Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2017-09-19T18:35:59Z No. of bitstreams: 1 Michel Jorge Dias.pdf: 1948643 bytes, checksum: 3d6a04a73d791af1eb3dad8d02b6c7a3 (MD5) / Made available in DSpace on 2017-09-19T18:35:59Z (GMT). No. of bitstreams: 1 Michel Jorge Dias.pdf: 1948643 bytes, checksum: 3d6a04a73d791af1eb3dad8d02b6c7a3 (MD5) Previous issue date: 2017-03-30 / Introduction: Motoboys are subject to cardiovascular risk matters that can negatively influence their ability to work, as well as cardiovascular risks or diseases itself. Objective: To compare the risks of cardiovascular venture and the minimums according to the work shift and a working day. Methodology: This is a cross-sectional, quantitative study, composed of registered motoboys without union of the syndicate of Cajazeiras - PB. The professionals were invited to join the study, which is a convenience sample, totaling 95 interviewed. The motoboys respond to a questionnaire about socio-demographic data, health and lifestyle, work and also performed blood collection to determine the plasma concentrations of glycemia, total cholesterol and fractions, in addition to triglycerides. Subsequently, cardiovascular risk was calculated based on the Framingham Global Score. The variables were described by ways of relative and absolute frequencies, measures of central tendency (average) and dispersion (standard deviation). The Kruskal-Wallis or Mann-Whitney tests were used to compare the variables of the non-parametric variables according to the work shift and the daily work day, and for the parametric oscilations the ANOVA or t- Student The qualitative variables were evaluated by the proportionality test (Chi-square and Fisher's Exact), according to the work shift and the daily workday. In all tests the level of 5% of statistical significance was adopted. Results: The average age of participants was 37,1 years; 59% was classified as mature, 96,8% were non-smokers, 57,9% were alcoholic, and 41,1% Of sedentary. Regarding the work characteristics, the predominance was 51,5% working morning and afternoon (daytime), 97.3% working from Monday to Saturday, 43,1% with a daily workday of eleven hours or more, 66,3% reported having a moderate necessity for recovery after work and 67,4% reported having a low capacity for work rate. Regarding cardiovascular risk factors, 84,2% of the interviewees were overweight and 80% had a high cervical perimeter. On the other hand, 67,4% had normal systemic arterial pressure, and 85,3% had a low-waist / hip ratio. As for the lipid profile, 52,6% had high cholesterol levels, 51,6% had high LDL-cholesterol, 56,8% had low HDL-cholesterol levels, 41,1% had high triglyceride levels and less 10% have high blood glycose levels. Regarding the Framingham Risk Score, the study showed that 51,6% of mototaxis are at risk for cardiovascular events. A higher proportion of motoboys with hypertriglyceridemia was evidenced in the professionals of the day shift and at night until 10 p.m. (p<0.05). There was a higher proportion of mototaxis with high glycemia among those working six to eight hours (p<0.01). The highest proportion of hypertriglyceridemia was among those who worked 11 hours or more (p<0.04). There was no significant alteration between insomnia regarding cardiovascular risk factors. Conclusion: The cardiovascular risk factors and the sleep aspects of the mototaxistas had little difference in the shifts and working days. There was also no difference in cardiovascular risk factors due to insomnia symptoms. On the other hand, the prevalence of cardiovascular risk factors, insomnia symptoms and risk for cardiovascular