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.

Little knowledge and contradictory results exist on the association of oral diseases with systemic diseases and with health predictors such as dental care utilization and health insurance. This research project aimed to examine 1) the association between Coronary heart disease (CHD) and periodontal disease using meta-analysis, 2) to examine the association between dental care utilization, health insurance coverage and periodontal disease with the prevalence of CVD, 3) the association between dental caries, periodontal disease and blood glucose level. For meta-analysis, literature searches were conducted using the PubMed computerized database (1966-2019), Cochrane Controlled Trials Register (1970-2019), EMBASE (1980-2019), and CINAHL (1982-2019). A systematic review of the literature identified fifteen prospective cohort studies and seven case control studies that meet the inclusion criteria. Maximum likelihood random effects analysis was used to compute the combining relative risk (RR) and odd ratio (OR). Data on periodontal disease, dental caries, dental care utilization, health insurance coverage, cardiovascular disease and blood glucose level were obtained from the National Health and Nutrition Examination Survey (2011–2014) for dentate community-dwelling persons 30 years of age and over. The outcome was cardiovascular disease (heart attack, hypertension, CHD, congestive heart failure and stroke) and glucose level (HbA1c and OGTT). The main independent variable was dental care utilization, insurance, periodontal disease and dental caries. Covariates included in the analysis were race/ethnicity, age, sex, income, education levels, body mass index, diabetes status, smoking status and alcohol drinking status. To obtain unbiased point estimates and correct variance estimation, proper sampling weights and statistical survey procedures were used. A-meta-analysis of the fifteen prospective cohort studies indicated that patients with periodontal disease are at 1.19 times increased the risk of having CHD compared to periodontally healthy patients (RR: 1.19, 95% CI (1.12 – 1.26)). The result of the seven case control studies, showed a significant association between periodontitis and CHD with odds ratio 2.37 (95% CI 1.72-3.28). In addition, lower dental care utilization and insurance were significantly increased the odd of developing CVD respectively; (OR 1.65, 95%CI 1.01–2.69, OR 1.52, 95% 1.09–2.11). Looking into the association between oral diseases and blood glucose level. Dental caries was significantly associated with increased the odd of high OGTT and HbA1c values respectively (OR 2.47, 95% 1.56-3.90, OR 1.37, 95% 1.14-1.64). However, periodontal disease was significantly associated with high HbA1c values only (OR 2.77, 95% 2.40-3.20). In conclusion, our analysis supports the association between periodontal disease and CHD. Additionally, using a large national representative sample, our analysis showed that health insurance and dental care utilization were significantly associated with the prevalence of CVD. Also, having either periodontal disease or dental caries increased the odds of poor glycemic control among US population.

Rural communities across the United States suffer from multiple health disparities that range from access to care to awareness of medical information. These disparities are characterized by increased incidence of illnesses, mortality rates, lower quality of life, and lower life expectancy when compared to the general urban population. Several risk factors have been identified that play a direct role in these characteristics. These include geographic isolation, lower socioeconomic status, higher rates of health risk behaviors, and limited job opportunities, and less health education. Hawkins County Tennessee is one such rural community that suffers from these disparities. The leading cause of death in Hawkins County is cardiovascular disease (CVD). Due to the nature of disease, early life long modifiable risk factors play a critical role in its development. Health education and awareness of the disease is also a key factor in the disease's effects in the community. Studies have shown that early life healthcare awareness is an “important determinant of adult health status.” This led us to examine the current state of cardiovascular disease awareness and perception among teens in the community. To examine the current perception of CVD in Hawkins country we created an assessment for ninth grade students attending Cherokee Highschool during their health class block. We also aimed to assess the effectiveness of an interactive interventional educational program targeted at both educating the technical knowledge surrounding CVD and at reducing modifiable risk factors that lead to CVD. The interactive educational program was designed and given to students (n=82; 47 Male 35 Female) across 5 class period in two sections (Cardiovascular health and Nutritional & Physical health) that were taught one week apart. Students underwent a Pre-test/survey that examined four areas of interest: perception & technical knowledge of CVD, perception of physical activity, perception of nutrition and diet, and current family health. After completing the program students were then given an identical post-test/survey. Result means were compared between Pre and Post survey using Independent sample T-test. Analysis showed that technical understanding of CVD and of modifiable risk factor significantly increased across all areas (P

