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Baker, J. E. "Ethnicity and cardiovascular disease prevention." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6524/.
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Background Public health interventions need to both improve health and reduce health inequalities, whilst using limited health care resources efficiently. Well-established ethnic differences in cardiovascular disease (CVD) raise the possibility that CVD prevention policies may not work equally well across ethnic groups. The aim of this thesis was to explore whether there are ethnic differences in the potential impact of two CVD prevention policy choices – the choice between mass and targeted screening for high cardiovascular risk, including the use of area deprivation measures to target screening, and the choice between population and high-risk approaches. Methods Cross-sectional data from the Health Survey for England 2003 and 2004 were used. Three sets of analyses were carried out – first, calculation of ethnic differences in the utility of area deprivation measures to identify individual socioeconomic deprivation; second, investigation of ethnic differences in the cost-effectiveness of mass and targeted screening for high cardiovascular risk; third, analysis of ethnic differences in the potential impact of population and high-risk approaches to CVD prevention. Results Area deprivation measures worked relatively effectively and efficiently at identifying individual socioeconomic deprivation in ethnic minority groups compared to the white group. In ethnic groups at high risk of CVD, cardiovascular risk screening programmes were a relatively cost-effective option, screening programmes targeted at deprived areas were particularly cost-effective, and population approaches were found to be an effective and equitable way of preventing CVD despite potential underestimation of their impact. Discussion This thesis found that ethnic minority groups in the UK are unlikely to be systematically disadvantaged by a range of CVD prevention policies that have been proposed, or implemented, for the general population. Additional CVD prevention policies, in particular those based on the population approach, should be implemented.
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Frauenberg, Sarah. "Aspirin Use for Primary Prevention of Cardiovascular Disease." Diss., North Dakota State University, 2019. https://hdl.handle.net/10365/29207.
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Cardiovascular disease (CVD) is a major cause of morbidity and mortality in the United States and aspirin is a well-known medication strongly associated with CVD prevention. Aspirin has undeniable benefits in the role of secondary prevention of CVD, however, the benefits are ambiguous when associated with primary prevention. The decision to start aspirin for primary prevention becomes complicated due to aspirin?s effect on coagulation and the risk of gastric ulceration. The United States Preventive Services Task Force (USPSTF) has level B recommendations in place regarding the use of low-dose aspirin (81 mg) for primary prevention of CVD. In addition, the American Heart Association (AHA) and American College of Cardiology (ACC) developed a calculator in 2013 to determine a patient?s 10-year CVD risk. The guideline and CVD calculator offer healthcare providers an easy-to-navigate tool to determine proper patient use of aspirin. However, despite the USPSTF guideline, appropriate aspirin use remains suboptimal. Successful adoption of the 2016 USPSTF guideline on aspirin use for primary prevention of CVD by providers in two rural North Dakota communities was the goal of this practice improvement project. The project began with education to providers and staff at the rural clinics regarding the USPSTF guideline and the ACC/AHA calculator. Following the educational session, implementation of the USPSTF guideline occurred for three months. Evaluation was performed through the use of a post-implementation survey. Results of the project demonstrated increased knowledge and usage of the guideline and a positive viewpoint related to implementation of the guideline with the providers in both of the communities having plans to sustain use in future practice. Data were also collected at a health screening fair in one of the rural communities to validate whether patients were taking aspirin per USPSTF guideline. Data gathered from the fair concluded only 59% of patients (41 out of 70) were taking, or not taking, aspirin appropriately according to the USPSTF guideline. Conclusively, primary care providers would be well served by using the ACC/AHA calculator and 2016 USPSTF guideline with all patients 40-79 years of age to determine appropriate use of aspirin for primary prevention of CVD.
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Chu, Paula N. "Identifying High-Value Lifestyle Interventions for Cardiovascular Disease Prevention." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:33493540.
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This dissertation evaluates lifestyle strategies for the management of cardiovascular risk factors and prevention of cardiovascular disease (CVD).
In Chapter 1, I systematically review and summarize the evidence of the effect of yoga, a popular mind-body practice, on cardiovascular disease and metabolic syndrome risk factors. I perform a narrative systematic review and a random-effects meta-analysis of randomized controlled trials (RCTs) of posture-based yoga practice. I find that yoga showed significant improvement in a variety of risk factors for CVD and metabolic syndrome, including body mass index, systolic blood pressure, and total cholesterol when compared to no or minimal intervention control groups. When compared to active exercise controls, yoga produced similar risk factor level reduction. Promising evidence supports yoga’s role in improving cardio-metabolic health. Findings are limited, however, by small trial sample sizes, heterogeneity, and moderate RCT quality.
In Chapter 2, I evaluate the comparative effectiveness of four different lifestyle strategies for reducing 10-year CVD risk. I used published literature on risk factor reductions associated with group therapy for smoking cessation, Mediterranean diet, aerobic exercise (walking), and yoga together with the Pooled Cohort risk algorithms to calculate a personalized optimal strategy for risk reduction based on different risk profiles. I find that for smokers, successful smoking cessation is an optimal strategy for reducing risk whereas for non-smokers or for smokers who do not quit successfully, stress reduction through yoga produces the greatest risk reductions.
In Chapter 3, I examine the cost-effectiveness of aerobic exercise and yoga compared to current medical practice for primary prevention of CVD in US adults. I use a subset of RCTs from Chapter 1, along with published literature on utilities, costs, and other parameters as inputs into a validated disease microsimulation model. I calculate the costs per quality-adjusted life year ($/QALY) of aerobic exercise and yoga with an exercise on prescription approach from the societal and healthcare perspective as well as if the activities were reimbursed. Results suggest that both interventions are not cost-effective using a threshold of $100,000/QALY due to high patient time costs in the societal perspective; when the activities are reimbursed and gains in quality of life are taken into account, then the activities can be cost-effective. Future research can explore patient preference and adherence and utility gains from physical activity.Health Policy
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Collins, Dylan Raymond James. "Cardiovascular risk scoring for the prevention of cardiovascular disease in low-resource settings." Thesis, University of Oxford, 2017. http://ora.ox.ac.uk/objects/uuid:839de6e8-6cf6-4482-a352-201f4a595d56.
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The aim of this thesis was to examine the use of total cardiovascular risk scoring for the prevention of cardiovascular disease (CVD) in low-resource settings. While risk scoring is popular in high-income countries, the overarching hypothesis was that it was sub-optimal for the prevention of CVD in low-resource settings. To achieve its aim, this thesis first synthesised evidence through a systematic review of systematic reviews on the impact of total CVD risk scoring on important patient outcomes. Second, it developed an R package to calculate World Health Organisation/International Society of Hypertension (WHO/ISH) CVD risk scores for all epidemiological subregions of the world. Third, using mixed methods and intensive fieldwork, it evaluated the practical implementation of WHO/ISH CVD risk scores in Médecins Sans Frontières clinics for Syrian refugees in Jordan. Lastly, it explored the potential to simplify CVD risk scores by replacing cholesterol information with body mass index using a contemporary CVD risk cohort from New Zealand. Overall, the findings showed that CVD risk scoring is sub-optimal for low-resource settings due to a lack of evidence of effectiveness, its difficulty to implement and test, and its potential to be simplified. Focus should be shifted towards conducting high quality randomised trials in low-resource settings, using simplified risk scores that can be completed in a single consultation, and further implementation studies in primary health care. With this in mind, cardiovascular risk scoring as a pivotal intervention for the prevention of CVD in low-resource settings should be judiciously compared to other alternatives, and if implemented, closely monitored for its impact on health outcomes.
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Wahman, Kerstin. "Cardiovascular disease prevention after spinal cord injury : a new challenge /." Stockholm, 2010. http://diss.kib.ki.se/2010/978-91-7409-936-2/.
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Shaw, I., BS Shaw, and GA Brown. "Influence of strength training on cardiac risk prevention in individuals without cardiovascular disease." African Journal for Physical, Health Education, Recreation and Dance, 2009. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1001650.
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Abstract
It has widely been shown that exercise, particularly aerobic exercise, has extensive cardioprotective
benefits and is an important tool in the prevention of coronary heart disease (CHD). The present
investigation aimed to determine the multivariate impact of strength training, designed to prevent the
development of CHD, on the Framingham Risk Assessment (FRA) score. Twenty-eight healthy
untrained men with low CHD risk (mean age 28 years and 7 months) participated in an eight-week (3-
d/wk) strength training programme. Self-administered smoking records, resting blood pressures, total
cholesterol (TC), high-density lipoprotein cholesterol (HDLC), FRA scores and absolute 10-year risks
for CHD were determined at the pre-test and post-test. After the eight-week period, no significant (p >
0.05) differences were found in number of cigarettes smoked daily, systolic blood pressure, TC, HDLC,
FRA scores and absolute 10-year risks for CHD in both the strength-trained (n = 13) and non-exercising
control (n = 15) groups. The data indicate that strength training did not reduce the risk of developing
CHD and absolute 10-year risk for CHD as assessed by the FRA score.
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Maeng, Jae G., and Stephen A. Geraci. "Cardiovirology Clinic for Primary Prevention in HIV Patients: a Quality Improvement Assessment." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/191.
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INTRODUCTION
With effective highly active antiretroviral therapy (HAART), individuals with human immunodeficiency virus (HIV) infection now enjoy life expectancies approaching those of uninfected individuals. Prolonged longevity has increased the prevalence of non-communicable comorbidities within the HIV patient population. HIV is a known independent risk factor for atherosclerotic cardiovascular disease (ASCVD), imparting a 1.5-2 -fold higher incidence of major adverse cardiovascular events (MACE) on infected patients. Deaths from ASCVD have increased as a result, despite a decline in total mortality. The Center of Excellence for HIV/AIDS care established a Cardiovirology Clinic (CvC) focused on providing primary and secondary preventative cardiovascular care to its patients. To date, there are no known data on the efficacy of such an intervention. We sought to define the performance of this care model for primary prevention.
METHODS
Unique CvC patients (n=68) with a treatment delivery window between September 1, 2017 to August 31, 2018 were identified through billing records. All patients were receiving HAART as prescribed by their infectious disease provider. Those with established ASCVD (n=10) were excluded from analysis to limit the study to primary prevention patients. We collected data on ASCVD risk factors (family history of premature ASCVD and personal histories of smoking, diabetes, hypertension [with degree of control], dyslipidemia, drug and alcohol use, and exercise) from the electronic health record. Body-mass index and systolic (SBP) and diastolic (DBP) blood pressures were also collected. Laboratory values including CD4 cell count, HIV-1 viral load, proteinuria, glomerular filtration rate, total cholesterol (TC), triglycerides (TG), and high (HDL) and low density (LDL) lipoprotein were included in the data collection. Estimates of 5-year risk of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or need for major revascularization was calculated using the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) equations.
Patient data were de-identified. Two-tailed, paired T-testing was performed for each factor comparing the initial and most recent follow-up values. Significance was defined as p value <0.05.
RESULTS
Using univariate analysis, reductions in D:A:D risk (relative 32.01%, absolute 1.49%, p
CONCLUSION
In this initial assessment, treated HIV patients appeared to enjoy meaningful reductions in MACE risk through the preventive care they received in this clinic, suggesting that CvCs could be a partial solution to the growing ASCVD morbidity and mortality among HIV-infected individuals. Limitations of this study include a small patient population (n=58) (limiting us to univariate analyses) and short duration of follow up (≤ 1 year). Data collection will continue annually for 4 additional years. With increasing subject numbers, multivariate analyses to determine if components of ASCVD risk reduction show interactions, and which factors, interactions and interventions impart the greatest risk reduction, will be performed in improve the quality of care.
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Song, Zhi 1970. "Antibiotic use in secondary prevention of cardiovascular disease : a pharmacoepidemiology study." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=98804.
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Background. Several trials of antibiotic use for the secondary prevention of cardiovascular diseases have been performed but individual studies have produced conflicting and inconclusive results. Therefore, we performed a systematic review of published studies to synthesize the evidence. We also examined a large cohort of previously revascularized patients to assess if a small but meaningful benefit of antibiotic exists.Research question. Whether antibiotic use, compared to non-use, can reduce future cardiovascular events in a population of previously revascularized patients.
Method. A meta-analysis and a nested case control study were both conducted to answer the research question. In the meta-analysis, PubMed and the Cochrane Central Registry of controlled trials were searched for studies published between January 1 1994 and December 31 2004 using keyword 'antibiotic use' and 'cardiovascular diseases'. 232 published papers were initially identified and 12 randomized trials meet our inclusion criteria. The data were combined using a random effects model. A sensitivity analysis with a fixed effects model was also performed. Our nested case control study was conducted on a cohort of all individuals ≥65 years of age who had a revascularization procedure from 1995 to 2000 and were registered in the Quebec universal health databases. The discharge date of each patient after revascularization was date of cohort entry. The primary endpoint was a composite of death, myocardial infraction and repeat revascularization. For each case, five controls were randomly selected and matched by date of cohort entry and age to the cases. Current users of antibiotics, those whose last prescription overlapped with the index date, were compared to individuals who were not exposed to antibiotics in the year preceding the event. Similarly the risk of recent (1-6 month) and past (6-12 months) antibiotic exposure was estimated. Odds ratios were calculated by using conditional logistic regression and adjusted for potential confounders.
Results. Our meta-analysis identified the 12 studies which randomized 10 231 patients to antibiotic treatment and 10 144 patients to control. The odds ratio for the composite event endpoint of death, myocardial infarction or revascularization was 0.92 (95CI%: 0.84-1.02). A similar result was found using a fixed effect model. No evidence for publication bias was found. Our nested case control study included 6 117 cases and 30 573 controls. The adjusted odds ratios of cardiac events for any current, recent and past antibiotic use were 1.12 [95%CI: 0.98-1.29], 1.21[95%CI: 1.07-1.28] and 1.31 [95%CI: 1.15-1.48], respectively.