events were high. / Introdução: Os mototaxistas são trabalhadores submetidos a condições de trabalho que podem prejudicar sua saúde, aumentando assim, o risco para o desenvolvimento de fatores de risco cardiovascular. Objetivo: Comparar os fatores de risco cardiovascular e os aspectos de sono de acordo com o turno de trabalho e a jornada de trabalho. Métodos: Trata-se de um estudo transversal, realizado com mototaxistas cadastrados no sindicato de Cajazeiras ¿ PB, onde a amostra foi composta por 95 profissionais. Os mototaxistas responderam a um questionário sobre dados sociodemográficos, saúde e estilo de vida, trabalho, e também realizaram coleta de sangue para determinação das concentrações plasmáticas de glicemia, colesterol total e frações, além dos triglicerídeos. Posteriormente, o risco cardiovascular foi calculado com base no Escore Global de Framingham. As variáveis foram descritas por meio de frequências relativa e absoluta, medidas de tendência central (média) e de dispersão (desvio padrão). Para comparação das médias das variáveis não paramétricas, de acordo com o turno de trabalho e a jornada diária de trabalho, realizou-se os testes Kruskal-Wallis ou Mann-Whitney, e para as variáveis paramétricas realizou-se os testes ANOVA ou t-student. As variáveis qualitativas foram avaliadas pelo teste de proporção (Qui-quadrado e Exato de Fisher), de acordo com o turno de trabalho e a jornada diária de trabalho. Em todos os testes foi adotado o nível de 5% de significância estatística. Resultados: A média de idade dos participantes foi de 37,1 anos, sendo que 59% foi classificada como idade madura, 96,8% referiram não ser fumantes, 57,9% ingerem bebidas alcoólicas, e apresentando percentual de 41,1% de sedentários. Sobre as características de trabalho, foi observado a predominância de 51,5% trabalhando de manhã e tarde (diurno), 97,3% trabalhando de segunda a sábado, 43,1% com jornada de trabalho diária de onze horas ou mais, 66,3% referiram ter uma necessidade de recuperação moderada após o trabalho e 67,4% apontaram ter um índice de capacidade para o trabalho baixo. Com relação aos fatores de risco cardiovascular, 84,2% dos entrevistados apresentam excesso de peso e 80% possuem elevado perímetro cervical. Por outro lado, 67,4% apresentam normalidade na pressão arterial sistêmica, e 85,3% com uma relação cintura/quadril considerada de baixo risco. Quanto ao perfil lipídico, verificamos que 52,6% apresentam níveis elevados de colesterol, 51,6% com elevado LDL-colesterol, 56,8% com níveis baixos de HDL-colesterol, 41,1% apresentam níveis elevados de triglicerídeos e menos de 10% apresentam níveis elevados de glicemia. Com relação ao Escore do risco de Framingham, o estudo evidenciou que 51,6% dos mototaxistas apresentam risco para eventos cardiovasculares. Foi evidenciado uma maior proporção de mototaxistas com hipertrigliceridemia nos profissionais do turno diurno e noite até às 22hs (p<0,05). Houve uma maior proporção de mototaxistas com elevada glicemia entre os que trabalham de seis a oito horas (p<0,01). Já a maior proporção de hipertrigliceridemia foi entre os que trabalhavam 11 horas ou mais (p<0,04). Não houve diferença significativa entre a insônia quanto aos fatores de risco cardiovascular. Conclusão: Os fatores de risco cardiovasculares e os aspectos de sono dos mototaxistas pouco diferiram pelos turnos e jornadas de trabalho. Também não foi verificada diferença dos fatores de risco cardiovascular pelos sintomas de insônia. Por outro lado, as prevalências dos fatores de risco cardiovasculares, dos sintomas de insônia e do risco para os eventos cardiovasculares foram elevadas.

