abstract: ABSTRACT Background. College students’ modifiable health behaviors, including unhealthful eating patterns, predispose them to risk for future cardiometabolic conditions. Purpose. This novel 8-week randomized control parallel-arm study compared the effects of a daily 18-hour Time-Restricted Feeding protocol vs. an 8-hour fast on diet quality in college students. Secondary outcomes were resting morning blood pressure, biomarkers of glucose regulation, biomarkers of lipid metabolism, and anthropometric measures. Methods. Eighteen healthy college students (age = 23 ± 4 years; BMI = 23.2 ± 2.3 kg/m2; MET = 58.8 ± 32.9 min/wk) completed this study. Participants were randomized to a daily 18-hour fasting protocol (Intervention; n = 8) or a daily 8-hour fasting protocol (Control; n = 10) for eight weeks. One ‘cheat’ day was permitted each week. Outcomes were measured at weeks 0 (baseline), 4, and 8. A non-parametric Mann Whitney U test was used to compare the week 4 change from baseline between groups. Statistical significance was set at p≤0.05. Results. Diet quality (p = 0.030) and body weight (p = 0.016) improved from baseline to week 4 for the INV group in comparison to the CON group. The data suggest these improvements may be related to reductions in snacking frequency and increased breakfast consumption. Fasting blood glucose and hip circumference tended to improve for the INV group in comparison to the CON group (p = 0.091 and p = 0.100). However, saturated fat intake tended to increase in the INV group in comparison to the CON group (p = 0.064). Finally, there were no treatment differences between groups (p>0.05) for the 4-week change in total calories, dietary vitamin C, added sugars, resting systolic blood pressure, resting diastolic blood pressure, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), low-density lipoprotein (LDL) cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, waist circumference, or MET. Conclusion. These data, although preliminary, suggest that the 18-hour fasting protocol was effective for improving diet quality and reducing weight in comparison to the 8-hour fasting protocol in healthy college students. Future intervention trials will need to confirm these findings and determine the long-term relevance of these improvements for health outcomes. / Dissertation/Thesis / Doctoral Dissertation Nutrition 2020

BACKGROUND: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. It is characterized by oligomenorrhea/menstrual irregularity, androgen excess, and polycystic ovary morphology. Currently there are three distinct diagnostic criteria used to ascertain PCOS in the population: The National Institutes of Health (NIH) criteria created in 1990 and later reviewed in 2012, the Rotterdam criteria established in 2003, and the most recent criteria by the Androgen Excess & PCOS Society (AE-PCOS) criteria developed in 2006. Some prevalence studies suggest that PCOS affects 6.5-8% of the population while others state 10-20% qualify for a PCOS diagnosis. Recent literature shows patients with PCOS have a 43% prevalence rate or 2-fold higher rate than the age-adjusted sample of all ages in the general US population of developing Metabolic Syndrome (Met-S ) (Apridonidze et al. 2005; Essah, Wickham, and Nestler 2007). This is important because it can alert physicians to refer their PCOS patients to a nutritionist or endocrinologist as a preventive measurement. OBJECTIVES: This thesis based on The Ovulation and Menstruation Health (OM) Pilot Study, sets out to accomplish the following: ascertain the prevalence of PCOS in different racial/ethnic groups, determine Body-Mass Index (BMI) distribution patterns in PCOS participants based on how they were diagnosed (by a physician/self-diagnosed), and most importantly to determine the prevalence of Met-S risk factors in PCOS vs. Non-PCOS groups. METHODS: The (OM) Pilot Study is an online survey with clinical, community, and online recruitment. After a consent and screening process, the survey asks questions related to demographics, anthropometrics, menstrual cycles, contraceptive history, medications and supplement use, PCOS, reproductive health, general health, diet and lifestyle and lastly, pregnancy and birth history. The questions in this online survey, were designed for an 8th-grade reading level to improve comprehension by a diverse cohort of women. This was done to help address the lack of diversity and PCOS ascertainment in pre-existing cohorts. RESULTS: Following recruitment for The OM Pilot Study, 388 participants completed the consent form and 4 declined consent. 