A link between early malnutrition and development of components of the metabolic syndrome later in life has been shown in epidemiological and animal data. Moreover, studies now tend to demonstrate that not only fetal environment is important for developmental programming but postnatal milieu could also participate to this process. The “predictive adaptive response” hypothesis stipulates that not only a suboptimal environment during fetal life will lead to development of metabolic disorders later in life but more likely is a mismatch between the early environment and that one really encountered later on that increases the risk of developing later disease. Based on this hypothesis, we examined the effect of an early mismatched environment produced by fetal protein restriction and postnatal catch-up growth on the development of obesity and cardiovascular disease in male mice. We focussed our study on the analysis of adipose tissue with in vitro examination of differentiation, proliferation of preadipocytes. We also investigated in vivo the development of overweight in adult mice and we measured the expression of specific adipose tissue molecules with microarray. Finally, we investigated the development of hypertension and atherosclerosis in parallel to obesity. Our results indicated that postnatal catch-up growth after fetal protein restriction favours the development of obesiy in adult male mice. Early mismatched nutrition also influenced the capacity of proliferation of preadipocyte as well as the expression of adipose tissue specific molecules involved mainly in lipid biosynthesis. Finally, early nutrition also induced hypertension in adult male mice while no influence of fetal protein restriction and postnatal catch-up growth was observed on atherosclerosis development.

Shift work is a work schedule being the opposite of normal daytime work, often defined as working time outside normal daytime hours (06:00 to 18:00). In recent years, shift work has been associated with an increased risk of numerous chronic conditions including for example cardiovascular disease, some types of cancer, type II diabetes, and the metabolic syndrome. While some studies on the association between shift work and chronic disease have found results supporting it, others have not. Therefore, more research is needed to clarify potential associations.The aim of this thesis was to further study the proposed association between shift work and cardiovascular disease. This was addressed by performing two studies, one analysing if shift workers had an increased risk of ischemic stroke compared to day workers. The other study analysed whether shift workers had an increased risk of short-term mortality (case fatality) after a myocardial infarction compared to day workers. The studies were performed using logistic regression analysis in two different case-control databasesThe findings from the first study indicated that shift workers did not have an increased risk of ischemic stroke. The findings from the second study showed that male shift workers had an increased risk of death within 28 days after a myocardial infarction; the results did not indicate an increased risk for female shift workers. The results from both studies were adjusted for both behavioural and medical risk factors without affecting the results. The findings from this thesis provide new evidence showing that male shift workers have an increased risk of death 28 days after a myocardial infarction, however more research is needed to clarify and characterise any such potential associations.

In the context of transitional Vietnam, although cardiovascular disease (CVD) has been shown to cause a large burden of mortality and morbidity in hospitals, little is known about the magnitude of its burden, risk factor levels and its relationship with socio-demographic status in the overall population. This thesis provides a preliminary insight into population-based knowledge of the CVD epidemiology in rural Vietnam and contributes to the development of methodologies for monitoring it. The ultimate goal of the work is to facilitate the formulation of evidence-based health interventions for reducing the burden of the CVD epidemic in Vietnam and elsewhere. This work was located in Bavi district, a rural community in the north of Vietnam. Studies on cause-specific mortality and risk factors were conducted within the framework of an ongoing Demographic Surveillance System (DSS) (called FilaBavi). The cause-specific mortality study used a verbal autopsy (VA) approach to identify causes of death in FilaBavi during 1999-2003. The risk factor study, conducted in 2002, employed the WHO STEPwise approach to surveillance of non-communicable disease (NCD) risk factors (WHO STEPS). Findings indicated that Bavi district, as an example of rural Vietnam, was already experiencing high rates of CVD mortality and associated risk factors. Mortality results indicated a substantial proportion of deaths due to CVD, which was the leading cause of death (20% and 25.7% of total mortality in 1999 and 2000, respectively and 32% of adult deaths during 1999-2003), exceeding infectious diseases. Hypertension was found to be a serious problem in terms both of its magnitude (14% of the population) and widespread unawareness (82% of the hypertensives). Smoking prevalence was very high among men (58% current daily smokers) and might be expected to cause a considerable number of future deaths without urgent action. CVD mortality and some risk factors seemed to be rising among disadvantaged groups (women, less educated people and the poor). The combination of DSS and WHO STEPS methodologies was shown to have potential for addressing basic epidemiological questions as to how NCD and CVD mortality and associated risk factors are distributed in populations. Given this evidence, actions to prevent CVD in Bavi and similar settings are clearly urgent. Interventions should be comprehensive and integrated, including both primary and secondary approaches, as well as policy-level involvement. Further studies, continuing on similar lines, plus qualitative approaches and deeper cross-site comparisons, are also needed to give further insights into CVD epidemiology in this type of setting.