Orientador: Valéria Cristina Sandrim / Resumo: Evidências apontam que a dieta vegetariana diminui a probabilidade de desenvolver doenças cardiovasculares (DCVs). Um dos principais mecanismos que levam às doenças cardiovasculares é a disfunção do endotélio, associada com a diminuição da biodisponibilidade de óxido nítrico (NO) e a produção excessiva de espécies reativas de oxigênio (ROS). Do ponto de vista de biomarcadores de estresse oxidativo/antioxidante e de envelhecimento biológico, enzimas com propriedades antioxidantes e o comprimento do telômero podem apresentar efeitos na modulação do sistema vascular. O presente estudo inclui dois manuscritos, sendo o primeiro relacionado a via de regulação NRF2/HO-1 e o segundo ao comprimento dos telômero em onívoros (ONI) e vegetarianos (VEG). No primeiro manuscrito, o objetivo foi verificar a concentração de HO-1 circulante, bem como investigar o efeito da incubação do plasma de ONI e VEG em células endoteliais sob a modulação da via NRF2/HO-1 e a produção de NO. Dos 745 indivíduos inicialmente recrutados, 44 ONI e 44 VEG do sexo masculino aparentemente saudáveis foram incluídos no estudo. A concentração de HO-1 circulante foi mensurado usando o ensaio de ELISA. As células endoteliais foram incubadas com amostras de plasma de ONI e VEG. Nós observamos que a concentração de HO-1 circulante foi maior nos ONI em relação aos VEG. A incubação das células endoteliais com o plasma de ONI induziu o aumento da expressão gênica/proteica do NRF2 e HO-1, bem como a atividade do ARE e a pr... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Several studies report that a vegetarian diet lowers the probability of developing cardiovascular diseases (CVDs). The endothelial dysfunction is one of the main mechanism that leads to CVDs, associated with decreased nitric oxide (NO) bioavailability and excessive production of reactive oxygen species (ROS). Regarding oxidative/antioxidant stress and biological aging biomarkers, enzymes with antioxidant properties and telomere length may have effects on vascular system modulation. The present study includes two manuscripts related to: 1) regulation of NRF2/HO-1 pathway and 2) telomere length in omnivorous (OMN) and vegetarians (VEG). In the first manuscript, our objectives were to verify circulating HO-1 levels and the effect of plasma incubation from omnivorous and vegetarians in endothelial cells on modulating of NRF2/HO-1 pathway and NO production. From 745 participants initially recruited, 44 omnivorous and 44 vegetarian men apparently healthy were included in this study and circulating HO-1 was measured using ELISA assay. Endothelial cells were incubated plasma samples from OMN and VEG. We found higher circulating HO-1 production in omnivorous compared to vegetarian. Moreover, the plasma collected from omnivorous was able to increase the gene/protein NRF2/HO-1 expression, ARE activity, and NO production in endothelial cells culture compared to vegetarian group. We suggest that HO-1 induction in omnivorous may indicate a pro-oxidative. Activation of the HO-1 / NRF2 pathw... (Complete abstract click electronic access below) / Doutor

Thesis (M.Sc. (Human Movement Science))--North-West University, Potchefstroom Campus, 2007.

Background: A sedentary lifestyle diminishes quality of life (QOL) and contributes to increasing prevalence of obesity, diabetes and cardiovascular diseases (CVD), and thus increases the economic burden on health care and society. Expensive and tightly controlled lifestyle interventions reduce cardiovascular risk and onset of diabetes. Transferring these findings to the primary care setting is of clinical importance. The primary aim of this thesis was to apply a lifestyle intervention program in the primary care setting among individuals with moderate-to-high risk for CVD, and evaluate the effects on physical activity, cardiovascular risk factor levels and QOL. A secondary aim was to investigate the cost-effectiveness. Methods: A randomized controlled trial with one intervention group (n=75) and one control group (n=76) with follow-up at 3, 12, 24 and 36 months was used. Patients with the diagnosis obesity, hypertension, dyslipidemia, type 2 diabetes or any combination thereof (mean age 54 yr, 57% female) were recruited from a primary health centre in northern Sweden. The three-month intervention period consisted of group-based supervised exercise sessions and diet