384 completed screener and 34 were deemed not eligible because: 18 were no longer menstruating and 16 were unable/unwilling to provide an email address to the receive survey; thus 350 were eligible. Of those 350 participants that were deemed eligible, only 283 started survey. 283 individuals determined to be eligible based on their gender, capacity to menstruate, and age started the survey. Age eligibility was ≥18 years old. 249 completed the survey through its last section (XIII. Pregnancy & Birth History). Of the 283 participants who enrolled and were eligible to partake in the study, 177 (64.1%) identified as White, 22 (7.97%) as Hispanic/Latina/Spanish Origin, 34 (12.3%) as Black/African American, 4 (1.4%) as East Asian, 5 (1.8%) as Southeast Asian, 7 (2.5%) as South Asian, 27 (9.8%) selected more than 1 race/ethnicity, and 7 (2.5%) chose not to answer (Table 5). Participants from the PCOS group had higher prevalence for all the risk factors for Met-S when compared to Non-PCOS group: abdominal fat determined as those who tend to gain weight around stomach/waist (73% versus 60%), abdominal fat ascertained by body figure (33% versus 17%), hypertension (6.9% versus 3.1%), high cholesterol (20.7% versus 8.8%), diabetes (5.3% versus 1.0%), non-alcoholic fatty liver disease (NAFLD) (5.2% versus 0.5%), and lastly sleep apnea (SA) (5.2% versus 2.1%). More noticeably is the absolute difference in prevalence in abdominal fat as determined by the body figure image in which the PCOS group (33%) had a 16% higher prevalence than the Non-PCOS group (17%). Participants that reported having PCOS diagnosed by a physician (37) had a higher prevalence of overweight/obese women (73%) than those that self-diagnosed (23) with PCOS (56.5%). CONCLUSIONS: The OM Pilot Study has demonstrated that it is possible to launch and recruit a diverse sample group representative of the actual population. With this new tool, future studies can better assess risk factors associated with Met-S in PCOS patients taking into consideration their racial/ethnic background.

The purpose of this study was to define a lower standard cuff occlusion time to induce reactive hyperemia in assessing endothelial dysfunction. In this study, strong evidence was found by a novel technique that used oscillometric methods, which supported that 3 minute reactive hyperemia was sufficient to elicit a significant difference in arterial compliance from baseline. Twenty healthy Cal Poly students were assessed, (n=12 female, n=8 male) aged 22 years old with a standard deviation of 2.04 years. Arterial compliance was estimated by measuring the peak-to-peak oscillations for baseline, 3 minute reactive hyperemia, and 5 minute reactive hyperemia tests, with the result being statistical evidence of an increase in arterial compliance after 3 minutes of cuff occlusion compared to baseline. The peak-to-peak mean for the 3 minute reactive hyperemia test was significantly greater than the baseline peak-to-peak mean with p-values less than 0.0001. These results support that 3 minute reactive hyperemia is sufficient to assess endothelial dysfunction using oscillometry techniques. Endothelial dysfunction is the most significant predictor of a major adverse cardiovascular event, so this test can be used as an early detection tool for cardiovascular disease and allow patients to find treatment before irreversible damage is done to the body. Implementing this test into routine doctor checkups has the potential to have a significant effect on cardiovascular disease, which is the leading cause of death globally. The currently accepted clinical benchmark performed in hospitals uses high-frequency ultrasound with a standard cuff occlusion time of 5 minutes. Although noninvasive, 5 minutes of cuff occlusion causes slight discomfort to the patient and is not desirable. This test was improved and shortened by using a system based on the oscillometric method of blood pressure measurement. By reducing the duration of the test from 5 minute reactive hyperemia to 3 minute reactive hyperemia, this will make the procedure practical for an increased number of patients, providing a noninvasive option to regularly check for early symptoms of cardiovascular disease.

