[Formulae and special characters can only be approximated here. Please see the pdf version of the abstract for an accurate reproduction.] Two randomised controlled trials were conducted to explore the relationship between the consumption of alcoholic beverages and cardiovascular disease risk factors. Study 1 was primarily designed to test the hypothesis that the cardio-protective effect of light alcohol could be mediated, in part, via improvements in endothelial function. Study 1 was also designed to explore the effect of alcohol on both traditional risk factors for cardiovascular disease, such as changes in lipid profile, haemostatic factors and blood pressure, and novel risk factors such as homocysteine, markers of inflammation and oxidative stress. The experimental design of this study also allowed us to determine whether reducing alcohol intake in these moderate-to-heavy drinkers could improvement insulin sensitivity, a component of the metabolic syndrome. In this group of sixteen healthy middle-aged men with a history of moderate to heavy alcohol intake of seven standard drinks per day, reducing intake down to approximately one standard drink per day for four weeks had no beneficial effects on conduit vessel endothelial function as assessed by post-ischaemic brachial artery flow-mediated dilatation, nor were there any detectable changes in soluble E-selectin, endothelin-1 and von Willebrand Factor, which are considered biomarkers of endothelial activation. As this study did not investigate the effect of alcohol on endothelial function in resistance vessels, it cannot exclude the possibility that alcohol may affect endothelial cells resident in that vascular bed. This study does show and confirm, however, that the relationship between alcohol and risk factors for cardiovascular disease is an extremely complex one. On the one hand it demonstrated that alcohol was potentially harmful, increasing blood pressure, plasma F2-isoprostane (oxidative stress), and homocysteine. On the other hand it showed that increasing alcohol intake led to significant reductions in two (i.e. fibrinogen and IL-6) of five inflammatory markers, in addition to improving the HDL-cholesterol profile of these subjects. Although the effects of alcohol on blood pressure, fibrinogen and HDL-cholesterol are not in themselves new, they support our choice of study design and strengthen the argument in favour of accepting the more novel findings of this study, specifically, the lack of effect on endothelial function and insulin sensitivity, and the harmful effect of alcohol in increasing oxidative stress and homocysteine. Study 2 was primarily designed to test the hypothesis that the consumption of red wine may confer greater cardio-protection than beer via improvements in endothelial function. Simultaneously, the study was also designed to determine whether drinking red wine for 4-weeks would have different effects than beer on either traditional risk factors for cardiovascular disease (i.e. blood pressure and lipid profile) or the more novel risk factors, homocysteine and oxidative stress. Using a randomised controlled cross-over study design, Study 2 provides evidence that the regular daily consumption of 4 standard drinks of either beer or red wine does not alter endothelial function, as measured by post-ischaemic flow-mediated vasodilatation of the brachial artery in healthy middle-aged men, nor was there evidence of any beneficial effect of de-alcoholised red wine on brachial artery response. As compliance with drinking protocol was confirmed with increased serum γ-GT and HDL during red wine and beer periods, and increased 24-hr urinary excretion of 4OMGA during red wine and de-alcoholised red wine periods, we are confident that there was excellent compliance with the beverage treatments. Study 2 also provides the first evidence from a carefully controlled intervention study that both red wine and beer elevate blood pressure to a similar degree, with no detectable difference in the magnitude of either treatment. As with endothelial function, there was also no evidence of any beneficial effect of de-alcoholised red wine on blood pressure. In addition, although post hoc analysis found evidence that alcohol increased both plasma homocysteine and urinary excretion of F2-isoprostane and endothelin-1, there was no apparent protective effect conferred from either red wine or de-alcoholised red wine on these cardiovascular risk markers. The results from this study cannot disprove the hypothesis that red wine is more beneficial for cardiovascular health; however, they suggest that if red wine has properties beyond those of beer to confer protection, they are not via any interactions with the nitric oxide regulatory function of the endothelium in conduit vessels nor are they via moderation of the vasopressor, homocysteine-raising, and oxidative stress effects of alcohol. The interpretation of the findings from both intervention studies and their place in the context of our current understanding of the role that alcoholic beverages play in the development and/or prevention of cardiovascular disease are explored in this thesis.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 6 uppsatser.