counselling, followed by regular, but sparse, group meetings with a behavioural approach during three years. Clinical measurements included anthropometrics, aerobic fitness, blood pressure and metabolic traits. Questionnaires on self-reported physical activity, stages of change for physical activity, and QOL were used. In a cost-utility analysis the costs, gained quality-adjusted life years (QALY), and savings in health care were considered. Probability of cost-effectiveness was described using Net Monetary Benefit Method. Results: Overall, the lifestyle intervention generated beneficial improvements in anthropometrics, blood pressure, aerobic fitness and activity level, and QOL, compared to the control group which only received one information meeting.  At 36 months, intention-to-treat analyses showed that lifestyle modification reduced waist circumference (–2.2 cm), waist-hip ratio (–0.02), systolic blood pressure (–5.1 mmHg), and diastolic blood pressure (–1.6 mmHg) and significantly improved aerobic fitness (5%).  BMI, lipid or glucose values did not differ between groups. Progression to active stages of change for physical activity and increases in time spent exercising and total physical activity were reported. Both physical and mental dimensions of QOL were improved during the study period, but after 3 years differences persisted mainly in physical dimensions. Cost per gained QALY was low, 1668-4813 USD (savings not counted). Visits to family physicians significantly decreased and there was a net saving of 47 USD per participant. Probabilities of cost-effectiveness were 89-100% when 50 000 USD was used as threshold of willingness to pay for a gained QALY. Conclusions: A group-based lifestyle intervention program in a primary health care setting favourably influences cardiovascular risk-factor profiles, increases physical activity level, and improves several dimensions of QOL in high-risk individuals, at least up to 3 years. The intervention method was highly cost-effective in relation to standard care. The results emphasize the advantage of an intervention that combines supervised exercise with regular follow-ups for reaching long term effects.  The study high-lights the feasibility of lifestyle interventions in the primary care setting and the importance of health care professionals supporting change in lifestyle.

Hintergrund: Es ist bislang unklar, inwieweit etablierte Scores zur Abschätzung des kardiovaskulären Risikos (PROCAM-Score, Framingham-Score, ESC-Score Deutschland) untereinander sowie mit der subjektiven Arzteinschätzung übereinstimmen. Methodik: An einer bundesrepräsentativen Stichprobe von 8 957 Hausarztpatienten im Alter von 40–65 Jahren ohne bekannte vorangegangene kardiovaskuläre Ereignisse wurde mittels unterschiedlicher Methoden das Risiko bestimmt, innerhalb der nächsten 10 Jahre einen Herzinfarkt oder Herztod zu erleiden. Ergebnisse: Das mittlere koronare 10-Jahres-Morbiditätsrisiko wurde mit dem PROCAM-Score auf 4,9% und mit dem Framingham-Score auf 10,1% geschätzt, das mittlere kardiovaskuläre 10-Jahres-Mortalitätsrisiko mit dem ESC-Score auf 2,9%. Die behandelnden Ärzte klassifizierten nur 2,7% der Patienten als kardiovaskuläre Hochrisikofälle. Nach Framingham wurden die meisten Patienten in die Hochrisikokategorie eingeordnet (22,6%). Bezüglich der Risikokategorisierung ergab sich eine nur moderate Übereinstimmung zwischen den drei Scores (bei 34% aller Risikofälle). Bei 5,9% der Patienten kamen die drei Scores zu einer komplett unterschiedlichen Risikobewertung. Den nach den verschiedenen Risikoscores in die Hochrisikogruppe kategorisierten Patienten wurde von den behandelnden Ärzten nur in ca. 8% der Fälle ebenfalls ein hohes kardiovaskuläres Risiko zugeordnet, in ca. 48% ein mittleres Risiko und in 41–46% (je nach Score) ein geringes Risiko. Schlussfolgerung: Die Methoden ergeben nur eine relativ geringe Übereinstimmung in der Beurteilung von Risikopatienten. Besonders niedrig fällt die Übereinstimmung bei der Hochrisikogruppe mit der Einschätzung der klinischen Risikoprädiktion durch den behandelnden Hausarzt aus. Die erhebliche Abweichung zur Arztbeurteilung scheint anzudeuten, dass die etablierten Risikoscores in der Praxis derzeit einen nur eingeschränkten praktischen Stellenwert besitzen. Welche der Vorhersagen mit dem tatsächlichen Risiko am besten übereinstimmen, wird derzeit mit den prospektiven DETECT-Studiendaten geprüft.