Background: A recent shift in the global burden of disease from communicable to noncommunicable has shown that a third of the global burden of disease is attributable to noncommunicable disease, with the heaviest burden affecting poor communities in urban areas. Musculoskeletal disease (MSD) is the most common cause of severe chronic or persistent pain, functional limitations, and physical disability, affecting 20-50% of adults. Globally, disability due to musculoskeletal disease is estimated to have increased by 45% from 1990 to 2010 accounting for 6.8% of total years lived with disability. Research has highlighted a possible co-existence of musculoskeletal disease and chronic noncommunicable diseases of lifestyle, however, there is inadequate South African evidence regarding these inter-relationships and possible risk factors. This highlights a gap in research as management may not be appropriately targeted toward risk factors and thus may not reduce the high prevalence rates of musculoskeletal disease. Aim: The main aims of this study were firstly to determine the prevalence and patterns of acute and chronic musculoskeletal disease. The secondary aim was to explore the relationship between these factors by examining the patterns of onset of musculoskeletal disease, chronic diseases of lifestyle, and risk factors across gender and six age categories (from 18 years to 70 years and older) in patients seeking medical services at a community health centre in Cape Town, South Africa. It was hypothesised that if some conditions were found to have an earlier onset, these conditions might lay the foundation for the development of other chronic diseases of lifestyle and musculoskeletal disease. Methodology: A descriptive, cross-sectional, analytical study design was used at primary health care level at a community health centre in Cape Town, South Africa. All males and females aged 18 years and older, except those who were pregnant or unable to answer the English, Afrikaans, or isiXhosa versions of the selected questionnaires, were eligible to participate. The outcome measures were the Community Orientated Program for Control of Rheumatic Diseases (COPCORD) screening tool for musculoskeletal disease, the Brief Pain Inventory (BPI), the European Quality of Life-5 Dimensions (EQ-5D) health-related quality of life measure, the International Physical Activity Questionnaire (IPAQ), and anthropometric measures of weight, height, and waist and hip circumference. Data were collected via interview and anthropometric measurement. Responses were captured by online questionnaires on mobile devices using the mobile data collection application Magpi by DataDyne Group, LLC. Data were exported to Microsoft Office Excel spreadsheets for descriptive and inferential statistical analysis. Ethical permission was obtained from the University of Cape Town. Results: This study recruited 1115 participants, with a mean age of 48.7 ± 16.8 years. A prevalence rate of 33.6% (95% Confidence Intervals; CI: 30.1-36.5%) for acute MSD and 43.3% (CI: 40.4-46.3%) for chronic MSD was found. The number of participants reporting an overall prevalence of any MSD was 505 (45.7%; CI: 42.8-48.7%). The highest prevalence of MSD was found in females aged 40-59 years. The most common anatomical sites of chronic MSD were the knees (35.6%; CI: 31.5-39.9%), low back/pelvis (33.8%; CI: 29.8- 38.0%), shoulders (26.8%; CI: 23.1-30.9%), and hands/fingers (21.9%; CI: 18.5-25.7%). Of those with MSD, exercise was reported as the best management strategy for musculoskeletal pain (35.6% of 191 respondents; CI: 29.1-42.6%). Hypertension was found to be the most prevalent chronic disease of lifestyle (47.8%; CI: 44.8-50.7%), followed by type 2 diabetes mellitus (21.4%; CI: 19.1-23.9%), and hypercholesterolaemia (20.2%; CI: 17.9-22.6%). All chronic diseases, except chronic obstructive airway disease (COAD), increased with age, while COAD and both acute and chronic MSD peaked around the 50-59 age category and then decreased with age. Most females reported to be highly physically active (46.0%) while males reported mostly low physical activity levels (47.8%). Around the 50-59 year old age group the proportion of participants with a ‘high’ physical activity level decreased while that of participants with a ‘low’ physical activity level increased at the same age group. A higher proportion of those without MSD reported ‘high’ levels of physical activity (41% compared to 32%). In the 30-39 and 40-49 age groups, low levels of physical activity were associated with chronic MSD (70.6% compared to 37.5% of those. with high levels; Chi-Square=13.833; df=2; p=0.001). Body mass index (BMI) category was found to be associated with MSD (p< 0.001) with 73% of those with MSD being overweight or obese and 27% being extremely obese. There were significant differences in BMI between those with and without hypertension (p< 0.001), hypercholesterolaemia (p <0.001), and type 2 diabetes mellitus (p< 0.001). A trend of increasing obesity, high waisthip ratio and low levels of physical activity with age was observed. In smokers, being 30 years of age or older was associated with an increased risk of MSD (42% compared to 21.1%). Gender emerged as a risk factor in the 40-49 and 50-59 age categories with 76.2% of females in these categories reporting chronic MSD compared to 45.1% of the males. However, no risk factor seemed to track the plot of MSD. Age emerged as having the highest association with chronic MSD (Chi-Square=136.6; p< 0.001). Conclusions: Bivariate associations of musculoskeletal disease and chronic diseases of lifestyle were detected because they all become more prevalent with age. The comorbidity of musculoskeletal disease and chronic disease of lifestyle appeared to almost entirely be due to the aging process, rather than the mutual influence that musculoskeletal disease and chronic diseases of lifestyle may have. Low levels of physical activity were only associated with musculoskeletal disease among those in the 30-49 age categories. As previous evidence has shown that increased levels of physical activity can reduce pain in chronic or persistent musculoskeletal disease, a window of opportunity is suggested where increasing physical activity levels in the 30-49 age group may result in a decrease in the prevalence of musculoskeletal disease in the older age group. The only factor that emerged as being predictive in the group with the highest prevalence of musculoskeletal disease, the 40-59 age categories, was gender. Although gender is clearly not modifiable, this finding should inform the development of culturally appropriate intervention strategies. Implications: Although it was not possible to detect any evidence supporting causation, the co-existence of chronic musculoskeletal disease, chronic diseases of lifestyle, and risk factors highlights the need for holistic care to address the multiple problems experienced by adults, specifically as age progresses. The impact of chronic musculoskeletal disease is large, both in terms of prevalence and impact on health-related quality of life. The management of chronic musculoskeletal disease should thus focus on the most effective and affordable intervention strategies and healthcare systems and coherent policies for dealing with this condition should be developed. This management should not only be based on a pharmacological model but on biopsychosocial integration emphasising self management.