Thesis (Ph.D. in Epidemiology) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 100-117). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Ces travaux de thèse portent sur le développement d’outils et de méthodologies innovantes permettant la caractérisation de la paroi artérielle coronarienne. Ce développement est nécessaire pour aider au diagnostic des maladies cardiovasculaires. L’approche mécanique a été utilisée pour mettre en place des méthodes de résolution inverse restituant des informations clés sur les propriétés mécaniques des tissus. La résolution du problème inverse en mécanique utilise entre autres des champs de déformation dont l’estimation est réalisée à l’aide d’algorithmes d’élastographie de déformation. Deux outils de caractérisation ont été étudiés : l’un visant à faciliter la détection par une palpation virtuelle et l’autre l’identification par la reconstruction de cartographies locales du module de Young. Ces outils de palpographie et de modulographie peuvent faciliter la caractérisation in vivo des plaques d’athérosclérose. Les contributions apportées portent successivement sur l’élastographie, la palpographie et la modulographie.Nous avons tout d’abord amélioré l’outil de modulographie iMOD (application existante de reconstruction du module de Young) en l’adaptant aux nouvelles contraintes liées aux modalités IVUS dites de haute définition (HD-IVUS). Les performances de ce nouvel outil perfectionné nommé E-iMOD (Extended iMOD) ont été évaluées en l’appliquant sur des données d’élastographie simulées.Ensuite, nous avons développé une nouvelle version de l’algorithme d’élastographie de déformation. En effet, l’estimation des déformations est un point critique conditionnant la bonne résolution du problème inverse en mécanique. Il a été montré que les améliorations introduites permettent l’amélioration des estimations sur des données simulées et sur des données expérimentales de fantôme.Dans un troisième temps, une analyse de l’apport de la technologie HD-IVUS vis-à-vis de l’imagerie IVUS actuelle a été menée sur données simulées et expérimentales. Elle a montré que les résultats peuvent être prometteurs mais que des efforts de développement sur l’élastographie sont encore nécessaires afin d’exploiter pleinement les avancées techniques de la HD.Une dernière partie traite de l’outil de palpographie relatif à la détection des lésions. Tout d’abord, ce volet est l’occasion de mettre en œuvre une phase expérimentale sur des acquisitions d’artères animales. Le traitement de ces données participe à une phase de validation d’une technique de palpographie développée dans l’équipe. Dans un second volet, une revue de littérature de différentes techniques de palpographie nous permet de mettre en avant les points forts et les faiblesses de ces techniques sur des données simulées. Nous introduisons également un nouvel indice de palpation adapté aux milieux anisotropes. Enfin, une méthode théorique originale repensant les résultats de la palpographie a été proposée. Cette approche permet le calcul d’un premier modulogramme pouvant améliorer le pré-conditionnement des processus d’optimisation de type E-iMOD / This work focuses on the development of innovative tools and methodologies for coronary artery wall characterization. These tools are required to support the diagnosis of cardiovascular disease. A mechanical approach was used to implement inverse resolution methods that provide key data about the mechanical properties of tissues. Resolution of inverse problems in mechanics uses strain fields, which are computed thanks to elastography algorithms. Two main characterization tools were used: one aimed to allow lesions detection by applying a virtual palpation technique and the other aimed to identify a reconstructed distribution of the Young's modulus. Palpography and Modulography tools can facilitate in vivo atherosclerotic plaques characterization. The current dissertation brings contribution in the elastography, palpography and modulography fields.We started by improving the iMOD Modulography tool (previously developed application to compute the Young's modulus map). We adapted iMOD to the new constraints related to high definition IVUS modality (HD-IVUS). This new advanced tool was named E-iMOD (Extended iMOD) and its performances were was evaluated with simulated elastography data.In next step, we developed a new version of the strain elastography algorithm. Indeed, strains estimations are critical to solve of the inverse problem in mechanics. It was shown that the introduced enhancements improved estimation for both vessel simulations and phantom experimental data.In a third stage, an analysis was lead to access the contribution of HD-IVUS technology to current IVUS imaging on simulated and experimental data. Even though hopeful results were showed, further efforts in the elastography algorithm are required in order to fully exploit the HD improvements.The last part of this work deals with the palpography tool that allows the detection of lesions. First, experimental ultrasound acquisitions from animal arteries were processed. These data were involved in a validation prototcol of palpography technique developed in our team. In a second part, a review of several palpography techniques allowed us to highlight their strengths and weaknesses on simulated data. A new palpation index adapted to anisotropic material was also introduced. Finally, an original theoretical method rethinking the results of palpography was proposed. This approach computes a first modulogram to improve the prior preconditioning of optimization processes, such as the optimization process of E-iMOD