Background: In the past 37 years, increased efforts have been directed toward a better understanding of the importance of Hcy in disease and it has now become clear that hyperhomocysteinemia is a major independent risk factor for CVD. Extensive research on the influence of vitamin supplementation leading to reductions in Hcy levels and improvements in cardiovascular function has been done. The importance of exercise in the lowering of cardiovascular risk factors, as well as its favourable influence on cardiovascular function has also been indicated in several studies, however, the limited number of studies investigating the effect of exercise on Hcy concentrations revealed contradicting results. Furthermore, a relationship between Hcy concentration and cardiovascular function with the intervention of an exercise training and a vitamin supplementation programme respectively has also not been investigated. Objective: The objective of this study was to examine the effect of a 12-week exercise training and a 12-week vitamin supplementation intervention respectively on tHcy concentrations and cardiovascular function, and whether the change in tHcy concentration within the different interventions correlated with the change in cardiovascular function. Methods: In a randomised controlled cross-over intervention study, 52 men matched for age, cardiorespiratory fitness levels and cardiovascular risk factors were randomly assigned to one of 3 groups (Group A = exercise training programme, 20-30min. at 70-80% of HRmax; Group B = 400 g folic acid and 25 g vitamin B12 supplement; Group C = control). Group A and B were crossed over for phase 11, and Group C remained the control. The questionnaires were completed, and the body composition variables (BMI, WHR and body fat percentage), cardiovascular function (Finometer), tHcy concentrations and VO2max, were measured before and after each 12-week intervention period. A 6-week washout period separated the crossovers. Results: The ANCOVA, adjusted for age and BMI, showed that the percentage change from baseline to end, corrected for baseline of the tHcy concentration increased significantly (p ≤ .05) by 9.7% with the exercise training intervention and decreased significantly (p ≤ .05) by 12.9%, with the vitamin supplementation intervention. The ANCOVA of the percentage change from baseline to end in cardiovascular function showed that the vitamin supplementation intervention resulted in improvements in cardiovascular function (decreased resting MAP, TPR and increased resting SV, CO, Cw) in comparison to the impairment in cardiovascular function with the exercise training intervention (increased resting DBP, MAP and TPR). The relationship between the tHcy concentration and cardiovascular function at baseline and within each of the different interventions were assessed by partial correlations adjusted for age, BMI and VO2max. Significant (p ≤ .05) relationships only occurred within the vitamin supplementation intervention, where decreased percentage change in tHcy concentration significantly correlated with increased percentage change of resting SV and CO and decreased percentage change of resting TPR. Conclusion: The general conclusion that can be drawn is that a 12-week vitamin supplementation intervention showed increased health related results, e.g. a significant reduction in tHcy concentration, an improvement in cardiovascular function and a significant positive relationship between these b o factors, in comparison to the 12-week exercise training intervention that significantly increased the tHcy concentration and did not show increased health related results. Due to inadequate compliance to the exercise training intervention, no conclusion can be drawn with regard to the effect of exercise training on tHcy concentrations and cardiovascular function. / Thesis (M.Sc. (Human Movement Science))--North-West University, Potchefstroom Campus, 2007