京都大学 / 新制・課程博士 / 博士(工学) / 甲第23494号 / 工博第4906号 / 新制||工||1766(附属図書館) / 京都大学大学院工学研究科都市環境工学専攻 / (主査)教授 高野 裕久, 教授 米田 稔, 准教授 上田 佳代 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

Introduktion: Kardiovaskulära sjukdomar är ett globalt folkhälsoproblem och den största dödsorsaken i världen. Sömnbesvär är ett eskalerande folkhälsoproblem och har en betydande risk för kardiovaskulär sjuklighet och död. Det krävs att kunskapen ökar gällande omvårdnadsinterventioner mot sömnbesvär hos personer med kardiovaskulära sjukdomar för att minska riskerna för folksjukdomar och för tidig död. Syfte: Redogöra för distriktssköterskans omvårdnadsinterventioner hos personer med kardiovaskulär sjukdom och sömnbesvär. Metod: En litteraturstudie med ett systematiskt arbetssätt har utförts, som utgår från Statens beredning för medicinsk utvärderings (SBU) riktlinjer. Åtta kvantitativa och tre kvalitativa studier inkluderades i resultatet. Resultat: I resultatet framkommer en huvudkategori samt fyra underkategorier av omvårdnadsinterventioner. Huvudkategorin: professionellt stöd och de fyra underkategorierna: kognitiv beteendeterapi mot sömnbesvär (KBT-I), individuella behandlingsplaner, utbildning samt komplementär och alternativmedicinsk behandling (KAM) som främjar sömnkvalitet hos patienter med kardiovaskulär sjukdom och sömnbesvär. Slutsats: Flera evidensbaserade omvårdnadsinterventioner har stor betydelse för att minska sömnbesvären och förbättra sömnkvalitet hos patienter med kardiovaskulär sjukdom och sömnbesvär. Det är av värde att behandlingen inkluderar professionellt stöd, sömnutbildning, sjukdomslära, läkemedelskunskap, erbjuda individanpassade behandlingar samt öka implementering av KBT-I. Omvårdnadsinterventioner kan appliceras inom alla områden som en distriktssköterska arbetar inom men det ställer högre krav på vården att få och erbjuda rätt utbildning. / Introduction: Cardiovascular disease is a global public health problem and the leading cause of death in the world. Sleep disorders are an escalating public health problem and sleep disorders have a significant risk of cardiovascular disease and death. Knowledge is required to increase current nursing interventions for sleep disorders in people with cardiovascular diseases in order to reduce the risks of common diseases and death. Aim: Describe the district nurse's nursing interventions in people with cardiovascular disease and sleep disorders. Method: A review with a systematic approach has been performed, which is based on SBU:s guidelines. Eight quantitative and three qualitative studies were included in the results. Results: The results show a main category and four subcategories of nursing interventions. The main category was professional support and the four subcategories were: cognitive behavioral therapy for sleep disorders (CBT-I), individual treatment, education and complementary and alternative medicine (CAM) that promotes sleep quality in patients with cardiovascular disease and sleep disorders. Conclusion: Several evidence-based nursing interventions are of great importance in reducing sleep disorders and improving sleep quality in patients with cardiovascular disease and sleep disorders. It is of value that all treatment includes professional support, training in sleep, pathology and pharmaceutical knowledge, offer individualized treatments and increase implementation of CBT-I. These nursing interventions can be applied in all areas in which a district nurse works, but it places higher demands on the care to receive and offer the right training.

Background: Since its introduction in the early 2000s, energy drinks have become increasingly popular among an extensive range of consumers, including adolescents and young adults. Currently, the United States Food and Drug Administration (FDA) does not regulate the formulation of energy drinks, which may vary widely in the amounts of caffeine and sugar, as well as various types of supplements. Recent reports of severe and fatal adverse effects related to energy drinks have led to growing concerns on the safety of energy drink consumption. Objective: This study aimed to investigate the effects of chronic daily consumption of energy drinks on cardiometabolic endpoints, including blood pressure, ECG parameters, blood glucose, lipid parameters, weight, body mass index, and body fat consumption in a healthy adult population. Methods: The study was an unblinded, non-randomized, proof-of-concept, prospective study that evaluated the effects of chronic consumption of energy drinks in a healthy, adult population. Each participant consumed two 16 oz. cans of a commercially available ED daily in two divided doses for 28 days. Investigators met with the participants on days 0, 7, 14, 21, and 28 of the study. Participants were required to complete a standardized log of consumption, which include date and time of consumption, as well an estimate of additional caffeine intake. The following measurements were taken for each participant over the 28 days: blood pressure (BP), electrocardiogram (ECG), fasting blood glucose (FBG), fasting lipid panel (FLP), weight, BMI, body fat composition, and serum creatinine. Adverse side effects related to energy