A prevalência de sobrepeso e obesidade entre crianças e adolescentes tem aumentado em países em desenvolvimento e desenvolvidos, ocasionando um sério problema de saúde pública. A obesidade na adolescência pode alterar o perfil lipídico, principalmente quando acompanhada de uma baixa aptidão cardiorrespiratória. A obesidade, bem como as dislipidemias são considerados importantes fatores de risco para a doença arterial coronariana. O presente estudo teve como objetivo avaliar a correlação entre o perfil lipídico, bem como outros marcadores de risco para doença arterial coronariana, e a aptidão cardiorrespiratória de crianças e adolescentes obesos, de ambos os gêneros. Um total de 63 crianças e adolescentes obesos, entre 11 e 17 anos, foi incluído em um estudo transversal, realizado na cidade de Porto Alegre. Foi utilizado o pacote estatístico SPSS, versão 10.0 para Windows. Foram aplicados o teste t para amostras independentes e o teste de Mann-Whitney para identificar diferenças entre gêneros e estágio maturacional quando a distribuição apresentava-se normal e não-normal, respectivamente. Utilizou-se a correlação de Pearson ou Spearman para dados paramétricos e não-paramétricos, respectivamente. Não encontramos correlação significativa entre o pic2 o V& O e os marcadores de risco para doença coronariana TG, CT, HDL-C, LDL-C, ApoA1, ApoB, Não-HDL-C, CT/HDL, LDL-C/HDL-C, insulina, glicose, índice HOMA-IR e PCRus. Do total de crianças e adolescentes avaliados, somente um indivíduo, do gênero masculino, não apresentava nenhum parâmetro metabólico alterado. Encontramos uma prevalência precoce importante de indivíduos com hipercolesterolemia (15,0%); hipertrigliceridemia (23,3%); hiperglicemia (35,6%); hiperinsulinemia (40,4%); valores altos de LDL-C (16,7%), PCRus (38,3%) e Não-HDL-C (26,7%); e valores baixos de HDL-C (21,7%) e do VO2pico (93,5% da meninas e 100% dos meninos). Concluindo, apesar de não encontrarmos correlação significativa entre o perfil lipídico e a aptidão cardiorrespiratória de crianças e adolescentes obesos neste estudo, uma prevalência alta de dislipidemias e outros marcadores de risco coronariano alterados foram encontrados. / The prevalence of overweight children and adolescents has been increasing in both developed and developing countries, creating a serious public health problem. Obesity in adolescence can alter the lipid profile mainly when accompanied by a low cardiorespiratory fitness. Obesity and dislipidemy are well-established risk factors for the coronary artery disease. The aim of the present study was to evaluate the correlation among the lipid profile, as well as other risk markers for the coronary artery disease, and the cardiorespiratory fitness of obese children and adolescents of both genders. A total of 63 children and adolescents between 11 and 17 years old were included in this cross-sectional study, developed in the city of Porto Alegre. Statistical analysis was performed by the software SPSS, version 10.0 for Windows. The T-test for independent samples and the Mann-Whitney test were applied to identify differences among gender and pubertal stage when the distribution was normal and abnormal, respectively. The Pearson’s or the Spearman’s correlation was used for parametric and nonparametric data, respectively. We did not find significant correlation between pea2 k V& O and the risk markers for the coronary disease TG, TC, HDL-C, LDL-C, non-HDL-C, TC/HDL, insulin, glucose, HOMA-IR values, and PCRus. Among all individuals evaluated, only one person – a male – did not show any altered metabolic parameter. We found an important precocious prevalence of individuals with hypercholesterolemia (15%); hypertriglyceridemia (23.3%); borderline hyperglycemia (35.6%); hyperinsulinemia (40.4%); high values of LDLC (16.7%), PCRus (38.3%), non-HDL-C (26.7%); and low values of HDL-C (21.7%) and 2 peak V& O (93.5% of the girls and 100% of the boys). In conclusion, although we did not find any significant correlation between lipid profile and cardiorespiratory fitness in obese children of both genders in this study, a high prevalence of undesirable lipid levels and other altered coronary risk markers were found.