Objective: To compare psychological work and life stress indicators among female hospital employees in both shift work (SW) and non-shift work (NSW) positions, and determine associations with demographic and vocational factors, and indicators of cardiovascular risk (CVR). Methods: Female employees from one Southeastern Ontario acute care hospital (n=212) provided fasting blood samples, demographic and work related data, and completed a physical assessment and questionnaires. Work stress was measured with the Job Content Questionnaire and Effort-Reward Balance Index (ERI). Life stress was assessed with the Derogatis Stress Profile. Metabolic Syndrome (MS) was determined based on Interim Societies Joint Guidelines. Results: SW in comparison to NSW employees reported higher mean scores in: global ERI (.70 (SD .4) vs. .58 (SD.29) p<.05), psychological job demands (21.2 (SD 4.8) vs. 19.2 (5.7) p<.01), physical job demands (13.8 (SD 2.6) vs. 10.2 (SD 3.8), skill discretion (36.5 (SD 4.4) vs. 34.7 (SD 5.4) p<.01), lower decision authority (31.6 (SD 5.8) vs. 33.5 (SD 6.5) p<.05), and lower total life stress scores (39.2 (SD 7.3) vs. 42.1 (SD 9.4) p<.05). There were no significant differences between SW and NSW group for MS or CVR factors. MS was present among 17% of all employees, 18.5% of SW, and 15.5% of NSW. In logistic regression analysis MS occurrence was associated with chronic SW exposure of 6 or more years (AOR 5.41 (95% CI, 1.84 – 15.87), decisional authority (AOR 1.09 (95% CI, 1.00 – 1.18), skill discretion (AOR 1.13 (95% CI, 1.01 – 1.26), and depression (AOR 1.26 (95% CI 1.08 – 1.46). Conclusions: Women working in SW positions experience more psychological and physical work stress, and effort-reward imbalance. The interplay between effort and reward aspects of the work environment may significantly contribute to psychological work stress and persist with increasing age among female hospital employees regardless of SW status. Among female hospital employees SW status and psychological stress measures do not appear to have an immediate effect upon CVR, as measured by the MS, but may contribute to its development with prolonged exposure. / Thesis (Master, Nursing) -- Queen's University, 2014-04-27 21:22:11.951

Objectius: a) avaluar la utilitat de la mesura de la pressió arterial a la consulta pel diplomat d'infermeria; b) establir quin és el punt de tall pel valor normal de l'automesura de la pressió arterial al domicili del propi malalt; c) determinar si l'exploració del fons d'ull als malalts hipertensos permet una millor estratificació del risc cardiovascular. Resultats: a) primer objectiu: els valors de la PAC de la infermera són molt similars a l'AMPA i les decisions s'han de prendre en funció d'aquesta mesura. b) segon objectiu: el risc de presentar alguna AOD en els hipertensos recent diagnosticats amb hipertensió clínica aïllada passa de forma progressiva d'una OR de 2.5 per un punt de tall de <125/80 mmHg a una OR de 4.0 pel punt de tall <135/85 mmHg. c) tercer objectiu: un nombre significatiu de pacients canvien de grup de risc quan es consideren els resultats de l'exploració del fons d'ull. / Goals: a) to evaluate the utility of BP measurement in the nurse office; b) to determine the normal 'cut-off' of HBPM at the moment of diagnosis; c) to determine if fundus eye examination permit a better cardiovascular risk stratification in hypertensive. Results: a) first goal: the values of the nurse measured blood pressure are very similar to AMPA and decisions should be based on this measure. b) second goal: the risk of target organ damage in some hypertensive patients newly diagnosed with isolated clinical hypertension occurs progressively from an OR of 2.5 for a cutoff of <125/80 mmHg OR of 4.0 for a cutoff <135/85 mmHg. The normal 'cut-off' is <130/80-85 mmHg. c) third goal: a significant number of patients change risk group when considering the results of the exploration of the fundus

Coronary heart disease is the single greatest contributor to mortality within developed countries in our time. Type 2 diabetes mellitus and obesity, both of which are potent risk factors for coronary heart disease, are common conditions with rapidly rising rates of prevalence both globally and in Australia. Within Australia, Indigenous Australians suffer from disproportionately high rates of diabetes, obesity and coronary heart disease, the reason for which lies, in part, with changes in dietary intake and decreased levels of physical activity over the past 200 years. These disease trends have led to a substantially reduced life expectancy from an increase in excess cardiovascular deaths in Indigenous Australians. Assessment of cardiovascular risk in Indigenous Australians is complicated by ethnic differences in cardiovascular risk factors and their prevalence. There is also evidence that Indigenous Australians are genetically predisposed to diabetes. Current cardiovascular