Rozprawy doktorskie: „Cardiovascular diseases (CVD)”

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Tan, Zhen. "Low noise heart sound acquisition in wearable system for individual-centered CVD diagnosis". Thesis, University of Macau, 2017. http://umaclib3.umac.mo/record=b3691773.

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ANGIUS, GIANMARCO. "Electronic devices and systems for monitoring of diabetes and cardiovascular diseases". Doctoral thesis, Università degli Studi di Cagliari, 2009. http://hdl.handle.net/11584/266006.

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Diabetes is a serious chronic disease which causes a high rate of morbidity and mortality all over the world. In 2007, more than 246 million people suffered from diabetes worldwide and unfortunately the incidence of diabetes is increasing at alarming rates. The number of people with diabetes is expected to double within the next 25 years due to a combination of population ageing, unhealthy diets, obesity and sedentary lifestyles. It can lead to blindness, heart disease, stroke, kidney failure, amputations and nerve damage. In women, diabetes can cause problems during pregnancy and make it more likely for the baby to be born with birth defects. Moreover, statistical analysis shows that 75% of diabetic patients die prematurely of cardiovascular disease (CVD). The absolute risk of cardiovascular disease in patients with type 1 (insulin-dependent) diabetes is lower than that in patients with type 2 (non-insulin-dependent) diabetes, in part because of their younger age and the lower prevalence of CVD risk factors, and in part because of the different pathophysiology of the two diseases. Unfortunately, about 9 out of 10 people with diabetes have type 2 diabetes. For these reasons, cardiopathes and diabetic patients need to be frequently monitored and in some cases they could easily perform at home the requested physiological measurements (i.e. glycemia, heart rate, blood pressure, body weight, and so on) sending the measured data to the care staff in the hospital. Several researches have been presented over the last years to address these issues by means of digital communication systems. The largest part of such works uses a PC or complex hardware/software systems for this purpose. Beyond the cost of such systems, it should be noted that they can be quite accessible by relatively young people but the same does not hold for elderly patients more accustomed to traditional equipments for personal entertainment such as TV sets. Wearable devices can permit continuous cardiovascular monitoring both in clinical settings and at home. Benefits may be realized in the diagnosis and treatment of a number of major 15 diseases. In conjunction with appropriate alarm algorithms, they can increase surveillance capabilities for CVD catastrophe for high-risk subjects. Moreover, they could play an important role in the wireless surveillance of people during hazardous operations (military, fire-fighting, etc.) or during sport activities. For patients with chronic cardiovascular disease, such as heart failure, home monitoring employing wearable device and tele-home care systems may detect exacerbations in very early stages or at dangerous levels that necessitate an emergency room visit and an immediate hospital admission. Taking into account mains principles for the design of good wearable devices and friendly tele-home care systems, such as safety, compactness, motion and other disturbance rejection, data storage and transmission, low power consumption, no direct doctor supervision, it is imperative that these systems are easy to use and comfortable to wear for long periods of time. The aim of this work is to develop an easy to use tele-home care system for diabetes and cardiovascular monitoring, well exploitable even by elderly people, which are the main target of a telemedicine system, and wearable devices for long term measuring of some parameters related to sleep apnoea, heart attack, atrial fibrillation and deep vein thrombosis. Since set-top boxes for Digital Video Broadcast Terrestrial (DVB-T) are in simple computers with their Operating System, a Java Virtual Machine, a modem for the uplink connection and a set of standard ports for the interfacing with external devices, elderly, diabetics and cardiopathes could easily send their self-made exam to the care staff placed elsewhere. The wearable devices developed are based on the well known photopletysmographic method which uses a led source/detector pair applied on the skin in order to obtain a biomedical signal related to the volume and percentage of oxygen in blood. Such devices investigate the possibility to obtain more information to those usually obtained by this technique (heart rate and percentage of oxygen saturation) in order to discover new algorithms for the continuous and remote or in ambulatory monitoring and screening of sleep apnoea, heart attack, atrial fibrillation and deep vein thrombosis.

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HANTIKAINEN, ESSI MARJATTA. "DIETARY NON ENZYMATIC ANTIOXIDANT CAPACITY AND THE RISK OF CARDIOVASCULAR DISEASES – AN EPIDEMIOLOGICAL APPROACH". Doctoral thesis, Università degli Studi di Milano-Bicocca, 2020. http://hdl.handle.net/10281/263728.

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ABSTRACT Cardiovascular diseases are the leading cause of premature death and disability in the world. A diet containing high amounts of plant-based foods has been associated with a reduced risk of cardiovascular diseases and the beneficial effect has been attributed to the antioxidants found in the foods. However, findings from randomized controlled trials on the role of antioxidant supplementation have been disappointing, reporting null results or even harmful effects. It has been suggested that antioxidants interact with each other to promote cardiovascular health. Therefore, the Non Enzymatic Antioxidant Capacity (NEAC) assay has been proposed, which measures the antioxidant potential of different dietary sources considering interactions between them. This thesis aimed to further clarify the effect of dietary antioxidants on the risk of cardiovascular diseases, with particular interest in measuring NEAC from diet. The specific aims were to prospectively study whether dietary NEAC is associated with a lower risk of myocardial infarction, stroke and heart failure in subjects free from CVD or cancer. Four studies were conducted using data from two large Swedish cohorts. Multivariable Cox proportional hazard regression models were fitted to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). In the Swedish Women’s Lifestyle and Health Cohort (n = 45,882), a higher baseline dietary NEAC was inversely associated with the risk of myocardial infarction (quintile 5 vs. quintile 1: HR: 0.60, 95% CI: 0.45-0.81, p for trend < 0.05) and heart failure (tertile 3 vs. tertile 1: HR: 0.63; 95% CI: 0.43-0.93; p for trend < 0.05) in young to middle aged women, whereas no association was found between dietary NEAC and stroke. In the Swedish National March Cohort (n = 34,543), dietary NEAC was inversely associated with the risk of overall (quartile 4 vs. quartile 1: HR: 0.77, 95% CI: 0.61-0.96; p for trend < 0.05) and non-fatal myocardial infarction (quartile 4 vs. quartile 1: HR: 0.72; 95% CI: 0.56-0.92; p for trend < 0.05), but not with fatal myocardial infarction. The association seemed to further be stronger in women compared to men. To conclude, these findings support the hypothesis that a diet with high NEAC might protect from the development of myocardial infarction and heart failure and that the beneficial effect might be exerted through interactions between antioxidants. Whether this is true for stroke needs to be further investigated. Nevertheless, it is suggested to implement high amounts of antioxidant rich foods and beverages, such as fruits, vegetables, whole grains and tea, in the daily diet to lower the burden of cardiovascular diseases.
ABSTRACT Cardiovascular diseases are the leading cause of premature death and disability in the world. A diet containing high amounts of plant-based foods has been associated with a reduced risk of cardiovascular diseases and the beneficial effect has been attributed to the antioxidants found in the foods. However, findings from randomized controlled trials on the role of antioxidant supplementation have been disappointing, reporting null results or even harmful effects. It has been suggested that antioxidants interact with each other to promote cardiovascular health. Therefore, the Non Enzymatic Antioxidant Capacity (NEAC) assay has been proposed, which measures the antioxidant potential of different dietary sources considering interactions between them. This thesis aimed to further clarify the effect of dietary antioxidants on the risk of cardiovascular diseases, with particular interest in measuring NEAC from diet. The specific aims were to prospectively study whether dietary NEAC is associated with a lower risk of myocardial infarction, stroke and heart failure in subjects free from CVD or cancer. Four studies were conducted using data from two large Swedish cohorts. Multivariable Cox proportional hazard regression models were fitted to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). In the Swedish Women’s Lifestyle and Health Cohort (n = 45,882), a higher baseline dietary NEAC was inversely associated with the risk of myocardial infarction (quintile 5 vs. quintile 1: HR: 0.60, 95% CI: 0.45-0.81, p for trend < 0.05) and heart failure (tertile 3 vs. tertile 1: HR: 0.63; 95% CI: 0.43-0.93; p for trend < 0.05) in young to middle aged women, whereas no association was found between dietary NEAC and stroke. In the Swedish National March Cohort (n = 34,543), dietary NEAC was inversely associated with the risk of overall (quartile 4 vs. quartile 1: HR: 0.77, 95% CI: 0.61-0.96; p for trend < 0.05) and non-fatal myocardial infarction (quartile 4 vs. quartile 1: HR: 0.72; 95% CI: 0.56-0.92; p for trend < 0.05), but not with fatal myocardial infarction. The association seemed to further be stronger in women compared to men. To conclude, these findings support the hypothesis that a diet with high NEAC might protect from the development of myocardial infarction and heart failure and that the beneficial effect might be exerted through interactions between antioxidants. Whether this is true for stroke needs to be further investigated. Nevertheless, it is suggested to implement high amounts of antioxidant rich foods and beverages, such as fruits, vegetables, whole grains and tea, in the daily diet to lower the burden of cardiovascular diseases.

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Zhang, Jingyu, i 张京煜. "A study on the perceptions and behaviour on smoking cessation among patients with cardiovascular disease (CVD) hospitalized in a smoke-free hospital in Beijing, China". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43085532.

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Andersson, Per. "Predicting Health Behaviour – Population-Based Studies of Knowledge and Behaviour Related to Cardiovascular Diseases". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7200.

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Al-Saeed, Eman. "A mixed methods study of the feasibility and acceptability of an opportunistic community pharmacy based CVD risk assessment service in Alexandria, Egypt". Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.709157.

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Deniz, Nathalie. "Ethnicity and Cardiovascular Disease in theMiddle East". Thesis, Högskolan i Gävle, Avdelningen för arbets- och folkhälsovetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-14691.

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The purpose of this study was to compare between ethnicities if there is a difference in survival and treatment when it comes to cardiovascular diseases in the Middle East. To find out if there is a difference 28 articles was selected for inclusion, both qualitative and quantitative studies. Searches were made in the databases Medline, PubMed, Google and Google Scholar.The results showed that it is possible that there are differences in mortality and morbidity between ethnicities affected by cardiovascular disease. These may be due to differences in abdominal obesity, insulin resistance in diabetes and other risks such as C-reactive protein in the blood plasma which is normally excreted in inflammation in the body and also adiponectin, which is a hormone found in fat tissue whose secretion is diminished in people who have diabetes. But studies saying that a difference does exist are too few and the need for more and larger studies is needed. It may also be that not all ethnicities are as benefited from current treatments available against cardiovascular diseases for example beta-blockers. The conclusion of this study is that more research in this area is needed as well as more comprehensive studies regarding public health in the Middle East.
Syftet med denna studie var att jämföra mellan etniska grupper om det finns en skillnad i överlevnad och behandling när det gäller hjärt-och kärlsjukdomar i Mellanöstern. För att ta reda på det har 28 artiklar valts ut efter inklusionskriterierna, både kvalitativa och kvantitativa studier. Sökningar gjordes i databaserna Medline, Pubmed, Google and Google Scholar.Resultatet visade på att det sannolikt finns skillnader i dödlighet samt sjuklighet mellan etniciteter som drabbats av hjärt- och kärlsjukdomar. Dessa kan bero på skillnader i abdominal fetma, insulin resistens vid diabetes och andra risker så som C-reaktivt protein som finns i blodplasman och i vanliga fall utsöndras vid inflammationer i kroppen och adiponectin som är ett hormon som finns i fettvävnaden vars utsöndring är sämre hos personer som har diabetes. Dock är studierna som visar på skillnader alldeles för få, det behövs fler och större undersökningar inom detta område. Denna litteratur översikt visar också att det även kan vara så att inte alla etniciteter gynnas av dagens behandlingar som finns mot hjärt- och kärlsjukdomar som t ex Betablockerare. Slutsatsen i denna studie är att mer forskning inom ämnet behövs samt fler övergripande studier gällande folkhälsan i Mellanöstern.

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Mathe, Nonsikelelo. "Adisposity and CVD risk factors : a comparison between ethnicities". Thesis, Bucks New University, 2010. http://bucks.collections.crest.ac.uk/9624/.