Conclusion. No prevention association between antibiotic use and future cardiovascular events was shown either in the meta-analysis or our nested case control study. On the contrary, our nested case control study suggested increased risk long term following antibiotic exposure. One hypothesis to explain these results is that antibiotic exposure is a surrogate marker for a heightened inflammatory status that is associated with later cardiovascular risk.
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Veroni, Margherita. "The use of pharmacotherapies in the secondary prevention of coronary heart disease." University of Western Australia. School of Population Health, 2006. http://theses.library.uwa.edu.au/adt-WU2006.0029.
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[Truncated abstract] Background: This thesis examines pharmacotherapy use in the secondary prevention of coronary heart disease. It includes antiplatelet agents, beta-blockers, statins and ACE inhibitors, all shown in landmark clinical trials and meta-analyses to reduce the risk of cardiac events in patients with known coronary disease. Underuse of effective preventive therapies represents a lost opportunity to reduce mortality and morbidity. Overseas studies have shown significant underuse of effective therapies at the time of hospital discharge following an acute event and later in ambulatory care. Australian data on prescribing practices following an acute coronary event and, ongoing use in ambulatory care are sparse. Aims: The aim of this thesis was to quantify the prescription of known effective therapies at the time of hospital discharge following an acute coronary event and ongoing use in ambulatory care. A secondary aim was to identify barriers to optimal secondary prevention thus providing an evidential basis to recommend change. Methods: This was an observational study of a cohort of post-MI patients admitted to a tertiary and affiliate hospital in Perth, Western Australia. The continuum of care from the treatment plan at discharge through to the treatment regimen and risk factor management 12 months post-MI was examined. The intermediate step, communication about the treatment plan with the patient and the primary health care provider was also examined. The study involved a review of hospital medical records and follow-up questionnaires to patients and their general practitioners at 3 and 12 months post-MI. All post-myocardial patients were included in the analysis of prescriptions at discharge. The follow-up study included patients 80 years and younger with no terminal conditions. Patient interviews at 3 months and interviews and focus groups with key hospital staff provided qualitative data to inform the quantitative data.
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Lamrock, Felicity. "The cost-effectiveness of novel biomarkers for the prevention of cardiovascular disease." Thesis, Queen's University Belfast, 2017. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.727416.
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Cardiovascular disease is still highly prevalent worldwide, and it has been shown that novel biomarkers such as C-reactive protein have the potential ability to predict who is at risk for a cardiovascular event. Decision-analytic models can be used to assess whether different prevention strategies are not only effective but cost-effective. Within decision-analytic models, Markov models have often been used to quantify the movements of individuals between different health states over time, where movements can be influenced by characteristics of the individuals as well as the prevention strategies being applied. This thesis presents a new five-state Markov model to capture the flow of individuals across the different health states. Hazard ratios for conventional risk factors, as well as several novel biomarkers, are obtained for each of the permitted transitions between health states. Several approaches are used to obtain the hazard ratios, and a novel biomarker panel score created by linearly combining three novel biomarkers: C-reactive protein, NT-pro BNP, and Troponin I. Net reclassification indices are calculated to quantify the movements between risk categories as defined by European guidelines, with and without the use of one or more novel biomarkers for 10 year risk prediction of cardiovascular death. Transition probabilities between each of the health states are calculated for a number of different strategies, and combined with cost and utility information to create a cost-effectiveness model. Individuals deemed to be at intermediate risk of a cardiovascular event are assessed to address if the use of the novel biomarker panel score is cost-effective. A sensitivity analysis is performed to assess the robustness of the cost-effectiveness model by varying parameter inputs and performing a deterministic and probabilistic sensitivity analysis. A validation of the model is also performed to assess how closely the model predicts the number of deaths compared to those that occurred.
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Marshall, Iain James. "Evidence-based medicine and the patient : the example of cardiovascular disease prevention." Thesis, King's College London (University of London), 2016. https://kclpure.kcl.ac.uk/portal/en/theses/evidencebased-medicine-and-the-patientthe-example-of-cardiovascular-disease-prevention(ef1297fe-7b0f-419d-8e33-04141cc27744).html.
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Background: Patient ideas about cardiovascular diseases (CVDs) differ widely from those of clinicians. The failure to understand these explanatory models has been suggested to be a key barrier to effective CVD prevention. Nonetheless, currently available decision-support interventions for cvd prevention have had limited patient involvement in their development. Aims: Through four studies, this thesis seeks to use qualitative and quantitative methods to identify barriers and recommend best practices for supporting decisions in cvd prevention: both for education, and communicating the risk of benefit and harm from treatment. Methods: Study i analyses data from the South London Stroke Register, examining factors associated with the diagnosis and treatment of risk factors prior-to-stroke. Study ii systematically reviews qualitative studies of patient perspectives on hypertension and medication taking. Study iii systematically reviews randomized controlled trials (RCTs) and qualitative studies examining the effectiveness of different strategies for communicating cvd risk. Study iv is a qualitative study of patient perspectives on CVD risk in two south London general practices. Results: Study i found low but increasing prescribing rates of all preventative medication classes; prescribing did not differ by ethnicity or socio-economic status. Study ii included 52 qualitative studies. Participants experienced hypertension as symptomatic and strongly associated with stress. Many actively avoided medication, or self-adjusted medication use at times of lower stress or symptoms; concerns about serious adverse effects were widespread. Study iii included 23 RCTs, and found communicating CVD risk did not affect clinical outcomes, and only modestly improved decision quality; different formats produced similar results. Four qualitative studies found the risks were widely perceived as too small or distant to merit taking action. Study iv found many did not trust cvd risk estimates, perceiving they were not applicable to them as individuals, and omitted pertinent personal characteristics.
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Ren, Siqian, and 任思倩. "The effects of polyphenols from grapes to prevent cardiovascular disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193801.
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Background: Cardiovascular disease is the leading cause of mortality and morbidity in the world and has something to do with daily diet. The polyphenol is the most abundant compound in daily diet, including grape. The red wine was rich in polyphenol because of composing much grape. Early study has already confirmed the “French Paradox” in cardiovascular protection power, which shed light on the dietary modulation on disease.
Objective: The main objective of the study was to evaluate the effect of products containing polyphenol such as red wine extract, grape juice and grape extract tablets or powder on cardiovascular disease risk factors. It mainly examined relationship between polyphenol and serum lipid in addition to blood pressure.
Methods: Studies working on effects of grape extract products on cardiovascular disease were searched from electronic resources MEDLINE and EMBASE. Nine clinical controlled trials were identified through PubMed and Ovid. CONSORT guideline and Jadad Score were used to appraise the quality of trials. Weighing two assessment guidelines, a total of three studies were in good quality, one was in bad quality while the rest four were fair to middle.
Results: The changes before and after intervention on serum lipid and blood pressure were contradictory. Some studies found polyphenol was statistically significant protective factors, while some did not find it siginificant but still showed a protective effect. One study found polyohenol had no effect on cardiovascular disease risk factors.
Conclusion: The prevention of polyphenol was not consistent in nine trials and there is no sufficient and strong evidence supporting its cardiovascular protection effect given that the study design of each trial differed. It was not recommeded to use grape polyphenol as cardiovascular protect products. There were limitations and weakness of current study on the association of polyphenol and cardiovascular disease. Further research on this topic is required, both in vivo and in vitro.published_or_final_version
Public Health
Master
Master of Public Health
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Brännström, Inger. "Community participation and social patterning in cardiovascular disease intervention." Doctoral thesis, Umeå universitet, Epidemiologi och folkhälsovetenskap, 1993. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-7544.
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This study addresses health policy and public health in the field of cardiovascular disease (CVD) on the local level in Sweden. The overall aim is to contribute to the assessment of structural and social conditions within public health by analysing participation processes and outcome patterns in a local health programme. The northern Swedish MONICA study served as a reference area. The research strategy has been to integrate quantitative and qualitative methodologies and, thereby, focus on different aspects of the health programme under study. The mortality rate was excessive in the study area of Norsjö relative to both provincial and national figures over a period of more than 10 years. This finding formed the basis for a tenyear comprehensive and community-based health programme towards the prevention of CVD and diabetes. Even in this seemingly homogeneous area it was found that socio-economic circumstances were associated with the public health. Almost half of the study population had hypercholesterolaemia (;>6.5 mmol/1), 19% of men and 25% of women were smokers and 30% and 29%, respectively, had high blood pressure. Age had a strong impact on all outcome measures. After adjustments for age and social factors it was found that the relative risk of having hypercholesterolaemia dropped significantly in both sexes during the six years of intervention. The probability of being a smoker was significantly reduced only in highly educated groups. No statistically significant change over time could be found for the risk of suffering high blood pressure. In the reference area of northern Sweden there were no changes over time for any of the selected risk factors. The likelihood of self-assessed good health decreased with increasing risk factor load, with the exception of hypercholesterolaemia , in all social strata. The authorities, including the health and medical staff, were the main actors on the mediastage. Men in manual occupations were least affected by the media coverage. The actors and the public as well as the media viewed the health programme as orientated towards individual lifestyles. Community participation was mainly defined by the actors based on the medical and health planning approach. Differences in interpretations, social interests, personal conflicts and ideological constraints among the actors at local level were observed. Some critical attitudes towards the organization and management of the health programme were also noted among the citizens. However, a majority of the public wanted the health programme to continue. The present study underlines the importance of considering age, gender and social differences in the planning and evaluation of CVD preventive programmes.digitalisering@umu
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Chamnan, Parinya. "Pragmatic approaches for identifying and treating individuals at high risk of diabetes and cardiovascular disease." Thesis, University of Cambridge, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.609168.
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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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Schmidt, Timothy Joseph. "Cardiovascular disease prevention in rheumatoid arthritis : three population-based studies in British Columbia." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/58362.
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Background: Previous research suggest that individuals with Rheumatoid Arthritis (RA) may have an increased risk of Diabetes Mellitus (DM). Furthermore, RA individuals may receive sub-optimal care for their non-RA health related complications. Aims: 1) evaluate the risk of DM in RA compared to the general population; 2) evaluate quality of care for cardiovascular disease (CVD) prevention in RA by measuring compliance with general population screening guidelines.
Methods: We conducted three studies using a population-based cohort of RA patients from 1996 to 2006, with follow-up until 2010, in British Columbia, identified using previously described criteria (N=36,438). Controls were selected from the general population and matched 1:1 to RA individuals on age, sex, and calendar year. Different inclusion and exclusion criteria were used in each study. Chapter 2 describes the risk of DM during follow-up in an incident RA cohort, and the risk associated with RA medications, using a Cox proportional hazard model. Chapter 3 and 4 describe the compliance with general population screening guidelines for DM and hyperlipidemia in RA compared to the general population, using predefined eligible periods. A generalized estimating equation model was used to compare RA compliance to controls.
Results: Incidence of DM was 8.37 and 7.41 per 1,000P/Y in RA and controls, respectively. RA individuals had a 9% increase in the risk of developing DM compared to controls (aHR [95%CI]:1.09[1.02,1.18]). Glucocorticosteroid use was associated with a doubling in the risk of DM, while hydroxychloroquine and methotrexate use were associated with a reduction in the risk of DM. Compliance with the DM screening guideline was 71.4% and 70.6% in RA and controls, respectively. Compliance with the lipid screening guideline was 56% and 59% in RA and controls, respectively. RA individuals had a 5% greater odds of receiving a plasma glucose test and no difference in receiving a lipid test compared to controls.
Conclusion: Risk of DM was higher in RA compared to controls, and screening for DM and hyperlipidemia in RA was similar to controls, but are still considered sub-optimal.Medicine, Faculty of
Experimental Medicine, Division of
Medicine, Department of
Graduate
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McClendon, Deborah. "Perceived Susceptibility of Cardiovascular Disease as a Moderator of Relationships between Perceived Severity and Cardiovascular Health Promoting Behaviors among Female Registered Nurses." Digital Archive @ GSU, 2011. http://digitalarchive.gsu.edu/nursing_diss/22.
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Significance: Morbidity and mortality related to CVD among women in the U.S. and most developed countries surpasses that of all cancers combined (AHA, 2008). Yet, CVD in women remains understudied, yielding low awareness among women and healthcare providers. The purpose of this study was to examine whether the relationship between health beliefs related to perceived cardiovascular disease (CVD) severity and health promoting behaviors were different in women with high self perception of CVD susceptibility versus women with low self perception of CVD susceptibility.
Methods: This study used a descriptive, correlational design. A convenience sample (N = 220) included female registered nurses (RNs), 23-66 years old (M = 48; SD = 9.7), mostly white (N = 143; 65%), who had worked in nursing an average of 21 years (SD = 11.3) and reported their job as stressful/very stressful (N = 129; 59%). Nurses were recruited from five acute care hospital systems in a large southeastern city. Data were collected using standard questionnaires that measured perceived CVD severity and susceptibility, social support, depression, stress, exercise and nutrition. Participants completed data collection via an online survey method.
Results: Data were analyzed using MANCOVA. For every standardized unit increase in perceived severity of CVD, participants had a 1.26 (95% CI: 0.02, 2.50) unit reduction in their healthy food choice score (lower scores = healthier food choices), and a 0.12 increase in their physical activity score (higher scores = more physical activity) (90% CI: 0.01, 0.23) unit. For every standardized unit increase in perceived CVD susceptibility there was an increase in the healthy food choice score by 2.37 (95% CI: 1.09, 3.65) units, and a reduction in the physical activity score by 0.27 (95% CI: 0.12, 0.41) unit. Greater age (p = 0.01) and greater depression (p = 0.001) were statistically significant predictors of lower physical activity. CVD susceptibility did not moderate the effect of CVD severity on nutrition or physical activity.
Conclusions: Higher perceived CVD severity was associated with increased likelihood for healthy food choices and physical activity. In contrast, higher perceived CVD susceptibility was associated with decreased likelihood for healthy food choices and physical activity. More research is needed to understand how susceptibility beliefs around CVD are formed in women and how to better engage women in risk reduction behavior.