risk stratification algorithms are suboptimal, significantly underestimating risk in Indigenous Australians. This thesis aimed to address these issues. Firstly, to evaluate the efficacy of a lifestyle intervention programme to sustainably improve markers of health outcome in a cohort of Indigenous Australians who were overweight or had type 2 diabetes mellitus by improving diet and physical activity levels. Secondly, to evaluate the utility of anthropometric markers of obesity, ultrasound markers of atherosclerotic burden and serum C-reactive protein as additional cardiovascular risk stratification tools. The Healthy Lifestyle Programme (HELP) was a two year prospective intervention study designed and implemented with substantial input from the Indigenous community. The primary intervention consisted of a series of educational workshops delivered predominantly by Indigenous health workers advocating improving diet and increasing physical activity. To complement these workshops, facilities were established within the community to support dietary improvement and increased physical activity. Sustainable changes to markers of cardiovascular outcome, including significant reductions in central obesity and blood pressure were demonstrated over time. A slowing in the deterioration of renal function as marked by albuminuria was also detected. These beneficial changes were accompanied by increased physical activity and improved dietary intake. In a substudy, individuals with the apolipoprotein E4 genotype, who were dyslipidaemic at baseline, benefited from lipid profiles that improved significantly during the course of the study. Changes in blood pressure and central obesity detected during the course of the project are likely to have significant clinical impact on health outcomes considering their sustained nature. Evaluating ultrasound imaging based markers of cardiovascular risk, carotid artery intimal medial thickness was a more reliable measure of risk based on its firm correlation with established cardiovascular risk factors compared to brachial artery flow mediated vasodilatation. Carotid artery intimal medial thickness may be the better surrogate marker to improve cardiovascular risk stratification in the Indigenous population. Examining anthropometric markers of obesity, body mass index and waist circumference but not waist hip ratio correlated well with traditional cardiovascular risk factors. Furthermore, both body mass index and waist circumference predicted insulin resistance fairly well using threshold values derived from receiver operating characteristics curve analyses. Both body mass index and waist circumference were simple to perform with a high degree of reproducibility between observers and will likely be valuable additional cardiovascular risk stratification tools. Raised inflammatory stress, as marked by elevated serum C-reactive protein levels, was found in individuals with diabetes or obesity. C-reactive protein levels did not correlate with carotid artery intimal medial thickness, suggesting that C-reactive protein raises cardiovascular risk by means other than increasing atherosclerotic burden. Genotyping a small random sample of our the C-reactive protein gene promoter region. This SNP was found to independently increase serum C-reactive protein in the Framingham cohort. A genetic basis for increased inflammatory stress may contribute to coronary heart disease in Indigenous Australians. In summary, a community centred lifestyle intervention programme was efficacious in producing sustainable improvement in markers of health outcome. Examination of additional cardiovascular risk markers in the Indigenous community have provided evidence for using carotid artery intimal medial thickness, waist circumference, body mass index and serum C-reactive protein levels to improve cardiovascular risk stratification. These additional tools would allow for more specific resource allocation to target individuals at highest cardiovascular risk for preventative management. C-reactive protein gene polymorphisms, their contribution to circulating C-reactive protein levels and cardiovascular outcomes warrants further investigation in the Indigenous population. A more proactive risk management plan, which includes a lifestyle intervention component, may yield the greatest improvement in long term health outcomes if targeted at younger members of the Indigenous community.

