Aim: - This research project was a community based intervention study of the impact of increased access to exercise opportunities and kangaroo meat on diabetes and cardiovascular disease risk factors in the Aboriginal community of Woorabinda. The exercise and dietary interventions were based on principles of community development including: training of community members to conduct exercise programmes; supply of exercise equipment; training of community members to harvest kangaroos; establishment of a butcher’s apprenticeship; and establishment of the kangaroo meat processing in the community. Methodology: - The impact of the kangaroo meat and exercise interventions on diabetes and cardiovascular disease risk factors was determined by pre- and post-intervention assessment. Pre-intervention baseline data was obtained by community clinical assessment, household meat surveys,and community exercise surveys. The post-intervention assessment was a repeat of modified meat and exercise surveys. A post-intervention community clinical assessment was not conducted due to unresolved difficulties encountered in conducting the research project. The Study Population: - The study population for the community clinical assessment and exercise surveys were volunteer adults B 15 years of age. Approximately one third of the adult population participated in the community clinical screening, 29% in the pre-intervention exercise survey, and 20.2% in the post-intervention exercise survey. The meat surveys were conducted on a household basis. There was 84% household participation in the pre-intervention meat survey and 44.3% postintervention. Findings and Discussion: - It was found that the exercise and kangaroo meat interventions did not follow the planned linear trajectory but rather proceeded in an episodic and incremental manner. The community clinical assessment found a high prevalence of diabetes (18.6%; 95% CI, 13.04 – 24.36%) and impaired glucose tolerance (13.2%; 95% CI, 8.3 – 18.1%) comparable to that found in other Indigenous communities. There was a low prevalence of hypercholesterolaemia (30.9%; 95% CI, 24.2 – 37.6%) and hypertension (19.7%; 95% CI, 13.9 – 25.5%). High prevalence for other diabetes and cardiovascular disease risk factors were found including: current smoking (48.3%;95% CI, 40.95 – 55.64%); and obesity as measured by body mass index (35%; 95% CI, 27.9 – 42%), waist circumference (83.7%; 95% CI, 76.5 - 90.86% in women; and 55.5%; 95% CI, 43.9 – 61.1% in men), and waist / hip ratio (75.5%; 95% CI, 66.9 – 84% in women; and 57.1%; 95% CI,46 – 68% in men). A high prevalence of abnormal ACR was found: the prevalence ACR 3.4 – 33.9g/mol was 11.7% (95% CI, -ve2.39 – 25.7%), and the prevalence ACR B 34g/mol was 7.6% (95% CI, -ve6.8 – 22%). The prevalence of proteinuria was 67.8% (95% CI, 59.3 – 76.3%). It was found that this high prevalence of renal disease indicators coincided with an escalating incidence of end-stage renal disease in the community. Analysis of the kangaroo meat surveys found evidence of positive dietary change including reduction in the amount of fat used to cook non-kangaroo meats, and a positive shift in stage of change for cooking for family health. In regard to kangaroo meat however it was found that the most common cooking method was unfavourable with the nutritional value of the meat being compromised by a significantly higher prevalence of frying than other meats. It was further found that this method for cooking kangaroo meat was unchanged by the research intervention. Evidence of positive change was also seen in analysis of the exercise surveys. It was found that at baseline, and post-intervention, that the majority of adults in the community met the recommended duration for exercise per week through activities of daily living. There was a positive shift in stage of change for exercise behaviour with a significant movement beyond the ‘precontemplation' towards the ‘action’ and ‘maintenance’ stages of change. This positive shift in thinking about exercise corresponded with a significant increase in the proportion of people exercising specifically for health and fitness. Conclusion: - Though not all the proposed intervention objectives were accomplished the research project contributed to furthering community aspirations and capacity. The community clinical assessment provided a useful overview of the health status of Woorabinda, and an opportunity of a thorough health check for community members. The community clinical assessment drew attention to future projections of disease in Woorabinda and prompted a concentrated health system response. Evidence of positive change in regard to meat consumption and exercise behaviours were found, changes however were slow and uneven. Improved infrastructure was important to increasing community capacity for kangaroo meat supply and exercise, but essential to the sustainability of community initiatives is skilled people, and on-going maintenance and support. The findings of this study indicate that simplistic assumptions around the health benefits of ‘traditional’ diet need to be reconsidered cognisant that communities such as Woorabinda are cultures in transition. Whilst limitations in the methodology require the findings to be considered with caution, this study provides useful evidence for planning future health education and health promotion initiatives for Woorabinda.