Sociopolitical and economic factors shape the lived experience of immigrants and subsequent US-born generations. Often marked by immigrant-related federal and subfederal (i.e., state, county, and city) government policies, but also inclusive of public sentiment toward immigrants, an anti-immigrant climate limits Latino immigrants’ and US-born Latinos’ access to pro-health resources and services, keeps them in a lower socioeconomic position, increases their exposure to interpersonal and structural discrimination, and directly and indirectly exposes them to acute and chronic stressors that can take a toll on their cardiovascular health. The objective of this dissertation is to examine the association between anti-immigrant climate, first defined using policies and then defined using anti-Latino immigrant sentiment, and a panel of traditional and non-traditional cardiovascular disease risk factors among immigrant and US-born Latino adults living in the United States. This dissertation is organized into five sections: 1) an introduction, 2) a systematic review and critical analysis of the literature on US federal and subfederal policies and physical and mental health outcomes among Latino adults, 3) an empirical study of subfederal immigrant-related policies enacted in 2007 and their association with a panel of cardiovascular disease risk factors among Latino adult participants in the National Health Interview Survey, 4) an empirical study of anti-Latino immigrant sentiment during the 2016 Presidential campaign and election and a panel of incident cardiovascular disease risk factors in a cohort of Latino participants of the Hispanic Community Health Survey/Study of Latinos, and 5) a discussion of findings and implications for future research. The systematic review did not identify any studies of immigrant-related policies and traditional cardiovascular disease health condition risk factors of obesity, hypertension, high cholesterol, or diabetes. Exclusionary policies were associated with poor mental health and poor self-rated health and no relationship between policies and adverse birth outcomes was observed. In the empirical study of subfederal immigrant-related policies, I did not observe a statistically significant association between exposure to exclusionary policy climates in 2007 and a greater increase in the prevalence of cardiovascular disease risk factors relative to exposure to neutral/inclusive policy climates. Although no statistically significant difference-in-differences were observed, Latinos living in exclusionary states had a statistically significant increase in the prevalence of high alcohol consumption one year after exposure, while the prevalence remained unchanged among Latinos living in neutral/inclusive states. This increase was reflective of increases among foreign-born Latinos, not US-born Latinos. In the empirical study of anti-Latino immigrant sentiment during the 2016 Presidential campaign and election, findings from models of high depressive symptoms suggested that among Latinos of Mexican and Central American background, the exposed were more likely to have incident high depressive symptoms than the unexposed. Findings also suggested an association between exposure status and incident current alcohol use, particularly among the foreign-born. An inverse association between exposure and risk of hypertension was observed, with further differences by duration of US residence. Patterns for alcohol consumption across both empirical studies suggest that future studies should continue to explore the effect of anti-immigrant climate on acute changes in alcohol consumption among Latinos in the US. Additionally, findings from the systematic review and the second empirical study also support the continued study of the relationship between anti-immigrant climate and mental health outcomes. As the sociopolitical climate of the US becomes increasingly harsh toward Latino immigrants and their families, studies should examine other health outcomes in order to understand which dimensions of health are affected by exposure to an anti-immigrant climate among one of the largest ethnic populations in the US.

[Truncated abstract] Vitamin E is comprised of a family of tocopherols (TOH) and tocotrienols. The most studied of these is [alpha]-tocopherol ([alpha]-TOH), as this form is retained within the body and any deficiency of vitamin E is corrected with this supplement. [alpha]-TOH is a lipid-soluble antioxidant required for the preservation of cell membranes and potentially acts as a defense against oxidative stress. Individuals who have a primary vitamin E deficiency such as low birth weight infants, secondary vitamin E deficiency due to fat malabsorption such as in abetalipoproteinaemia, or a genetic defect in TOH transport require supplementation. There is debate as to whether vitamin E supplementation in other patient groups is required. Vitamin E supplementation has been recommended for persons with FHBL, a rare disorder of lipoprotein metabolism that leads to low serum [alpha]-TOH and decreased LDL cholesterol and apolipoprotein B concentrations. We examined the effect of truncated apoB variants on vitamin E metabolism and oxidative stress in persons with heterozygous FHBL. We used HPLC with electrochemical detection to measure [alpha]- and [gamma]-TOH in serum, erythrocytes, and platelets, and GC-MS to measure urinary F2-isoprostanes and TOH metabolites as markers of oxidative stress and TOH intake, respectively. Erythrocyte [alpha]-TOH was decreased, but we observed no differences in lipid-adjusted serum TOHs, erythrocyte [gamma]-TOH, platelet [alpha]- or [gamma]-TOH, urinary F2-isoprostanes, or TOH metabolites. Taken together, our findings do not support the recommendation that persons with heterozygous FHBL should receive vitamin E supplementation. ... Sesame lignans are natural components of sesame seed oil and there is evidence that these lignans can inhibit CYP450 enzymes, in particular, those responsible for vitamin E metabolism. We hypothesised that sesame seed ingestion would increase serum [gamma]-TOH, lower plasma lipids and inhibit platelet function in human subjects with at least one cardiovascular risk factor. We used HPLC with electrochemical detection to measure [alpha]- and -TOH in serum and GC-MS to measure F2-isoprostanes and TOH metabolites as markers of oxidative stress and TOH intake, respectively. We used high-sensitive C-reactive protein as a measure of systemic inflammation. Platelet function was assessed using the PFA-100 platelet aggregation assay. Although serum [gamma]-TOH increased by 17%, we observed no effect on lipid metabolism, markers of inflammation, oxidative stress or platelet function following treatment with ~25 g/day sesame seeds for five weeks. Our findings challenge the hypothesis that sesame seed ingestion provides beneficial cardiovascular effects. In summary, we have studied the metabolism and transport of both [alpha]- and [gamma]-TOH in humans to evaluate the requirements for supplementation and the effects of vitamin E on platelet function and CYP3A4 activity. Specialised techniques using HPLC were developed to measure serum and cellular TOH concentrations both in supplemented and un-supplemented individuals. We also used GCMS to provide a sensitive, accurate assessment of TOH metabolites and midazolam pharmacokinetics in humans after vitamin E supplementation. We have examined the role vitamin E has on important biochemical endpoints, with emphasis on the implications for TOH supplementation in subjects at risk of CVD.