drink consumption were also recorded. Wilcoxan signed-rank tests were used to compare and detect statistical difference between endpoints for baseline and maximum post-dose systolic BP, QTc, FBG, FLP, weight, BMI, body fat, and serum creatinine values. Results: Of the 14 total participants that were enrolled in the study, 12 participants completed the full study protocol for 28 days. Maximum measurements in peripheral systolic blood pressure (pSBP), peripheral diastolic blood pressure (pDBP), central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), and heart rate (HR) were found to be statistically significantly higher than baseline measurements (all P < 0.05). The maximum change from baseline to maximum pSBP, pDBP, cSBP, and cDBP were 9±7 mmHg, 5±4 mmHg, 7±6 mmHg, 5±4 mmHg, respectively. Maximum QTcB and QTcF intervals were also statistically higher than baseline (both P = 0.001). The maximum change from baseline in QTcB and QTcF interval were 19±13 ms and 15±10 ms, respectively. Both QTcB and QTcF intervals on days 7, 14, 21, and 28 were all found to be significantly higher than baseline (all P Results: Of the 14 total participants that were enrolled in the study, 12 participants completed the full study protocol for 28 days. Maximum measurements in peripheral systolic blood pressure (pSBP), peripheral diastolic blood pressure (pDBP), central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), and heart rate (HR) were found to be statistically significantly higher than baseline measurements (all P < 0.05). The maximum change from baseline to maximum pSBP, pDBP, cSBP, and cDBP were 9±7 mmHg, 5±4 mmHg, 7±6 mmHg, 5±4 mmHg, respectively. Maximum QTcB and QTcF intervals were also statistically higher than baseline (both P = 0.001). The maximum change from baseline in QTcB and QTcF interval were 19±13 ms and 15±10 ms, respectively. Both QTcB and QTcF intervals on days 7, 14, 21, and 28 were all found to be significantly higher than baseline (all P

Philosophiae Doctor - PhD / Background Overweight/obesity is a risk factor for non-communicable diseases such as cardiovascular diseases, diabetes, and some cancers. Obesity in childhood is known to predict later obesity in adolescence and adulthood. Understanding the factors associated with overweight/obesity among children may present an opportunity for timely and appropriate interventions in the African setting. Aims 1. To describe the prevalence of overweight and obesity and associated factors among school children aged 8 - 11 years in primary schools in Adentan Municipality, Ghana. 2. To review the available literature on childhood obesity in the African context to provide evidence to support the design and improvement of appropriate school-based interventions for the prevention and control of overweight/obesity among African learners. Methodology This was a cross-sectional study design which was conducted in two phases. In Phase I, the available literature on the prevalence of overweight and obesity among learners, school-based interventions to promote healthy nutrition and physical activity (PA), and weight status, and key policy interventions at the national levels to provide supportive environments in the African context was reviewed and synthesised. In Phase II, interviews were conducted to collect individual and family data from 543 learners in 14 schools to assess family socio-demographics characteristics, dietary, PA, and sedentary behaviours, and sleep duration. Body weight, height, and waist circumference were measured. Data on perceived school neighbourhood/ community, school food, and PA environments were collected from school heads/administrators. A sub-sample of 183 children participated in the assessment of body fat using the deuterium dilution method. Multivariable and logistic regressions, multilevel logistic regressions, and multilevel linear regression models were used to examine the associations among child, family, and school level explanatory variables, and overweight/obesity, abdominal obesity and body mass index (BMI). Results The reviews revealed the following: (i) The pooled overweight and obesity estimates across Africa were: (10.5% 95% CI: 7.1-14.3) and 6.1% (3.4-9.7) by World Health Organization; 9.5% (6.5-13.0) and 4.0% (2.5-5.9) by International Obesity Task Force; and 11.5% (9.6-13.4) and 6.9% (5.0-9.0) by Centers for Disease Control and Prevention, respectively and differed for overweight (p=0.0027) and obesity (p<0.0001) by the criteria. The estimates were mostly higher in urban, and private schools, but generally similar by gender, major geographic regions, publication year, and sample size; (ii) Although inconsistent, school-based interventions broadly improved weight status and some energy-balance related health behaviours of African learners; (iii) On applying the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, key interventions on unhealthy diets and physical inactivity targeted the school, family and community settings, and macro environments, and broadly aligned with global recommendations. In the school-based study, 16.4% of Ghanaian learners were overweight (9.2%) or obese (7.2%), with the prevalence being significantly higher