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Background: The prevalence of overweight, obesity and obesity-related disease, mainly cardiovascular disease (CVD), is increasing in both developed and developing countries. Ethnic differences have been reported in the prevalence of overweight, obesity and CVD. However, measures used to define overweight and obesity, and identify increased risk of CVD were developed and validated in predominately Caucasian populations in developed countries. Consequently, these measures may not accurately define disease risk in all population groups. Therefore the specific aims of this programme of study were: 1. To establish the relationship between adiposity and cardiovascular risk factors in different ethnic groups. 2. To identify field measures of adiposity, relating to cardiovascular risk in different ethnic groups. 3. To compare the relationship of adiposity and cardiovascular risk factors in a single ethnic group, that of a rural and an urban population in Zimbabwe. 4. To identify risk factors for CVD related to adiposity in a population of African origin. Study design: Three empirical studies were undertaken. In study one, 312 adult subjects from three ethnic groups (Afro-Caribbean (n=106), Caucasian (n=165) and South Asian (n=41)) were recruited from a University. Twenty-six (26) of each group were individually matched for age (±3 years) gender and BMI (±2 kg/m2) to allow for comparability. Measures of body composition included height, weight, waist and hip circumferences, skinfold thickness measures, body density and percentagebody fat. In study two, 81 subjects from two ethnic groups (Afro-Caribbean (n=39) and Caucasian (n=42)) were recruited and tested. They were matched for age, gender and BMI using the same criteria as study one. In addition to the body composition measures taken in study one, random non-fasting blood glucose, total cholesterol, triglycerides and blood pressure were taken. In study three, 55 men and 108 women from rural Zimbabwe, 8 men and 17 women from an urban low-density suburb in Harare Zimbabwe, and 28 male and 16 female students from the University of Zimbabwe were recruited and tested. In addition to all measures of body composition in studies one and metabolic analysis in study two, participants’ dietary intake was assessed by food frequency questionnaire and 24hour recall and physical activity was assessed by a physical activity questionnaire. Main findings: • The relationship between BMI and %BF was not the same in all ethnic groups. (aim 1) • There were ethnic differences in the cardiovascular risk predictors between Afro-Caribbean and Caucasian men and women. (aim 1) • It is not recommended that BIA is used as a substitute for TBW estimation in multi-compartment models. (aim 2) • In three groups of Zimbabweans from urban, rural and university locations, a pattern emerged. Amongst women, urban women were at greatest risk, reporting highest values for all variables, followed by rural then university women. Amongst men, urban men were at highest risk, however there were few differences between rural and university men. (aim 3). • Finally, increased WC and dyslipidemia are associated with increasing BMI in populations of African origin. (aim 4) Conclusions: The relationships between overweight, obesity and risk of obesity-related disease differ between different ethnic groups. Moreover, in the groups from Zimbabwe, differences in obesity-related risk were associated with being female and living in urban areas. Therefore, application of universal measures for defining obesity and related diseases may not be applicable to all ethnic groups.

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Saleem, Afsah. "Machine learning for computer-aided diagnostics from complex medical images". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2025. https://ro.ecu.edu.au/theses/2927.

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Machine learning has significantly transformed medical image analysis in the current age of artificial intelligence offering vast potential in improving disease diagnosis and management. Cardiovascular diseases (CVDs) are among the leading cause of global mortality, emphasizing the need for early detection for effective intervention and prevention. Abdominal Aortic Calcification (AAC) is an early indicator and contributor to Atherosclerotic Cardiovascular Diseases (ASCVDs) and is commonly assessed through imaging modalities such as computed tomography (CT), X-rays, and Dual-energy X-ray Absorptiometry (DXA). Among these, lateral spine DXA scans, commonly used for osteoporosis screening, offer a cost-effective and low-radiation opportunity for opportunistic CVD risk assessment. Despite advancements in medical imaging technologies, AAC evaluation still relies on manual interpretation by trained clinicians, a process that is labor-intensive, subjective, and prone to variability. Automating the process of AAC quantification can address these challenges and enable consistent, early screening for CVD risk. This research presents robust machine-learning frameworks for the automated and accurate prediction of the AAC-24 score and its classification into relevant risk classes (low, moderate, and high). First, we explore deep feature ensembling methods to develop a deep feature fusion network for AAC-4 scoring using regression loss. However, its performance was limited by class ambiguities from inter-class similarities, intra-class variations, and low resolution VFA DXA artifacts. To mitigate this problem, we formulate AAC-24 scoring as an ordinal regression problem and propose a novel supervised contrastive ordinal learning (SCOL) framework. SCOL leverages a label-dependent distance metric to capture the ordinal nature of AAC labels. Using SCOL, we develop a Dual-encoder Contrastive Ordinal Learning (DCOL) framework to learn contrastive ordinal representation at global and local levels, improving feature separability and class diversity in the latent space among the AAC-24 categories. Clinical validation demonstrated a strong association between ML-AAC-24 scores and ASCVD risk, with substantial agreement between ML predictions and expert assessments. To enhance generalizability across different imaging modalities, SCOL framework is further explored for lateral spine X-rays via cross-domain fine-tuning, enhancing its utility in diverse clinical settings. To strengthen this work on highly imbalanced disease grading medical datasets, a prototype-based learning approach is incorporated within the SCOL framework to develop a generic disease grading system. The framework is evaluated on public datasets for diabetic retinopathy grading and breast cancer staging, demonstrating its ability to learn robust, ordinal-aware prototypes that generalize across diverse medical imaging tasks. Additionally, to enhance the interpretability and reliability of automated systems in clinical diagnosis, we develop a context-aware ordinal learning framework for granular-level AAC-24 scoring. We address the challenges of SCOl in handling class imbalance for ordinal regression tasks and introduce SCOL+. We explore SCOL+ in a multi-label setting to determine the extent of calcification in each section of the aorta to aid clinicians in making detailed and interpretable diagnoses. In this thesis, the AAC algorithms are developed using five large clinical datasets obtained from machines with different manufactures, including patients from Australia, Canada, and the United States, spanning both male and female patients. In conclusion, as DXA scans are commonly captured in various clinical scenarios, this research offers a novel and opportunistic approach to cardiovascular disease detection and monitoring in clinical practice, potentially revolutionizing the way we approach CVD risk screening.

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Lymbury, Robyn S. "Cardiovascular Disease, Antioxidant Enzyme Systems, and Selenium". Thesis, Griffith University, 2008. http://hdl.handle.net/10072/367925.

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Globally, cardiovascular disease (CVD) is the leading cause of mortality, representing 30 % of all deaths in 2005. The prevalence of CVD is predicted to increase steadily over the coming years and this has been attributed to a number of factors including an increase in overall life expectancy, as well as a projected increase in the number of people with common risk factors. As in most developed countries, Australia is experiencing a rise in the proportion of aged population, with current predictions estimating that by 2051, the number of people aged 65 years and over will increase from the current 2.5 million to 7.2 million. This is of particular concern considering the strong correlation between CVD risk and age. Reactive oxygen species (ROS) and a lowered antioxidant status have been heavily implicated in the pathogenesis of several CVD states including hypertension, vascular disease, ischemic heart disease and chronic heart failure. Deficiencies in the essential micronutrient, selenium (Se), have been associated with an increased incidence and a worse prognosis of a range of CVDs. The biological function of Se is mediated through the selenoproteins, of which 35 have been identified to date. Although the selenoproteins have been implicated in multiple metabolic pathways, they are primarily recognised for their role in endogenous antioxidant defence. This thesis aimed to further evaluate the significance of Se and the selenoenzyme antioxidant systems in CVD pathogenesis and prevention, with particular emphasis on the Se status of the Australian population...
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medical Science
Griffith Health
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Nelson-Majewski, Lisa C. "The Association of Resilience with Cardiovascular Disease Among Members of the Cowlitz Indian Tribe". OpenSIUC, 2015. https://opensiuc.lib.siu.edu/dissertations/1125.

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AN ABSTRACT OF THE DISSERTATION OF Lisa Nelson-Majewski, for the Doctor of Philosophy degree in Education, presented on October 30, 2015, at Southern Illinois University Carbondale. TITLE: THE ASSOCIATION OF RESILIENCE WITH CARDIOVASCULAR DISEASE AMONG MEMBERS OF THE COWLITZ INDIAN TRIBE MAJOR PROFESSOR: Dr. Dhitinut Ratnapradipa Cardiovascular disease is the leading cause of death in the United States, and among the American Indian population (AHA, 2012; IHS, 2013). The concept of resilience is receiving increasing attention in chronic conditions. Resilience has been shown to play a protective role in patients with chronic disease conditions including osteoarthritis (Wright, Zautra, & Going, 2008), breast and ovarian cancer (Brix et.al., 2008; Costanzo et. Al., 2009) and diabetes (DeNisco, 2010; Yi, Vataliano, Smith, Yi, & Weinger, 2008; Yi-Frazier et al., 2010). This study follows the paradigm shift from research focusing on risk factors of cardiovascular disease, to explore if resilience is significantly different among study participants of the Cowlitz Indian Tribe without a diagnosis of cardiovascular disease versus tribal participants with heart disease. The purpose of this study was to explore the relationships between resilience and cardiovascular health status, as well the relationship between resilience and the top six modifiable risk factors for cardiovascular disease, within the members of the Cowlitz Indian Tribe. Method. Following IRB approval, enrolled tribal members of the Cowlitz Indian Tribe, over the age of 18 years completed two survey tools. The tool utilized measure resilience this study is the 10-item Connor-Davidson Resilience Scale (CD-RISC). The second survey tool, including demographics and questions to assess cardiovascular risk factors, is the Behavioral Risk Factor Surveillance System (BRFSS). The cardiovascular risk factor questions include the same BFRSS questions utilized from the 2009-2010 BRFSS tribal questionnaires. Results. Resilience and six selected cardiovascular disease risk factors were surveyed from a total of 201 enrolled members of the Cowlitz Indian Tribe after informed consent obtained. Statistical analysis, with an alpha level of .05, revealed statistical difference between resilience and members with CVD versus resilience of members without CVD, (F (1,199) = 16.563, p = .000, ) (Table 5). All constructs of resilience impact overall resilience, while the second construct of resilience (trust in one’s instincts, tolerance of negative affect and strengthening effects of stress, emotional/cognitive control under pressure), had the most impact on overall resilience for those without CVD (r =0.909) (Table 6). HTN and resilience versus no HTN and resilience and resilience scores between those with normal cholesterol versus resilience scores of those with hyperlipidemia were the only two risk factors for CVD significantly impacted by resilience p = .049 and p = .020 respectively (Table 11; Table 13). While there was not a statistically significant difference (t (657) = -0.985) between Cowlitz Indian (N=201) resilience scores and the general population (N=458) (Davidson, 2003) (Table 22). The Cowlitz Indians (N=201) overall resilience score was statistically lower (t(359) = -3.12) than another federally recognized tribe (N = 160) Goins, Gregg, and Fiske (2012) (Table 21). Conclusion. Resilience is significantly different in members of the Cowlitz Indian Tribe who have not been diagnosed with CVD versus resilience scores of those self-identified as having CVD. Trust in one’s instincts, tolerance of negative affect and strengthening effects of stress, and emotional/cognitive control under pressure, was the construct of resilience that has the most impact on overall Cowlitz Indian resilience scores. Cowlitz participants with hypertension and hyperlipidemia, two of the six risk CVD factors evaluated, had statistical significance between the resilience scores versus the participants without the presence of these CVD risk factors.

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Whitman, Mark S. "Rate Pressure Product as a Diagnostic and Prognostic Measure for Cardiovascular Outcomes during Cardiac Stress Testing". Thesis, Griffith University, 2019. http://hdl.handle.net/10072/389846.