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A HipertensÃo Arterial SistÃmica à uma das doenÃas de maior importÃncia epidemio-lÃgica no Brasil. Dentre as principais causas de morte decorrentes da hipertensÃo, as complicaÃÃes cardiovasculares apresentam grande relevÃncia devido à sua fre-qÃÃncia e gravidade. Estudos anteriormente realizados em vÃrios paÃses demonstra-ram que a prestaÃÃo da AtenÃÃo FarmacÃutica (AF) proporcionou reduÃÃo da taxa de risco cardiovascular (%RCV) em pacientes hipertensos. Tendo em vista esse fa-to, foi decidido averiguar e demonstrar, atravÃs de um ensaio clÃnico randomizado, a influÃncia da prestaÃÃo da AF na %RCV de pacientes hipertensos atendidos pela farmÃcia da Unidade BÃsica de SaÃde Dr. AnastÃcio MagalhÃes. Com esse intuito, foram formados dois grupos de estudo, um Grupo IntervenÃÃo (GI), no qual os parti-cipantes foram submetidos a um Acompanhamento FarmacoterapÃutico (AFT) de nove meses de duraÃÃo segundo o MÃtodo DÃder, e um Grupo Controle (GC), no qual os participantes receberam a assistÃncia tradicional e foram monitorados duran-te o mesmo perÃodo. Ao inÃcio, meio e fim do estudo, foram registrados exames labo-ratoriais e nÃveis pressÃricos dos participantes, indicadores necessÃrios para o cÃl-culo da %RCV, realizado posteriormente atravÃs da Escala de Framingham. Foram incluÃdos 68 pacientes, com 56 deles tendo completado o estudo. No fim, foram ana-lisadas as diferenÃas entre os resultados obtidos, para cada grupo, durante o estu-do. ApÃs anÃlise estatÃstica, observou-se que houve reduÃÃo estatisticamente signi-ficante nas %RCV e nos nÃveis de pressÃo arterial sistÃlica (PAS) de 26,9% e de 4,5% do valor inicial, respectivamente no GI, enquanto que no GC nÃo houve mu-danÃa significante. AlÃm disso, observou-se tendÃncia à resultados positivos nos demais indicadores clÃnicos dos participantes da pesquisa, sendo mais acentuado no GI. TambÃm foi analisada, durante o estudo, a incidÃncia de Problemas Relaciona-dos a Medicamentos (PRM), tendo sido identificados e classificados 151 casos, ha-vendo predominÃncia do PRM 04, 03 e 05, com freqÃÃncia de 31,8, 28,5 e 21,2%, respectivamente. A maioria foi considerada real (65,6%), sendo 28,3% deles classifi-cados como PRM 04, tambÃm sendo o mais freqÃente dentre os considerados po-tenciais (34,4%), com freqÃÃncia de 38,5% dos potenciais. Foram realizadas 124 intervenÃÃes farmacÃuticas a fim de resolver ou prevenir os PRM, sendo, a mais fre-qÃente, o aprazamento das tomadas dos medicamentos (52,4%). ApÃs a realizaÃÃo das intervenÃÃes, 89,2% das que tiveram seu desfecho avaliado resultaram em so-luÃÃo/prevenÃÃo dos problemas. Ao fim do trabalho, pÃde-se inferir que a inclusÃo do serviÃo de AF na assistÃncia ao paciente hipertenso foi mais eficaz na reduÃÃo da %RCV e nÃveis de PAS, principalmente, em comparaÃÃo à assistÃncia tradicional oferecida. Por fim, enfatiza-se a importÃncia da prestaÃÃo da AF a pacientes hiper-tensos em relaÃÃo à melhora do quadro de saÃde atual e da prevenÃÃo de compli-caÃÃes cardiovasculares futuras, bem como de problemas relacionados à terapia normalmente nÃo detectados ou negligenciados. / The Systemic Arterial Hypertension is one of the most important diseases in Brazil regarding epidemiology. Among the major causes for death in individuals with hyper-tension the cardiovascular complications show great relevance due to their severity and frequency. Prior studies from several countries demonstrated that, through the Pharmaceutical Care (PC) practice, there was a decrease in the cardiovascular risk rate (%CVR) of patients with hypertension. Up to that, it was decided to investigate and demonstrate, by means of a randomized clinical assay, the influence of the PC practice on the %CVR from hypertensive patients attended by the pharmacy service from the Primary Care Unit Dr. AnastÃcio MagalhÃes. Aiming this, two study groups were formed, an Intervention Group (IG), in which the participants went through a 9 month Pharmacotherapeutic Follow-up (PTF) according to the DÃder Method, and a Control Group (CG), in which the participants received traditional care and were mo-nitored during the same period of time. At the beginning, middle and end of the study, laboratorial exams and blood pressure levels from the participants were registered. These were necessary for the %CVR assessment which was performed after using the Framingham Scale. Were included 68 patients and 56 of them completed the study. At the end, the differences between results from each group were analyzed. After the statistical analysis, it was observed a statistically significant decrease on the %CVR and systolic blood pressure level from the IG patients, equivalent to 26.9% and 4.5% from the baseline, respectively. The CG didnât show any significant differ-ence. Beside this, it was observed a tendency for positive results on the other clinic indicators