Background: Evidence supports a significant non-linear relationship between alcohol consumption and cardiovascular disease-specific mortality among US adults. Epidemiologic investigations presume that the J/U-shaped distribution is the sum of the detrimental effect of high consumption on other causes of death and the protective effect on coronary heart disease (CHD) morbidity and mortality. Studies demonstrated that heavy alcohol consumption reduces the risk of CHD. However, results have been inconsistent among heavy drinkers. In this study, we investigated the association of heavy alcohol consumption with CHD among different subgroups in the US. Methods: Data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) were used. BRFSS is an annual survey of Americans’ health-related risk behaviors, chronic health conditions, and the use of preventive services among the general adult population via self-report. Logistic regression analysis was conducted to determine the association between history of CHD and heavy alcohol consumption. Heavy alcohol use was defined as consuming greater than 14 drinks per week for men and greater than 7 drinks per week for women. The model was adjusted for other risk factors. Results: A total of 398,656 cases were included. Approximately, 5.67% of the study population reported history of CHD and 6.47% reported heavy alcohol consumption. Overall, the odds of having CHD among heavy alcohol drinkers was 42% less than those who were not heavy alcohol drinkers (adjusted odds ratio): 0.58, 95% confidence interval (CI): (0.50-0.68). Stratified by age, we found that heavy alcohol consumption could be either risk factor or protective factor of CHD or no effect on CHD across different age groups: for 18-24 age group, the odds of having CHD among heavy alcohol drinkers was 25% higher than those who were not heavy alcohol drinkers, OR 1.25 (CI 0.54-2.90); for 25-34 age group, 1.42 (0.94-2.14); for 35-44 age group, 1.04 (0.75-1.43); for 45-54 age group, 0.78 (0.63-0.96); for 55-64 age group, 0.71 (0.62-0.82); for >64 age group, 0.61 (0.55-0.67). Stratified by race, for the male group, the odds of having CHD among heavy alcohol drinkers was 45% lower than those who were not heavy alcohol drinkers, 0.55 (0.46-0.67); for the female group, 0.52 (0.41-0.66). Stratified by race, for the White group, the odds of having CHD among heavy alcohol drinkers was 47% lower than those who were not heavy alcohol drinkers 0.53 (0.49-0.57); for the Black group, 0.44 (0.30-0.66); for the Hispanic group, 0.84 (0.62-1.13); for Other groups, 0.56 (0.41-0.77). Conclusion: The study findings demonstrate that heavy alcohol consumption is a protective factor for CHD among people aged >44, the older the more protective, but the younger the more risk of having CHD among people aged