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Cardiovascular disease (CVD) is the leading cause of mortality worldwide accounting for almost a third of all deaths. Nearly 18 million people around the world die from this disease each year with coronary artery disease (CAD) causing myocardial infarction, and stroke accounting for 80% of the mortality. The most frequently used test when screening for CAD is the cardiac stress test. This is performed by using exercise modalities (treadmill, cycle ergometer or arm ergometer) or by using pharmacological agents to induce cardiac stress. Beyond acknowledged contraindications to terminate these tests, there has been much debate regarding a suitable measure of sufficient cardiac stress. For many years age-predicted maximum heart rate (APMHR) has been accepted as an appropriate termination point consistent with significant cardiac stress in those without a positive indication of CAD. Surprisingly, this practice has not been validated in the setting of screening for CAD. Rate pressure product (RPP) (heart rate x systolic blood pressure) however has been demonstrated as an accurate indirect measure of myocardial oxygen consumption and therefore work of the heart. While RPP is frequently reported as a surrogate measure for cardiovascular (CV) or microvascular function, it is not commonly used as a measure of sufficient cardiac stress. The overall aim of the studies reported in this thesis was to evaluate RPP as a suitable diagnostic and prognostic measure of CV outcome in patients screened for CAD both during exercise and pharmacological stress. RPP demonstrated valuable diagnostic and prognostic outcomes during exercise, showing significant superiority to predict CV events to the widely used APMHR. Chapter 1 of this thesis briefly introduces the reader to the research subject. The 2nd chapter provides a literature review on RPP with a focus in the setting of CAD. Chapter 3 discusses the research aims and significance of the project in the clinical setting and wider community. Chapter 4 describes the general methodology used in this research with emphasis on the standardisation of the testing procedures employed throughout. Chapter 5 looks at the RPP response comparing the use of handrail support and no handrail support during exercise treadmill testing (ETT). While overall there was no difference in maximum RPP (MRPP) with and without handrail support, those unfamiliar with treadmill exercise produced a significantly greater MRPP with support (7.5% increase). When extrapolated to a clinical population this could be useful in screening for CAD when the goal of the ETT is to elicit maximal cardiac work. Chapter 6 explores the utility of RPP as a diagnostic and prognostic variable for future CV events in patients with reduced functional capacity during ETT. A cut point for RPP was revealed above which very few CV events were documented during a 5- year follow-up, potentially alleviating the need for downstream testing in this group. Furthermore, RPP outperformed APMHR when comparisons between these 2 variables were made. The 7th chapter evaluates RPP, APMHR and heart rate reserve (HRR), as diagnostic and prognostic predictors of future CV events. Unlike earlier studies this chapter reports the utilisation of pharmacological myocardial stress with dobutamine. We demonstrated HRR to be an excellent predictor of future CV events in those performing an otherwise negative dobutamine stress echocardiogram (DSE). In doing so we identified the shortcomings of RPP and APMHR in this setting. We believe this is the first study to demonstrate this. Chapter 8 describes the final experimental study performed aiming to confirm the findings of chapter 6. This study comprised a much larger cohort than reported in chapter 6 and included additional echocardiographic findings. Unlike chapter 6 where only those with reduced functional capacity were included, the current study involved all negative tests performed during the collection period. Remarkably, the RPP cut point demonstrating the best predictive outcome, was nearly identical to that noted in chapter 6. Furthermore, failure to produce the cut-off value for RPP was the strongest predictor of CV events during follow-up. Similarly, to the findings in chapter 6, APMHR was found to be inferior to RPP for the detection of future CV events. Chapter 9 is comprised of a case study series drawn from the experimental studies reported in chapters 6 to 8. The cases were selected to display the strengths and weaknesses of RPP in the setting of coronary compensatory mechanisms (collateralisation, non-dominant flow and balanced ischemia) that inadvertently mask myocardial ischemia during exercise testing. The individual cases discussed demonstrated the effective use of MRPP in conjunction with maximum fatigue in unmasking ischemia in these complex scenarios albeit with associated caveats. In conclusion, the work reported in this thesis demonstrates RPP during ETT to be superior to APMHR as a diagnostic and prognostic predictor of future CV events. The results herein warrant further investigation in this area to validate the use of RPP in clinical decision-making in patients screened for CAD.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School Allied Health Sciences
Griffith Health
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Gonzales-Vigilar, Maria Carmen Rita V. "Cardiovascular risks of Caucasian and African-American women and change with intervention". Thesis, Virginia Tech, 1995. http://hdl.handle.net/10919/42130.

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The study was conducted regarding the prevalence of risks for cardiovascular disease (CVD) among 150 Caucasian and African-American, low-income women and the effectiveness of a six-month intervention in reducing risks. Seventy-four and 76 participants were randomly assigned to the experimental and control groups, respectively. Intervention consisted of 18 lessons taught by EFNEP paraprofessionals. A family record, three random-repeat 24-hour food recalls, and a health risk appraisal were collected at pre- and post-intervention sessions. Lipid profile, height, weight, percent body fat, and body mass index were measured on a sub-sample of 75 subjects. Descriptive statistics, two-sample t-tests and ANOVA (P < 0.05) were calculated. Results suggest that African-American and Caucasian, low-income women have high risks for CVD due to excessive intakes of total fat, saturated fats, sodium, and fats and sweets, but have low-intakes of dietary fiber, calcium, milk, vegetables, and fruits. They also had high incidences of obesity and smoking and low levels of physical activity. The intervention was successful in reducing intakes of energy and fats, sweets, and increasing intakes of dietary fiber I vegetable, and fruits. No significant change occurred with lipid profiles, obesity, and smoking. A six-month education program resulted in significant dietary improvement, but interventions of longer duration, specifically targeting obesity, physical activity, and smoking, are needed to improve those risk factors.

Master of Science

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Shi, Jun. "Constructing FHNNs to detect CVDs through hemodynamic parameters derived from sphygmogram". Thesis, University of Macau, 2011. http://umaclib3.umac.mo/record=b2493321.

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Chauke, Chesa Gift. "Defining the African green monkey (Chlorocebus Aethiops): expression behaviour of selected lipid metabolism genes in response to niacin". Thesis, University of Western Cape, 2012. http://hdl.handle.net/11394/3307.

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Philosophiae Doctor - PhD
In this century most major medical advances have resulted in part from research on animals and non-human primates such as the African green monkey and therefore often serve as a critical link between basic research and human clinical application. Due to its close evolutionary relationship to humans, the African green monkey is known to be an excellent and most sought after models for studies of human cardiovascular disease (CVD). While the human genome project and some others related to model organisms are very well advanced or even complete, little sequence information has been acquired for the African green monkey. Given the importance of this species in biomedical research generally and CVD specifically, and the fundamental significance of sequence data, it is critical that this paucity of genome information concerning this specific animal model be addressed in order to better define the molecular basis and to further understand the mechanism of cholesterol metabolism in this species which will also contribute immensely to primatology. There is a growing interest in the role of genetic polymorphisms in predicting susceptibility to disease and responsiveness to drug interventions. Since plasma lipid abnormalities are risk factors for coronary atherosclerosis, determination of these plasma lipid concentrations, especially for genes involved in lipid transport and metabolism may be influenced by genetic variations. In this study, the African green monkey was used as a model to evaluate the effect of niacin on plasma lipids and reverse cholesterol transport by examine gene expression and the influence of several polymorphisms found in genes that are involved in cholesterol metabolism in humans. A survey of genetic variation spanning ten prioritised “candidate” genes was conducted, all of which are known to produce proteins that play key roles in the reverse cholesterol pathway (RCT), and in the homeostatic regulation of blood lipid profiles related to cardiovascular health and disease. everse transcription polymerase chain reaction (RT-PCR) was used to evaluate mRNA expression of those “candidate” genes. Twenty two coincident singlenucleotide polymorphisms (cSNPs), reported to play a vital role in RCT, were genotyped within these genes. This study’s findings implicate a subset of six of the twenty two genetic variants, spanning five “candidate” genes. To assess possible involvement of these prioritised “candidate” genes and their polymorphisms, biochemical analyses of known risk factors of coronary artery disease such as HDL-C and LDL-C were conducted. Eight healthy African green monkeys were entered in this study of which four were treated with niacin at an escalating dosage. Their mean lipid-lowering response following drug therapy was analysed, compared to those with the same genotype in a control group. Niacin treatment was associated with a considerable reduction in LDL-Cholesterol, up-regulation of HDL synthesis, and increase of apo A-1 levels. Gene expression had minimal effect on niacin treatment, except CYP7A1 which was down-regulated at the same time when considerable change in HDL-C, LDL-C and apoA-1 levels was observed. The presence of CYP7A1:Asn233Ser polymorphism may have played a critical role in metabolising niacin and influencing the up-regulation of HDL-C synthesis in the African green monkey. Although cholesterol lowering alone may explain the anti-atherosclerotic effect of niacin on HDL-C, in this study, gene expression data also shed some light in supporting the hypothesis that genetic variants may influence the expression of genes involved in RCT, which may also have played a role in the anti-atherosclerotic effect of the drug.

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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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Tao, Andy Kenji. "Knowledge, Perceived Barriers, and Preventive Behaviors Associated with Cardiovascular Disease Among Gallaudet University Employees". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4818.

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When the Minority Health Improvement and Health Disparity Elimination Act of 2007 went into effect, there was a corresponding increase in research focused on cardiovascular disease (CVD) in underrepresented groups, except for 1: culturally Deaf Americans. Guided by the health belief model, the purpose of this study was to determine if there were significant differences in the level of knowledge, perceived barriers, and preventive behaviors associated with CVD among Deaf and hearing employees at Gallaudet University, Washington D.C. This cross-sectional quantitative research study used a survey with questions derived from 2 existing national surveys. One hundred eighty-six subjects were recruited on the campus of Gallaudet University. Chi-square analysis was conducted to seek any association between respondents and cardiovascular knowledge. A t test assessed for association between respondent characteristics and knowledge of CVD. A multivariate linear regression model was used to discover if differences in CVD knowledge score were predicted by socioeconomic factors. Deaf (28%) and hearing (43%) participants differed significantly in identifying all 6 correct signs/symptoms of heart attack (p = 0.04). Hearing females (80%) managed their blood pressure at healthy levels which is twice more than their Deaf female counterparts (61%, p = 0.01). Hearing Blacks (78%) had a discussion of their high blood pressure with their doctor more than Deaf Black counterparts (28%, p = 0.05). Gaining a better understanding of the Deaf health trends on CVD could inspire positive social change that ultimately could improve health for Deaf individuals in the United States.

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Jones-Jack, Nkenge H. "Socioeconomic Status Mobility and Lifetime Exposure to Discrimination on Cardiovascular Disease Events". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2549.

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Blacks in the United States have the highest rates of hypertension in the world, and their cardiovascular disease mortality rates are higher than for any other population group as a result of traditional risk factors such as obesity and stronger family history. However, additional underlying factors, such as social determinants of health (e.g., socioeconomic status [SES]) and macrosocial factors (e.g., racism), also correlate with adverse health outcomes. This study investigated whether the interaction between SES mobility over the lifecourse and lifetime racial discrimination influenced the extent to which hypertension contributed to the cardiovascular disease health disparities observed among Blacks in the Jackson Heart Study (JHS). Using a socioecological framework, cross-sectional data collected from the baseline period on a cohort of 5,302 JHS participants were analyzed with multiple regression techniques. The study findings indicated that SES mobility, as measured by education, predicted both the racial discrimination exposure and the burden that individuals experience. However, neither SES mobility nor racial discrimination had any effect in moderating the relationship between hypertension and cardiovascular disease when examined individually or collectively. This study examined a new approach for measuring the influence of racial discrimination on health outcomes. Multidisciplinary public health and research partners should continue to advance understanding of the complex health impact of such experiences on individuals and the dynamics that create racial factors in order to effect social change.

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Zhang, Jingyu. "A study on the perceptions and behaviour on smoking cessation among patients with cardiovascular disease (CVD) hospitalized in a smoke-free hospital in Beijing, China". Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43085532.

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Santhakumar, Abishek Bommannan. "Role of Antioxidants and Polyphenols in Thrombosis and Haemostatic Function". Thesis, Griffith University, 2014. http://hdl.handle.net/10072/366508.

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The metabolic system is one of the most fundamental requirements for precise physiological functioning and survival. The dysfunction of this system can lead to a variety of chronic metabolic disorders such as cardiovascular disease (CVD) and type 2 diabetes (T2DM). According to the National Heart Foundation of Australia, CVD and stroke is the leading cause of death in Australia, with 45,622 deaths in 2011. Oxidative stress plays a central role in the pathogenesis of a wide range of cardiovascular related diseases, including thrombosis, T2DM, hyper-cholesterolaemia and atherosclerosis. Extensive research during the last 25 years has demonstrated that free radicals, particularly, reactive oxygen species and reactive nitrogen species play a cardinal role in the damage caused by oxidative stress. There is increased oxidative stress due to pathological conditions such as T2DM and lifestyle related disorders such as obesity, which impairs muscle glucose uptake, by damaging the blood vessel walls, by oxidising lipids and in turn activating platelets resulting in thrombosis and other cardiac complications.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medical Science
Griffith Health
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Brotherton, Emily J. "Vascular and Haemorheological Responses following Acute Exercise in Lean and Active women with Polycystic Ovary Syndrome". Thesis, Griffith University, 2019. http://hdl.handle.net/10072/389734.