from the participants, which was greater on the IG. The incidence of the Drug Related Problems (DRP) was determined, and 151 DRP were identified and classified. The DRP 04, 03 and 05 were the most predominant with frequency of 31.8% 28.5% and 21.2%, respectively. The majority of the DRP was considered the real type (65.6%), with 28.3% of them classified as DRP 04. Among the potential type (34.4%) the most common was also the DRP 04, representing 38.5% of this group. Several pharmaceutical interventions were taken in order to solve or prevent the identified DRP (124 total). The most common intervention made was the teaching about the right time to take the drugs (52.4%). After the developing of the interven-tions, 89.2% of the problems were solved/prevented. At the end, we were able to conclude that the inclusion of the PC service on the hypertensive patient health care was more effective at decreasing %CVR and SBP level, especially, in comparison to the traditional health care offered. Finally, we emphasize the importance of the PC practice oriented to patients with hypertension as a good strategy to improve current health status and the future cardiovascular complications prevention as well as the prevention of the therapy related problems which are normally undetected or ne-glected.

O crescente aumento no número de idosos na população mundial aumenta a preocupação, pelos profissionais da saúde, com relação à prevenção e manejo de doenças associadas ao envelhecimento. A demência, uma das doenças mais comuns e mais devastadoras em idosos, incide em 4,6 milhões de casos em todo o mundo e manifesta-se em idosos acima de 65 anos e principalmente acima de 85 anos de idade. Os dois tipos mais comuns de demência é a doença de Alzheimer (DA), seguida da demência vascular (DV), as quais partilham muitas características comuns patológicas, sintomáticas e neuroquímicas. Entre os principais fatores de risco para demência estão a idade, baixa escolaridade, hipertensão (HAS), cardiopatias, dislipidemias (DLP), sobrepeso/obesidade, genética, tabagismo, etilismo, acidente vascular cerebral (AVC) e o diabetes. Diante da sobreposição de causas e fatores de risco para as demências mais comuns, a identificação das alterações cognitivas associada à identificação de doenças cardiovasculares, seria extremamente importante. A associação dos principais fatores de risco cardiovasculares (FRCV) com a idade e o tipo das demências foi avaliada neste estudo, em 2 grupos de idosos diabéticos com DA (n=47) e demência mista ou vascular (n=49). Os resultados foram obtidos pelo teste t-student, qui-quadrado e apresentados os valores de Odds Ratio Bruto e Ajustado. O controle glicêmico não apresentou diferença entre os indivíduos das duas demências nem relação com a idade do caso novo. A presença de hipertensão e dislipidemia foram os principais FRCV encontrados. Estes e outros fatores como obesidade, tabagismo e fibrilação atrial não demonstraram associação com a idade e o tipo da demência. O AVC e o gênero masculino tiveram associação com a demência vascular. A presença marcante de FRCV além do diabetes nos dois tipos principais de demência, reforça a hipótese de sobreposição de causas e das formas de manifestação das demências e a dificuldade em identificá-las. / The increase in the number of elderly in the world population increases concern by health professionals, regarding prevention and management of diseases associated with aging. Dementia , one of the most common and devastating diseases in the elderly, falls at 4.6 million cases worldwide and is manifested in the elderly over 65 and mostly above 85 years of age. The two most common types of dementia is Alzheimer\'s disease (AD), followed by vascular dementia ( VD), which share many common pathological features, symptomatic and neurochemical. Among the main risk factors for dementia are age, low education, hypertension( HBP) , heart disease , dyslipidemia( DLP ) , overweight / obesity, genetics, smoking, alcoholism, cerebral vascular accidents (CVA) and diabetes. Given the overlapping causes and risk factors for the most common dementia, identification of cognitive changes associated with identification of cardiovascular diseases would be extremely important. The association of major cardiovascular risk factors (CVRF) with age and type of dementia was assessed in this study in two groups of elderly diabetic patients with AD ( n = 47 ) and mixed or vascular ( n = 49 ) dementia. The results were obtained by Student\'s t test , chi-square values and presented Adjusted Odds Ratio . Glycemic control did not differ between individuals of the two dementias or relationship with the age of the diagnosis. The presence of hypertension and dyslipidemia were the main CVRF found. These and other factors such as obesity, smoking and atrial fibrillation showed no association with age and type of dementia . The CVA and male gender were associated with vascular dementia. The striking presence of CVRF besides diabetes in the two main types of dementia reinforces the hypothesis of overlapping causes and manifestations of dementia and the difficulty in identifying them.