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Zhang, Guishui Medical Sciences Faculty of Medicine UNSW. "Roles of c-Jun in angiogenesis and cancer: insights using gene targeting approaches." Awarded by:University of New South Wales. Medical Sciences, 2006. http://handle.unsw.edu.au/1959.4/24943.
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Cardiovascular disease and cancer are the two most common causes of death worldwide. Angiogenesis plays a critical role tumourigenesis and atherogenesis. As a member of the basic region-leucine zipper protein family, c-Jun, has been linked with cell proliferation, migration and cell survival. However, the relationship between c-Jun and angiogenesis has not been firmly established. In this thesis, strategies targeting c-Jun mRNA such as DNAzyme and siRNA have been designed and evaluated for their ability to inhibit the c-Jun mRNA and c-Jun protein expression in vitro and in vivo. These agents block c-Jun expression and inhibit DNA binding activity of c-Jun. Luciferase assay showed that c-Jun siRNA suppressed c-Jun/AP-1-dependent reporter activity. The processes of cell proliferation, migration, invasion and tube formation were all down-regulated after treatment with c-Jun targeting agents. In vivo, c-Jun DNAzymes and siRNA inhibit angiogenesis in multiple models of angiogenesis in multiple models of angiogenesis, including tumour angiogenesis and growth, matrix angiogenesis, corneal angiogenesis and retinal neovascularization. This is mediated, at least in part, by c-Jun siRNA or DNAzyme inhibition of MMP-2 expression. These findings demonstrate the critical role played by c-Jun in the involvement of neovascularization and suggest that DNAzymes or siRNAs are efficient gene-silencing agents. The ability to identify and control key genes in angiogenesis provides opportunities for developing therapeutic molecular tools to treat cancer or other angiogenesis related diseases.
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Khanji, Mohmed Yunus. "Clinical effectiveness of tailored E2 coaching in reducing cardiovascular risk assessed using cardiovascular imaging and functional assessment : a primary prevention trial in moderate to high risk individuals." Thesis, Queen Mary, University of London, 2017. http://qmro.qmul.ac.uk/xmlui/handle/123456789/24707.
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Cardiovascular disease remains one of the leading causes of mortality globally. Innovative techniques are required to tackle its anticipated rise due to rising obesity, diabetes and an ageing population. Personalised electronic coaching (eb coaching) using the Internet and emails may help motivate healthier living and be of clinical benefit in complementing current programmes for cardiovascular risk reduction. I investigated whether personalised ebcoaching on top of SOC was more clinically effective than SOC alone, in reducing cardiovascular risk in asymptomatic individuals with high cardiovascular risk. I lead a randomised controlled trial of 402 participants using robust surrogate markers to identify change over 6 months. I assessed the feasibility of using cardiovascular magnetic resonance surrogate markers to guide their use in future studies of lifestyle interventions. I performed systematic reviews to identify 1) similarities and differences among leading primary prevention guidelines that address cardiovascular screening and risk assessment and 2) guideline recommendations on lifestyle advice and interventions to identify how ebcoaching could be used and what advice to incorporate in ebcoaching platforms. I found modest but statistically significant improvements in both ebcoaching and SOC groups to a similar level. Personalised ebcoaching did not show additional benefit in a highbrisk primary prevention cohort. It is feasible to use cardiovascular surrogate markers derived from cardiovascular magnetic resonance in lifestyle interventions studies. However, further studies correlating change in these markers with longbterm outcomes are required. Considerable discrepancies exist in the guidelines on risk on cardiovascular screening and risk assessment, with no consensus on optimum screening strategies or classification of high risk thus affecting treatment threshold. Guidelines did highlight the importance of lifestyle interventions in primary prevention and generally provided similar advice. Ebcoaching should not be incorporated into current prevention programmes for high risk populations unless the tools are improved and effectiveness is proven.
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Gava, Fabiana Gonçalves Seki. "Risco cardiovascular em indivíduos segurados por planos de saúde privados." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-15052008-152246/.
Full textAbstract:
As doenças cardiovasculares são uma realidade no país, apresentando um impacto significativo na morbi-mortalidade dos indivíduos e no gasto público relacionado aos tratamentos e aposentadorias precoces. Os altos índices de morte por doença cardiovascular podem ser explicados pela grande incidência de fatores de risco associados a baixos níveis de intervenção sobre esses fatores. O presente trabalho tem como objetivos: caracterizar os indivíduos segurados por planos de saúde privados com relação às variáveis sociodemográficas, antropométrica, comportamental e clínicas; identificar o risco cardiovascular obtido por meio do Escore de Risco de Framingham (ERF) e comparar o ERF entre os indivíduos com relação às referidas variáveis.Trata-se de um estudo transversal comparativo/correlacional, de abordagem quantitativa. A pesquisa foi realizada em uma empresa privada prestadora de serviços de gerenciamento de doentes crônicos para operadoras de planos privados de saúde, em diversos estados do Brasil. Os critérios de inclusão na amostra foram ter pessoas de ambos os sexos; com idade entre 30 e 74 anos e com prontuários eletrônicos completos para a realização do estudo. Foram estudados 2967 associados, sendo 1339 homens e 1628 mulheres. A amostra foi composta em sua maioria por mulheres (54,9%), por pessoas com 60 anos ou mais (57,4%), com sobrepeso ou obesas (79,5%), com colesterol total e HDL-c dentro da normalidade (61,5% e 59%, respectivamente), normotensos (PAS < 130 = 55,2%; PAD < 85 = 83,1%), não diabéticos (57,9%), não tabagistas (91,4%) e aposentados e donas do lar (60,1%). A escolaridade mostrou predomínio de indivíduos analfabetos ou com nível de escolaridade até o ensino fundamental (39,1%). As patologias mostraram predomínio de indivíduos portadores da HAS (35,8%) e de HAS acompanhada por DM (20,9%). Com relação à estratificação do risco cardiovascular, a maior parte da amostra estava classificada na faixa de médio e alto, ou seja, risco superior a 10% de desenvolver doença arterial coronariana em 10 anos - (55,6%). A análise de regressão logística mostrou que possuem maior risco de apresentar ERF médio/alto os indivíduos do sexo masculino, mais velhos, obesos, com baixa escolaridade, fumantes, com CT >= 200 mg/dl, com baixos níveis de HDL-c, com PAS >= 130 mmHg, com PAD > 90 mmHg e diabéticos (p< 0,05). A análise de regressão multinomial mostrou que possuem maior risco de apresentar ERF médio e alto os indivíduos do sexo masculino, acima do peso, com baixa escolaridade, fumantes, CT >= 200 mg/dl, HDL < 60 mg/dl, PAS >= 130 mmHg, PAD >= 85 mmHg e diabéticos (p< 0,05). O uso da curva ROC mostrou que o ERF pode identificar indivíduos de baixo risco, médio/alto risco, médio risco e alto risco com acurácia considerada ótima (com valores da área sob a curva variando de 0,82 a 0,94). Esses resultados fornecem subsídios na determinação de prioridades de intervenção na pratica clinica com relação aos fatores de riscoThe cardiovascular diseases are reality in Brazil, presenting a significant impact in morbi-mortality of the population and in the public expenses related to treatments and precocious retirements. The high averages of death for cardiovascular illness can be explained by the great incidence of risk factors associated to low levels of intervention on these factors. The present research has as objective: to characterize people insured for private health plans related to sociodemographics, anthropometrics, behavioral and clinical variables; to identify the cardiovascular risk by the Framingham Heart Score (FHS) and to compare the FHS among the participants and based on the related variables. This is a transversal, comparative/correlational, quantitative study. The research was realized in a private company that manages people who has chronic diseases for private health plans operators, in diverse states of Brazil. The criteria of inclusion in the sample was: to include people of both the gender; aged between 30 and 74 years and having complete electronic medical register for the accomplishment of the study. 2967 associates had been studied, 1339 men and 1628 women. The sample was composed in its majority by women (54,9%), 60 years old or more (57,4%), overweight or obeses (79,5%), normal results of serum cholesterol and HDL-c (61.5% and 59%, respectively), normal blood presure (systolic blood pressure - SBP < 130 = 55,2%; diastolic blood pressure - DBP < 85 = 83.1%), non diabetic (57,9%), non smoking (91,4%) and pensioners and housewives (60,1%). The scholarity level showed predominance of illiterate individuals or with low scholarity level (39,1%). The patologies showed predominance of associates who have hypertension (35,8%) and hypertension and diabetes (20,9%). About the stratification of the cardiovascular risk, most of the sample was classified in the band of medium/high risk, and/or risk higher than 10% to develop coronary arterial disease in 10 years (55,6%). The analysis of logistic regression showed that have greater risk to present FHS medium/high: male sex associates, older, obeses, with low scholarity levels, smokers, serum cholesterol >= 200 mg/dl, low levels of HDL-c, SBP >= 130 mmHg, DBP > 90 mmHg and diabetic (p < 0,05). The analysis of multinomial regression showed that have greater risk to present average and high FHS: male sex associates, overweight, low scholarity levels, smokers, serum cholesterol >= 200 mg/dl, HDL-c < 60 mg/dl, SBP >= 130 mmHg, DBP >= 85 mmHg and diabetic (p < 0,05). The ROC curve showed FHS can identify individuals of low risk, medium/high risk, medium risk and high risk with accuracy considered excellent (values of the area under the curve varying from 0,82 to 0,94). These results supply subsidies to determine priorities of intervention on risk factors in clinical practice
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Feigl, Andrea B. "Managing Non-Communicable Disease Risk Factors in Developing Countries: Tobacco Control, Cardiovascular Disease Risk Surveillance, and Diabetes Prevention." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121160.
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Non-communicable diseases (cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and mental illnesses) and associated risk factors (unhealthy diets, physical inactivity, harmful use of alcohol, physical inactivity) are on the rise in developing countries, posing a threat to the health and financial systems of emerging economies.
In response, international organizations and Ministries of Health alike have started to tackle chronic diseases and associated risk factors with policies and treatment programs. Yet to this day, the body of evidence for best practices regarding the monitoring, prevention, and control of non-communicable diseases in low- and middle-income countries remains small.
This doctoral thesis adds to this body of evidence. The first paper of my thesis assesses the impact of a national tobacco control program in high schools in Chile. Specifically, it evaluates the effectiveness and makes several policy recommendations based on the findings. My second dissertation paper assesses the modifying effect of a change in anti-retroviral treatment among HIV-positive subjects in KwaZulu-Natal, South Africa on cardiovascular disease risk factors of high body mass index and high blood pressure. The third paper is based on a randomized controlled trial assessing the effectiveness of a social-network-based diabetes and weight management program in Jordan.Global Health and Population
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Gonçalves, Sandra Filipa Silva. "Ingestão nutricional em prevenção cardiovascular." Bachelor's thesis, [s.n.], 2017. http://hdl.handle.net/10284/7562.
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Trabalho Complementar apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Ciências da NutriçãoEm Portugal e noutros países economicamente mais desenvolvidos, as doenças cardiovasculares representam a principal causa de mortalidade por doenças transmissíveis. A sua etiologia é multifatorial mas pensa-se que os estilos de vida, nomeadamente uma alimentação saudável seja fundamental para a prevenção primária e secundária das doenças cardiovasculares. Este trabalho reviu a literatura científica sobre o efeito da ingestão nutricional com efeito na saúde cardiovascular e realçou as atuais recomendações nutricionais para a prevenção cardiovascular primária e secundária. Foi feita uma revisão bibliográfica da literatura a partir das bases de dados da PubMed e ScienceDirect, complementada por pesquisa manual, e também por pesquisas em revistas científicas e sites da internet. No contexto de prevenção cardiovascular, o consumo de sal deve de ser inferiro a 5g/dia. Preconiza-se também que o consumo de gorduras totais não ultrapasse os 30% do valor energético diário assim como deve ser feita uma redução no consumo de ácidos gordos trans. A evidência para os ácidos gordos saturados é ainda controversa, com base em resultados de uma meta-análise de estudos de coorte prospetivos. Deve ser dada preferência ao consumo de ácidos gordos insaturados tais como os monoinsaturados e os polinsaturados, nomeadamente os ácidos gordos ómega 3 dado os seus efeitos antiinflamatórios e anti-trombóticos. Os indivíduos saudáveis deverão consumir 500 mg/dia de ácidos gordos ómega 3 e os indivíduos com história de doença cardiovascular devem consumir 800 mg/dia, pelo que as recomendações diferem em prevenção primária e secundária. Destaca-se ainda, que a relação ómega 6 versus ómega 3 deve de estar equilibrada, sendo o equilíbrio ideal de 3:1. O papel do colesterol alimentar na doença cardiovascular não está totalmente esclarecido, sendo necessários futuramente mais estudos. No entanto, as recomendações alertam que este consumo não deve ser superior a 300 mg/dia para indivíduos saudáveis e a 200 mg/dia para indivíduos com histórico de doença cardiovascular. O consumo de 200 a 400 mg/dia de fitoesterois apresenta efeitos benéficos nas concentrações de colesterol total. O consumo moderado de álcool, isto é 10 g/dia para as mulheres e 20 g/dia para os homens, apresenta benefícios na prevenção cardiovascular e este efeito pode ser independente do tipo e bebida alcoólica. O consumo de proteínas também deve de ser moderado, dando preferência ao consumo de proteínas de origem vegetal, como por exemplo as proteínas da soja. Deve-se privilegiar uma dieta rica em produtos hortofrutícolas, grãos integrais e soja para a manutenção dos níveis ideias de fibras. A suplementação em antioxidantes não está recomendada em prevenção cardiovascular, sendo que é de privilegiar uma alimentação rica em frutas e hortícolas como fontes de grandes quantidades de antioxidantes tais como a vitamina E, vitamina C, carotenoides e flavonoides devido ao seu elevado efeito protetor na prevenção cardiovascular. É de salientar ainda que, a Dieta Mediterrânica e a Dieta DASH são atualmente reconhecidas pela evidência científica como padrões alimentares a seguir para a prevenção primária e secundária da doença cardiovascular. Este trabalho concluiu que uma alimentação saudável que garanta o consumo adequado de macronutrientes e micronutrientes é a base fundamental para a prevenção das doenças cardiovasculares.