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Polycystic Ovary Syndrome (PCOS) is associated with an increased risk of cardiovascular disease (CVD), which is suggested to be largely due to vascular endothelial dysfunction. Endothelial dysfunction is typically represented as an impaired vasodilatory response to an appropriate shear stimulus which is dictated by the flow of blood and its components as well as vessel diameter. Notably, both vascular and haemorheological parameters have been well-documented to improve following long-term exercise in many disease states that share similar characteristics to PCOS. As such, high levels of cardiorespiratory fitness have been associated with healthy vascular function and blood characteristics in various populations. In contrast to long-term exercise, vascular and haemorheological responses to acute exercise would provide insight into the mechanisms that may stimulate beneficial long-term exercise-induced adaptions. Therefore, the current study aimed to examine the vascular and haemorheological responses in PCOS to two acute exercise bouts (moderate and heavy-intensity) compared to controls matched for cardiorespiratory fitness. The findings of the present study may provide an understanding to the influence of exercise training on vascular function and haemorheology in women with PCOS and whether prolonged adaptations or impairments to these variables are observed in this population. Methods: Endothelial function and haemorheological measurements were performed at baseline and following moderate and heavy-intensity exercise in eight women with PCOS (age: 26 ± 4 years) and ten controls (age: 28 ± 6 years), matched for BMI (23.8 ± 3.1; 21.2 ± 3.1 kg·m-2) and cardiorespiratory fitness (V̇O2max: 39.33 ± 6.07; 40.70 ± 5.74 mL·kg-1·min-1). Endothelial function was assessed by flow-mediated dilation (FMD), and normalised for the shear stimulus (FMD:SRAUC). FMD variables measured at baseline and following exercise were expressed as absolute and magnitude in change values. Haemorheology was assessed by measurement of blood viscosity (at native and standardised haematocrit), red blood cell (RBC) aggregation (at native and standardised haematocrit), plasma viscosity and RBC deformability. Cardiorespiratory fitness and metabolic, hormone and cardiovascular profiles were also assessed. Results: At baseline, there were no significant differences in FMD variables between groups, however RBC aggregation indices in both native and standardised haematocrit (p = 0.001) and plasma viscosity (p = 0.026) were elevated in PCOS women compared to controls. FMD and haemorheological parameters were not different between groups following moderate-intensity exercise (p > 0.05). Following heavy-intensity exercise, the baseline to post-exercise change in SRAUC (p = 0.04) and SR max (p = 0.009) were significantly greater in women with PCOS compared to controls. In contrast, women with PCOS demonstrated a significantly lower baseline to post exercise change in FMD:SRAUC (p = 0.021) following heavy-intensity exercise in comparison to controls. Conclusion: The findings of the present study demonstrated that at rest, women with PCOS exhibited preserved vascular function, however haemorheology (as demonstrated by elevations in RBC aggregation and plasma viscosity) was altered despite being young, healthy weight and fit. Furthermore, vascular reactivity was similar between groups following moderate-intensity exercise. In contrast, women with PCOS demonstrated an altered vasodilatory response in comparison to controls following heavy-intensity exercise. These findings provide new evidence that despite being young, lean and fit, women with PCOS exhibit altered baseline haemorheology parameters and an altered vasodilatory response to heavy-intensity exercise ─ factors that can further exacerbate endothelial dysfunction, potentially increasing the risk of CVD.
Thesis (Masters)
Master of Medical Research (MMedRes)
School of Medical Science
Griffith Health
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Saglimbene, Valeria. "Diet and health outcomes in adults with end stage kidney disease treated with haemodialysis". Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20172.

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

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Thomasouli, Maria-Anna. "A lifestyle modification programme for people with Obstructive Sleep Apnoea (OSA) at high risk of Cardiovascular Disease (CVD) and Dysglycaemia". Thesis, University of Leicester, 2014. http://hdl.handle.net/2381/28832.

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The aim of the work reported in this thesis was centred on the development of a fit for purpose structured education lifestyle modification programme for the self-management of Obstructive Sleep Apnoea (OSA). The programme aimed to promote compliance to Continuous Positive Airway Pressure (CPAP) therapy and increase physical activity levels. A mixed method study, the Predicting the Use of Continuous Positive Airway Pressure Therapy in Obstructive Sleep Apnoea in a UK population: The PUCOSA-UK study was carried out to explore the interplay of potential psycho-social predictors of CPAP adherence using a strong framework of psychology models in newly diagnosed and established OSA patients. The study showed that adherence to CPAP therapy was heavily dependent on the early formation of strong beliefs and preconceptions of the condition and CPAP therapy prior to trialling the therapy. The qualitative element of the study identified a number of common barriers associated with CPAP compliance including inability to recognise symptoms and link to with being diagnosed with OSA, initial negative reactions to the idea of using CPAP therapy, discomfort and inconvenience caused when wearing a CPAP mask and operating a CPAP device, lack of spousal or peer support and self-image issues. A systematic review and meta-analysis was conducted to evaluate the impact of diet, exercise and lifestyle modification interventions with or without CPAP therapy on obesity indices, OSA parameters and quality of life in adults with OSA. Intensive lifestyle intervention programmes were found to be more effective in reducing indices of obesity and in improving OSA parameters than less intensive lifestyle interventions or routine care. A structured education curriculum was written and piloted in small groups. The results of the pilot work combined with the results of the aforementioned studies informed the content of the curriculum. Overall, the patients benefited from attending the education programme and learnt useful self-management skills. Concluding, the findings from the work reported here warrant formal testing of the educational programme in a definitive randomised controlled trial.

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Foo, Maxmilian T. "Investigating the in-vivo effects of silymarin flavonolignans on serum bilirubin concentration and platelet characteristics". Thesis, Griffith University, 2020. http://hdl.handle.net/10072/392392.

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Introduction: Elevation in serum bilirubin concentration is associated with reduced risk of cardiovascular disease (CVD). Silymarin, an extract of the Milk Thistle plant, inhibits UGT1A1 enzymes, the main enzyme responsible for the conjugation and elimination of bilirubin from the body. This effect of elevated serum bilirubin may potentially protect against CVD. Aim/Objective: Using a single-blind, placebo-controlled crossover trial to investigate the in-vivo effects of Legalon®, on circulating bilirubin concentrations, platelet characteristics, and coagulation, recognised CVD biomarkers. Method: The effects of Milk Thistle (Silibinin) On circulating unconJugated bilirubin levels and markers of Oxidative stress and inflammation (MOJO) study was a randomised single-blind, crossover, placebo-controlled trial. The required number of participants, based on power calculation and basis of the trial was sixty-five participants. Participants were provided Legalon® and placebo during two supplementation phases, each of 14 days duration with a 28 day washout period in between. Demographic data and blood samples were collected during seven participant visits (screening, Day 0, Day 7, and Day 14 for each arm). Light transmission aggregometry, flow cytometry, clinical biochemistry, haematology, coagulation analysis, and high-pressure liquid chromatography (HPLC) were performed for collecting blood samples. Subsequent statistical analysis was conducted for seventeen participants who had satisfactory compliance (> 80% compliance for both study arms). Results: Twenty-five male participants were enrolled into the MOJO trial. Seventeen male participants completed the trial with satisfactory compliance (>80% for both the Legalon® and placebo capsules). Circulating total bilirubin (TB) and direct bilirubin (DB) showed no significant difference between time points, and between the study arms (TB ANOVA time p=0.8773, treatment p=0.8971; DB ANOVA time p=0.9210, treatment p=0.9849). This was confirmed with HPLC analysis. Platelet aggregation induced by no agonist (NA), collagen, adenosine diphosphate (ADP) and thrombin receptor-activating peptide (TRAP) did not significantly differ between time points, and between study arms (maximum aggregation (%) NA ANOVA time p=0.4672, treatment p=0.1946; collagen ANOVA time p=0.6387, treatment p=0.3527; ADP ANOVA time p=0.3740, treatment p=0.9956; TRAP ANOVA time p=0.5790, treatment p=0.2029). No significant difference in platelet activation was observed between the Legalon®-arm and placebo-arm in flow cytometry analysis (ADP CD62P ANOVA time p=0.2943, treatment p=0.6460; ADP PAC-1 treatment p=0.1093; TRAP CD62P ANOVA time p=0.3032, treatment p=0.7140; TRAP PAC-1 ANOVA time p=0.4070, treatment p=0.3103). However, a significant increase was observed for PAC-1 between Day 0 and Day 14, in response to ADP (ANOVA time p=0.0311). Mean platelet volume (MPV) and platelet count showed no significant change between time points and between the study arms (MPV ANOVA time p=0.2631, treatment p=0.6900; platelet count ANOVA time p=0.8766; treatment p=0.8766). Prothrombin (PT) and activated prothrombin time (aPTT) did not differ significantly between the study arms or between time points (PT ANOVA time p=0.8106, treatment p=0.9331; aPTT ANOVA time p=0.8106, treatment p=0.9331). Conclusion: The MOJO trial did not demonstrate significant changes to the primary or secondary outcomes. When compared to other clinical studies that utilised silymarin, the differences in silymarin preparation, the participants involved, duration of administration and dosage of the intervention may have contributed to these findings. Despite this, Legalon® capsules were taken at the prescribed dose, therefore, these results are important and challenge claims made by the manufacturer. The main limitation of the present study, includes that the sample size (17 participants), did not meet the required participant number (65 participants), as such this trial is underpowered. Secondly, the duration of Legalon® administration was another limitation as the two-week duration may have been too short in comparison to other clinical studies, who administered Silymarin for over a month. Other factors such as the poor bioavailability of Legalon®, time of blood collection, and variability in lifestyle may have contributed to the lack of significant findings. The MOJO trial remains an important field of research and challenges the manufacturer claims for this preparation and explored the in-vivo effects of silymarin on circulating bilirubin levels and its correlation to platelet characteristics, platelet function and coagulation in humans. Recommended changes to the MOJO trial include changing the silymarin preparation (silipide) and increasing participant recruitment. Initiating these changes may demonstrate a novel means to increase circulating bilirubin and therefore reduce CVD risk, which remains the world’s greatest cause of mortality.
Thesis (Masters)
Master of Medical Research (MMedRes)
School of Medical Science
Griffith Health
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Mamudu, Hadii M., Timir K. Paul, Liang Wang, Sreenivas P. Veeranki, Hemang B. Panchal, Arsham Alamian i Matthew Budoff. "Association Between Multiple Modifiable Risk Factors of Cardiovascular Disease and Hypertension among Asymptomatic Patients in Central Appalachia". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1374.

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Objectives: The central Appalachian region of the United States is disproportionately burdened with cardiovascular diseases (CVD) and associated risk factors; however, research to inform clinical practice and policies and programs is sparse. This study aimed to examine the association between multiple modifiable risk factors for CVD and hypertension in asymptomatic patients in central Appalachia. Methods: Between January 2011 and December 2012, 1629 asymptomatic individuals from central Appalachia participated in screening for subclinical atherosclerosis. Participants were asked to report their hypertension status (yes/no). In addition, data on two nonmodifiable risk factors (sex, age) and five modifiable risk factors (obesity, diabetes mellitus, hypercholesterolemia, smoking, and sedentary lifestyle) were collected. Multivariable logistic regression analyses were conducted to assess association between hypertension and risk factors. Results: Of the 1629 participants, approximately half (49.8%) had hypertension. Among people with hypertension, 31.4% were obese and 62.3% had hypercholesterolemia. After adjusting for sex and age, obesity and diabetes mellitus were associated with a more than twofold increased odds of having hypertension (odds ratio [OR] 2.02, confidence interval [CI] 1.57–2.60 and OR 2.30, CI 1.66–3.18, respectively). Hypercholesterolemia and sedentary lifestyle were associated with higher odds for hypertension (OR 1.26, CI 1.02–1.56 and OR 1.38, CI 1.12–1.70, respectively), compared with referent groups. Having two, three, and four to five modifiable risk factors was associated with increased odds of having hypertension by about twofold (OR 1.72, CI 1.21–2.44), 2.5-fold (OR 2.55, CI 1.74–3.74), and sixfold (OR 5.96, CI 3.42–10.41), respectively. Conclusions: This study suggests that the odds of having hypertension increases with a higher number of modifiable risk factors for CVD. As such, implementing an integrated CVD program for treating and controlling modifiable risk factors for hypertension would likely decrease the future risk of CVD.

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Mohan, Andrea Rene Mary. "An exploration of knowledge and risk perceptions of cardiovascular disease from the perspectives of prisoners and stakeholders to guide the development of a cardiovascular risk reduction intervention". Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27281.