Purpose: The purposes of this study were to translate current knowledge regarding cardiovascular risk factors, screening, and prevention to a disparate population of women and to ascertain the cardiovascular health status and risk factors in a sample of minority and underserved Appalachian women.Data sources: Demographic data were collected from a voluntary sample of women from a disparate population living in Appalachian Tennessee. A coronary risk profile recorded family health history, personal health history, and lifestyle habits affecting risk for cardiovascular disease. Physiologic measurements included body mass index, blood pressure, fasting glucose, cholesterol levels, ankle brachial index, and carotid artery stenosis.Conclusions: Women in Appalachia Tennessee from a disparate population have high risks for heart disease and stroke. This is a critical time to address any modifiable risk factors and aggressively treat underlying cardiovascular diseases such as hypertension and hypercholesterolemia.Implications for practice: Nurse practitioners (NPs) often provide primary care to women who may not be aware of their cardiovascular risks or actual disease. NPs can ensure that their practice incorporates primary and secondary cardiovascular prevention through screening, individual health education, and aggressive evidence-based treatment plans for women.

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Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2014-10-14T12:13:52Z No. of bitstreams: 2 Dissertacao - Erika Pereira de Sousa e Silva - Ciencias da Saude.pdf: 2543710 bytes, checksum: b2724690edf58def58456f7de1f5455d (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-10-17T20:40:14Z (GMT) No. of bitstreams: 2 Dissertacao - Erika Pereira de Sousa e Silva - Ciencias da Saude.pdf: 2543710 bytes, checksum: b2724690edf58def58456f7de1f5455d (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-17T20:40:14Z (GMT). No. of bitstreams: 2 Dissertacao - Erika Pereira de Sousa e Silva - Ciencias da Saude.pdf: 2543710 bytes, checksum: b2724690edf58def58456f7de1f5455d (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-12-12 / OBJECTIVES: To investigate the prevalence of risk factors for cardiovascular disease (CVD), estimate the cardiovascular risk, acoording to the Framingham and Systematic Coronary Risk Evaluation (SCORE) risk models, and evaluate the agreement between both risk models in middleaged breast cancer survivors (BCS). METHODS: A cross-sectional study was conducted between august 2002 and june 2003, including 67 breast cancer survivors. Participants were recruited from the Menopause and Breast Cancer Outpatient Facilities ( Universidade Estadual de Campinas - UNICAMP), ranging in age from 45 – 65 years, who underwent complete oncologic treatment and were not users of hormone replacement therapy, tamoxifen or aromatase inhibitors in the last six months. Evaluated risk factors for CVD like us: dyslipidemia, obesity, arterial hypertension, diabetes and smoking, and risk of CVD. The risk of CVD was estimated according to the Framingham and SCORE models. The risk of CVD was classified as low ( < 10%) , moderate ( 10 -20%) and high ( > 20%), according to Framingham function, and low ( < 3%), moderate ( ≥ 3% and < 5%) and high ( ≥ 5%), according to SCORE model. A descriptive analysis with absolute and relative frequencies, means and standard deviations (SD) was carried out. To investigate agreement between both risk models, the kappa coefficient was calculated with is respective 95% confidence interval (CI). RESULTS: The mean age of the participants was 53.2± 6.0 years and body mass index (BMI) was 27.8 ± 5.7 Kg/m². Obesity and arterial hypertension occurred in 27% and 34% of participants, respectively. Ninety