In Portugal and other economically developed countries, cardiovascular diseases represent the leading cause of mortality by non-communicable diseases. Its etiology is multifactorial, but it is believed that lifestyles, particularly a healthy is essential for primary and secondary prevention of cardiovascular diseases. This paper reviewed the scientific literature on the effect of nutritional intake on cardiovascular health effect and highlighted the current nutritional recommendations for primary and secondary cardiovascular prevention. A bibliographical review was conducted based on PubMed and ScienceDirect databases, complemented by a manual search, as well as other scientific journals and websites. For cardiovascular prevention, salt intake should be less than 5 g/day. It is also recommended that the consumption of total fat does not exceed 30% of the total daily energy intake, as well as a reduction in the consumption of trans fatty. Evidence for saturated fatty acids is still controversial based on evidence from a meta-analysis of prospective cohort studies. In general, the consumption of unsaturated fatty acids such as monounsaturated and polyunsaturated ones should be preferred, namely omega-3, given its anti-inflammatory and anti-thrombotic effects. Healthy subjects should consume 500 mg/day of omega-3 fatty acids and individuals with a history of cardiovascular disease should consume 800 mg/day, and thus recommendations differ in primary and secondary prevention. It should also be noted that the omega-6 versus omega-3 ratio must be balanced, with the ideal balance being of 3: 1. The role of dietary cholesterol in cardiovascular diseases is not fully understood, leading to the need of more studies in the future. However, the recommendations warn that this consumption should not exceed 300 mg/day for healthy subjects and 200 mg/day for individuals with a history of cardiovascular disease. The consumption of 200 to 400 mg/day of phytosterols has beneficial effects on total cholesterol concentrations. Moderate alcohol consumption (10 g/day for women and 20 g/day for men) has benefits in cardiovascular prevention, and this effect may be independent of the type of alcoholic beverage. Protein consumption should also be moderate, giving preference to the consumption of proteins of plant origin, such as soy proteins. A diet rich in fruit and vegetables, whole grains and soybeans should be privileged to maintain the optimal levels of fibers. Supplementation with antioxidants is not recommended in cardiovascular prevention, as it is preferable to eat a rich diet of fruit and vegetables as sources of large amounts of antioxidants such as vitamin E, vitamin C, carotenoids and flavonoids due to their high protective effect in cardiovascular prevention. It should also be noted that the Mediterranean Diet and the DASH Diet are currently recognized by the scientific evidence as dietary patterns to follow for primary and secondary prevention of cardiovascular disease. This study concluded that a healthy diet which guarantees an adequate consumption of macronutrients and micronutrients is the fundamental basis for the prevention of cardiovascular diseases.
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Liew, Su May. "The impact of treatment and time on cardiovascular risk scores." Thesis, University of Oxford, 2012. http://ora.ox.ac.uk/objects/uuid:c7840ca1-f99a-472a-8a8b-aa7493504a3d.
Full textAbstract:
Cardiovascular risk scores predict an individual’s risk of developing cardiovascular disease. Many were developed and validated in study cohorts on risk-factor lowering treatment – a cause of inaccuracy. In addition, risk scores are criticised as being biased towards the elderly due to the prominence of age as a risk predictor. Although present guidelines advocate the use of short-term (5-10 year) absolute risk scores, other approaches to redress this perceived imbalance such as lifetime risk scores are being considered. The overall objective of this thesis is to identify the most appropriate cardiovascular risk score for use in general practice, taking account of the impact of treatment and time on assessed risk. This objective was met by three different methods. First, a systematic review of cardiovascular risk scores was conducted. This explored the derivation of each score, including the extent of treatment. Next, doctors were interviewed in depth to understand their perception and use of risk scores. Finally, mathematical models were devised to determine whether a true difference in life expectancy exists at different ages but the same short-term cardiovascular risk. The models incorporated age-specific case fatality rates, competing risks and time preference to estimate the potential years of life lost due to a five-year treatment delay in different age groups with the same short-term coronary heart disease risk. The findings demonstrate that cardiovascular risk scores do not take account of treatment effects. This significantly affects their application in clinical practice. In addition, there is little difference in potential life years lost between ages at the same risk level because of higher case-fatalities in older people. When time preference is considered, any residual case for treating the same level of short-term risk differently at different ages is abolished. The overall conclusion is that the five to ten-year absolute cardiovascular risk score is the most appropriate approach to primary cardiovascular disease prevention. By overestimating risk in the young, other approaches benefit the few at the expense of the many.
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Lindholm, Lars. "Health economic evaluation of community-based cardiovascular disease prevention : some theoretical aspects and empirical results." Doctoral thesis, Umeå universitet, Epidemiologi och folkhälsovetenskap, 1996. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-7539.
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This thesis addresses the health economic evaluation of community-based interventions against cardiovascular disease (CVD), with special emphasis on the Västerbotten Intervention Project (VIP), run since 1985. The framework is a simple evaluation model consisting of two parts; the selection and measurement of empirical consequences caused by the project under evaluation (e.g. changes in mortality, well-being, use of resources) and a set of values (e.g. efficiency, equity) aimed at assessing the goodness of these consequences. The project’s effects on CVD were predicted by means of risk factors measured in Norsjö between 1985-1990, applied to an epidemiological model based on a logistic risk equation derived from the Framingham population. Cost per life-years saved ranged from £14 900 to net savings, depending on the assumptions. The favourable cost-effectiveness in this kind of intervention has earlier been predicted from theoretical models, but this is the first study based on real experiences from contemporary community-based interventions against CVD. Furthermore, all social classes have benefited from the intervention. Also potential adverse effects in the form of excess mortality due to low cholesterol levels were investigated, and they were negligible in comparison with the health gains. The value of an intervention from a citizen’s perspective was investigated through an interview study (n≈100) in accordance with the contingent valuation method. Great expectations concerning mortality effects on the community level and future savings in health care were good predictors for assigning the intervention a high value. On the contrary, personal benefits in the form of a decreasing risk for CVD had no positive association with the value of the intervention. Hence, the consequences that the cost-effectiveness analysis accounts for - mortality and savings - coincide with the most valuable consequences from the citizen's perspective. In a democracy, the set of values used to determine the success or failure of a programme like a prevention project must agree with values held by the majority of the citizens. Therefore, the attitudes to ethical values among Swedish politicians (n≈450) responsible for health care have been mapped. The support for the health maximization principle was weak, and a trade-off between efficiency and equity was preferred. About 70% of the respondents were prepared to sacrifice health gains to achieve increased equity.digitalisering@umu
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Hull, S. S. A. "Studies in the pathophysiology and prevention of cardiovascular disease in obesity and type 2 diabetes." Thesis, Queen's University Belfast, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.426747.
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Silwer, Louise. "Public Health Aspects of Pharmaceutical Prescription Patterns : Exemplified by treatments for prevention of cardiovascular disease." Doctoral thesis, Nordic School of Public Health NHV, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3425.
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Public health aspects of pharmaceutical prescription patterns: Exemplified by treatments for prevention of cardiovascular disease. Louise Silwer. ISBN: 978-91-85721-18-4 ISSN: 0283-1961Main aim:To study patterns and trends of dispensed prescriptions, to explore what proportion of the population is exposed to some of the more prevalently prescribed pharmaceuticals, and to find possible ways of measuring drug-induced adverse symptoms in the population. Further, to illuminate conditions surrounding prescribing in primary prevention of cardiovascular disease. Methods: In three descriptive studies of prescription patterns, prescription data at aggregate level from a Swedish county were analysed retrospectively, and proportions were calculated. Data from the first ten years of the studies were obtained from a local prescription study, and data from another five years were local data from a national prescription survey. Data from a Danish database (OPED), with data at the individual level, were used for a prescription sequence symmetry analysis, and when Swedish national prescription data at the individual level became accessible, they were used for calculations of drug prevalence in the entire Swedish population. In a qualitative analysis of interview data, a phenomenographic approach was used. Main results: The purchase of pharmaceuticals on prescription almost doubled in the studied county in the period 1988-2002. Some common pharmaceuticals that increased to a great extent among the older part of the population were cardiovascular preventive drugs, such as antihypertensive and lipid modifying agents, and also hormone replacement therapy for women. In 2005, over half of all Swedish citizens, aged 60 or over, purchased antihypertensive or lipid modifying preparations during a six-month period. The different views that were found among GPs, regarding beliefs and practical management of primary prevention of CVD, could be interpreted as a reflection of the complexity of patient counselling in primary prevention in practice. Conclusion: The increase in dispensed prescriptions over the 15 years and the magnitude of the prevalence of the studied pharmaceuticals, such as antihypertensive, lipid modifying and hormonal treatments, which to a great extent are used by ‘healthy’ people, point to the need of following-up both beneficial and harmful consequences on public health. The prevalence of preventive treatments together with the variation in views of administration of primary prevention of cardiovascular disease, also point to the need of clarification of guidelines regarding pharmaceutical primary prevention and encouragement of therapy discussions among GPs.
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Pandya, Ankur. "Optimizing Cardiovascular Disease Screening and Projection Efforts in the United States." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10160.
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The objective of this dissertation is to develop and evaluate quantitative models that have the potential to improve cardiovascular disease (CVD) screening and projection efforts in the U.S. Paper 1 assesses the exchangeability of a non-laboratory-based CVD risk score (predictors do not include cholesterol) with more commonly-used laboratory-based scores, such as the Framingham risk equations. Under conventional thresholds for identifying high-risk individuals, 92-96% of adults in the National Health and Nutrition Examination Survey (NHANES III) were equivalently characterized as high- or low-risk using either type of score. The 10-year CVD death results also suggest that simple CVD risk assessment could be a useful proxy for more expensive laboratory-based screening strategies in the U.S. or other resource-limited settings. Paper 2 uses micro-simulation modeling techniques to evaluate the cost effectiveness of primary cardiovascular disease (CVD) screening using staged laboratory-based and/or non-laboratory-based total CVD risk assessment. The results imply that efficient screening guidelines should include non-laboratory-based risk assessment, either as a single stage or as part of multistage screening approach. Compared to current CVD screening guidelines, fewer cholesterol tests would be administered and more adults would receive low-cost statins under cost-effective screening policies. Paper 3 examines the trends of CVD risk factors, treatment, and total risk in the U.S. from 1973-2010, and offers projections of these variables for 2015-2030. Nine waves of cross-sectional NHANES data show that the divergent, observed trends in common CVD risk factors (such as smoking, BMI, total cholesterol, and blood pressure) are expected to continue in future years. Age-adjusted CVD risk has decreased over time (during the observed and projected periods), but total risk has increased when considering the impact of aging on CVD risk. Scenario analyses suggest that strategies targeting cholesterol and blood pressure treatment have the greatest potential to reduce future CVD burden in the U.S.
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Beneke, Jeanine. "Obesity as a metabolic syndrome determinant and the influence of physical activity in treatment and prevention / Jeanine Beneke." Thesis, North-West University, 2005. http://hdl.handle.net/10394/1020.
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The prevalence of obesity in both the developed and developing world have
increased, which leads to diverse health outcomes and is placing a heavy
burden on the economy. Abdominal obesity proved to be one of the main
features in predicting metabolic and cardiovascular disease (CVD) risk and
may be the link that unifies the metabolic syndrome (MS) through pro-inflammatory
pathways. While the pathogenesis of the MS and each of its
components are complex and not well understood, abdominal obesity remains
the mechanism that relates to increased lipolysis causing the liver to increase
blood glucose and very low lipoprotein output. This in turns leads to raised
blood glucose, triglycerides, low-density lipoprotein cholesterol (LDL-C), blood
pressure and inflammatory markers (C-reactive protein, interleukin-6 and
tumor necrosis factor-a) and decreased high-density lipoprotein cholesterol
(HDL-C). Prevention of the metabolic syndrome and treatment of its main
characteristics are now considered of utmost importance in order to combat
the increased CVD risk and all-cause mortality. Decreasing sedentary
behaviour through regular physical activity is a key element in successful
treatment of obesity through an increase in energy expenditure, but the ability
to decrease low-grade systemic inflammation may be an even greater
outcome.
Aims
The aims of this study was firstly, to determine by means of a literature review,
how obesity could be related to a state of chronic systemic inflammation
(increased CRP and IL-6). Secondly to determine whether physical activity
could serve as a suitable method to decrease inflammation associated with
obesity and related disorders. Thirdly to determine if abdominal obesity is a
predictor of the metabolic syndrome and CVD and finally, to determine if
measures of obesity can predict risk for the metabolic syndrome and CVD
risk.
Methods
For this review study, a computer-assisted literature search were utilized to
identify research published between 1990 and 2005. the following databases
were utilized for the search: NEXUS, Science Direct, PubMed and Medline.
Keywords related to obesity (abdominal obesity, overweight), metabolic
syndrome (insulin resistance syndrome, dysmetabolic syndrome, syndrome
X), cardiovascular disease (coronary heart disease, coronary artery disease),
cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus,
physical activity), inflammatory markers (CRP, IL-6, chronic low-grade
inflammation) and physical activity (fitness, exercise and training) were
included as part of the search, including the references identified by previous
reviewers (not identified as part of the computerized literature search).
Results and conclusions
Several research studies concluded that obesity could be an
inflammatory disorder due to low-grade systemic inflammation. Adipose
tissue is known to be a sectretory organ producing cytokines, acute
phase reactants and other circulating factors. The synthesis of adipose
tissue TNF-a could induce the production of IL-6, CRP and other acute
phase reactants. CRP is a acute phase reactant, synthesized primarily
in hepatocytes and secreted by the liver in response to a variety of
inflammatory cytokines of which IL-6 and TNF-a are mainly involved.
CRP increases rapidly in response to trauma, inflammation and
infection. Thus, enhanced levels of CRP can be used as a marker of
inflammation.