Coronary heart disease is the single greatest contributor to mortality within developed countries in our time. Type 2 diabetes mellitus and obesity, both of which are potent risk factors for coronary heart disease, are common conditions with rapidly rising rates of prevalence both globally and in Australia. Within Australia, Indigenous Australians suffer from disproportionately high rates of diabetes, obesity and coronary heart disease, the reason for which lies, in part, with changes in dietary intake and decreased levels of physical activity over the past 200 years. These disease trends have led to a substantially reduced life expectancy from an increase in excess cardiovascular deaths in Indigenous Australians. Assessment of cardiovascular risk in Indigenous Australians is complicated by ethnic differences in cardiovascular risk factors and their prevalence. There is also evidence that Indigenous Australians are genetically predisposed to diabetes. Current cardiovascular risk stratification algorithms are suboptimal, significantly underestimating risk in Indigenous Australians. This thesis aimed to address these issues. Firstly, to evaluate the efficacy of a lifestyle intervention programme to sustainably improve markers of health outcome in a cohort of Indigenous Australians who were overweight or had type 2 diabetes mellitus by improving diet and physical activity levels. Secondly, to evaluate the utility of anthropometric markers of obesity, ultrasound markers of atherosclerotic burden and serum C-reactive protein as additional cardiovascular risk stratification tools. The Healthy Lifestyle Programme (HELP) was a two year prospective intervention study designed and implemented with substantial input from the Indigenous community. The primary intervention consisted of a series of educational workshops delivered predominantly by Indigenous health workers advocating improving diet and increasing physical activity. To complement these workshops, facilities were established within the community to support dietary improvement and increased physical activity. Sustainable changes to markers of cardiovascular outcome, including significant reductions in central obesity and blood pressure were demonstrated over time. A slowing in the deterioration of renal function as marked by albuminuria was also detected. These beneficial changes were accompanied by increased physical activity and improved dietary intake. In a substudy, individuals with the apolipoprotein E4 genotype, who were dyslipidaemic at baseline, benefited from lipid profiles that improved significantly during the course of the study. Changes in blood pressure and central obesity detected during the course of the project are likely to have significant clinical impact on health outcomes considering their sustained nature. Evaluating ultrasound imaging based markers of cardiovascular risk, carotid artery intimal medial thickness was a more reliable measure of risk based on its firm correlation with established cardiovascular risk factors compared to brachial artery flow mediated vasodilatation. Carotid artery intimal medial thickness may be the better surrogate marker to improve cardiovascular risk stratification in the Indigenous population. Examining anthropometric markers of obesity, body mass index and waist circumference but not waist hip ratio correlated well with traditional cardiovascular risk factors. Furthermore, both body mass index and waist circumference predicted insulin resistance fairly well using threshold values derived from receiver operating characteristics curve analyses. Both body mass index and waist circumference were simple to perform with a high degree of reproducibility between observers and will likely be valuable additional cardiovascular risk stratification tools. Raised inflammatory stress, as marked by elevated serum C-reactive protein levels, was found in individuals with diabetes or obesity. C-reactive protein levels did not correlate with carotid artery intimal medial thickness, suggesting that C-reactive protein raises cardiovascular risk by means other than increasing atherosclerotic burden. Genotyping a small random sample of our the C-reactive protein gene promoter region. This SNP was found to independently increase serum C-reactive protein in the Framingham cohort. A genetic basis for increased inflammatory stress may contribute to coronary heart disease in Indigenous Australians. In summary, a community centred lifestyle intervention programme was efficacious in producing sustainable improvement in markers of health outcome. Examination of additional cardiovascular risk markers in the Indigenous community have provided evidence for using carotid artery intimal medial thickness, waist circumference, body mass index and serum C-reactive protein levels to improve cardiovascular risk stratification. These additional tools would allow for more specific resource allocation to target individuals at highest cardiovascular risk for preventative management. C-reactive protein gene polymorphisms, their contribution to circulating C-reactive protein levels and cardiovascular outcomes warrants further investigation in the Indigenous population. A more proactive risk management plan, which includes a lifestyle intervention component, may yield the greatest improvement in long term health outcomes if targeted at younger members of the Indigenous community.