percent of participants had at least one type of dyslipidemia. The most prevalent dyslipidemias were: high total cholesterol levels (≥ 200 mg/dl) in 70%, high LDL-C (≥ 130 mg/dl) in 51% and high non-HDL-C (≥ 160 mg/dl) in 48% of the participants. The risk of CVD, according to the Framingham model, was classified as low (45%), moderate (33%) and high (22%); and low (96%) and moderate (4%) according to the SCORE equation. The agreement between Framingham and SCORE models was poor (kappa coefficient of 0.122 with 95% CI: 0.013 to 0.231). CONCLUSIONS: The prevalence of risk factors for cardiovascular disease was high. Dyslipidemia was common in this cohort. The majority of participants had low to moderate cardiovascular risk. The agreement between both risk models was poor. These data indicate that the prevention of CVD in middle-aged breast cancer survivors is necessary and close attention should be focused on adequate control of serum lipid levels. KEYWORDS: breast cancer, dyslipidemia, disease cardiovascular, score of cardiovascular risk. / OBJETIVOS: Investigar a prevalência de fatores de risco de doença cardiovascular (DCV), estimar o risco cardiovascular de acordo com os modelos de Framingham e Systematic Coronary Risk Evaluation (SCORE), e avaliar a concordância entre esses dois modelos de risco em mulheres de meia-idade com câncer de mama. METODOLOGIA: Conduziu-se estudo de corte transversal entre agosto de 2002 a julho de 2003, incluindo 67 mulheres do Ambulatório de Menopausa e Ambulatório de Oncologia Mamária da Universidade Estadual de Campinas (UNICAMP), com idade entre 45-65 anos, não usuárias de terapia hormonal, tamoxifeno ou inibidores de aromatase nos últimos seis meses. Avaliou-se a prevalência de fatores de risco cardiovascular tais como: dislipidemia, diabetes, obesidade, tabagismo e hipertensão arterial e o risco de DCV. O risco de DCV foi calculado de acordo com os modelos de Framingham e SCORE. O risco de DCV foi classificado em baixo (<10%), moderado (10-20%) e alto (>20%) de acordo com a função de Framingham, e em baixo (< 3%), moderado (≥3% e < 5%) e alto (≥ 5%), segundo o modelo SCORE. Realizou-se análise descritiva dos dados com cálculo das frequências absoluta e relativa, média e desvio padrão. Para investigar a concordância entre os dois modelos de risco cadiovascular calculou-se o coeficiente kappa (k) com seu respectivo intervalo de confiança (IC) de 95%. RESULTADOS: A média de idade das participantes foi de 53,2±6,04 anos e do índice de massa corpórea (IMC) de 27,8±5,7Kg/m². A prevalência de obesidade e hipertensão foi 27% e 34%, respectivamente. Noventa porcento das participantesapresentaram pelo menos um tipo de dislipidemia. As anormalidades mais frequentes no perfil lipídico foram: colesterol total elevado (≥200 mg/dL) em 70%, alto LDL-C (≥ 130 mg/dL) em 51% e alto não-HDL-C ( (≥ 160mg/dL) em 48% das participantes. O risco de DCV, segundo o modelo de Framingham, foi classificado como baixo (45%), moderado (33%) e alto (22%), e, segundo a equação SCORE, como baixo (96%) e moderado (4%). A concordância entre os modelos Framingham e SCORE foi ruim ( kappa: 0,122; IC 95%: 0,013-0,231), considerando populações de alto risco de DCV. CONCLUSÕES: A prevalência de fatores de risco de DCV foi elevada. Dislipidemia foi comum nessa coorte. A maior parte das participantes apresentou risco baixo a moderado de DCV. A concordância entre os dois modelos de risco foi ruim. Esses dados indicam a necessidade de incluir na rotina de seguimento de mulheres com câncer de mama a avaliação do perfil lipídico e do risco de DCV, atentando-se para o adequado controle dos níveis séricos de lipídios. PALAVRAS-CHAVES: câncer de mama, dislipidemia, doença cardiovascular, modelos de risco cardiovascular.