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Background: Cardiovascular disease (CVD) is an important health concern in prison populations as they have an increased risk of the disease compared to the general population. However, there is a lack of interventions to reduce prisoners’ cardiovascular risk, and little is known about the knowledge and risk perceptions of the disease in prison. This study aims to explore the knowledge and risk perceptions of CVD from the perspectives of prisoners and staff to guide the development of a cardiovascular risk reduction intervention for prisoners. Methods: This was a qualitative, exploratory study. Semi-structured interviews were conducted with 16 prisoners and 11 staff, who were purposively recruited from a private prison in Scotland. Framework analysis was used to analyse the data. Findings: The prisoners and staff had limited, non-expert knowledge of CVD. Common behavioural risk factors and cardiovascular events were identified, but gaps in knowledge were evidenced. There were similarities and differences in perceptions of prisoners’ risk of the disease; risk was primarily assessed by judgements about the prisoners’ current health status rather than their risk factor status. Prisoners’ risk of CVD was attributed to negative health behaviours such as smoking and physical inactivity, and these were influenced by multiple factors that interacted across three levels of influence. Individual factors included self-efficacy and mental health problems, social factors included the prison culture and social interactions, and institutional factors included the prison regime and healthcare barriers. An ecological framework was designed to guide a cardiovascular risk reduction intervention that focuses on the multi-level influences of prisoners’ cardiovascular risk. Conclusion: Prisoners have limited knowledge and misconceptions of CVD, and engage in several risky behaviours. There are multi-level influences on prisoners’ CVD risk and cardiovascular health. An ecological approach is recommended to address these influences to reduce the prisoners’ risk of CVD.

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Radhakrishnan, Jeyasundar. "Changes in arterial stiffness and other cardiovascular risk variables following specific exercise programmes". Thesis, Bucks New University, 2012. http://bucks.collections.crest.ac.uk/9587/.

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Arterial stiffness is one of the major risk factors and markers of cardiovascular disease (CVD). An increase in the arterial stiffness is influenced by various factors such as age, lifestyle, genetics and the presence of other cardiovascular risks such as obesity and diabetes. Arterial stiffness is a consistent thread in this thesis. This thesis investigates the effects of exercise-based management programmes for CVD and risk factors with a focus on carotid-radial applanation tonometry which is a specific non-invasive technique for measuring arterial stiffness. Erectile dysfunction is a marker of CVD and is associated with endothelial dysfunction that leads to arterial stiffness. The effects of centrebased, supervised and exercise-based cardiac rehabilitation (CR) programmes were studied on the changes in arterial stiffness, erectile dysfunction and quality of life of patients with CVD. Despite the effectiveness of CR programmes, there is poor attendance at these programmes and unsupervised home-based, IT (information technology)-supported programmes could improve patient participation and cost effectiveness. Moreover, earlier identification of risks and appropriate management can reduce the incidence of CVD. There are no such programmes for early stages of CVD in practice, especially in developing countries such as India. A 12-week, IT-supported home-based exercise programme in India, for patients with metabolic syndrome was developed and studied. In general, arterial stiffness was improved in both centre-based and home-based exercise programmes. There were acute increases in arterial stiffness following exercise in healthy Caucasians and South Asians as well as people with metabolic syndrome. Carotid-radial pulse wave analysis could be a simple and reliable prognostic tool in exercise based rehabilitation programmes.

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Lane, Deirdre Anne. "The effects of depression and anxiety on mortality, CHD incidence, and quality-of-life after myocardial infarction". Thesis, University of Birmingham, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368439.

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The main purpose of this study was to determine the impact of depression and anxiety on mortality, CHD incidence, and quality-of-life in patients hospitalised for an acute myocardial infarction (MI). Questionnaires, including the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory were completed during hospitalisation by 288 MI patients, and four months and 12 months after discharge among survivors. Quality-of-life was assessed at both follow-up points using the Dartmouth COOP charts. Twenty-five (8.7%) patients died, 22 of cardiac causes, during the four month follow-up. Six further fatalities occurred between four and 12 months following MI. Symptoms of depression and anxiety did not predict either cardiac or all-cause mortality, or CHD incidence at either follow-up point. Indices of disease severity predicted both four month and 12 month mortality and CHD incidence. In a subset of seven patients who died prior to discharge, depressive symptoms did predict mortality, but the association did not withstand correction for severity of infarction. Multiple regression analyses revealed that baseline depression and state anxiety, as well as severity of infarction, predicted both four and 12 month quality-of-life. In addition, partner status and living alone also predicted four and 12 month quality-of-life, respectively. Attendance at rehabilitation was positively associated with quality-of-life at both four and 12 months, and negatively associated with 12 month CHD morbidity. In conclusion, depression and anxiety were not significant predictors of mortality, or CHD incidence, during the first year following MI but they were predictive of four and 12 month quality-of-life among survivors.

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Katko, Nicholas John. "Hard-Hearted Doctors: Hard-Hearted Doctors: The Incremental Validity of Explicit and Implicit-Based Methods in Predicting Cardiovascular Disease in Physicians". University of Toledo / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1290084946.

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Boon, Ai Ching. "Physiological Effects of Bilirubin: Protection from Protein Oxidation, Kidney Dysfunction and Regulation of Hepatic Lipid Metabolism". Thesis, Griffith University, 2015. http://hdl.handle.net/10072/367250.

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Clinical evidence indicates that hyperbilirubinaemic individuals with Gilbert’s syndrome (GS) are at reduced risk of developing cardiovascular and chronic kidney disease. This thesis consists of five manuscripts which review and explore various mechanisms whereby unconjugated bilirubin (UCB) may prevent cardiovascular disease (CVD) and chronic kidney disease (CKD). The first study of this thesis followed and extended upon the candidate’s Master of Medical Research program. Forty-four age, gender and body mass index matched Gilbert’s syndrome (GS) and healthy controls were recruited and blood was analysed for lipid parameters and plasma antioxidants/oxidative stress status. Individuals with GS had elevated unconjugated bilirubin (UCB), reduced thiol and glutathione concentrations compared to controls. Oxidative stress biomarkers including oxidised glutathione, protein carbonyl and oxidised low-density lipoprotein concentration were significantly reduced in GS and were negatively correlated with UCB concentrations. To better characterise bilirubin’s ability to inhibit atherogenesis based upon its antioxidant capacity, study two investigated the susceptibility of plasma to myeloperoxidase induced oxidation was tested in hyperbilirubinaemic humans and rodents. Plasma with exogenous UCB supplementation (15.6-250 µM) inhibited HOCl (100 µM) and (100 nM)-hydrogen peroxide (H2O2; 50-100 µM) induced chloramine formation in a dose dependent manner. Chloramine formation was significantly reduced in GS plasma and Gunn rat serum and which was negatively correlated with UCB concentrations. Chloramine decomposition, including protein carbonyl and malondialdehyde formations were significantly reduced in a dose-dependent manner. This study suggested that UCB could inhibit protein and lipid oxidation induced by the formation of biologically relevant radicals/oxidants in vitro.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medical Science
Griffith Health
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Nel, Rumada. "Physical conditioning, total plasma homocysteine concentration and cardiovascular function in middle-aged men with coronary heart disease risk factors / Rumada Nel". Thesis, North-West University, 2006. http://hdl.handle.net/10394/1365.

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Gaiz, AlMottesembellah A. "Anthocyanin as an Antiplatelet Therapy in Diabetes: Immunopathological Assessment". Thesis, Griffith University, 2021. http://hdl.handle.net/10072/403246.

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Diabetes mellitus—in particular, Type 2 diabetes mellitus (T2DM)—is one of the most prevalent chronic illnesses in many countries. Diabetes mellitus is regarded as an independent risk factor for cardiovascular disease (CVD). Cardiovascular disease is one of the main causes of mortality in patients with diabetes, mainly due to macrovascular complications. One of these macrovascular complications in diabetes is atherosclerosis, which involves a complicated pathophysiological process. In addition to hyperglycaemia, oxidative stress (OS) plays a significant role in the pathogenesis of diabetes and its associated risk of CVD. Platelet hyperactivity, in the presence of OS, has a major effect on the progression of atherosclerosis and thrombotic events. Aspirin (AS) is the most-used antiplatelet therapy for the prevention of thrombotic complications in people with T2DM. AS attenuates platelet hyperactivity. Although aspirin is a frequently used therapy for the inhibition of platelet hyperactivity, there is much evidence for AS non-responsiveness. The anthocyanin (AC) antioxidant has been shown to have an inhibitory effect on platelets and consequently may be used as a complement to other antiplatelet therapies to attenuate the negative effect of atherosclerosis and CVD in people with T2DM. Although many dietary intervention studies have shown that intake of AC-rich food may be negatively related to some CVD risk factors, the effect of pure AC on thrombotic markers such as platelet hyperactivity and haemostasis is yet to be explored. The main aim of the studies commenced for this thesis were to examine the effect of AC on thrombotic parameters and reveal the pathways by which AC might affect platelet hyperactivity, thereby providing individuals with T2DM with better protection against CVD. The aim of the first study (see Chapter 4) was to evaluate the in vitro effect of AC on platelet activation and aggregation. Fasting blood samples were collected from 13 screened and healthy volunteers after obtaining ethics clearance and signed informed consent. A full blood examination was conducted, and a dose-response curve was created by incubating platelets with five concentrations of AC (25–200 mg/L). Flow-cytometer assessed platelet activity by recording platelet surface marker expression of activation independent (CD41a) and dependent (P-selectin and PAC-1). Platelet aggregation studies were performed using the turbidimetric method by stimulating platelets using three different agonists: adenosine diphosphate (ADP), collagen and arachidonic acid (AA). The results of this study confirmed that AC at 50 mg/L significantly lowered platelet activation as expressed by the P-selectin surface activation marker and AA-stimulated platelet aggregation. However, a similar effect of AC was not detected when ADP or collagen was applied to induce platelet aggregation. Reduced AA-stimulated platelet aggregation by in vitro–adding of AC suggests that AC may reduce platelet hyperactivity, thus reducing the risk of vascular thrombosis and promoting cardioprotective effects. Following the results of Chapter 4, a subsequent study (see Chapter 5) was conducted to assess if AC had a comparable antithrombotic effect ex vivo. Twenty-six randomly recruited healthy (25–75-year-old) participants contributed to this study and consumed 320 mg of AC a day in the form of Medox® capsules for 28 days. This study was conducted in laboratories of the School of Medical Science at Griffith University. Fasting blood samples were collected pre- and post-intervention to perform platelet activation studies, which were done by measuring platelet surface marker expression of CD41a and P-selectin, and platelet–monocyte aggregates in ADP-stimulated platelets. Platelet aggregation studies were performed by stimulating platelets with various agonists such as ADP, collagen and AA. Full blood examination, coagulation and biochemistry profile analyses were also evaluated pre- and post-intervention. A flow-cytometry analysis showed that AC had a significant effect on the expression of P-selectin as measured by the platelet surface expression of CD62p. A significant decrease in ADP-stimulated platelet aggregation was detected in the blood of healthy individuals. These results endorse the idea that AC might reduce platelet aggregation by affecting a mechanism of platelet activation, specifically the P2Y2–P2Y12 receptor. Similarly, AC significantly reduced platelet activation, as a lesser concentration of fibrinogen and decreased mean platelet volume (MPV) were detected due to AC effects in normal participants. The results from Chapter 5 suggest that AC consumption may enhance protection against platelet hyperactivity–related thrombosis. Based on the results of Chapter 5, the aim of the next study (see Chapter 6) was to identify and elucidate any possible influence of AC on thrombotic risks in people with T2DM. This study involved patients with T2DM. Twenty-four patients with T2DM were recruited for this study, and they consumed 320 mg of AC a day in the form of Medox® capsules for 28 days. Blood pressure and anthropometric measures were taken before and after the intervention period. Fasting blood samples were collected pre- and post-intervention to perform platelet activation studies, which were done by measuring platelet surface marker expression of CD41a and P-selectin in ADP-stimulated platelets. Platelet aggregation, full blood examination, coagulation and biochemistry profile analyses were also evaluated pre- and post-intervention. The data from this study showed that AC had a probable lowering effect on collagen and ADP-induced platelet aggregation in T2DM. This clinical trial also demonstrated the reducing effect of AC on the TC level in the blood. The figures shown in Chapter 6 suggest that the ingestion of AC may mitigate the development of thrombotic risks due to platelet hyperactivity. Following the outcome of Chapter 6, a fourth study (see Chapter 7) was conducted to assess if AC was comparable to AS in lowering different thrombotic biomarkers as well as platelet activation and aggregation. Antiplatelet medications, such as AS, diminish platelet hyperactivity and aggregation and decrease the risk of thrombosis. These antiplatelet drugs inhibit platelet activation through different pathways. Antiplatelet agents are indicated for mitigating thrombosis, which is partly mediated by platelet hyperactivity. However, AS non-responsiveness and side effects have been reported. Antioxidants alleviate the development of atherosclerosis and mitigate the prognosis of CVD. Two groups of healthy participants consumed AC and AS for four weeks. They were tested before and after the intervention period for different parameters including full blood count, platelet activation and aggregation, biochemical tests of lipid profile, uric acid, glucose and C-reactive protein, and coagulation assay. This study (see Chapter 7) showed a significant decrease in platelet hyperactivity—as expressed by CD62p (P-selectin) caused by AC—in the participants, yet the effect of AS was more powerful. AC had a reducing effect on ADP and collagen-stimulated platelet aggregation, but AS applied a greater inhibitory effect on this. Alleviated platelet activation, along with reduced platelet aggregation, were also detected. Lower platelet degranulation correlates with a decrease in thrombus size, as P-selectin (which is expressed by platelets upon activation) is recognised to attract nearby white blood cells (WBCs) dynamically, thus increasing thrombus size. The outcomes from this study (see Chapter 7) suggest that AC could possibly be used to decrease platelet function. However, this study also showed AC to be less useful than AS in lowering the risk of thrombosis. The results achieved from the studies completed for this thesis demonstrate a positive relationship between the consumption of AC and a decrease in platelet activity, which may be instrumental in lowering the risk of thrombosis, thus providing better prevention against CVD. The hypothesised total antioxidant effect of AC may be responsible for reduced platelet activity, which is expected to delay or even prevent macrovascular or microvascular events in patients who suffer from elevated OS as a result of different diseases such as T2DM. Reduced MPV and lowered fibrinogen levels also suggest that ingestion of AC may have an effect in suspending the early stages of atherosclerosis. Thus, AC has the potential to alleviate thrombotic risk and probably reduce the risk of cardiovascular events.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medical Science
Griffith Health
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Hadeiba, Tareg Hadi Ahmed. "The role of iron in oxidative stress accelerated endothelial dysfunction in chronic kidney disease". Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14325.