Cardiovascular Diseases (CVD) have become the leading cause of death in India and other developing countries. The aims of this study were to: (1) describe the geographical epidemiology of CVD in India, (2) provide a graphical display of CVD risk factors and mortality outcomes, and (3) describe the sources of bias. Five large, nationally-representative datasets from India were studied. Cardiovascular death rates were 308/100,000 among males and 198/100,000 among females in middle-age (30-69years). Wide variations between states were noted in the distribution of risk factors and mortality. The selected risk factors explained 49% and 43% of the variation among males and females respectively. Ecologic analysis revealed death rates at state-level were associated with rates of overweight and vegetarianism among males; no such association was found among females. This study has implications for identification of areas with high burden, formulation of hypotheses, and assessing needs for disease control at national/regional levels.

This study addresses health policy and public health in the field of cardiovascular disease (CVD) on the local level in Sweden. The overall aim is to contribute to the assessment of structural and social conditions within public health by analysing participation processes and outcome patterns in a local health programme. The northern Swedish MONICA study served as a reference area. The research strategy has been to integrate quantitative and  qualitative methodologies and, thereby, focus on different aspects of the health programme under study. The mortality rate was excessive in the study area of Norsjö relative to both provincial and national figures over a period of more than 10 years. This finding formed the basis for a tenyear comprehensive and community-based health programme towards the prevention of CVD and diabetes. Even in this seemingly homogeneous area it was found that socio-economic circumstances were associated with the public health. Almost half of the study population had hypercholesterolaemia (;>6.5 mmol/1), 19% of men and 25% of women were smokers and 30% and 29%, respectively, had high blood pressure. Age had a strong impact on all outcome measures. After adjustments for age and social factors it was found that the relative risk of having hypercholesterolaemia dropped significantly in both sexes during the six years of intervention. The probability of being a smoker was significantly reduced only in highly educated groups. No statistically significant change over time could be found for the risk of suffering high blood pressure. In the reference area of northern Sweden there were no changes over time for any of the selected risk factors. The likelihood of self-assessed good health decreased with increasing risk factor load, with the exception of hypercholesterolaemia , in all social strata. The authorities, including the health and medical staff, were the main actors on the mediastage. Men in manual occupations were least affected by the media coverage. The actors and the public as well as the media viewed the health programme as orientated towards individual lifestyles. Community participation was mainly defined by the actors based on the medical and health planning approach. Differences in interpretations, social interests, personal conflicts and ideological constraints among the actors at local level were observed. Some critical attitudes towards the organization and management of the health programme were also noted among the citizens. However, a majority of the public wanted the health programme to continue. The present study underlines the importance of considering age, gender and social differences in the planning and evaluation of CVD preventive programmes. / digitalisering@umu

Cardiovascular Diseases (CVD) have become the leading cause of death in India and other developing countries. The aims of this study were to: (1) describe the geographical epidemiology of CVD in India, (2) provide a graphical display of CVD risk factors and mortality outcomes, and (3) describe the sources of bias. Five large, nationally-representative datasets from India were studied. Cardiovascular death rates were 308/100,000 among males and 198/100,000 among females in middle-age (30-69years). Wide variations between states were noted in the distribution of risk factors and mortality. The selected risk factors explained 49% and 43% of the variation among males and females respectively. Ecologic analysis revealed death rates at state-level were associated with rates of overweight and vegetarianism among males; no such association was found among females. This study has implications for identification of areas with high burden, formulation of hypotheses, and assessing needs for disease control at national/regional levels.

Women smokers with heart disease (HD) are at increased risk for negative health effects. At the time of invasive cardiovascular (CV) interventions is a critical opportunity to make lifestyle changes to reduce future CV interventions. The purposes of this study guided by the Health Belief Model were to determine which factors predict smoking cessation (SC) in women following an invasive CV procedure and to explore assistance received with SC. A correlational, prospective design was used. Data were collected from women smokers at the time of an invasive CV intervention and three months later. Instruments measured commitment to stop smoking, perceived threat of HD and future interventions, cessation self efficacy, barriers to SC, benefits of SC, cues to action, and motivation. Analyses included Chi-square, t-tests, and multiple, hierarchical, and logistic regression. On average women (N = 76) were middle-aged (M = 55.9 ± 8.0 yrs), smoked M = 15.3 ± 9.8 daily cigarettes and smoked for M = 33.6 ± 10.2 years. At baseline, fewer perceived barriers to SC, high cessation self-efficacy, and being more autonomously motivated to quit smoking explained 67 % of variance in commitment to stop smoking, F (6, 67) = 19.37, p < .001. At 3 months, only 8 (n = 54) women had quit smoking. Women smoked fewer daily cigarettes (M = 10.6 ± SD = 8.5) at 3 months compared to time of procedure (M = 15.3 ± 9.8), t(51) = 3.43, p < .01. Higher baseline cessation self-efficacy and lower HD threat were predictors of SC at three months, X2 (4, N=54) = 18.67, p = .001. At the three month follow up, the most common barrier to SC was anxiety (24%) and cigarette cravings (24%). While women were highly committed and confident they could quit, they reported receiving little help from their health care provider (HCP) other than simple advice to quit smoking. Most women undergoing an invasive CV procedure were unable to quit smoking even with a high desire to do so. Referrals for assistance from HCP to decrease anxiety and nicotine dependence and to address ongoing challenges to SC are needed.