Evidências favoráveis impulsionaram o uso da técnica transradial nos últimos anos. Estudos originais que apresentam o uso dessa prática apontam baixo risco de complicações locais, maior conforto para os pacientes, possibilidade de mobilização e deambulação precoce após procedimento, diminuição do período de internação hospitalar e redução de custos hospitalares. Entre as complicações possíveis, a mais temida é a oclusão da artéria radial (OAR). Embora seja preocupante essa complicação, ainda não há consenso quanto à avaliação rotineira da patência da artéria antes da alta hospitalar e sua relação com o dispositivo hemostático utilizado. Visando preencher essa lacuna do conhecimento, este estudo foi planejado para comparar o efeito de dois dispositivos de hemostasia após cateterismo cardíaco realizado por acesso transradial na ocorrência de OAR. Foi conduzido um ensaio clínico randomizado (ECR) de dois grupos, aberto, no Laboratório de Hemodinâmica (LH) de um hospital público e universitário da região metropolitana de Porto Alegre, Rio Grande do Sul. O período de coleta foi de novembro de 2015 a outubro de 2016. Foram incluídos pacientes adultos ambulatoriais e internados, submetidos a cateterismo cardíaco diagnóstico e/ou terapêutico por acesso transradial, em caráter eletivo e/ou de urgência. Os participantes foram randomizados em dois grupos: Grupo Intervenção (GI) – hemostasia com dispositivo TR Band; e Grupo Controle (GC) – hemostasia com dispositivo de gaze e bandagem elástica adesiva. O desfecho primário foi a OAR imediata ao procedimento e em 30 dias; os desfechos secundários foram a migração dos padrões das curvas após retirada imediata do dispositivo e em 30 dias, a necessidade de tempo a mais para alcance da hemostasia, as demais complicações vasculares relacionadas ao sítio de punção (sangramento e hematoma) e a presença e intensidade de dor. Foram incluídos 600 pacientes: GI (n=301) e GC (n=299), predominantemente do sexo masculino, com média de idade de 63 ± 10 anos; a OAR imediatamente após a remoção do dispositivo ocorreu em 24 (8%) e 19 (6%), no GI e GC, respectivamente; em 30 dias para um terço da amostra foi de 5 (5%) e 7 (6%), no GI e GC, respectivamente. Para estes dois períodos não foram demonstradas diferenças estatísticas; o tempo de hemostasia adicional, assim como o tempo necessário para outro tipo de compressão, foi significativamente maior no GI, p=0,006 e p<0,001, respectivamente; pacientes de ambos os grupos mantiveram um padrão e migração de curvas semelhantes na avaliação pré procedimento, imediatamente após a retirada dos dispositivos e em 30 dias; o sangramento menor foi significativamente maior no GI, quando comparado ao GC, 67 (22%) vs. 40 (13%), respectivamente, p = 0,006; o hematoma foi semelhante entre os dois grupos. O relato de dor foi similar entre os grupos, e a intensidade relatada foi moderada. Os resultados deste estudo permitem concluir que a incidência de OAR foi semelhante entre os grupos TR Band e bandagem elástica adesiva. Os padrões de curva do teste de Barbeau foram semelhantes em todas as avaliações. Pacientes que utilizaram TR Band precisaram de mais tempo adicional de hemostasia assim como mais tempo com outro tipo de compressão. O sangramento menor foi mais incidente no grupo TR Band, enquanto o hematoma foi semelhante entre os grupos. A ocorrência de dor moderada foi semelhante entre os dois grupos. / Favorable evidence increase the use of the transradial technique in recent years. Original studies that address this approach suggest low risk of local complications, greater comfort for patients, the possibility of early mobilization and ambulation after the procedure, a shorter hospital stay and reduced hospital costs. Among the possible complications, the most feared is radial artery occlusion (RAO). Although RAO is of concern, there is still no consensus regarding the routine assessment of radial artery patency before discharge and its relationship to the hemostatic device used. In order to fill this knowledge gap, this study was planned to compare the effect of two hemostasis devices after cardiac catheterization performed by transradial access on the