A prática regular de exercícios físicos supervisionados tem sido recomendada devido a seus benefícios na saúde. Porém, a supervisão limita o número de praticantes. Uma alternativa para a promoção da saúde pública é o treinamento de caminhada prescrita de forma individualizada e realizada sem supervisão, mas seus efeitos foram pouco estudados em uma situação real. Além disso, a possível influência do nível inicial de atividade física (AF) e de aptidão física (ApF) sobre os efeitos desse treinamento não é conhecida. Assim, este estudo investigou na situação real do Projeto Exercício e Coração: 1) a relação do nível de AF e de ApF com o risco cardiovascular avaliado de forma isolada e global; 2) o efeito do treinamento de caminhada prescrita de forma individualizada e executada sem supervisão sobre esse risco cardiovascular; e 3) a influência do nível inicial de AF e de ApF nas respostas ao treinamento. O risco cardiovascular isolado foi avaliado pela medida do índice de massa corporal (IMC), circunferência da cintura (CC), glicemia, colesterol total e pressão arterial (PA) sistólica e diastólica, enquanto que o risco global foi calculado pelo escore Z (EZ, somatório do escore z de todos os fatores isolados). O nível de AF foi avaliado pelos minutos semanais de AF de lazer e a ApF pelo resultado do teste de marcha estacionária dividido em quartis (Q1 = pior ApF e Q4 = melhor ApF). O IMC e a CC foram menores no grupo muito ativo (MA, +300 min/sem AF) do que no inativo (I, sem nenhuma AF de lazer), enquanto que o EZ foi menor no grupo MA que no I e no ativo (A, 150 a 299 min/sem de AF). Além disso, o IMC e a glicemia foram menores no Q4 que no Q1, a CC foi menor no Q2, Q3 e Q4 que no Q1, e o EZ foi menor no Q3 e Q4 que no Q1 e no Q4 que no Q2. O treinamento de caminhada diminuiu significantemente o IMC, CC, PA sistólica e EZ na amostra total. Além disso, ele reduziu significantemente todos os indicadores de risco específicos em subamostras com valores alterados, com exceção da glicemia. Para finalizar, o efeito do treinamento de caminhada no risco cardiovascular isolado e global foi semelhante nos indivíduos MA e I e nos indivíduos do Q1 e Q4 de ApF. Assim, é possível concluir que: 1) em participantes de uma situação real de promoção de AF para a saúde há associação inversa entre os níveis de AF e de ApF com marcadores de obesidade, glicemia (só ApF) e com o risco cardiovascular global; 2) o treinamento de caminhada prescrita de forma individual e executada sem supervisão em uma situação real reduz alguns fatores de risco isolados, principalmente quando eles estão alterados, e diminui o risco cardiovascular global; e 3) nem o nível inicial de AF nem o de ApF afetam os efeitos de um treinamento de caminhada prescrito de forma individualizada e executado sem supervisão em uma situação real sobre o risco cardiovascular / The regular practice of supervised physical exercise has been recommended due to its benefits on health. However, supervision limits the number of practitioners. An interesting alternative for the promotion of public health is the walking training prescribed individually and executed without supervision, however its effects have been poorly investigated under real situations. In addition, the possible influence of the initial level of physical activity (PA) and physical fitness (PF) on these effects are unknown. Thus, this study investigated under a real situation of the \"Exercise and Heart Project\": 1) the relationship between level of PA and PF with cardiovascular risk evaluated by isolated factors and globally; 2) the effects of walking training prescribed individually and executed without supervision on cardiovascular risk; and 3) the influence of initial level of PA and PF on the responses to walking training. Isolated cardiovascular risk was analyzed by the measurement of body mass index (BMI), waist circumference (WC), blood glucose, total cholesterol, and systolic and diastolic blood pressure (BP), while global risk was calculated by Z score (ZS, sum of Z score of all the factors). PA level was evaluated by weekly minutes of leisure time PA, and PF was evaluated by the results in the 2 minutes step test divided in quartiles (Q1 being the lowest PF and Q4 the highest PF). BMI and WC were significantly lower in the very active (VA, +300 min/week of PA) than in the inactive group (I, no leisure time PA), while ZS was lower in the VA than in the I and active groups (A, between 150 and 299 min/week of PA). In addition, BMI and blood glucose was significantly lower in Q4 than Q1, WC was lower in Q2, Q3 and Q4 than in Q1, and ZS was lower in Q3 and Q4 than Q1 and in Q4 than Q2. Walking training significantly decreased BMI, WC, systolic BP and ZS in the total sample. Also, it decreased all specific risk factors, with exception of blood glucose in subgroups with altered values. Finally, the effects of walking training on isolated risk factors and on ZS were similar in VA and I groups as well as in Q1 and Q4 groups. Thus, it is possible to conclude that: 1) in participants of a real intervention for health promotion, there is an inverse association between the PA and PF levels with the obesity markers, blood glucose (only PF) and global cardiovascular risk; 2) the walking training prescribed individually and executed without supervision in a real situation reduces some isolated cardiovascular risk factors, especially when they are altered, and decreases global cardiovascular risk; and 3) neither the initial level of PA nor the initial levels of PF affects the effects of walking training prescribed individually and executed without supervision in a real situation on cardiovascular risk