Several studies of large population cohorts provide evidence for an
inverse, independent dose-response relation between plasma CRP
concentration and level of physical activity in both men and women.
Trends for decreased IL-6, TNF-a and CRP concentrations were linear
with increasing amounts of reported exercise in most of the research
studies, physical activity proved effective in lowering measures of
adiposity (BMI, WHR, WC and percentage body fat) and obesity related
inflammatory markers (CRP & IL-6). Thereby indicating a potential anti-inflammatory
effect.
In the studies reviewed in this article abdominal obesity is identified as
a predictor and independent risk factor for CVD in both men and
women. High levels of deep abdominal fat have also been correlated
with components of the metabolic syndrome, glucose intolerance,
hyperinsulinemia, hypertension, diabetes, increases in plasma
triglyceride levels and a decrease in HDL-C levels (dyslipidemia) in
many of the studies. Prospective epidemiological studies have revealed
that abdominal obesity (determined by WC and WHR) conveys an
independent prediction of CVD risk and is more relevant compared to
general obesity (determined by BMI).
Abdominal fat has been linked to metabolic risk factors like high systolic
blood pressure, atherogenic dyslipidemia, with increased serum TG
and decreased HDL-C, and glucose intolerance. Although magnetic
resonance imaging (MRI) and computerized tomography (CT) have
been used successfully in many studies to measure adipose
compartments of the abdomen (subcutaneous and visceral fat),
anthropometrical measures like WHR and WC have been proven to be
an effective measure in predicting the metabolic syndrome. WC has
also been included in the metabolic syndrome definitions of the WHO,
ATP Ill and new IDF.The prevalence of obesity in both the developed and developing world have increased, which leads to diverse health outcomes and is placing a heavy burden on the economy. Abdominal obesity proved to be one of the main features in predicting metabolic and cardiovascular disease (CVD) risk and may be the link that unifies the metabolic syndrome (MS) through pro-inflammatory pathways. While the pathogenesis of the MS and each of its components are complex and not well understood, abdominal obesity remains the mechanism that relates to increased lipolysis causing the liver to increase blood glucose and very low lipoprotein output. This in turns leads to raised blood glucose, triglycerides, low-density lipoprotein cholesterol (LDL-C), blood pressure and inflammatory markers (C-reactive protein, interleukin-6 and tumor necrosis factor-a) and decreased high-density lipoprotein cholesterol (HDL-C). Prevention of the metabolic syndrome and treatment of its main characteristics are now considered of utmost importance in order to combat the increased CVD risk and all-cause mortality. Decreasing sedentary behaviour through regular physical activity is a key element in successful treatment of obesity through an increase in energy expenditure, but the ability to decrease low-grade systemic inflammation may be an even greater outcome. Aims The aims of this study was firstly, to determine by means of a literature review, how obesity could be related to a state of chronic systemic inflammation (increased CRP and IL-6). Secondly to determine whether physical activity could serve as a suitable method to decrease inflammation associated with obesity and related disorders. Thirdly to determine if abdominal obesity is a predictor of the metabolic syndrome and CVD and finally, to determine if measures of obesity can predict risk for the metabolic syndrome and CVD risk. Methods For this review study, a computer-assisted literature search were utilized to identify research published between 1990 and 2005. the following databases were utilized for the search: NEXUS, Science Direct, PubMed and Medline. Keywords related to obesity (abdominal obesity, overweight), metabolic syndrome (insulin resistance syndrome, dysmetabolic syndrome, syndrome X), cardiovascular disease (coronary heart disease, coronary artery disease), cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, physical activity), inflammatory markers (CRP, IL-6, chronic low-grade inflammation) and physical activity (fitness, exercise and training) were included as part of the search, including the references identified by previous reviewers (not identified as part of the computerized literature search). Results and conclusions Several research studies concluded that obesity could be an inflammatory disorder due to low-grade systemic inflammation. Adipose tissue is known to be a sectretory organ producing cytokines, acute phase reactants and other circulating factors. The synthesis of adipose tissue TNF-a could induce the production of IL-6, CRP and other acute phase reactants. CRP is a acute phase reactant, synthesized primarily in hepatocytes and secreted by the liver in response to a variety of inflammatory cytokines of which IL-6 and TNF-a are mainly involved. CRP increases rapidly in response to trauma, inflammation and infection. Thus, enhanced levels of CRP can be used as a marker of inflammation. Several studies of large population cohorts provide evidence for an inverse, independent dose-response relation between plasma CRP concentration and level of physical activity in both men and women. Trends for decreased IL-6, TNF-a and CRP concentrations were linear with increasing amounts of reported exercise in most of the research studies, physical activity proved effective in lowering measures of adiposity (BMI, WHR, WC and percentage body fat) and obesity related inflammatory markers (CRP & IL-6). Thereby indicating a potential anti-inflammatory effect. In the studies reviewed in this article abdominal obesity is identified as a predictor and independent risk factor for CVD in both men and women. High levels of deep abdominal fat have also been correlated with components of the metabolic syndrome, glucose intolerance, hyperinsulinemia, hypertension, diabetes, increases in plasma triglyceride levels and a decrease in HDL-C levels (dyslipidemia) in many of the studies. Prospective epidemiological studies have revealed that abdominal obesity (determined by WC and WHR) conveys an independent prediction of CVD risk and is more relevant compared to general obesity (determined by BMI). Abdominal fat has been linked to metabolic risk factors like high systolic blood pressure, atherogenic dyslipidemia, with increased serum TG and decreased HDL-C, and glucose intolerance. Although magnetic resonance imaging (MRI) and computerized tomography (CT) have been used successfully in many studies to measure adipose compartments of the abdomen (subcutaneous and visceral fat), anthropometrical measures like WHR and WC have been proven to be an effective measure in predicting the metabolic syndrome. WC has also been included in the metabolic syndrome definitions of the WHO, ATP Ill and new IDF.
Thesis (M.A. (Human Movement Science))--North-West University, Potchefstroom Campus, 2006.
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Diab, Mohammad Issam. "Pharmaceutical care in management of type-2 diabetes and primary prevention of cardiovascular disease with risk analysis of developing cardiovascular events." Thesis, University of Strathclyde, 2012. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=19150.
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Aim: To identify the needs for improved levels of care provided to patients with type-2 diabetes in Qatar with a special focus on cardiovascular disease (CVD) prevention. Subjects and Settings: 305 patients attending the diabetes clinic in Hamad General Hospital, Qatar, from 2010-2011, all having type-2 diabetes and no history of CVD. Patients' medical records accessed from medical files manually and electronically. Methods: a) 38 criteria medication assessment tool (MAT) designed from recommendations on the management of type-2 diabetes and combined with recommendations relevant to primary prevention of CVD. The MAT was validated by a group of researchers and practitioners and field tested. Levels of applicability and adherence to each criterion and for each patient were calculated individually and the overall adherence determined. Areas needing improvement were identified and patients' clinical factors associated with prescribing adherence were studied b) Patients' 10 year risk estimates of developing any coronary heart disease (CHD), fatal CHD, any stroke and fatal stroke obtained using the type-2 specific CVD risk calculator from the UK Prospective Diabetes Study (UKPDS risk engine). Patients were defined to be at 'high' risk if estimates were 15%. The association between each risk factor within the risk calculator and being at a higher risk of developing CVD was studied and used to target patients for a designed pharmaceutical care plan. Levels of care provided to patients at higher risk of developing CVD were also assessed and used to address care issues to achieve effective CVD risk reduction in clinical practice. Results a)- The MAT was applied to the whole study sample (11590 assessed criteria in 305 patients). Application of the MAT identified 18/38 criteria with high levels of adherence (80%), 10/38 criteria with intermediate levels of adherence (50%; <80%) and 10/38 criteria with low levels of adherence (<50%). The over patients was 68.1% (95% CI: 67, 69; n= 6657 applicable criteria). Insufficient documentation to assess care was found in 1.1% (95% CI: 0.9, 1.4; n=74) of the applicable criteria. Total non-adherences were found in 30.7% (95% CI: 30, 32; n=2049) of the applicable criteria in which only 5.8% (95% CI: 5, 7; n=118) had a documented justification. Consequently 94.2% (95% CI: 93, 95; n=1931) had unjustified non-adherence and indicated a need for inclusion in a treatment review through an appropriate pharmaceutical care plan. Adherence using the individual patient as the unit of analysis (MAT adherence per patient) revealed that prescribers adhered to < 70% of the applicable criteria in 50.5% (95% CI: 45, 56; n=154) of patients. Only blood pressure status and total cholesterol levels were found to be associated with prescribing adherence levels. ( b) Overall, in the following patient groups: any CHD (n= 282 eligible), fatal CHD (n=278 eligible), any stroke (n=274 eligible) and fatal stroke (n=305 eligible) there were 46.1% (95% CI: 40.3, 51.9, n=130), 29.5% (95% CI: 24.4, 35.1, n=82), 12.8% (95% CI: 9.3, 17.3, n=35) and 0% (95% CI: 0, 0) high risk patie nts identified respectively. A high risk of developing any CHD was significantly associated with increased means ± [standard deviation (SD)] of age (60.0±[8.7] vs 47.0±[9.7], p<0.0001), diabetes duration in years (13.6±[6.9] vs 7.5±[4.5], p<0.0001), systolic blood pressure, SBP (144±[16.9] vs 136±[17.5], p<0.0001), HbA1c level (9.0±[1.7] vs 8.1±[1.9], p<0.0001), and reduced high density lipoprotein (1.07±[0.3] vs 1.2±[0.42], p=0.002). Significantly more males than females were at high risk of developing CHD (64.6% vs. 35.4%, respectively, p<0.0001). In addition to total cholesterol (4.9±[1.1] vs 4.6±[1.0], p=0.04), similar associations and trends were also observed when these above variables were compared with the risk of developing fatal CHD. High risk of developing any stroke was significantly associated with increased means of age (69.4±[5.4] vs 49.5±[9.2], p<0.0001), diabetes duration in years (18.4±[7.2] vs 8.6±[5.0], p<0.0001) and SBP (145±[19.8] vs ). Targeted HbA1c and blood pressure values were not achieved in the majority of patients (84% and 75%, respectively) who are at higher risk of developing CVD. Conclusion: The study identified levels of adherence to guideline recommendations, the need for additional documentation and criteria with low adherence that might be a focus for a possible change at individual or organisational levels (changes in policies or structures) as well as educational interventions and a starting point for targeted pharmaceutical care. The risk of developing any CHD in patients with type-2 diabetes was significantly higher than the risk of developing fatal CHD, any stroke or fatal stroke. Risk calculators can be used to target patients for pharmaceutical care according to their CVD risk factors.
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Garcia, Roxann. "A needs assessment of selected variables for a worksite cardiovascular disease prevention program in a university-based medical center /." Access Digital Full Text version, 1987. http://pocketknowledge.tc.columbia.edu/home.php/bybib/10778470.
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Thesis (Ed. D.)--Teachers College, Columbia University, 1987.Typescript; issued also on microfilm. Sponsor: Charles E. Basch. Dissertation Committee: John P. Allegrante. Bibliography: leaves 206-221.
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Vani, Gannabathula Sree. "Hiperhomocisteinemia e o risco cardiovascular." Universidade de São Paulo, 2002. http://www.teses.usp.br/teses/disponiveis/46/46131/tde-02122015-124049/.
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Nível elevado de homocisteína (Hcy) no plasma é considerado fator de risco de doença cardiovascular. Consumo reduzido de vitaminas B6, B12 e ácido fólico tem sido relacionado com hiperhomocisteinemia. O objetivo desse estudo foi verificar o consumo de vitaminas B6, B12 e ácido fólico nas populações urbana e rural, bem como a correlação dos níveis plasmáticos dessas vitaminas com os níveis plasmáticos de Hcy. Também determinamos os níveis séricos de lipídeos e avaliamos o risco cardiovascular das populações frente a hiperlipemia. O consumo de B6 e ácido fólico é maior na população urbana, com p=0,00 e p=0,04 respectivamente, sendo o consumo de B12 maior na população rural, com p=0,47. As correlações são significativamente negativa entre Hcy e as vitaminas B12 e ácido fólico . A população rural apresenta Hcy com valor médio de 16,5±9,2µmol/L, classificada como hiperhomocisteinemia moderada, e a população urbana 12,8±5,5 µmol/L, o qual está dentro da faixa de referência. O valor médio de LDL sérica é maior na população urbana (3,4±0,8mmoI/L) do que na população rural (2,8±0,9mmoI/L), com valor de p=0,00. Como fator de risco cardiovascular, consideramos Hcy plasmática >14µmol/L e LDL sérica >3,38mmol/L. Neste caso, 41,4% da população rural e 7,4% população urbana apresentam Hcy maior que 14µmol/L. O inverso ocorre em relação a LDL, onde 43,2% da população urbana e 11% na população rural apresentam níveis acima de 3,38mmol/L. Concluímos que o risco cardiovascular decorrente de hiperhomocisteinemia é maior na população rural que na urbana e este risco poderia reduzir mediante o consumo de vitaminas.Elevated levels of plasma homocysteine (Hey) are considered a risk factor for cardiovascular diseases. Low intake of vitamins 86, 812 and folic acid have been related to hyperhomocysteinemia. The purpose of the present study is to determine the consumption of the vitamins B6, B12 and folic acid in two Brazilian urban and rural populations, along with the plasmatic levels of these vitamins and plasmatic homocysteine. In addition, the serum levels of lipids have been determined to evaluate the cardiovascular risk in the two populations regarding their hyperlipidemie comdition. The consumption of B6 and folic acid is higher in the urban population (p=0.00 and p=0.04 respective/y), while the consumption of B12 is not significantly different (p=0.47). There is a negative correlation between B12 and folic acid with Hcy. The rural population shows mean Hcy value of 16.5±9.2µmol/L and is classified as having moderate hyperhomocysteinemia, while for the urban population, the mean value is 12.8±5.5µmol/L and is well within the normal range. The mean value of the serum LDL is higher in the urban population (3.4±0.8mmol/L) compared to the rural population (2.8±0.9mmol/lL) with a significance of p=0.00. Plasma Hcy values >14µmol/L and serum LDL >3.38mmol/L were considered as the risk factors for cardiovascular disease. With in the reference values, 41.4% of the rural population and 7.4% of the urban population showa Hcy as a risk factor. For LDL, the inverse is true, i.e 43.2% of urban and 11% of the rural population are at risk. We conclude that the cardiovascular risk arising from hyperhomocysteinemia is higher in the rural population and that this can be reduced by increased consumption of vitamins.