in children from middle- to high socio-economic status (SES) households, and private schools. In multivariable regression models, attending private school (AOR = 2.44, 1.39–4.29) and excessive television viewing (AOR = 1.72, 1.05–2.82) significantly increased the likelihood of overweight/obesity, whereas adequate sleep (AOR = 0.53, 0.31–0.88), and active transport to and from school (AOR = 0.51, 0.31 – 0.82) decreased the odds. Using deuterium-derived percent body fat as criterion method, the published BMI criteria was found to be highly specific but with moderate sensitivity for diagnosing obesity among Ghanaian children. Moreover, the BMI-for-age z-scores that optimise sensitivity, specificity, and predictive values for obesity were lower than the published cut-off points. Multilevel logistic and linear regression analyses revealed that the school contextual level contributed 30.0%, 20.6% and 19.7% of the total variance observed in overweight (including obesity), abdominal obesity, and BMI respectively. Availability of school cafeteria (β = 1.83, p = 0.017) and shops (β = 2.34, p = 0.001), healthy foods (β = 0.77, p = 0.046), less healthy foods (β = 0.38, p = 0.048), child age (β = 0.40, p = 0.008), school-level SES (β = 1.02, p < 0.0001), private school attendance (β = -1.80, p = 0.006), and after-school recreational facilities (β = 0.89, p < 0.0001) were all associated with BMI. In the mutually adjusted models for all significant predictors, school-level SES, healthy foods, after-school recreational facilities, and PA facility index remained significant predictors of overweight and or abdominal obesity. Conclusions The prevalence of overweight/obesity is significantly higher in urban children attending private or high SES schools, regardless of criteria used to define obesity. A number of individual, family, and school-level factors significantly predicted weight status of school children in Ghana. Given that many African governments have initiated policy interventions aiming to provide supportive environments for healthy choices, it is recommended that resources are made readily available for the implementation of these interventions across the home, school and community.

Kardiovaskulära sjukdomar är den vanligaste dödsorsaken i världen. Hjärtrehabilitering är en omtumlande situation för de drabbade. Att som vårdpersonal ha insikt om patienters erfarenheter av hjärtrehabilitering efter kardiovaskulär sjukdom är betydelsefullt för att kunna tillgodose en god och personcentrerad omvårdnad. Den strukturerade litteraturstudiens syfte var att belysa patienters erfarenheter av hjärtrehabilitering vid kardiovaskulära sjukdomar. Studiens resultat grundades på 11 vetenskapliga artiklar med kvalitativ ansats. Tre huvudteman framkom i resultatet; Erfarenhet av stöd, Erfarenhet av information och Erfarenhet av fysisk aktivitet. I resultatet framkom det att peer support har en betydande roll i hjärtrehabiliteringen, både ur ett socialt- och psykiskt perspektiv. Det fanns en osäkerhet kring fysisk aktivitet efter insjuknande, framförallt vid kroppsliga reaktioner som påminde om insjuknandet. Den stora mängd information som gavs i den akuta fasen ansågs vara svår att absorbera. Den erhållna informationen ansågs vara mer generell och inte skräddarsydd efter patientens egna hinder och möjligheter. Det finns ett behov av vidare utbildning om patienters erfarenheter hos vårdpersonal för att kunna applicera en god och personcentrerad omvårdnad till patientgruppen. / Cardiovascular diseases is the most common cause of death in the world. Cardiac rehabilitation is an difficult time for the affected. Health professionals need insight in patients experiences of cardiac rehabilitation to be able to provide good and person centered care. The aim of the structured literature study was to explore patients affected by cardiovascular diseases experiences of cardiac rehabilitation. the result of the study was based on 11 scientific articles with a qualitative approach. Three main themes emerged: Experiences of support, Experiences of information and Experiences of physical activity. The result illustrate the significance of peer support in cardiac rehabilitation for participants, both social and psychological. Participants experienced insecurity regarding physical activity, especially because it reminded them of their negative experiences of chest pain and increased heart rate.The information received at the acute phase was hard for the patients to absorb. The information was perceived as general by the patients and not customized for their specific situation. A need for further education about patients experiences for health professionals is seen for them to be able to provide a good and person centered care