A prática regular de exercícios físicos supervisionados tem sido recomendada devido a seus benefícios na saúde. Porém, a supervisão limita o número de praticantes. Uma alternativa para a promoção da saúde pública é o treinamento de caminhada prescrita de forma individualizada e realizada sem supervisão, mas seus efeitos foram pouco estudados em uma situação real. Além disso, a possível influência do nível inicial de atividade física (AF) e de aptidão física (ApF) sobre os efeitos desse treinamento não é conhecida. Assim, este estudo investigou na situação real do Projeto Exercício e Coração: 1) a relação do nível de AF e de ApF com o risco cardiovascular avaliado de forma isolada e global; 2) o efeito do treinamento de caminhada prescrita de forma individualizada e executada sem supervisão sobre esse risco cardiovascular; e 3) a influência do nível inicial de AF e de ApF nas respostas ao treinamento. O risco cardiovascular isolado foi avaliado pela medida do índice de massa corporal (IMC), circunferência da cintura (CC), glicemia, colesterol total e pressão arterial (PA) sistólica e diastólica, enquanto que o risco global foi calculado pelo escore Z (EZ, somatório do escore z de todos os fatores isolados). O nível de AF foi avaliado pelos minutos semanais de AF de lazer e a ApF pelo resultado do teste de marcha estacionária dividido em quartis (Q1 = pior ApF e Q4 = melhor ApF). O IMC e a CC foram menores no grupo muito ativo (MA, +300 min/sem AF) do que no inativo (I, sem nenhuma AF de lazer), enquanto que o EZ foi menor no grupo MA que no I e no ativo (A, 150 a 299 min/sem de AF). Além disso, o IMC e a glicemia foram menores no Q4 que no Q1, a CC foi menor no Q2, Q3 e Q4 que no Q1, e o EZ foi menor no Q3 e Q4 que no Q1 e no Q4 que no Q2. O treinamento de caminhada diminuiu significantemente o IMC, CC, PA sistólica e EZ na amostra total. Além disso, ele reduziu significantemente todos os indicadores de risco específicos em subamostras com valores alterados, com exceção da glicemia. Para finalizar, o efeito do treinamento de caminhada no risco cardiovascular isolado e global foi semelhante nos indivíduos MA e I e nos indivíduos do Q1 e Q4 de ApF. Assim, é possível concluir que: 1) em participantes de uma situação real de promoção de AF para a saúde há associação inversa entre os níveis de AF e de ApF com marcadores de obesidade, glicemia (só ApF) e com o risco cardiovascular global; 2) o treinamento de caminhada prescrita de forma individual e executada sem supervisão em uma situação real reduz alguns fatores de risco isolados, principalmente quando eles estão alterados, e diminui o risco cardiovascular global; e 3) nem o nível inicial de AF nem o de ApF afetam os efeitos de um treinamento de caminhada prescrito de forma individualizada e executado sem supervisão em uma situação real sobre o risco cardiovascular / The regular practice of supervised physical exercise has been recommended due to its benefits on health. However, supervision limits the number of practitioners. An interesting alternative for the promotion of public health is the walking training prescribed individually and executed without supervision, however its effects have been poorly investigated under real situations. In addition, the possible influence of the initial level of physical activity (PA) and physical fitness (PF) on these effects are unknown. Thus, this study investigated under a real situation of the \"Exercise and Heart Project\": 1) the relationship between level of PA and PF with cardiovascular risk evaluated by isolated factors and globally; 2) the effects of walking training prescribed individually and executed without supervision on cardiovascular risk; and 3) the influence of initial level of PA and PF on the responses to walking training. Isolated cardiovascular risk was analyzed by the measurement of body mass index (BMI), waist circumference (WC), blood glucose, total cholesterol, and systolic and diastolic blood pressure (BP), while global risk was calculated by Z score (ZS, sum of Z score of all the factors). PA level was evaluated by weekly minutes of leisure time PA, and PF was evaluated by the results in the 2 minutes step test divided in quartiles (Q1 being the lowest PF and Q4 the highest PF). BMI and WC were significantly lower in the very active (VA, +300 min/week of PA) than in the inactive group (I, no leisure time PA), while ZS was lower in the VA than in the I and active groups (A, between 150 and 299 min/week of PA). In addition, BMI and blood glucose was significantly lower in Q4 than Q1, WC was lower in Q2, Q3 and Q4 than in Q1, and