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Nyholt, Dana. "Molecular mechanisms of high-density lipoprotein biogenesis, metabolism and function: relevance to cardiovascular disease prevention and treatment." Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=104635.
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Coronary artery disease (CAD) remains the primary source of global mortality. Multiple epidemiologic studies support a low level of high-density lipoprotein cholesterol (HDL-C) to be an independent risk factor for CAD. We believe that a complete understanding of the mechanisms underlying HDL biogenesis, metabolism, and function will aid in defining the therapeutic potential of raising HDL in treating CAD. This thesis consists of five inter-related studies with the central unifying theme of HDL physiology. First, we examine the cellular mechanism of HDL biogenesis involving the lipidation of apolipoprotein A-I (apoA-I) by the ATP-binding cassette transporter (ABCA)1. We show that the lipidation of apoA-I occurs in two distinguishable compartments, the plasma membrane and intracellular compartments. Second, we investigate the interaction between apoA-I and an ABCA1/phospholipid microdomain binding site(s) called the high-capacity binding site (HCBS). Using sucrose density fractionation, we observe that both ABCA1 and the HCBS are localized to detergent-soluble membrane domains and that apoA-I selectively removes phosphatidylcholine (PtdC) from detergent-soluble membrane domains. Additionally, we observe that cholesterol loading or depletion or PtdC depletion modifies apoA-I binding to ABCA1/HCBS, and that incubation with apoA-I leads to transcriptional induction of PtdC synthesis enzymes, as well as PtdC synthesis. Third, we examine nascent HDL-remodeling in vitro by developing a lipid-transfer assay and in vivo in a rabbit model. This study suggests that nascent HDL remodeling involves plasma apoB-containing lipoproteins and phospholipid transfer protein (PLTP). Fourth, we assess the capacity of a novel small molecule, RVX-208, to increase apoA-I and HDL-C levels in vitro and in vivo. We show that RVX-208 increases apoA-I and HDL-C production and maintains HDL-C function with respect to reverse cholesterol transport. Fifth, we examine the HDL proteome in acute coronary syndromes (ACS) subjects by shotgun proteomics. Our results support that the HDL proteome differs between control, CAD and ACS patients. Although strong epidemiological evidence exists to support HDL-C as an independent risk factor for CAD, it remains to be determined whether increasing HDL-C levels or improving HDL function in man will reduce residual CAD events. We believe that the aforementioned areas of research will aid in identifying new therapeutic targets and/or biomarkers to assess new HDL-targeted therapeutics. Specifically, we believe that understanding HDL biogenesis and metabolism is of critical importance to develop HDL-elevating compounds, while analysis of HDL protein composition gives insight into previously unknown or unappreciated functions of HDL. Together, this allows a better assessment of the therapeutic potential of raising HDL levels and/or function in preventing or regressing atherosclerosis.La maladie coronarienne athéroscléreuse (MCAS) demeure la principale cause de mortalité à l'échelle mondiale. Plusieurs études épidémiologiques ont démontré que des niveaux abaissés de cholestérol HDL (C-HDL) représentent un facteur de risque indépendant de MCAS. Nous croyons qu'une compréhension approfondie des mécanismes de biogenèse, du métabolisme et de la fonction des HDL aidera à mieux définir le potentiel thérapeutique visant à augmenter les niveaux de C-HDL dans le traitement de la MCAS. Cette thèse comporte cinq études interdépendantes ayant comme thème central et conducteur l'étude de la physiologie des particules HDL.Dans un premier temps nous avons examiné les mécanismes cellulaires liés à la biogenèse des HDL, impliquant la lipidation de l'apolipoprotéine A-I (apoA-I) par le transporteur ABCA1. Nous démontrons que la lipidation de l'apoA-I survient dans deux régions cellulaires distinctes : la membrane cellulaire et les compartiments intracellulaires. Deuxièmement, nous avons examiné l'interaction de l'apoA-I avec un/des site(s) de liaison constitués de microdomaines ABCA1/phospholipides que nous avons désignés « site de liaison de grande capacité (HCBS) ». En utilisant le fractionnement cellulaire sur gradient de densité de sucrose, nous observons que l'ABCA1 et le HCBS sont localisés dans des domaines membranaires solubles aux détergents et que l'apoA-I désorbe sélectivement la phosphatidylcholine (PtdC) de ces domaines. De plus, nous mettons en évidence qu'une charge en cholestérol ou un épuisement en PtdC dans la cellule modifient la liaison de l'apoA-I à l'ABCA1/HCBS. Nous observons d'autre part qu'une incubation de la cellule avec l'apoA-I induit une activité transcriptionnelle d'enzymes de synthèse de la PtdC ainsi que de synthèse de PtdC. Troisièmement, nous avons examiné le remodelage de la particule HDL naissante in vitro en développant un essai qui mesure le transfert de lipides in vivo dans un modèle de lapin. Cette étude suggère que le remodelage de la particule HDL naissante implique l'apolipoprotéine B plasmatique et la protéine de transfert des phospholipides. Quatrièmement, nous avons évalué la capacité d'une nouvelle molécule, le RVX-208, à augmenter les niveaux d'apoA-I et de C-HDL in vitro et in vivo. Nous démontrons que le RVX-208 augmente l'apoA-I et la production de C-HDL et améliore la fonction des HDL dans la voie de retour du cholestérol. Cinquièmement, nous avons procédé à des analyses protéomiques des HDL dans le syndrome coronarien aigu (ACS) chez des sujets. Nos résultats supportent le concept que la signature protéomique des HDL diffère entre des témoins contrôles, des patients MCAS et des patients ACS.Bien que de fortes évidences épidémiologiques supportent le C-HDL comme facteur de risque indépendant de la MCAS, il demeure à déterminer si une augmentation des niveaux de C-HDL plasmatique ou une amélioration de la fonction des HDL chez l'humain réduisent la MCAS. Nous croyons quel les pistes de recherches explorées ci-haut aideront à l'identification de nouvelles cibles thérapeutiques et/ou de biomarqueurs dans l'évaluation de nouvelles thérapies ciblant les HDL. Plus particulièrement, nous croyons qu'une compréhension de la biogenèse et du métabolisme des HDL est d'une importance cruciale pour l'élaboration de composés augmentant les niveaux de HDL. D'autre part, l'analyse de la composition en protéines des HDL fournit des informations sur des fonctions jusqu'alors non connues ou considérées des HDL. Ces données mises ensembles permettent une meilleure évaluation du potentiel thérapeutique à augmenter les niveaux de C-HDL et/ou améliorer la fonction des HDL dans la prévention ou la régression de l'athérosclérose coronarienne.
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Blackburn, R. M. "Exploring the effectiveness of statins for primary prevention of cardiovascular disease in people with severe mental illness." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1476263/.
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Cardiovascular disease (CVD) is the leading cause of death amongst people with severe mental illness (SMI) and drives substantial portion of the 15-20 year deficit in life expectancy experienced by this group relative to the general population. Statins form a core part of CVD prevention in the general population, but the evidence-base for people with SMI is unclear. Evidence on the effectiveness of statins for primary prevention of CVD was systematically searched but did not identify any studies investigating CVD events or associated mortality in people with SMI; therefore highlighting the need for studies on the long term impacts of statin prescribing. Two analytical studies were undertaken using longitudinal data from The Health Improvement Network (THIN) primary care database to investigate: 1) CVD screening and statin prescribing in people with and without SMI and 2) to explore the effectiveness of statins for CVD prevention in individuals with SMI. Collectively the work has established that CVD screening and statin prescribing is increasingly accessed by individuals with SMI at levels that are comparable to people without similar mental health conditions. The results from this study provide the first evidence that statin prescribing to people with SMI is associated with statistically significant reductions in total cholesterol (of 1.2mmol/L for up to 2 years, p < 0.001). There were small non-significant reductions in the rate of combined MI and stroke (0.89; 95% CI; 0.68-1.15) and all-cause mortality 0.89 (95% CI; 0.78, 1.02). This study provides evidence that statin prescribing to people with SMI may have a magnitude of effectiveness that is broadly similar to the general population.
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Lazdam, Merzaka. "Cardiovascular impact of preeclampsia on mother and offspring." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:2914ce9e-5619-4d46-94cd-b1d8a2122dcb.
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Preeclampsia is one of the leading causes of maternal and fetal mortality and morbidity. Furthermore, women who have had preeclampsia have an increased risk of cardiovascular events over the next 10-15 years. Indeed, preeclampsia is associated with a four-fold increase in the risk of hypertension and double the risk of fatal and non fatal ischaemic heart disease and stroke. In addition, offspring born to preeclampsia are more likely to have higher blood pressure from childhood and stroke in later life. The risk to mother and offspring is greatest when preeclampsia is diagnosed at an earlier gestation, suggesting a more severe form of preeclampsia. As the long term cardiovascular risk to both mother and child is known from delivery, the main interest of my research was to identify key phenotypic variations in mothers and children during the years between the episode of preeclampsia and emergence of established cardiovascular disease, which might explain the link between the two conditions. This information could then be used to devise ways to identify subjects at greatest risk of later cardiovascular disease and to establish intermediate endpoints for future preventative interventions. Therefore, in a case control study, women diagnosed with preeclampsia between 1998 and 2003 and their offspring were recruited and underwent comprehensive cardiovascular and metabolic phenotyping. Furthermore, young adults born preterm to hypertensive pregnancy were also investigated in their twenties. The research demonstrates that early-onset preeclampsia, diagnosed before 34 weeks gestation, is associated with blood pressure patterns in mothers 6-13 years after pregnancy that are distinct from those seen following later-onset disease. Furthermore, there is evidence of distinct differences in cardiac, vascular and metabolic profiles in these individuals with women having evidence of increased arterial stiffness, changes in cardiac function and reduced capillary density. Preterm offspring of hypertensive pregnancies similarly have higher blood pressure than seen in those born following late-onset disease and, in young adult life, have reduced endothelial function and changes in cardiac size proportional to this dysfunction. This research demonstrates adverse cardiac and vascular remodelling after preeclampsia in mothers and offspring that are evident before the development of clinical cardiovascular disease. The identified differences in cardiac and vascular function may be useful as surrogate endpoints in future preventive trials.
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Flank, Peter. "Spinal cord injuries in Sweden : studies on clinical follow-ups." Doctoral thesis, Umeå universitet, Rehabiliteringsmedicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-125202.
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A spinal cord injury is a serious medical condition, often caused by a physical trauma. An injury to the spinal cord affects the neurotransmission between the brain and spinal cord segments below the level of injury. The SCI causes a loss of motor function, sensory function and autonomic regulation of the body, temporary or permanent. Significantly improved acute care, primary comprehensive rehabilitation and life-long structured follow-up has led to persons with spinal cord injury (SCI) living longer than ever before. However, increased long-time survival has allowed secondary conditions to emerge, like diabetes mellitus and where cardiovascular disease (CVD) now is the most common cause of death among SCI patients. Other possible CVD-related comorbidities in this patient group have been reported to be pain and mood disturbances. There is still lack of, and need for more knowledge in the field of CVD-related screening and prevention after SCI. The overall aim of this thesis was to contribute to a scientific ground regarding the need for CVD-related screening and prevention after SCI. In Paper I and Paper II, patients with wheelchair-dependent post-traumatic SCI (paraplegia) were assessed. The results in paper I showed that 80% of the examined patients had at least one cardiovascular disease risk marker irrespective of body mass index (BMI). Dyslipidemia was common for both men and women at all BMI categories. The study also showed a high prevalence of hypertension, especially in men. Paper II showed a low frequency of self-reported physical activity, where only one out of 5 persons reported undertaking physical activity >30 min/day. The physically active had lower diastolic blood pressure but no significant difference in blood lipids. In paper III and IV, patients with SCI (tetraplegia and paraplegia) participated in the studies. Eighty-one percent of the patients had dyslipidemia, where also a majority of the patients with normal abdominal clinical measures had dyslipidemia. Self-reported physical activity >30min/day was reported by one third of the patients. No differences were found between physically active and not physically active patients when it came to blood glucose, serum lipid values and clinical measures (paper III). Pain was common in the patient group, however, most often on a mild to moderate level. Anxiety and depression was less common than reported in other studies (paper IV).
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Sawyer, Ceinwen. "The primary prevention of cardiovascular disease in women with an emphasis on physical activity : a social marketing approach." Thesis, Cardiff Metropolitan University, 2012. http://hdl.handle.net/10369/4494.