appearance of RAO. A two-group Randomized Clinical Trial (RCT) was conducted at the Hemodynamic Laboratory (HL) of the Hospital de Clínicas of Porto Alegre (HCPA), a public university hospital in the metropolitan region of Porto Alegre, Rio Grande do Sul. The collection period was from November 2015 to October 2016. Adult patients from the outpatient clinic and hospitalized patients undergoing cardiac diagnostic and / or therapeutic catheterization due to transradial access, in an elective and / or emergency manner, were included. Participants were randomized into two groups: intervention group (IG) - hemostasis with TR Band device; Control Group (CG) - hemostasis with gaze device and adhesive elastic bandage. The primary outcome was immediate RAO to the procedure and in 30 days; secondary outcomes were migration of the curvature patterns after immediate device removal and in 30 days, the need for extra time to reach hemostasis other vascular complications related to the puncture site (bleeding and hematoma), and the presence and intensity of pain. A total of 600 patients were included: IG (n=301) and CG (n=299), predominantly males with a mean age of 63 ± 10 years; RAO immediately following device removal occurred in 24 (8%) and 19 (6%), in the IG and CG groups, respectively; in 30 days for a third of the sample was 5 (5%) and 7 (6%) in IG and CG, respectively. For these two periods no statistical difference was demonstrated. The additional hemostasis time, as well as the time required for another type of compression, was significantly higher in IG, p=0.006 and p<0.001, respectively; patients from both groups maintained a pattern of migration of similar curves in the pre-procedure assessment, immediately after the device withdrawal and in 30 days; The lowest bleeding was significantly higher in the IG, compared to the GC, 67 (22%) vs 40 (13%), respectively, p = 0.006; the hematoma was similar between the two groups. The reported pain was similar between the groups, and the reported intensity was moderate. The results of this study allow us to conclude that the incidence of RAO was similar between TR Band groups and adhesive elastic bandage. The standards of the Barbeau test curve were similar in all assessments. Patients who used TR Band required more extra hemostasis time as well as more time with another type of compression. Minor bleeding was more incident in the TR Band group, while the hematoma was similar between the groups. The occurrence of moderate pain was similar between the two groups.

Orientador: Luiz Carlos Marques Vanderlei / Banca: Carlos Marcelo Pastre / Banca: Francis da Silva Lopes / Resumo: A perda de massa muscular secundária à idade e à inatividade física é clinicamente relevante na população cardíaca, contudo a prescrição do exercício resistido dinâmico para esses pacientes apresenta-se inconclusiva na literatura. Objetivo: Reunir informações sobre a especificidade dos componentes do treinamento resistido prescrito à população cardiopata. Metodologia: Foi realizada busca sistemática de literatura, a partir das bases de dados LILACS, SciELO e PubMed, utilizando os seguintes descritores na língua portuguesa: força muscular, exercício isométrico, esforço físico, cardiopatia e coronariopatia, e seus correspondentes na língua inglesa (muscle strength, isometric exercise, physical effort, heart disease e artery coronary disease), os quais foram ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Loss of muscle mass secondary to age and physical inactivity is clinically relevant in cardiac population, however dynamic resistance exercise prescription to these patients presents inconclusive in literature. Objective: Adjoin information about specific components of resistance exercise prescribed to cardiac population. Methodology: Systematic search was performed, using the data bases LILACS, SciELO and PubMed. The descriptors used were: muscle strength, isometric exercise, physical effort, heart disease and artery coronary disease, which were surveyed separately and combined, considering for this review articles that ... (Complete abstract click electronic access below) / Mestre

