. Nadat aanpassings gemaak is vir ouderdom, geslag en ras, is geen verskille waargeneem in genotipe verspreiding of alleel frekwensies tussen histologies bevestigde NALV (tipes 1,2) en NASH (tipes 3,4) pasiënte nie, terwyl die minor alleel telling vir die TNF-α rs1800629 betekenisvol hoër was in die totale NALV (tipes 1–4) (p=0.047) asook die NASH subgroep (NALV tipes 3,4) (p=0.03) in vergelyking met vetsugtige pasiënte sonder ’n histologies bevestigde diagnose. ‘n Statisties beteknisvolle korrelasie is verder waargeneem tussen die aantal TNF-α rs1800629 A-allele en toenemende CRP vlakke (p=0.029), met n gunstige verlaagde effek in die teenwoordigheid van lae alcohol gebruik. Die gemiddelde middellyf-omtrek van fisies aktiewe NALV pasiënte was 12% minder as fisies onaktiewe pasiente (p=0.004). Na aanleiding van die resultate van hierdie studie behoort insluiting van geselekteerde ENP’s, en in besonder die pro-inflammatoriese TNF-α rs1800629 polimorfisme, as deel van ’n omvattende kardiovaskulere risiko evaluasie oorweeg te word. Aan die einde van die dag mag vroeë identifikasie van NALV pasiente en effektieve intervensie gebasseer op die onderliggende siekte meganisme, vordering tot NASH verhoed wat getoon is om ’n onafhanklike risiko faktor vir kardiovaskulêre siekte te wees.
Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology
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Hurtig, Wennlöf Anita. "Cardiovascular risk factors in children /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-179-2/.
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Abbott, Rebecca A. "Physical activity in childhood and its relation to biochemical and physiological markers of cardiovascular health." Thesis, Queensland University of Technology, 2000. https://eprints.qut.edu.au/36776/1/36776_Digitised%20Thesis.pdf.
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There is considerable concern, worldwide, that the current lifestyles that children lead are placing them at increased risk of a range of adult diseases later in life, as well as having more immediate short-term consequences for their health. Of particular concern is the concept that children are becoming more sedentary and less physically active.
The importance, in adulthood, of regular and appropriate physical activity with regards to health has been convincingly shown. In particular, individuals who are more active are less likely to develop coronary heart diseases and cerebrovascular disease. When combined these account for the major cause of death in Australia and developed countries across the world. With the knowledge that physical activity patterns developed in childhood carry through into adulthood, declining activity levels in the first two decades of life could clearly have strong implications for subsequent health. In the short term, reduced physical activity has been linked with a worsening cardiovascular risk profile. However the exact relationship of physical activity with risk factors is not clear due to the inconsistent and varied methodologies used to determine physical activity.
This thesis therefore, investigated physical activity levels in 6.0 to 10.5 year old children by a number of techniques, which ranged from the accurate measurement of total energy expenditure through to the more subjective assessment by diary and questionnaire. The parameters of activity were then related to both novel and standard markers of cardiovascular risk, in particular flow-mediated dilation - a measure of arterial health. Total energy expenditure levels and time spent in moderate to vigorous intense physical activity matched published recommendations. Furthermore, as a group, the children had habitual physical activity levels that categorised the children as moderately active. However, both habitual physical activity and intensity of activity were positively related to endothelial function. In addition, increasing levels of habitual activity and intense physical activity were inversely related to both percentage body fat and an unfavourable blood lipid profile.
This research showed that although the children were moderately active, reduced physical activity was associated with increased cardiovascular risk, even at this young age.
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Sjögren, Per. "Cardiovascular risk factors, diet and the metabolic syndrome /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-894-0/.
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Hergens, Maria-Pia. "Swedish moist snuff and the risk of cardiovascular diseases /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-372-6/.
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Rafnsson, Snorri Björn. "Cardiovascular diseases, risk factors and cognitive decline in the general population." Thesis, University of Edinburgh, 2007. http://hdl.handle.net/1842/30665.
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The principal aim of the present study was to examine the longitudinal change in cognitive test performance in relation to major clinical CVDs and vascular risk factors in a population-based sample of older people. The analysis is based on a cohort of 809 men and 783 women aged 55-74 years which in 1987/8 was randomly selected from the general population of Edinburgh. The findings from the present study further add to those of previous investigations demonstrating a relationship between CVDs, vascular risk factors, and cognitive decline in older people. Specifically, they reveal that, even in the absence of overt stroke, clinical CVDs are associated with a greater cognitive decline in the elderly, independently of potential confounding by a wide range of vascular risk factors. Also, the relationships between several vascular risk factors and cognitive decline proved to be independent of co-existing vascular pathology. Based on these findings, further study is needed to determine the combined effects of CVDs and multiple risk factors on cognitive outcomes in samples of older people. In addition, what the likely pathological mechanisms are underlying cognitive decline associated with atherosclerotic disease and vascular risk factors risk factors needs to be addressed in future studies. From a perspective of preventing or delaying vascular-based cognitive decline and impairment, more research is required to assess the effectiveness of both individual and population-based strategies targeting vascular disease and risk factors in older age groups. Finally, further investigation is needed to address the potential impact of subtle cognitive deficits on indictors of the quality of life and the capability of self-maintenance of elderly vascular patients, on adherence to medical treatment and rehabilitation, and further cognitive decrements and survival.
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Bolinder, Gunilla. "Long-term use of smokeless tobacco : cardiovascular mortality and risk factors /." Stockholm, 1997. http://www.kibic.ki.se/ki/diss/971024boli.html.
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