ZS was lower in Q3 and Q4 than Q1 and in Q4 than Q2. Walking training significantly decreased BMI, WC, systolic BP and ZS in the total sample. Also, it decreased all specific risk factors, with exception of blood glucose in subgroups with altered values. Finally, the effects of walking training on isolated risk factors and on ZS were similar in VA and I groups as well as in Q1 and Q4 groups. Thus, it is possible to conclude that: 1) in participants of a real intervention for health promotion, there is an inverse association between the PA and PF levels with the obesity markers, blood glucose (only PF) and global cardiovascular risk; 2) the walking training prescribed individually and executed without supervision in a real situation reduces some isolated cardiovascular risk factors, especially when they are altered, and decreases global cardiovascular risk; and 3) neither the initial level of PA nor the initial levels of PF affects the effects of walking training prescribed individually and executed without supervision in a real situation on cardiovascular risk

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Well-established risk factors for CVD include increasing age, male sex, sedentary lifestyle, obesity, smoking, diabetes, hypertension, dyslipidaemia and low socio-economic status. Traditional risk factors do, however, not fully explain cardiovascular risk in general. In this thesis we focused on two conventional risk factors (smoking, blood pressure), and two unconventional risk markers (adiponectin, an adipocyte derived protein; and sialic acid (SA), a marker of systemic inflammation) for prediction of CVD events. Aims: In Paper I we examined to what degree smoking habits modify the risk of CVD in relation to systolic blood pressure levels in middle-aged men. In Paper II we investigated the predictive role of adiponectin for risk of CVD as well as the cross-sectional associations between adiponectin and markers of glucose metabolism, also in men. In Paper III we examined if increasing pulse pressure (PP) and increasing levels of SA both increase the risk of CVD and whether their effects act in synergism. In Paper IV the association of SA with risk of incident diabetes mellitus and related complications, resulting in hospitalization, was studied. Subjects and Methods: Two large-scale, population-based, screening studies with long follow-up periods have been used. The Malmö Preventive Project (MPP) was used with 22,444 individuals in Paper I and a sub cohort of 3,885 individuals in Paper II. The Värmland Health Survey (VHS) was used in Papers III and IV with 37,843 and 87,035 individuals, respectively. Results: CVD risk increases with increasing systolic blood pressure levels and this risk is almost doubled in smokers. Total adiponectin level is not associated with increased risk of future CVD but it is inversely associated with markers of glucose metabolism. PP and SA both contribute to risk of future CVD. Adjustment for mean arterial pressure reduces the risk induced by PP. Elevated SA contributes to increased risk of incident diabetes and related complications leading to hospitalization.

Bien que les progrès thérapeutiques aient permis de freiner la progression des maladies cardio-vasculaires (CV), mais surtout d'améliorer leur prévention et par conséquent de réduire la survenue d'accidents CV, ces maladies devraient rester les premières causes mondiales de décès dans les prochaines années. Cet état des lieux épidémiologique illustre donc des insuffisances concernant à la fois la prévention, mais également la prise en charge du risque CV. Ce travail de thèse s'est alors intéressé à la compréhension des mécanismes physiopathologiques de l'insuffisance cardiaque ischémique (ICi), maladie CV la plus répandue, afin de proposer des stratégies préventives limitant le remodelage cardiaque délétère ; ainsi qu'à l'étude de la pollution atmosphérique comme potentiel facteur de risque CV. Le couplage excitation-métabolisme-contraction (E-M-C), qui sous-tend la fonction de la pompe cardiaque, s'adapte en réponse à différents stimuli par une modification des interrelations spatiales et temporelles complexes entre activités électriques, énergétiques et mécaniques. Ces modifications à différents niveaux peuvent initier un remodelage délétère évoluant vers une altération du fonctionnement, voire une défaillance chronique, du myocarde.Ce travail de thèse met en évidence un découplage entre les activités mitochondriales et contractiles, à l'origine d'un déséquilibre des homéostasies ioniques et redox, responsables des dysfonctions cardiaques étudiées dans des contextes d'ICi et d'exposition en milieu pollué au CO. Ainsi, une approche thérapeutique, visant à restaurer les fonctions mitochondriales et à rétablir le couplage E-M-C cardiaque, pourrait être considérée afin de préserver au mieux la fonction myocardique. Ce travail de thèse permet alors une meilleure compréhension des mécanismes physiopathologiques de l'ICi, et identifie la pollution atmosphérique comme facteur de risque CV à considérer en clinique afin de mieux prévenir le risque CV. / Abstract non available.