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The policies of the Welsh Assembly Government (WAG) regarding the health of the Welsh population are underpinned by a social marketing approach. This is where the individual is supported in their efforts to take personal responsibility for their health. Atherogenic cardiovascular disease (CVD) is a prevalent health problem for women who can take preventative steps through attention to major modifiable risk factors for the disease. There is a paucity of information about the experience of preventing CVD from the perspective of Welsh women and this was the stimulus for this project involving a profiling of apparently healthy women aged between 25 and 79 years living in the Vale of Glamorgan. The thesis consisted of three exploratory studies the first of which utilised a 27-item questionnaire developed by the primary investigator to ascertain knowledge of CVD, preferred sources of health information, physical activity levels, prevalence of overweight and obesity, smoking status, perceptions of risk, and health screening behaviours of 724 women aged between 25 and 65 years. The second study of women aged between 25 and 65 years (n = 58) utilised a Chester Step test to measure women‘s aerobic fitness facilitating comparison with thresholds of CVD risk identified in the literature, and comparison of self-perceptions of aerobic fitness with measured aerobic fitness. Additionally, measured body-weight and stature enabled estimation of body mass index and this together with measured waist circumference allowed comparison with risk thresholds identified in the literature. The third study investigated and compared perceptions of exercise benefits and barriers of women aged between 25 and 79 years (n = 128) utilising an Exercise Benefits and Barriers Scale (Sechrist et al., 1987). Participants for the three studies were obtained by convenience sampling and this took place in various localities where women were known to meet for leisure or employment. The results of study one highlighted gaps in women‘s knowledge base of CVD, a concerning prevalence of overweight and obesity, low levels of physical activity, poor uptake of screening for cholesterol and blood pressure, and misperceptions of personal CVD risk. Preferred sources of information about CVD were magazines and television and only 10.0% of women reported discussing CVD prevention with their General Practitioner. The results of study two suggested that women were moderately accurate regarding self-perception of their aerobic fitness and 75.8% reported partially meeting recommendations for physical activity. Fifty-seven percent were overweight or obese and 50.0% were over thresholds advised by the National Institute for Health and Clinical Excellence (2006) for risk of CVD and other long-term illness. Nineteen percent had an increased risk of all-cause mortality and cardiovascular events based on failure to achieve an aerobic threshold of 7.9 METs suggested by Kodama et al. (2009). The results of study three demonstrated that women in the sample perceived more exercise benefits than barriers. Physical performance and psychological outcome benefits were the most agreed with exercise benefits in women aged between 25 and 65 years but in women aged between 66 and 79 years social interaction was the most important. Preventative health benefits were not ranked highly across the age spectrum. The most agreed with barrier in women aged between 25 and 79 years was that of exercise as tiring or fatiguing, and restrictions caused by time and family responsibilities also ranked highly. The overall results indicated that interventions to increase exercise participation in women must account for possible negative perceptions of exercise as tiring and fatiguing and efforts to increase participation should focus on enjoyment. Furthermore, account should be taken of the time restrictions faced by women, and exercise opportunities should be easily accessible and convenient. The prevention of CVD entails attention to major modifiable risk factors. The overall results of this thesis suggested that women might more readily take responsibility for CVD prevention if gaps in their knowledge base were addressed, they were supported in efforts at maintaining xviii a healthy body-weight, were engaged in talking with health professionals about prevention, and if more attention was paid to their perceptions of exercise benefits and barriers. Further research could capitalise on these findings adding to what is known about women and the prevention of CVD, particularly with regard to interventions to increase physical activity and for the management of body-weight.
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Duque, Mildren Lopes Wada. "Pedagogia de projetos na prevenção de doenças cardiovasculares." Faculdade de Medicina de São José do Rio Preto, 2015. http://hdl.handle.net/tede/359.
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Introduction: Cardiovascular diseases (CVD) are the leading cause of death in Brazil, being categorized as chronic diseases because they require ongoing management over a period of several years or decades. Therefore, early intervention on these risk factors is required. Objective: This study is an action research, which aims to analyze educational activities for the prevention of cardiovascular risk factors using as theoretical basis for projects in pedagogy of six teenagers in the study of an elementary school. Methods: After the educational intervention was carried out one guiding question to study participants. Two categories emerged from the Bardin content analysis: acquisition of knowledge about healthy habits and change in lifestyle. Results: The educational intervention using the pedagogy of projects allowed for study subjects to reflect on their way of life, helping to build new knowledge, awareness of their daily life and the prevention of cardiovascular risk factors. Conclusions: The pedagogy projects showed effectiveness in health education, however the lack of studies on it requires more research is done.
Introdução: As doenças cardiovasculares (DCV) representam a principal causa de morte no Brasil, sendo categorizadas como doenças crônicas não transmissíveis, pois requerem gerenciamento contínuo por um período de vários anos ou décadas. Portanto, é necessária a intervenção precoce sobre esses fatores de risco. Este estudo é uma pesquisa-ação. Objetivo: Este estudo é uma pesquisa-ação, que tem como objetivo analisar ação educativa da prevenção de fatores de risco cardiovasculares utilizando como base teórica a pedagogia de projetos com seis adolescentes do estudo de uma escola de ensino fundamental. Métodos: Depois da intervenção educativa foi realizada uma questão norteadora aos participantes do estudo. Emergiram duas categorias na análise de conteúdo de Bardin: aquisição de conhecimentos sobre hábitos saudáveis e a mudança no estilo de vida. Resultados: A intervenção educativa utilizando a pedagogia de projetos possibilitou para os sujeitos do estudo a reflexão sobre seu modo de vida, ajudando na construção de novos conhecimentos, a consciência de seu cotidiano e a prevenção dos fatores de risco cardiovasculares. Conclusões: A pedagogia de projetos mostrou eficácia na educação em saúde, contudo pela escassez de estudos sobre ela necessita que mais pesquisas sejam realizadas.
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Dewi, Fatwa Sari Tetra. "Working with community : exploring community empowerment to support non-communicable disease prevention in a middle-incom country." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-64181.
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Background: Non communicable diseases (NCD) are recognized as a major burden of human health globally, especially in low and middle-income countries including Indonesia. This thesis addresses a community intervention program utilizing a community empowerment approach to study whether this is a reasonable strategy to control NCD. Objective: To explore possible opportunities, common pitfalls, and barriers in the process of developing a pilot community intervention program to prevent NCD in an urban area of a middle-income country. Methods: The study was conducted in Yogyakarta Municipality. The baseline risk factor survey in 2004 (n=3205) describes the pattern of NCD risk factors (smoking, physical inactivity and low fruit and vegetable intake) and demographic characteristics using STEPwise instrument. A qualitative study was conducted in order to illustrate peoples’ perceptions about NCD risk factors and how NCD might be prevented. A pilot intervention was developed based on the baseline survey and the qualitative data. The pilot intervention was conducted in four intervention communities while one community served as the referent area. The intervention was evaluated using quantitative and qualitative approaches. Finally, a second cross-sectional survey conducted in 2009 (n= 2467) to measure NCD risk factor changes during the five year period. Results: Baseline qualitative data showed that people in the high SES (Socio Economic Status) group preferred individual activities, whereas people in the low SES group preferred collective activities. Baseline survey data showed that the prevalence of all NCD risk factors were high. The community intervention was designed to promote passive smoking protection, promote healthy diet and physical activity, improve people’s knowledge of NCD, and provide a supporting environment. A mutual understanding between the Proriva team and community leadership was bargained. Several interactive group discussions were performed to increase NCD awareness. A working team was assigned to set goals and develop programs, and the programs were delivered to the community. There were more frequent activities and higher participation rates in the low SES group than in high SES group. The repeated cross-sectional surveys showed that the percentage of men predicted to be at high risk of getting an NCD event had significantly increased in 2009 compared to 2004. Conclusion: The community empowerment model was a feasible choice as a “moderate”strategy to accommodate with people’s need when implementing a community intervention that also interacts with the service provided by the existing health system. A community empowerment approach may improve program acceptance among the people.
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Xie, Lixia. "Effects of salvianolic acid B against apoptosis and adhesion molecules expression in the vascular endothelial cells." HKBU Institutional Repository, 2009. http://repository.hkbu.edu.hk/etd_ra/1082.
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Andersson, Rosanna, and Kajsa Örtengren. "Effekter av motiverande samtal vid prevention av hjärt- och kärlsjukdom." Thesis, Högskolan i Halmstad, Sektionen för hälsa och samhälle (HOS), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-25633.
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Hjärt- och kärlsjukdom är den främsta dödsorsaken i Sverige. Majoriteten av dem kan förebyggas med hjälp av en livsstilsförändring, men för att göra det krävs motivation. En evidensbaserad metod som används för att främja motivation och livsstilsförändringar är motiverande samtal (MI). Syftet med litteraturstudien var att utforska vilka effekter MI kunde ha i sjuksköterskans prevention av hjärt- och kärlsjukdom. Resultatet visade att MI hade en varierande, men genomgående positiv effekt i att förbättra de levnadsvanor som är kopplade till hjärt- och kärlsjukdom. Bland patienterna som hade deltagit i MI visades främst positiva effekter på fysisk aktivitet, kroppsmått och blodtryck. Kostvanorna hade kortsiktigt förbättrats, men långsiktigt varierade det hur länge de goda vanorna kunde behållas. Den hälsorelaterade livskvaliteten förbättrades, men patienterna upplevde dessutom en ökad ångest. Resultatet visade att MI är en effektiv metod i att främja livsstilsförändringar, däremot är val av utformandet av hur MI ska föras, i kombination med andra metoder och vilken patientgrupp som skulle gynnas mest oklart och implicerar vidare forskning i ämnet.Cardiovascular disease (CVD) is the leading cause of death in Sweden. The majority of all CVDs can be prevented with the help of a lifestyle change, but to do so it requires motivation. An evidence-based approach used to promote motivation and lifestyle changes is motivational interviewing (MI). The aim of this literature review was to explore the effects that MI may have in the nurse’s preventive work against CVD. The results showed that MI had a varied but mainly positive effect in improving lifestyles that are associated with CVD. Among the patients who had participated in MI improvements were shown mainly in physical activity, body size and blood pressure. Dietary habits had improved in the short term, but in the long term it varied how long the good habits could be maintained. The health related quality of life had improved, but the patients also experienced an increase in anxiety. The results showed that MI is an effective method in promoting lifestyle changes, however, it is unclear which design of MI should be chosen, in combination with other methods, and what patient group would benefit the most, which implies further research on the subject.
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Webb, David Robert. "Multi-factorial prevention of cardiovascular disease and novel markers of risk in early glucose disorders : The Addition-Leicester Study." Thesis, University of Leicester, 2011. http://hdl.handle.net/2381/10136.
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Jakobsson, Stina. "Cardiovascular disease and diabetes or renal insufficiency : the risk of ischemic stroke and risk factor intervention." Doctoral thesis, Umeå universitet, Kardiologi, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-109785.
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Background In patients with diabetes mellitus (DM) or chronic kidney disease (CKD), established cardiovascular disease (CVD) is associated with an increased risk of recurrent events and poor outcome. Ischemic stroke after an acute myocardial infarction (AMI) is a devastating event that carries high risks of decreased patient independence and death. Among patients with DM or CKD, the risk of an ischemic stroke within a year following an AMI is not known. Improved risk factor control is required to reduce the likelihood of CVD recurrence. Guidelines recommend target lipid profile and blood pressure values; however, data show that these targets are often not met. Therefore, there remains an urgent need for improved cardiovascular secondary preventive follow- up. Aims The aims of the present studies were to define trends in the incidence and predictors of ischemic stroke after an AMI in patients with DM or CKD. Furthermore to assess whether secondary preventive follow-up with nurse-based telephone follow-up including medication titration after CVD improves risk factor values in patients with DM or CKD and to investigate if this method performs better than usual care to implement a new treatment guideline in diabetic patients. Methods To assess the risk of post-AMI ischemic stroke, patient data were obtained from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). In separate studies, we compared a total of 173 233 AMI patients with and without DM, and 118 434 AMI patients with and without CKD. Within the nurse-based age-independent intervention to limit evolution of disease (NAILED) trial, we investigated a nurse-based cardiovascular secondary preventive follow-up protocol. Patients with acute coronary syndrome, stroke, or transient ischemic attack were randomized to receive either nurse-based telephone follow-up (intervention) or usual care (control). Low-density lipoprotein (LDL-C) levels and blood pressure (BP) were measured at 1 month (baseline) and 12 months post- discharge. Intervention patients with above-target baseline values received medication titration to achieve treatment goals, while the measurements for control patients were forwarded to their general practitioners for assessment. We calculated the changes in LDL-C level and BP between baseline and 12 months post-discharge, and compared these changes between 225 intervention patients and 215 control patients with concurrent DM or CKD. During the course of the NAILED trial, new secondary preventive guidelines for DM patients were released, including a new LDL-C target value. To assess adherence to the new guidelines within the NAILED trial, we compared LDL-C levels in the 101 intervention patients and 100 control patients with DM. Results Ischemic stroke after AMI The rates of ischemic stroke within one-year after admission for an AMI decreased over time, from 7.1% in 1998–2000 to 4.7% in 2007–2008 among DM patients, and from 4.2% to 3.7% during the same time periods for non-diabetic patients. Lower stroke risk was associated with percutaneous coronary intervention (PCI) and initiation of secondary preventive treatments in-hospital. In-hospital ischemic stroke occurred in 2.3% of CKD patients and 1.2% of non-CKD patients, with no change in these incidences over time. The rates of one-year post- discharge ischemic stroke decreased between 2003–2004 and 2009–2010 from 4.1% to 2.5% among CKD patients, and from 2.0% to 1.3% among non-CKD patients. Lower rates of post-discharge stroke were associated with PCI and statins. Cardiovascular secondary preventive follow-up Among DM and CKD patients with above-target baseline values in the NAILED trial, the median LDL-C value at 12 months was 2.2 versus 3.0 mmol/L (p<0.001) and median systolic BP was 140 versus 145 mmHg (p=0.26) for intervention and control patients, respectively. Before the guideline change, 96% of the intervention and 70% of the control patients reached the target LDL-C value (p<0.001). After the guideline change, the corresponding respective proportions were 65% and 36% (p<0.001). Conclusion Ischemic stroke is a fairly common post-AMI complication among patients with DM and CKD. This risk of stroke has decreased during recent years, possibly due to the increased use of evidence-based therapies. Compared with usual care, cardiovascular secondary prevention including nurse-based telephone follow-up improved LDL-C values at 12 months after discharge in patients with DM or CVD, and led to more efficient implementation of new secondary preventive guidelines.
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Aachi, Venkat Raghav. "Preliminary Characterization of Mitochondrial ATP-sensitive Potassium Channel (MitoKATP) Activity in Mouse Heart Mitochondria." PDXScholar, 2009. https://pdxscholar.library.pdx.edu/open_access_etds/1667.