Aim: The aim of this literary study is to investigate the incidence and causal factors of periodontitis among individuals ≥50 years of age with coronary heart disease. Method: The method used for this literary study was to search for original scientific articles in the databases CINAHL, DOSS and MEDLINE. Relevant keywords were used for the search in the databases with restriction for the selection with inclusion and exclusion criteria. Original scientific articles were quality reviewed, medium and high quality of the articles were included. Results: The study shows a link between periodontitis and coronary heart disease. The severity of periodontitis affects the onset and progression of coronary heart disease. Factors that affect disease development are the inflammatory process and its biomarkers (interleukins and adiponectin) as well as age and specific periodontal bacteria. Conclusion: The result of this literary study shows a connection between the occurrence of periodontitis and coronary heart disease. Common risk factors for the diseases that has been identified are the inflammatory process, inflammatory biomarkers, age and oral bacteria.

Introduction Cardiovascular disease (CVD) is the leading cause of death for women in the United States, causing one in every five female deaths, and high blood pressure is a precursor to CVD. Approximately half a million people attend the emergency departments with complications arising from substance use, many of which are concerned with cardiovascular events. The higher the number of substances used, the greater the risk of cardiovascular heart diseases; this association is even stronger among women than men. The purpose of this study is to determine the extent to which women's substance-related behavior impacts high blood pressure, which in turn is a significant risk factor for cardiovascular disease in the US. Methods This cross-sectional study used the 2019 Behavioral Risk Factor Surveillance System (BRFSS) to examine the relationship between having blood pressure and women who smoke and engage in binge drinking. Women who responded yes, yes during pregnancy and were told borderline high or pre-hypertensive to the question of "ever been told by a doctor, nurse or another health professional that you have high blood pressure” were categorized as having high blood pressure. Those who responded no, don’t know/not sure, and refused were considered as not having high blood pressure. Smoking and binge drinking were the two key independent variables for this study. Women were categorized into 4-level smoker status: everyday smoker, someday smoker, former smoker, and non-smoker. Binge drinkers were women who takes four or more drinks on one occasion, with responses being "yes, no or don't know/refused/missing.” A chi-square test for independence was examined to determine the association between having high blood pressure and smoking or binge drinking. Multivariable regression analysis was also performed to account for other factors (such as age, race, educational attainment, income, body mass index and blood cholesterol) potentially associated with high blood pressure among women. Results Approximately 418, 264 individuals responded to the survey items. Among respondents are 227,706 women, who are the study population of interest. The women included in this study are 18-34, 35-64, and above 65 years old. Among the study population, 33% reported having high blood pressure with no record of high blood pressure, amongst 67%. Among women who reported binge drinking, 22.9% reported high blood pressure compared to 34.6% of women who did not binge drink (p= Conclusion This study found that substance abuse was not associated with having high blood pressure. It is possible that women with high blood pressure quit or reduced these behaviors due to a high blood pressure diagnosis. Notwithstanding the high prevalence of high blood pressure and substance use, further research is needed to examine this association among women overall and subpopulations at high risk. This research should support prioritizing interventions and informing public health programs.