The purpose of this study is to determine if African American Women (AAW) with low fitness levels have low fitness related to a lifestyle choice of decreased physical activity (PA) or the cardiovascular disadvantage of greater proportion of Type II (FT) muscle fibers. Forty-eight apparently healthy AAW participated in the study. The women had no known risk factors for CVD; were sedentary (no structured fitness training program within last six months) or minimally fit (PA ≤ 3 x week for 20 minutes); and were not taking any prescription medications for blood pressure, diabetes, or lipid control. On the first visit the following measurements were taken: 1.) height and weight (electronic scale and stadiometer); 2.) body fat percentage (dual energy x-ray absorptiometry (DXA % body fat); and 3.) CRF (submaximal treadmill exercise test). On the second visit additional measurements included: 1.) blood pressure (stethoscope and sphygmomanometer); 2.) lipid profile and high sensitivity-C reactive protein (hs-CRP) (Cholestech LDX analyzer); 3.) thigh anthropometric measurements; 4.) isokinetic power and fatigue testing (KIN-COM dynamometer). Pearson product correlation coefficient (r) was used to analyze the relationship between the variables. The results indicated that gross oxygen consumption at 85% maximal heart rate (VO2) was not significantly related to PA (r = -.06, p = .67) or FT fibers (r = 0.14, p = 0.34). VO2 was negatively correlated with hs-CRP (r = -.31, p < 0.05), systolic blood pressure (r = -0.47, p < 0.01), diastolic blood pressure (r = -0.42, p < 0.01), and DXA % body fat (r = -0.64, p < 0.01). There were no significant relationships between PA and any of the variables. FT fibers were negatively correlated with low density lipoprotein (r = -0.30, p < 0.05) and DXA % body fat (r = -0.46, p < 0.01). In conclusion, low cardiorespiratory fitness in AAW does not seem to be a related to reported levels of PA or proportion of FT fibers. This suggests that there may be other factors that are contributing to the low levels of cardiorespiratory fitness observed in this sample of AAW.

Bakgrund: Hjärt- och kärlsjukdomar var vanligt förekommande och hade kommit att bli ett stort hälsoproblem. Ofta ledde diagnosen till ett försämrat välbefinnande för både den vårdsökande personen och även för partnern. För flertalet var dock sexualiteten en viktig del av välbefinnandet. Risken att välbefinnandet kunde kommit att påverkas var stor då förekomsten av sexuella problem visats vara dubbelt så hög i denna grupp gentemot den allmänna populationen. Syfte: Syftet var att beskriva hur hjärt- och kärlsjukdomen påverkade sexualiteten hos vårdsökande personer och deras partner. Metod: Litteraturöversikt med kvalitativ analys genomfördes. Nio artiklar som söktes fram genom Cinahl och Medline samt en artikel genom sekundärsökning ingick i översikten. Artiklarna var relevanta gentemot syftet och godkändes utifrån ett kvalitetsgranskningsprotokoll. Den kvalitativa analysen resulterade i två huvudteman: Emotionell påverkan, fysisk påverkan och fem sub-teman. Resultat: Enligt litteraturöversiktens resultat framkom det att merparten av de vårdsökande personerna och deras partner upplevde att hjärt- och kärlsjukdomen orsakade försämringar i den sexuella aktiviteten. Sjukdomen innebar begränsningar både i den fysiska förmågan och emotionellt vilket bidrog till försämrat välbefinnande för båda i parrelationen. Det fanns de som  upplevde en fortsatt eller förbättring i den sexuella aktiviteten efter sjukdomens debut. Slutsats: Hos de vårdsökande personerna som levde med en hjärt-och kärlsjukdom samt deras partner förekom stora skillnader i hur sjukdomen påverkat deras sexuella aktivitet. Oro, ångest och rädsla var framträdande faktorer som bidrog till att den sexuella aktiviteten och välbefinnandet förändrats i negativ riktning. I förhållanden där kommunikationen däremot utgjordes av en större öppenhet paren emellan resulterade detta i en fortsatt eller i vissa fall förbättrad sexuell aktivitet. Möjligheten till en tillfredställande sexuell aktivitet fanns trots att det förelåg sjukdom. / Background: Cardiovascular disease was common and had become a major health problem. Often the diagnosis lead to a reduced wellbeing for both the person with diagnose and their partner. For many, sexuality was an important part of wellbeing. There was a risk that the wellbeing could be affected since the prevalence of sexual problems was twice as high in this group in relation to the general population. Aim: The aim was to describe how the cardiovascular disease impacted on the sexuality among people and their partner. Method: A literature review with a qualitative approach was conducted. Nine articles were found through Medline and Cinahl and one article was found through secondary search. The articles were relevant in relation to the aim and were approved by a quality control protocol. The qualitative analysis resulted in two main themes: Emotional impact, Physical impact and five sub themes. Results: According to the literature review, the results showed that the majority of the persons and their partners felt that cardiovascular disease caused deterioration in the sexual activity. The disease meant limitation in both the physical ability and emotional, which contributed to a reduced wellbeing for both individuals in the relationship. Only a few of the couples experienced a continuation or improvement in the sexual activity after the debute. Conclusion: There were major differences in the way the disease affected the sexual activity in both the persons who lived with cardiovascular disease and their partners. Worry anxiety and fear were prominent factors contributing to the negative change in the sexual activity and wellbeing. When communication however included a greater openness in the relationship between the couples, it resulted in a continued or in some cases an improved sexual activity. Despite the existence of the disease there was a possibility of a satisfying sexual activity.