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Myocardial ischemia, infarction, heart failure and arrhythmias are the manifestations of coronary artery disease. Reduction of ischemic damage is a major concern of cardiovascular biology research. As per recent studies, the mitochondrial ATP-sensitive potassium channel (mitoKATP) opening is believed to play key role in the physiology of cardioprotection, protection against ischemia-reperfusion injury or apoptosis. However, the structural information of mitoKATP is not precisely known. Elucidating the structural integrity and functioning of the mitoKATP is therefore a major goal of cardiovascular biology research. The known structure and function of the cell ATP-sensitive potassium channel (cellKATP) is functional in interpreting the structural and functional properties of mitoKATP.
The primary goal of my research was to characterize the activity of mitoKATP in the isolated mitochondria from the control mouse heart. The mitoKATP activity, if preliminarily characterized in the control strains through the light scattering technique, then the structure of the channel could possibly be established and analyzed by means of the transgenic model and with the help of immunological techniques such as western blotting and immunoflorescence.
With this experimental model it was possible to demonstrate that the mitoKATP activity in control mouse heart mitochondria is activated by potassium channel openers (KCOs) such as diazoxide and cromakalim and activators of mitoKATP such as PMA (phorbol12 myristate-13-acetate), and inhibited by KATP inhibitors such as glibenc1amide and 5-hydroxydecanoate (5 HD).
It was evident that the KATP activity in mouse heart mitochondria was comparable to that exhibited by the rat heart mitochondria. The various selective and non-selective activators and inhibitors of the channel elicited their activity at a similar concentration used for the rat heart mitochondria. The results were reproducible in five independent experiments for each combination, further reinforcing the significance of existing channel activity in the mouse heart mitochondria.
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Howard, Dominic Peter James. "Extra-coronary arterial disease : incidence, projected future burden, risk factors and prevention." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:6ac90d2b-b919-45d4-abfd-2128efb31bc6.
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Vascular disease is the leading cause of death and disability worldwide. Incidence, risk factors, and outcome of coronary artery disease have been extensively studied, but there are fewer data on other forms of arterial disease, including carotid, aortic, visceral, and peripheral arterial disease. Although the burden of these diseases may be increasing due to the ageing population, we lack the most basic epidemiological data on which to base clinical decisions on individual patients (short and long-term prognosis); local service provision (current incidence and projected future burden); public health / screening initiatives (age and sex-specific incidence, risk factors, and outcome); and with which to assess current levels of primary prevention (pre-morbid risk factor control). Indeed, it is this lack of data, rather than a lack of treatments that is the greatest barrier to effective prevention. I have contributed to, cleaned, and analysed data from the Oxford Vascular Study, a prospective, population-based study (n=92,728) of all acute vascular events (2002-2012), and the Oxford Plaque Study, a carotid atherosclerosis biobank of over 1000 carotid plaques, in order to study these conditions. For acute aortic disease, I aimed to assess the risk factors associated with acute abdominal aortic aneurysms (AAA) and the population impact of the current UK AAA screening programme; and the incidence, risk factors, outcome, and projected future burden of acute aortic dissection. For acute peripheral arterial disease, I assessed the risk factors associated with premature onset and poor outcome, together with current levels of primary prevention. For symptomatic carotid artery disease, I studied the timing and benefits of surgical intervention in the current era; and went on to assess whether underlying carotid plaque morphology can be used to improve stroke risk stratification and help explain why ocular and cerebral stroke types have vast differences in future ipsilateral stroke risk. I found that compared with the current UK AAA screening strategy (one-off scan for men aged 65), screening of male smokers at 65 and all men at 75 would prevent nearly four-times as many deaths and three-times as many life-years lost with 21% fewer annual scans. I have also shown that incidence of acute aortic dissection is higher than previous estimates, a third of cases are out-of-hospital deaths, and uncontrolled hypertension is the most significant treatable risk factor for this condition. For acute peripheral arterial disease, the presence of multiple atherosclerotic risk factors are associated with premature onset, and severity of ischaemia, pre-morbid renal dysfunction, cardiac failure, and diabetes mellitus are predictive of future limb loss and survival. A significant proportion of acute peripheral events are AF-related in high risk patients who were not pre-morbidly anticoagulated despite having no contraindications and being at low risk of bleeding. Symptomatic carotid artery disease currently accounts for <10% of incident cerebrovascular events, and only 40% of these patients undergo surgical intervention. Due to improvements in medical therapy and on-going delays to intervention, little benefit is currently obtained from intervening in patients with <70% stenosis. Ipsilateral stroke risk is correlated with several carotid plaque features in a time-dependent manner, confirming the potential utility of plaque morphology in risk stratification. In addition, plaques from patients with cerebral events were significantly more unstable and inflammatory than from those with ocular events, helping explain differences in stroke risk between these groups. My findings advance the understanding of these conditions that form the backbone of modern vascular surgical practice, and I hope will improve prevention, clinical management, and outcome for patients with vascular disease.
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Cupit, Caroline Susan. "An ethnographic study of cardiovascular disease prevention : the social organisation of measures, knowledge, interventions and tensions in English general practice." Thesis, University of Leicester, 2018. http://hdl.handle.net/2381/43097.
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This thesis is about different ways of knowing about people's health, and about what happens when these different knowledges intersect at the frontline of general practice - when people (patients) consult with healthcare professionals. Starting with the accounts of patients, I use institutional ethnography (Smith, 2005b) to explore how patients' (and healthcare professionals') knowledge and practices are socially organised. Within healthcare services, policymakers are coordinating activities to prevent cardiovascular disease, based on knowledge of population health from vast epidemiological datasets such as the Global Burden of Disease project. A suite of 'lifestyle' and pharmaceutical interventions are promoted by policymakers as evidence-based approaches to preventing cardiovascular disease (including heart attacks and strokes) within the population. The flagship Health Check programme aims to prompt people to make changes to their diet and exercise habits, and identify some who will benefit from additional interventions to reduce their risk. However, interviews with patients, observation of preventive care in practice, and the concerns of some general practitioners suggest that cardiovascular disease prevention is not as simple or unproblematic as it first appears; patients' knowledge of their own health needs is often at odds with the preventive care provided. I show how patients look for a discussion with healthcare professionals about how they can best implement preventive approaches, but find that they are given standardised 'automated' responses which do not take account of their own individual circumstances or preferences. Despite prominent notions of 'shared decision-making' and patient involvement written into clinical guidelines, and despite healthcare professionals striving to provide 'patient centred care', tensions persist between an institutional knowledge of prevention and a local, experienced knowledge of what is required to improve health. This thesis explores these tensions, their impact, and how both HCPs' and patients' activities are coordinated remotely from the frontline of general practice.
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Murugasen, Serini. "Age at menarche and menopause : their correlates and association with selected cardiovascular disease risk factors among 300,000 Chinese women in the China Kadoorie Biobank." Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:3e5b66b9-0782-47c3-89a2-d95400e11689.
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Background: Age-standardised mortality rates for cardiovascular disease (CVD) are generally higher among men than women, prompting suggestions that reproductive factors may be partly responsible. Moreover, there have been major changes in women’s reproductive patterns and CVD rates in China over the last few decades, but the association between them is still poorly understood. Objectives: To start addressing these issues, this thesis examines the secular trends and correlates of age at menarche and menopause (the major physiological events defining a woman’s reproductive window), as well as their association with blood pressure and anthropometry in 302,180 women born in 1930-74 from 10 areas across China using cross-sectional demographic, behavioural, physical and reproductive data from the China Kadoorie Biobank. Results: Mean age at menarche decreased by 2 years over a 44-year period (1930-1974), with the exception of an increase of about 1 year for women exposed to the Great Chinese Famine in early adolescence. No other factor showed as large an effect on age at menarche. Among women aged >57 years at the baseline, mean age at menopause increased by 1.4 years over a 21-year period (1930-1951) and was significantly associated with several reproductive and behavioural factors, notably gravidity (2 years later menopause) and smoking (6 months earlier menopause). Blood pressure and anthropometry were weakly inversely associated with age at menarche (0.2mmHg and 0.2kg/m² lower per year later menarche) and even more weakly positively associated with age at menopause (0.06mmHg and 0.04kg/m² higher per year later menopause). These trends and associations all varied to some extent by area and socioeconomic status. (All p-values <0.0001) Conclusion: This study adds new information on the secular trends and correlates of age at menarche and menopause in a large Chinese population born around the mid-20th century and provides a basis for further prospective work on the association of reproductive history with the incidence of CVD in China.
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Nguyen, Quang Ngoc. "Understanding and managing cardiovascular disease risk factors in Vietnam : integrating clinical and public health perspectives." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-55132.
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Background: Vietnam, like other low-income countries, is facing an epidemic burden of cardiovascular disease risk factors (CVDRFs). The magnitude and directions of CVDRF progression are matters of uncertainty. Objectives: To describe the epidemiological progression of CVDRFs and the preventive effects of community lifestyle interventions, with reference to the differences in progression of CVDRF patterns between men and women. Methods: The study was conducted during 2001-2009 in nationally representative samples and in a local setting of rural areas of Ba-Vi district, Ha-Tay province. Both epidemiological and interventional approaches were applied: (i) a population-based cross-sectional survey of 2,130 people aged ≥25 years in Thai-Binh and Hanoi; (ii) an individual participant-level meta analysis of 23,563 people aged 24-74 years from multiple similar surveys in 9 provinces around Vietnam; (iii) a 17-month cohort study of 497 patients in a hypertension management programme; (iv) a quasi-experimental trial on community lifestyle promotion integrated with a hypertension management programme, evaluated by surveys of 4,645 people in both intervention and reference communes before and after a 3-year intervention. Main findings: (i) in the general adult population ≥25 years, CVDRFs were common, often clustered within individuals, and increased with age; (ii) the Vietnamese population is facing a growing epidemic of CVDRFs, which are generally not well managed; (iii) it is possible to launch a community intervention in low-resource settings within the scope of a commune-based patient-targeted programme on hypertension management; (iv) community health intervention with comprehensive healthy lifestyle promotion improves blood pressure and some behavioural CVDRFs. Conclusion: Alarming increases in CVDRFs in the general population need comprehensive multi-level prevention strategies, which combine both individual high-risk and population health approaches. The commune-based hypertension-centred management programmes integrated with community health promotion are the initial but essential steps towards comprehensive and effective management of CVDRFs and should be part of an integrated and co-ordinated national program on the prevention and control of chronic diseases in low-resource settings like Vietnam.
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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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Onyirimba, Esther. "Standardized Clinical Guideline for Assessment, Documentation, and Treatment of Statins." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7499.
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The purpose of this project was to develop a practice guideline for screening patients at risk for cardiovascular disease, educate the staff at the site about the guideline, and implement the guideline at a primary care clinic. The intention was to identify and treat patients at risk for cardiovascular disease to prevent occurrence of heart disease. Cardiovascular disease includes hypertension, coronary heart disease, heart failure, and stroke. Coronary heart disease is one of the leading causes of death in the Western world. The local practice problem and focus of this project was underprescribed statin therapy for patients at risk for developing heart disease at a clinic in the southern United States. The practice-focused question that guided this project explored whether an evidence-based clinical guideline that might impact the prescription of statins for the prevention of cardiovascular disease would be approved for implementation in a primary care clinic serving adult and geriatric patients. The appraisal of guidelines for research and evaluation and the Fineout-Overholt model were used to guide this project. Sources of evidence to meet the purpose of this project were obtained from the literature and scholarly articles. The results of the presentation to the expert panel indicated that this clinical practice guideline would be implemented at the project site and would be used by nurse practitioners and physicians. The implications of this project for positive social change might include improved management of patients who are at risk for heart disease and a decrease in premature deaths related to cardiovascular disease.
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Silva, Sara Maria Oliveira da. "Proteína C reativa e doença cardiovascular." Master's thesis, [s.n.], 2015. http://hdl.handle.net/10284/5318.
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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências FarmacêuticasAs doenças cardiovasculares (DCV) são responsáveis por uma elevada taxa de mortalidade na sociedade portuguesa. Uma das causas mais comuns das DCV é a inflamação vascular que se associa à patogénese da aterosclerose. Como forma de auxiliar a deteção das DCV e acompanhar a sua evolução, são utilizados os biomarcadores inflamatórios, que constituem uma ferramenta valiosa na avaliação do prognóstico da patologia e na terapêutica a implementar. A proteína C reativa (PCR) é uma proteína de fase aguda (PFA), produzida essencialmente no fígado, pelos hepatócitos, após estimulação pelas citocinas proinflamatórias. A PCR é considerada um marcador significativo da reação inflamatória, cuja concentração não é afetada pela dieta ou variações circadianas. Esta PFA é também apontada como um importante mediador do processo de desenvolvimento da aterosclerose. A sua concentração é quantificada por métodos de alta sensibilidade (PCRas). Estes procedimentos possibilitam a identificação e diagnóstico de indivíduos com maior risco de adquirir problemas cardiovasculares, bem como o acompanhamento e a terapêutica associada à situação clínica de cada doente portador de DCV.
Cardiovascular diseases (CVD) are responsible for a high rate of mortality in Portuguese society. One of the most common causes of CVD is vascular inflammation which is associated to the pathogenesis of atherosclerosis. As a way to assist the detection of CVD and monitor its evolution, are used inflammatory biomarkers, which constitute a valuable tool in evaluating the prognosis of pathology and therapy implement. The C-reactive protein (CRP) is an acute phase protein (APP), produced mainly in the liver by hepatocytes, after stimulation by cytokines pro-inflammatory. CRP is considered a significant marker of inflammatory reaction, since it is not affected by diet or circadian variations. This APP is also pointed as an important mediator of the atherosclerosis development. Its concentrations can be quantified by high sensitivity methods (hs-CRP). These procedures enable the identification and diagnosis of individuals with increased risk of acquiring cardiovascular problems, as well as monitoring and therapy associated with clinical situation of each patient bearer of CVD.