Background: Cardiovascular disease (CVD) are some of the most common illnesses globally. It has been proven that there is a connection between CVD and sexual concerns. Patients sexual health is a fundamental factor and should be provided with proper care from a nursing perspective. Aim: To describe factors that influence the nurse’s work on sexual health for patients with cardiovascular disease. Method: A quantitative literature review with an inductive approach was implemented and based on 13 scientific articles. Results: The analysis resulted in two main themes; “The nurses’ perspective affects” and “Organizational obstacles affects” that are followed by six subthemes; “Attitudes, beliefs and emotions”, “Experience, knowledge and education”, “Responsibility”, “Patients’ gender and age”, “Guidelines and routines” and lastly “Lack of time and prioritizing”. Conclusion: Based on nurses globally, there should be a development of the area sexual health among patients with CVD. There are several obstacles that persuades the area into being secluded. Negative attitudes, incompetence, prejudice and organizational barriers are some of the common mentioned difficulties. / Bakgrund: Kardiovaskulära sjukdomar är några av de vanligaste sjukdomarna runtom i världen. Det är påvisat att det finns en koppling mellan kardiovaskulära sjukdomar och sexuell ohälsa. Den sexuella hälsan är en väsentlig del av individens liv och bör behandlas med respekt utifrån sjuksköterskans ansvarsområde. Syfte: Att beskriva faktorer som påverkar sjuksköterskans arbete med sexuell hälsa för patienter med kardiovaskulär sjukdom. Metod: En kvantitativ litteraturöversikt med induktiv ansats sammanställdes utifrån 13 vetenskapliga artiklar. Resultat: Analysen resulterade i två huvudteman; “Sjuksköterskans perspektiv påverkar” och “Organisatoriska hinder påverkar” som följs av sex subteman; ”Attityder, värderingar och känslor”, “Erfarenhet, kunskap och utbildning”, “Ansvar”, “Patientens ålder och kön”, “Riktlinjer och rutiner” samt “Tidsbrist och prioritering”. Slutsats: Baserat på sjuksköterskor globalt, bör det ske en utveckling kring området sexuell hälsa hos patienter med kardiovaskulära sjukdomar. Det finns flera hinder i arbetet som leder till att området hamnat i skymundan. Negativa attityder, inkompetens, fördomar och organisationsrelaterade faktorer är några av de barriärer som framkommer bland sjuksköterskor.

Rheumatoid arthritis (RA) is a chronic inflammatory condition of unknown etiology for which there is no cure. It is one of the most disabling diseases and affects about 1% of the world‟s population. Recent developments in the field of molecular biology have resulted in the production of new drugs used in the treatment RA. Despite these advancements, achieving optimal disease control and prevention of disease progression is still difficult in many patients, leading to a continued search for treatment methods that will improve patient outcomes. Non-biologic forms of treatment that are still being investigated include the use of statins as an adjunct therapy due to their reported antiinflammatory effects. Some studies have shown that the use of statins in patients with RA help in reducing disease activity and swollen joint count in addition to lowering cardiovascular risk. As evidence continue to increase on the anti-inflammatory effect of statins, researchers have started investigating possible benefits that may result from the use of statins in treatment of RA, a chronic disease marked by high levels of systemic and local inflammation. This study investigated the anti-inflammatory effect of statins in rheumatoid arthritis patients with associated risks for cardiovascular disease, using simvastatin as the investigational product. Patients with moderately active RA despite being on maximum disease-modifying antirheumatic drugs (DMARDs) therapy and having associated risks for cardiovascular disease were screened for the study. Eligible patients were randomized into two groups, 1 and 2. Patients in group 1 received simvastatin treatment (20mg/day) for a period of 3 months in addition to their usual DMARDs after which they stopped simvastatin treatment and were followed up for a further 3 months off simvastatin treatment. Those in group 2 were allowed to continue on their usual DMARDs without simvastatin treatment for the first 3 months of the study after which they received 20mg/day simvastatin for a period of 3 months in addition to their usual DMARDs. The anti-inflammatory effect of simvastatin was assessed by monitoring the inflammatory variables; erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) and disease activity in the two groups at screening, at the crossover point and at end of the study. Disease activity was significantly reduced with simvastatin treatment in the two groups. The mean change in disease activity score with simvastatin treatment was 1.30 (p = 0.01) in group 1 and 1.74 (p = 0.01) in group 2. ESR was significantly reduced with simvastatin treatment in group 1 with a mean change of 19.0 (p = 0.005) and marginally reduced in group 2 with a mean change 26.0 (p = 0.09). There was no significant change in CRP with simvastatin treatment in the two groups. The mean change in CRP with simvastatin treatment was 7.0 (p = 0.24) in group 1 and 14.7 (p =0.20) in group 2. All the patients benefited from the lipid-lowering effect of simvastatin. These findings suggest that statins may have mild anti-inflammatory properties and will be good adjuvant in RA patients with associated risks for cardiovascular disease. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Pharmacology / unrestricted