Sixty-six percent of the ground beef consumed in the U.S. contains 16-30 percent fat by weight, and at the retail level, ground beef fat varies widely with regards to saturated, monounsaturated and trans-fatty acid content. Through two independent studies the effect of fatty acid composition of ground beef on selected cardiovascular disease risk indicators was evaluated. In the first study, 27 free-living normocholesterolemic men completed a three-way crossover dietary intervention. Subjects consumed five, 114-g ground beef patties per week for 5 wk with intervening 4-wk washout periods. Patties contained 24 percent total fat with monounsaturated fatty acid:saturated fatty acid (MUFA:SFA) of either 0.71 (low-MUFA, pasture-fed), 0.83 (mid-MUFA, short-term corn-fed), or 1.10 (high-MUFA, long-term corn-fed). Blood was collected from each subject before and at the end of each diet period. Overall, the ground beef interventions decreased plasma insulin, HDL2, and HDL3 particle diameter and α-linolenic acid (18:2 (n-3)), and increased plasma arachidonic (20:4(n-6)). The greatest increase in HDL cholesterol from baseline (0.07 mmol/L) was after the high-MUFA ground beef intervention. An increase from baseline in LDL particle diameter (0.5 nm) occurred after the mid- and high-MUFA interventions.We concluded that low-MUFA ground beef from pasture/hay-fed cattle was no more “heart healthy” than high-MUFA ground beef from corn-fed cattle as judged by common clinical criteria. In the second study, 19 of 29 post menopausal women completed a two-way crossover design. Subjects consumed five, 114-g ground beef patties per week for 6 wk periods separated by a 4 wk washout period. The low-MUFA patties contained 19.4 percent fat with MUFA:SFA of 0.9. The high-MUFA patties contained 22.5 percent fat with a MUFA:SFA ratio of 1.3. In addition to patty consumption, the subjects completed a bout of exercise during the last week of each phase. Blood was taken before, each diet phase (24 hr before exercise) and 24 hr post exercise. Total cholesterol was increased by the high-MUFA patties with the most significant increase seen in HDL cholesterol, mainly HDL2b subfraction. Lipid-rich lipoprotein fractions were increased with the low-MUFA diet, but not by the high-MUFA diet. Very long chain fatty acids were depressed by low MUFA patty consumption. When unadjusted for plasma volume shifts (raw), exercise decreased triglycerides in all three phases. Raw VLDL cholesterol was reduced after exercise during the intervention phases. Raw RLP and IDL cholesterol were reduced after exercise during the high-MUFA intervention. HDL2b was reduced after exercise during the high-MUFA phase. LDL mean size increased and LDL mean density decreased after exercise during the low-MUFA intervention. HDL mean density increased after exercise during both ground beef interventions. The data indicate that high-oleic ground beef can reduce some cardiovascular disease risk factors and can be a part of a healthful diet. Exercise can have a beneficial impact on cardiovascular disease risk factors independent and in conjunction with ground beef consumption.