A prevalência de sobrepeso e obesidade entre crianças e adolescentes tem aumentado em países em desenvolvimento e desenvolvidos, ocasionando um sério problema de saúde pública. A obesidade na adolescência pode alterar o perfil lipídico, principalmente quando acompanhada de uma baixa aptidão cardiorrespiratória. A obesidade, bem como as dislipidemias são considerados importantes fatores de risco para a doença arterial coronariana. O presente estudo teve como objetivo avaliar a correlação entre o perfil lipídico, bem como outros marcadores de risco para doença arterial coronariana, e a aptidão cardiorrespiratória de crianças e adolescentes obesos, de ambos os gêneros. Um total de 63 crianças e adolescentes obesos, entre 11 e 17 anos, foi incluído em um estudo transversal, realizado na cidade de Porto Alegre. Foi utilizado o pacote estatístico SPSS, versão 10.0 para Windows. Foram aplicados o teste t para amostras independentes e o teste de Mann-Whitney para identificar diferenças entre gêneros e estágio maturacional quando a distribuição apresentava-se normal e não-normal, respectivamente. Utilizou-se a correlação de Pearson ou Spearman para dados paramétricos e não-paramétricos, respectivamente. Não encontramos correlação significativa entre o pic2 o V& O e os marcadores de risco para doença coronariana TG, CT, HDL-C, LDL-C, ApoA1, ApoB, Não-HDL-C, CT/HDL, LDL-C/HDL-C, insulina, glicose, índice HOMA-IR e PCRus. Do total de crianças e adolescentes avaliados, somente um indivíduo, do gênero masculino, não apresentava nenhum parâmetro metabólico alterado. Encontramos uma prevalência precoce importante de indivíduos com hipercolesterolemia (15,0%); hipertrigliceridemia (23,3%); hiperglicemia (35,6%); hiperinsulinemia (40,4%); valores altos de LDL-C (16,7%), PCRus (38,3%) e Não-HDL-C (26,7%); e valores baixos de HDL-C (21,7%) e do VO2pico (93,5% da meninas e 100% dos meninos). Concluindo, apesar de não encontrarmos correlação significativa entre o perfil lipídico e a aptidão cardiorrespiratória de crianças e adolescentes obesos neste estudo, uma prevalência alta de dislipidemias e outros marcadores de risco coronariano alterados foram encontrados. / The prevalence of overweight children and adolescents has been increasing in both developed and developing countries, creating a serious public health problem. Obesity in adolescence can alter the lipid profile mainly when accompanied by a low cardiorespiratory fitness. Obesity and dislipidemy are well-established risk factors for the coronary artery disease. The aim of the present study was to evaluate the correlation among the lipid profile, as well as other risk markers for the coronary artery disease, and the cardiorespiratory fitness of obese children and adolescents of both genders. A total of 63 children and adolescents between 11 and 17 years old were included in this cross-sectional study, developed in the city of Porto Alegre. Statistical analysis was performed by the software SPSS, version 10.0 for Windows. The T-test for independent samples and the Mann-Whitney test were applied to identify differences among gender and pubertal stage when the distribution was normal and abnormal, respectively. The Pearson’s or the Spearman’s correlation was used for parametric and nonparametric data, respectively. We did not find significant correlation between pea2 k V& O and the risk markers for the coronary disease TG, TC, HDL-C, LDL-C, non-HDL-C, TC/HDL, insulin, glucose, HOMA-IR values, and PCRus. Among all individuals evaluated, only one person – a male – did not show any altered metabolic parameter. We found an important precocious prevalence of individuals with hypercholesterolemia (15%); hypertriglyceridemia (23.3%); borderline hyperglycemia (35.6%); hyperinsulinemia (40.4%); high values of LDLC (16.7%), PCRus (38.3%), non-HDL-C (26.7%); and low values of HDL-C (21.7%) and 2 peak V& O (93.5% of the girls and 100% of the boys). In conclusion, although we did not find any significant correlation between lipid profile and cardiorespiratory fitness in obese children of both genders in this study, a high prevalence of undesirable lipid levels and other altered coronary risk markers were found.