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Chronic kidney disease (CKD) is growing global public health problem affecting 1 in 10 adults in developed countries and recognised as an important risk factor for cardiovascular disease (CVD) development. CVD is the main cause of death among CKD patients. Endothelial injury and dysfunction are critical steps in atherosclerosis, a major CVD. Oxidative stress (increased level of reactive oxygen species, ROS) has been associated with CVD development. Intravenous (IV) iron preparations are widely used in the management of CKD mediated anaemia, and have been associated with increased oxidative stress and cellular dysfunction. This study examined the effect of pharmacologically-relevant concentrations of IV Venofer (iron sucrose) or IV Ferinject (Ferric carboxymaltose, FCM) on primary human umbilical vein endothelial cell (HUVEC) activation/damage and on intracellular ROS generation as well as studying the potential mechanisms responsible. Data from TUNEL assay and Annexin V-FITC/PI staining showed that, IV FCM had no effect, but IV iron sucrose increased HUVEC apoptosis at 24hr. IV iron sucrose inhibited cell proliferation and reduced cell viability. Both compounds induced EC activation through sustained activation of p38 MAPK and up-regulation of ICAM-1 and VCAM-1. Additionally, the compounds induced significant increase in total ROS and superoxide anion production, which was attenuated by the anti-oxidant N-acetylcysteine (NAC). P38 MAPK showed up-regulation of pro-apoptotic protein Bax and down-regulation of antiapoptotic Bcl-2 protein in HUVEC treated with IV iron sucrose and p38 inhibition reversed these effects. In summary, these results suggest that IV iron sucrose causes more severe EC injury than IV FCM. However, both IV iron preparations induced intracellular ROS and superoxide anion generation in HUVEC leading to EC activation/dysfunction, providing a potential explanation for vascular damage in CKD patients.

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Bakrania, Bhavisha. "Bilirubin Induced Cardioprotection: From Endogenous Protection to Therapeutic Potential". Thesis, Griffith University, 2015. http://hdl.handle.net/10072/367882.

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Over the past 30 years, knowledge concerning the in vivo relevance of bilirubin has evolved from being an inert waste product of haem catabolism to a physiologically important antioxidant and biomarker of cardiovascular disease (CVD). Elevated serum bilirubin concentrations, as observed in human Gilbert’s syndrome (GS), are associated with reduced incidence of atherosclerosis, ischaemic heart disease (IHD), and a reduction in overall cardiovascular mortality. However, a comprehensive understanding of the mechanisms that might explain these associations remains to be delineated. Aside from its potent antioxidant capacity, bilirubin inhibits smooth muscle cell proliferation, intima-media thickening and influences vascular tone, all of which could represent additional mechanisms by which bilirubin could protect from CVD and associated mortality. This thesis addressed three aims; 1) to investigate whether endogenously elevated bilirubin affects cardiac structure and function in healthy rats; 2) to determine whether endogenously and exogenously elevated bilirubin impacts on cardiac stress resistance in aged and young rat hearts; and 3) to explore the effects of elevated endogenous bilirubin on expression of genes in left ventricular myocardium. If bilirubin was found to protect from myocardial ischaemia-reperfusion injury, the research within this thesis could underpin the development of therapies for myocardial infarction, for which there is currently no treatment.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medical Science
Griffith Health
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Li, Xia. "C - Reactive Protein, Coronary Heart Disease and Ischemic Stroke in the Elderly: The Cardiovascular Health Study". VCU Scholars Compass, 2006. http://hdl.handle.net/10156/2037.

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Ngqaneka, Thobile. "The impact of Niacin on PCSK9 levels in vervet monkeys (Chlorocebus aethiops)". University of Western Cape, 2020. http://hdl.handle.net/11394/7931.

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Magister Pharmaceuticae - MPharm
Cardiovascular diseases (CVDs) such as ischaemic heart diseases, heart failure and stroke remain a major cause of death globally. Various deep-rooted factors influence CVD development; these include but are not limited to elevated blood lipids, high blood pressure, obesity and diabetes. A considerable number of proteins are involved directly and indirectly in the transport, maintenance and elimination of plasma lipids, including high and low-density lipoprotein cholesterol (HDL-C and LDL-C). There are several mechanisms involved in the removal of LDL particles from systemic circulation. One such mechanism is associated with the gene that encodes proprotein convertase subtilisin/kexin type 9 (PCSK9), which has become an exciting therapeutic target for the reduction of residual risk of CVDs. Currently, statins are the mainstay treatment to reduce LDL-C, and a need exists to further develop more effective LDL-C-lowering drugs that might supplement statins. This study was aimed at contributing to the generation of knowledge regarding the effect of niacin in reducing LDL levels through PCSK9 interaction.

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Mirza, Majd A. I. "The role of fibroblast growth factor-23 in chronic kidney disease-mineral and bone disorder". Doctoral thesis, Uppsala universitet, Medicin, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-130339.

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Fibroblast growth factor-23 (FGF23) was initially identified as the causative factor of autosomal dominant hypophosphatemic rickets. Further studies confirmed that FGF23 is predominantly expressed in the osteocytes and osteoblasts of bone and that circulating FGF23 acts on the kidney to inhibit renal phosphate reabsorption and 1,25(OH)2D3 hydroxylation. With the progression of chronic kidney disease (CKD), the kidneys become insufficient to maintain a normal systemic mineral homeostasis, resulting in various abnormalities of bone and mineral metabolism, generally referred to as Chronic Kidney Disease – Mineral and Bone Disorders (CKD-MBD). FGF23 increases early in the course of CKD in order to maintain normal serum phosphate levels; long before a significant increase in serum phosphate can be detected. Recent studies suggest that increased FGF23 levels are associated with progression of CKD, mortality, and the development of refractory secondary hyperparathyroidism. Because FGF23 is the very earliest marker of CKD-MBD, it is of particular interest to evaluate the relation between FGF23 and CKD-MBD abnormalities, in the setting of early CKD and also in individuals with normal renal function. In the present work, we show that FGF23 is linked to several dynamic measurements of vascular function, including endothelial dysfunction, arterial stiffness, and atherosclerosis. FGF23 is also positively associated with left ventricular mass index and an increased risk of having left ventricular hypertrophy. All associations were independent of serum phosphate and were strengthened in subjects with diminished renal function. Furthermore, we found significant evidence for an association between higher FGF23 and increased fat mass and dyslipidemia, which could represent a novel pathway linking FGF23 to cardiovascular disease. Finally, we show that FGF23 is a significant predictor of future fracture risk. Although these associations could be reflecting the increased risk associated with hyperphosphatemia and calcitriol deficiency, current evidence points towards FGF23 being more than an innocent bystander. At the very least, FGF23 holds promise of being a bio-marker of cardiovascular status and phosphate-related toxicity both in CKD and in the general population, and might be a therapeutic target that could improve the fatal prognosis in CKD patients.

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Mente, Andrew. "Defensive hostility, an association with cardiovascular responses to stress as a mechanism for the development of coronary artery disease (CAD)". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq22868.pdf.

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Yasуnska, E. Ts. "Assessment of the influence of psychological factors on the occurrence of adverse cardiovascular prognosis in patients with coronarysheart disease (CHD)". Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18862.

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El-Khoury, Joe M. "Chronic Kidney Disease: Vitamin D Treatment Regimens and Novel Assay Development for Kidney and Cardiovascular Function Biomarkers". Cleveland State University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=csu1343914060.

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Kim, Sungho. "Influence of biomechanical force and mass transfer on the progression of atherosclerosis in human carotid arteries". Diss., Georgia Institute of Technology, 2011. http://hdl.handle.net/1853/41192.

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Atherosclerosis is a vascular degenerative disease leading to progressive thickening in the intima of large and medium sized arteries through the formation of plaque that is very rich with cholesterol. The cholesterol is carried by LDL (low density lipoprotein) particles which pass through the endothelium and accumulate in the intima. The passage of LDL is influenced by wall shear stress which activates physiological responses of the endothelium. However, the causal relationship between the physiological responses and their effect on LDL mass transport is not fully understood. To obtain blood flow patterns in human carotid arteries, a fluid structure interaction (FSI) computational approach is employed, based on the in-vivo arterial geometry constructed from black blood magnetic resonance images (BBMRI) and flow rate boundary conditions obtained from phase contrast images (PC). Wall shear stress (WSS) on the luminal surface is computed, and this variable is related to the formation of leaky junctions, which is a major transendothelial pathway for LDL. A model for the fraction of leaky junction at a surface is incorporated into the overall computational scheme for mass transport, along with pore theory. The theoretical model is applied to images from three human carotid arteries in which the degree of disease ranges from mild to moderate. Maximum mass flux is predicted to be in the downstream region of stenoses where WSS is low, and this result is consistent with the clinical observation of plaque progression downstream of the stenosis. The hypothesis that the majority of LDL enters into the intima through leaky junctions is supported by observation of similar distributions between the pattern of volume flux via leaky junctions and mass flux. These studies suggest that mass flux of LDL can be a predictor to indicate areas with potential for plaque formation and progression in human carotid artery disease.

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Link-Malcolm, Jessica. "Health message framing : motivating cardiovascular risk factor screening in young adults". Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9066/.

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As the leading cause of death in the United States, coronary heart disease (CHD) is a growing public health problem, despite the fact that many risk factors for the disease are preventable, especially if addressed early in life. The purpose of the current study was to examine the effects of loss-framed versus gain-framed versus information-only health messages on both intention to attend and actual attendance at an appointment to get screened for CHD risk factors (i.e., hypertension, diabetes, and dyslipidemia). It was hypothesized that a population of young adults would be more likely to view screening for CHD risk factors as a low-risk, health-affirming behavior as opposed to a risky, illness-detecting behavior and would thus be more strongly influenced by gain-framed messages than loss-framed messages. Additional goals included the exploration of the extensively researched individual health beliefs of perceived threat (as defined by the health belief model) and health locus of control as they relate to message frames. One hundred forty-three undergraduate students were randomly assigned to either the loss-framed, gain-framed, or information-only control conditions. Framing manipulation checks revealed that participants failed to discern differences in the tone and emphasis of the experimental pamphlets. As a result, no tests of framing effects could be conducted. Sixteen (11.2%) of the 143 participants who participated in Part 1 of the experiment participated in Part 2 (i.e., attended a risk factor screening appointment). Multiple regression analysis revealed risk index, age, and powerful others health locus of control as significant predictors of screening intention. Gender was the only demographic or health related variable that was significantly related to screening outcome, such that women were more likely to get screened than men. Limitations and recommendations are discussed.

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Benton, Miles Clifford. "Identification of Susceptibility Genes for Metabolic Syndrome in the Isolated Population of Norfolk Island". Thesis, Griffith University, 2014. http://hdl.handle.net/10072/366757.