Cardiovascular Disease (CVD) accounts for the leading number of deaths worldwide. Prior to menopause, women exhibit lower rates of CVD compared to age-matched men, however, risks for women increase with menopause. Studies show estrogen loss and age exacerbating cardiac β-adrenergic receptor (β-AR) signaling and contractile function. We therefore hypothesized that prolonged estrogen deficiency and chronic β-adrenergic stimulation cause decreases in cardiac function and increases in fibrosis in aged female hearts. Female mice underwent either an ovariectomy (OVX) or a control SHAM surgery at 10 weeks old and were infused with Isoproterenol for three days via mini osmotic pumps in order to induce chronic β-adrenergic stimulation 12-months post-surgery. Our results show prolonged estrogen deficiency from the OVX exacerbates cardiac function and fibrosis compared to SHAM. These differences highlight the importance of continued research on cardiac estrogen deficiency mechanisms to understand the long-term effects in the heart during both CVD and menopause.

Cardiovascular disease is the leading cause of death generally and the most common cause of death during pregnancy in industrialized countries. Improvement in early diagnosis and treatment of congenital heart disease has increased the number of women with such conditions reaching reproductive age. The growing prevalence of diabetes, hypertension, obesity, hyperlipidemia, and metabolic syndrome has concurrently added to the population of pregnant women with acquired heart disease, including coronary artery disease. Physiologic changes occurring during pregnancy can stress a compromised cardiovascular system, resulting in maternal morbidity, mortality, and compromised fetal outcomes. These risks complicate affected women's decisions to become pregnant, their ability to carry a pregnancy to term, and the complexity and risk benefit of cardiovascular treatments delivered during pregnancy. Risk assessment indices assist the obstetrician, cardiologist, and primary care provider in determining the general prognosis of the patient during pregnancy and although imperfect, can aid patients in making informed decisions. Treatments must be selected that ideally benefit the health of both mother and fetus and at a minimum limit risk to the fetus during gestation.

Cardiovascular disease is the leading cause of death generally and the most common cause of death during pregnancy in industrialized countries. Improvement in early diagnosis and treatment of congenital heart disease has increased the number of women with such conditions reaching reproductive age. The growing prevalence of diabetes, hypertension, obesity, hyperlipidemia, and metabolic syndrome has concurrently added to the population of pregnant women with acquired heart disease, including coronary artery disease. Physiologic changes occurring during pregnancy can stress a compromised cardiovascular system, resulting in maternal morbidity, mortality, and compromised fetal outcomes. These risks complicate affected women's decisions to become pregnant, their ability to carry a pregnancy to term, and the complexity and risk benefit of cardiovascular treatments delivered during pregnancy. Risk assessment indices assist the obstetrician, cardiologist, and primary care provider in determining the general prognosis of the patient during pregnancy and although imperfect, can aid patients in making informed decisions. Treatments must be selected that ideally benefit the health of both mother and fetus and at a minimum limit risk to the fetus during gestation.