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The Metabolic Syndrome (MetS) is a common disorder characterized by obesity and abnormal lipid and carbohydrate metabolism. Although not a disease in itself, MetS leads to markedly increased risk of developing type-2 diabetes (T2D) and cardiovascular disease (CVD). MetS, and its component traits, are influenced by a complex interplay of multiple factors including modifiable environmental variables and inherited genetic predisposition. These envirogenomic relationships are yet to be completely elucidated and are likely to vary among different populations. The Norfolk Island (NI) community is an isolated population whereby the majority of inhabitants are direct descendants of 18th century European Bounty Mutineers and Polynesian (Tahitian) women, who relocated to NI from Pitcairn Island in 1856. Due to it's geographic separation from mainland Australia the NI population grew in isolation from other communities, which has resulted in a characteristic gene pool with features including reduced genetic diversity and Polynesian admixture. There is also a very well documented family history that has been used to establish a large multi-generational pedigree. Genetic isolates such as this can provide a powerful resource for studies of genetically influenced conditions, as their pedigree structure and size can provide improved inheritance information content and statistical power. To date, the prevalence or risk of MetS, CVD and T2D, have not been formally examined in the NI population, nor has there been research specifically focusing on the genetic susceptibility of MetS in this population.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medical Science
Griffith Health
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Simba, Kudakwashe. "The impact of vascular calcification among dialysis dependent South African CKD patients. A five year follow up study. Cardiovascular mortality and morbidity, ethnic variation and hemodynamic correlates". Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31257.

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BACKGROUND Vascular calcification is a major risk factor for cardiovascular morbidity and mortality in patients with end stage renal disease (ESRD). In Western countries, Blacks with ESRD appear to have lesser degrees of vascular calcification compared to non-Blacks. However, there is no published data on the association of ethnic differences in vascular calcification and survival in ESRD from Sub-Saharan Africa. METHODS This study assessed the 5-year change in vascular calcification and mortality in a previously published cohort of patients with ESRD. Vascular calcification was assessed by abdominal aortic calcification score (lateral abdominal radiograph) and vascular stiffness by pulse wave velocity. RESULTS Sixty-six of the original 74 participants, studied a baseline, were identified. The median age was 46.6 years (37.6-59.2) and 57.6% were women. Abdominal aortic calcification showed no progression among Blacks [baseline range 0-5, follow up range 0-8 (p=1.00)], but a nonsignificant trend to progression among non-Blacks [baseline range 0-19, follow up range 0-22 (p=0.066)]. Black participants did not display a survival advantage (p=0.870). Overall, sepsis was the most common cause of mortality (64% of those with an identifiable cause of death). Non-Blacks had higher parathyroidectomy rates than Blacks with 9/30 cases compared to 2/36 (p=0.036). After adjustment for parathyroidectomy at follow up, the odds ratio of having abdominal vascular calcification score of ≥1 amongst non-Blacks was 8.6-fold greater compared to Blacks (p= 0.03). Central aortic systolic pressures (CASP) and pulse wave velocities (PWV) were higher in the study population than age matched normative values. At follow up, a positive correlation (r=0.3) was observed between PWV and abdominal aortic calcification (p=0.04). Elevated baseline coronary artery calcification score and FGF-23 level at baseline were not associated with a difference in mortality. CONCLUSION There was no significant progression in vascular calcification among Blacks. After adjusting for increased parathyroidectomy rates, there was a greater progression of vascular calcification amongst non-Blacks compared to Blacks highlighting possible ethnic differences in calcium phosphate metabolism in patients with ESRD. The lack of vascular calcification progression in Blacks was not however associated with improved survival, but the sample size was small.

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El, Chamieh Carolla. "Influence des toxines urémiques sur la morbi-mortalité cardiovasculaire des patients en Maladie Rénale Chronique dans la cohorte CKD-REIN". Electronic Thesis or Diss., université Paris-Saclay, 2024. http://www.theses.fr/2024UPASR003.

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La maladie rénale chronique (MRC) est un problème majeur de santé publique, touchant plus que 10 % de la population adulte mondiale. Les patients avec une MRC ont un risque accru de morbi-mortalité cardiovasculaire, soulignant ainsi l'importance cruciale d'identifier des facteurs de risque associés. Les toxines urémiques (TUs) sont des molécules qui s'accumulent chez les patients avec une MRC, et qui ont été identifiées comme facteurs de risque cardiovasculaires spécifiques à la MRC. Une revue narrative, incluant toutes les études in vitro, in vivo, et observationnelles entre 2002 et 2022 sur le lien entre les TUs et le risque cardiovasculaire, a été réalisée au début de la thèse. Ceci nous a permis de conclure que la kynurénine, une TU liée aux protéines et dérivée du métabolisme du tryptophane, n'a jamais été étudiée chez les patients pré-dialysés. Ainsi le deuxième travail de thèse a permis d'évaluer l'association de la kynurénine avec les évènements cardiovasculaires. En outre, il est essentiel de repérer les facteurs qui peuvent influencer les concentrations sériques en TUs, d'autant plus que les informations disponibles sur ce sujet sont limitées. Or les inhibiteurs de pompes à protons (IPPs), qui sont des médicaments fréquemment prescrits chez les patients avec une MRC, et certaines TUs sont éliminés par les transporteurs d'anions organiques au niveau des reins. L'hypothèse d'une potentielle interaction entre ces deux n'a jamais été évalué dans la littérature. D'où l'intérêt du troisième travail de cette thèse qui a évalué l'association entre les IPPs et les TUs. Ces deux derniers travaux originaux ont été réalisés à partir des données de la cohorte CKD-REIN, qui est une large cohorte prospective représentative réalisée dans 40 consultations de néphrologie en France, incluant des patients avec une MRC modérée-à-avancée. Nous avons mis en évidence qu'une double augmentation des concentrations sériques de kynurénine libre était associée à une augmentation de 19% du rapport de risque instantané d'évènement cardiovasculaire fatal ou non (466 événements, rapport de risque [IC 95 %] : 1,19 [1,03-1,39]), indépendamment du débit de filtration glomérulaire, de la concentration sérique de tryptophane libre ou d'autres TUs, des médicaments cardioprotecteurs et des facteurs de risque cardiovasculaires traditionnels. La kynurénine libre était particulièrement associée aux évènements cardiovasculaires non-athéromateux (rapport de risque [IC 95 %] : 1,31 [1,09-1,6]). Cependant, nous n'avons pas retrouvé d'association significative entre la kynurénine libre et la mortalité toute cause (311 événements, rapport de risque [IC 95 %] : 1,18 [0,9-1,4]). Dans un échantillon tiré au hasard de CKD-REIN, 31 % des patients avaient des prescriptions d'IPPs à l'inclusion. Nous avons montré que les concentrations sériques de l'indoxyl sulfate libre et total, du p-cresyl glucuronide libre et total, et de la phénylacétylglutamine étaient significativement et indépendamment plus élevées chez les patients prenant des IPPs que chez ceux qui n'en prennent pas. Cette thèse souligne la nécessité de mener davantage de recherches pour comprendre les mécanismes sous-jacents de l'effet des TUs sur la santé cardiovasculaire chez les patients atteints de MRC et développer de nouveaux traitements et approches pour réduire leur impact sur la santé de ces patients
Chronic kidney disease (CKD) is a major public health problem, affecting more than 10% of the worldwide adult population. Patients with CKD have an increased risk of cardiovascular morbidity and mortality, highlighting the importance of identifying associated risk factors. Uremic toxins (UTs) are molecules that accumulate in patients with CKD, and which have been identified as cardiovascular risk factors specific to CKD. A narrative review, including all in vitro, in vivo, and observational studies between 2002 and 2022 evaluating the link between UTs and cardiovascular risk, was carried out at the beginning of the thesis. This allowed us to conclude that kynurenine, a protein-bound UT derived from tryptophan metabolism, has never been studied in pre-dialysis patients. Thus the second objective of the thesis evaluated the association between kynurenine and cardiovascular events. Furthermore, it is crucial to identify factors that may influence serum concentrations of UTs, for which available information is limited. Proton pump inhibitors (PPIs), commonly prescribed for patients with CKD, and certain UTs are eliminated by the organic anion transporters in the kidneys. The hypothesis of a potential interaction between PPIs and UTs has never been assessed in the literature. Hence, our last objective was to evaluate their association. The last two objectives of the thesis were conducted using data from the CKD-REIN cohort, a large prospective cohort carried out in 40 nephrology clinics in France, including patients with moderate-to-advanced CKD. We found that a doubling of serum free kynurenine levels was associated with an 19%-increased hazard of cardiovascular events (466 events, HR[95%CI]: 1.19 [1.03-1.39]), independently of glomerular filtration rate, serum free tryptophan level or other UTs, cardioprotective drugs and traditional cardiovascular risk factors. Serum free kynurenine was particularly associated with non-atheromatous cardiovascular events (HR[95%CI]: 1.31 [1.09-1.6]). However, we did not find a significant association between serum free kynurenine and all-cause mortality (311 events,HR[95%CI]: 1.18 [0.9-1.4]). In a randomly selected sub-cohort from CKD-REIN, 31% of patients had PPI prescriptions at baseline. We demonstrated that serum concentrations of free and total indoxyl sulfate, free and total p-cresyl glucuronide, and phenylacetylglutamine were significantly and independently higher in patients taking PPIs compared to those who were not. This thesis highlights the need for further research to understand the underlying mechanisms of the effect of UTs on cardiovascular health in patients with CKD and to develop new treatments and approaches to mitigate their impact on the health of these patients

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Fernandez, Sanchez Javier. "Knowledge Discovery and Data Mining Using Demographic and Clinical Data to Diagnose Heart Disease". Thesis, KTH, Skolan för kemi, bioteknologi och hälsa (CBH), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-233978.

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Cardiovascular disease (CVD) is the leading cause of morbidity, mortality, premature death and reduced quality of life for the citizens of the EU. It has been reported that CVD represents a major economic load on health care sys- tems in terms of hospitalizations, rehabilitation services, physician visits and medication. Data Mining techniques with clinical data has become an interesting tool to prevent, diagnose or treat CVD. In this thesis, Knowledge Dis- covery and Data Mining (KDD) was employed to analyse clinical and demographic data, which could be used to diagnose coronary artery disease (CAD). The exploratory data analysis (EDA) showed that female patients at an el- derly age with a higher level of cholesterol, maximum achieved heart rate and ST-depression are more prone to be diagnosed with heart disease. Furthermore, patients with atypical angina are more likely to be at an elderly age with a slightly higher level of cholesterol and maximum achieved heart rate than asymptotic chest pain patients. More- over, patients with exercise induced angina contained lower values of maximum achieved heart rate than those who do not experience it. We could verify that patients who experience exercise induced angina and asymptomatic chest pain are more likely to be diagnosed with heart disease. On the other hand, Logistic Regression, K-Nearest Neighbors, Support Vector Machines, Decision Tree, Bagging and Boosting methods were evaluated by adopting a stratified 10 fold cross-validation approach. The learning models provided an average of 78-83% F-score and a mean AUC of 85-88%. Among all the models, the highest score is given by Radial Basis Function Kernel Support Vector Machines (RBF-SVM), achieving 82.5% ± 4.7% of F-score and an AUC of 87.6% ± 5.8%. Our research con- firmed that data mining techniques can support physicians in their interpretations of heart disease diagnosis in addition to clinical and demographic characteristics of patients.

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Soita, David Jonah. "Cardiovascular disease risk profile of the South-African mixed ancestry population with high incidence of diabetes mellitus: baseline and three year follow-up". Thesis, Cape Peninsula University of Technology, 2013. http://hdl.handle.net/20.500.11838/1519.

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THESIS SUBMITED IN FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF DOCTOR OF TECHNOLOGY OF BIOMEDICAL TECHNOLOGTY IN THE FACULTY OF HEALTH AND WELLNESS SCIENCES AT THE CAPE PENINSULA UNIVERSITY OF TECHNOLOGY SUPERVISORS: PROF T.E. MATSHA PROF R.T. ERASMUS DR A. ZEMLIN SUBMITED DECEMBER 2013
Introduction: Cardiovascular diseases (CVD) have become the leading cause of morbidity and mortality amongst the global population. Originally thought to be a health burden of high income countries, the prevalence is rapidly increasing in developing countries. For example, in 2008, an estimated 17.3 million died from CVD, and 80% of these (13.8 mil) were from low to middle income countries. Epidemiological data on CVD in Africa is scanty and of poor quality and national vital registration is available in only 5% of Africa’s 53 countries. Furthermore, data on CVD risk amongst the South African population and specifically the mixed ancestry community is poorly described. The increasing global population of people with CVD has been largely attributed to increasing rates of determinants and risk factors which include obesity, metabolic syndrome (MetS), type 2 diabetes mellitus (DM) and chronic kidney diseases (CKD). The prevalence of DM in South Africa is known to be on the rise with more affected communities being South African Asians followed by coloureds. Aims and objectives: The aim of this study was to determine the CVD risk profile of the Bellville South community during a baseline and three year follow-up study, by assessment of known risk factors, MetS, type 2 DM, obesity and CKD. Methods: Participants for this study were drawn from an urban community of the Bellville South suburb of Cape Town. At baseline (January 2008 and March 2009) 946 individuals aged 16 to 95 participated. All participants received a standardized interview and physical examination during which anthropometric measurements were performed three times and their average used for analysis: weight (kg), height (cm), waist (cm) and hip (cm) circumferences. Body Mass Index (BMI) was calculated as weight per square metre (kg/m2). A blood sample was obtained from all participants after an overnight fast for the determination of biochemical profiles: glucose, glycated haemoglobin, creatinine, total cholesterol, high density lipoprotein cholesterol (HDL-C), triglycerides and low density lipoprotein cholesterol (LDL-C) which was calculated using Friedewald’s formula. Kidney function test was assessed through estimated glomerular filtration rate (eGFR) using the cockcroft-Gault and MDRD equations. Blood pressure was measured according to the World Health Organisation (WHO) guidelines. Participants with no history of doctor diagnosed DM underwent a 75 g oral glucose tolerance test as recommended by the WHO. Metabolic syndrome was determined using JIS, NCEP ATPIII and IDF criteria. The follow-up examination was conducted in 2011 (3 years from vii baseline) using similar procedures. A total of 198 participants formed the follow-up cohort whose measurements were compared to those of the baseline. Finally, the prediction and processes/progression of the risk factors were determined. Results: At both baseline and follow-up studies, females had a higher BMI compared to their male counterparts. The crude prevalence of type 2 DM, including the previously diagnosed type 2 DM was 28.59% (age-adjusted = 33.5%, 95%CI: 30.01 – 36.92), and that of undiagnosed type 2 DM was 17.8% (age-adjusted = 12.4%, 95%CI: 9.8 – 14.8). The overall prevalence of CKD was 28.7% (269) and was higher in females (31.4%) compared to 20.2% in males. MetS was present in 46.5% of the participants. Gender-specific prediction for CVD risk calculated using the 30-year CVD interactive risk calculator showed that high CVD risk was present in normoglycaemic and younger subjects (under 35 years). At follow-up, the cumulative incidence of progression in glucose tolerance status was: 16.2% (32 participants including 11 with new-onset diabetes), and increased in a stepwise fashion with the number of components of MetS. Between baseline and 3-year evaluation glomerular filtration rate (eGFR) increased by 8.7 ml/min (95% confidence interval: 6.9-10.7), reflecting variables trajectories across baseline strata of kidney functions. Conclusion: Given the findings of this study and the estimated increases in the determinants and risk factors of CVD in the mixed ancestry population of South Africa this trend may continue to worsen if current trajectories do not change.

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Cheddani, Lynda. "Comparaison du risque cardiovasculaire et de la mortalité entre patients transplantés rénaux et malades rénaux chroniques à fonction rénale équivalente. Uremic Toxins and Clinical Outcomes: The Impact of Kidney Transplantation Higher mortality risk among kidney transplant recipients than among estimated glomerular filtration rate-matched patients with CKD – preliminary results Less arterial stiffness in kidney transplant recipients than chronic kidney disease patients matched for renal function". Thesis, université Paris-Saclay, 2021. http://www.theses.fr/2021UPASR006.

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La maladie rénale chronique(MRC) s’associe à un très haut risque cardiovasculaire(CV), et les maladies CV représentent après greffe une des principales causes de décès avec greffon fonctionnel. Le débit de filtration glomérulaire(DFG) influe sur le risque CV. L’objectif de ce travail était de comparer pour la 1ère fois patients MRC et transplantés rénaux(TR) à même niveau de DFG sur 1) le risque de mortalité; 2) le niveau de rigidité aortique (évaluée par la vitesse de l’onde de pouls carotido-fémorale, CF-VOP). Le 3ème objectif visait à comparer l’évolution de la pression pulsée (PP) selon le devenir rénal (dialyse ou transplantation rénale préemptive, TRP) des patients MRC inscrits préemptivement sur liste de greffe. Méthodes. Ce travail est basé sur l’analyse de plusieurs cohortes. Pour l’objectif 1, les données étaient issues de CKD-REIN et DIVAT. CKD-REIN est une cohorte prospective réalisée dans 40 consultations de néphrologie en France, incluant 3033 patients avec MRC modérée à sévère. Le registre DIVAT recense prospectivement les données de patients transplantés de 8 centres français, notre étude concernait le registre nantais. L’objectif 2 était étudié au sein d’une partie de la cohorte prospective parisienne NephroTEST de patients MRC adressés pour bilan standardisé au service des Explorations Fonctionnelles de l’Hôpital Tenon (Paris), et de la cohorte rétrospective TransplanTEST de patients TR également évalués dans ce service (168 patients TR à l’Hôpital Foch-Suresnes). Pour ces objectifs, les patients TR et MRC étaient appariés sur un score de propension qui incluait notamment le DFG. Le 3ème objectif concernait les patients de CKD-REIN inscrits préemptivement sur liste de greffe: le niveau de PP et son évolution étaient comparés selon le type de suppléance rénale (SR) initié au cours du suivi (dialyse ou TRP). Résultats. Dans notre 1ère étude, la TR était associée à une augmentation du risque de mortalité relativement aux patients MRC appariés (HR: 2,6[1,54- 4,56], p=0,001 après ajustement sur l’âge, le DFG et le ratio protide/creatinine urinaire). L’augmentation du risque apparaissait davantage liée à une fréquence accrue des infections sévères et cancers qu’à une augmentation du risque CV. Il n’a pas été mis en évidence de différence concernant le risque de survenue de ≥ 1 événement CV non létal au cours du suivi (HR : 0,8[0,44-1,50], p=0,501). Dans la 2ème étude, les patients TR présentaient à 12 mois de la greffe une CF-VOP significativement plus basse que les patients MRC appariés (10,1m/s vs 11,0m/s, p=0,008), contrairement à l’évaluation réalisée à 3 mois de greffe (10,5m/s vs 11,0m/s, p=0,242). L’amélioration survenant au cours de la 1ère année de greffe conférait aux patients TR évalués à 12 mois un moindre niveau de rigidité aortique relativement aux patients MRC de même DFG. Après ajustement sur l’âge, la pression artérielle moyenne, le DFG mesuré, l’indice de masse corporelle, le statut diabétique et le niveau de PTH sérique, la TR s’associait à une réduction de 60% du risque de CF-VOP>10,6m/s (médiane) à 12 mois de la greffe (OR: 0,4[0,23-0,68]). Enfin, les résultats (préliminaires) de notre 3ème étude n’ont pas retrouvé d’association entre le type de SR et les modalités d’évolution de la PP au cours des 6 mois suivant l’initiation, chez les patients inscrits préemptivement sur liste de greffe. La dégradation du DFG dans l’année précédant la SR était plus rapide dans le groupe ayant évolué vers la dialyse (à étiologies de MRC comparables). Conclusion. Nos résultats confortent l’idée qu’une remise à zéro du risque de mortalité et d’événement CV des patients MRC n’est pas rendu possible, même après TR, de même qu’un retour au niveau d’un patient MRC comparable. Les complications CV post TR apparaissent différer de celles des patients MRC de même DFG. Les stratégies de prévention et de ralentissement de la progression de la MRC doivent par conséquent constituer une priorité en néphrologie
Chronic kidney disease (CKD) is associated with a very high cardiovascular (CV) risk, and CV disease is one of the main causes of death with a functioning transplant after kidney transplantation. Glomerular filtration rate (GFR) influences CV risk. The objective of this work was to compare for the first time CKD-patients and renal transplant recipients (RTR) with similar GFR level: 1) on the risk of overall mortality; 2) on aortic stiffness level (assessed by carotid-femoral pulse wave velocity, CF-PWV), a CV risk biomarker. The third objective was to compare pulse pressure (PP) and its evolution according to renal replacement therapy modality (dialysis or preemptive renal transplantation, PRT) in CKD patients pre-emptively registered on the kidney transplant waiting list.Methods. This work is based on the analysis of several cohorts. For the first objective, data came from CKD-REIN and DIVAT. CKD-REIN is a French prospective cohort performed in 40 nephrology consultations, including 3033 patients with moderate to severe CKD. The DIVAT register prospectively collects data of transplant recipients from 8 French centers, our study focused on the Nantes’ register. The second objective was studied in part of the prospective Parisian NephroTEST cohort of CKD-patients who were referred to the Physiology Unit of Tenon Hospital (Paris) for a one-day standardized evaluation, and of the RTR TransplanTEST cohort (retrospective cohort of 168 TR patients at Foch Hospital-Suresnes) evaluated in the same Physiology Unit. For these two objectives, RTR and CKD-patients were matched on a propensity score which included GFR among others. For the third objective, CKD-REIN patients who were pre-emptively registered on the kidney transplant waiting list were compared on PP level and on its evolution, according to the renal replacement therapy (RRT) modality initiated during the follow-up (dialysis or PRT). Results. In our first study, RTR was associated with an increased risk of overall mortality relative to the matched CKD-patients (HR: 2.6 [1.54-4.56], p=0.001 after adjusting for age, GFR and protide/creatinine urinary ratio). The increased risk appeared to be more related to an increased frequency of severe infections and neoplasms than to an increased CV risk. There was no difference between the two groups concerning the occurrence of at least one non-fatal CV event during the follow-up (HR: 0.8 [0.44-1.50], p=0.501). On the other hand, in the second study, RTR presented a significantly lower CF-PWV at 12-months after kidney transplant than the CKD-matched patients (10.1m/s vs 11.0m/s, p=0.008), unlike the evaluation performed at 3 months post-transplant (10.5m/s vs 11.0m/s, p=0.242). The improvement occurring within the 1st year of RT conferred to RTR assessed at 12 months a lower aortic stiffness level in comparison to the CKD-matched patients with similar GFR. After adjustment for age, mean arterial pressure, measured GFR, body mass index, diabetic status and serum PTH level, RT was associated with a 60% reduction in the risk of CF-VOP > 10.6m/s (median) at 12 months after RT (OR: 0.4 [0.23-0.68]). Finally, our latest (preliminary) results (third study) did not find any association between the RRT modality and PP evolution within the 6 months following RRT initiation in patients who were pre-emptively registered on the kidney transplant waiting list. The GFR decline in the year prior to RRT initiation was faster in-group of patients who initiate dialysis (with comparable CKD etiologies). Conclusion. Our results support the idea that, RT does not offset the excess mortality risk observed in CKD patients. At the same level of GFR, post-TR CV complications appear to be different from CV complications in CKD patients. Therefore, we believe that prevention and slowing CKD progression strategies must remain a priority in nephrology

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Ukomadu, Chinyere. "An Educational Module on High Blood Pressure Management and Control". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7765.

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An educational module, based on evidence-based practice (EBP) guidelines by the 8th Joint National Committee (JNC 8) and the American College of Cardiology (ACC), was created and implemented to determine if its implementation would impact the knowledge of clinic staff regarding current EBP guidelines about self-management of hypertension (HTN). The module has the potential to contribute to the resolution of patient noncompliance on HTN treatment and management by increasing nursing staff proficiency in knowledge transfer to patients on effective self-management of their health condition. The creation of the module was guided by the concept of need or asset assessment and the theory of planned behavior. The module was composed of 2 short lecture presentations on HTN, current EBP guidelines on lifestyle modifications, and proper blood pressure measurement. The module also included pre- and postlecture surveys to evaluate knowledge and practices of staff, and reiterated the current guidelines and approaches presented in the lectures. Survey data were analyzed using McNemar’s test for paired and binary data. Results showed the agreement of all the staff in recognizing the utility of the module in standardizing their knowledge of current EBP guidelines on lifestyle modifications and blood pressure measurement procedures. The results also showed the enhancement of staff proficiency which might lead to efficient education of patients on effective HTN treatment and management protocol. This pathway has the potential to bring about social change by decreasing the incidence of patient noncompliance and improving patient health.

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

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

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