University of Macau / Institute of Chinese Medical Sciences

Atherosclerosis is a vascular degenerative disease leading to progressive thickening in the intima of large and medium sized arteries through the formation of plaque that is very rich with cholesterol. The cholesterol is carried by LDL (low density lipoprotein) particles which pass through the endothelium and accumulate in the intima. The passage of LDL is influenced by wall shear stress which activates physiological responses of the endothelium. However, the causal relationship between the physiological responses and their effect on LDL mass transport is not fully understood. To obtain blood flow patterns in human carotid arteries, a fluid structure interaction (FSI) computational approach is employed, based on the in-vivo arterial geometry constructed from black blood magnetic resonance images (BBMRI) and flow rate boundary conditions obtained from phase contrast images (PC). Wall shear stress (WSS) on the luminal surface is computed, and this variable is related to the formation of leaky junctions, which is a major transendothelial pathway for LDL. A model for the fraction of leaky junction at a surface is incorporated into the overall computational scheme for mass transport, along with pore theory. The theoretical model is applied to images from three human carotid arteries in which the degree of disease ranges from mild to moderate. Maximum mass flux is predicted to be in the downstream region of stenoses where WSS is low, and this result is consistent with the clinical observation of plaque progression downstream of the stenosis. The hypothesis that the majority of LDL enters into the intima through leaky junctions is supported by observation of similar distributions between the pattern of volume flux via leaky junctions and mass flux. These studies suggest that mass flux of LDL can be a predictor to indicate areas with potential for plaque formation and progression in human carotid artery disease.

Imaging guidance may allow minimally invasive alternatives to open surgical exposure and help reduce procedure risk and morbidity. The inherent vascular and soft-tissue contrast of MRI make it an appealing imaging modality to guide cardiovascular interventional procedures. Advances in real-time MRI have made MRI-guided procedures a realistic possibility. The MR environment, however, introduces additional challenges to the development of compatible, conspicuous and safe devices. The overall goal of this work was to enable selected MRI-guided cardiovascular interventional procedures with clearly visible MR devices. In the first part of this work, we developed actively visualized devices for three distinct MRI-guided interventional procedures and techniques to assess their signal performance. We then investigated factors influencing complex device safety in the MR environment and evaluated a technique to better determine and monitor potential device heating. This input contributed to the development of a system to further improve device safety with continual device monitoring and dynamic scanner feedback control. In the final part of this work, we demonstrated the utility of MRI guidance and actively visualized devices to enable traditional and complex cardiovascular access. Together these provide important elements to bring MRI-guided cardiovascular interventional procedures closer to clinical implementation.

University of Macau / Institute of Chinese Medical Sciences

No abstract available. / Thesis (M.D.)-University of Natal, 1973.

Understanding variability of heath status is highly likely to be an important component of personalized medicine to predict health status of individuals and to promote personal health. Evidences of Genome Wide Association Study and gene expression study indicating that genetic factors affect the risk susceptibility of individuals have suggested adding genetic factors as a component of health status measurements. In order to validate or to predict health risk status with collected personal data such as clinical measurements or genomic data, it is important to have a well-established profile of diseases. The primary effort of this work was to find genomic evidence relevant to coronary artery disease. Two major methods of genomic analysis, gene expression profiling and GWAS on gene expression, were performed to dissect transcriptional and genotypic fingerprints of coronary artery disease. Blood-informative transcriptional Axes that can be described by 10 covariating transcripts per each Axis were utilized as a crucial measure of gene expression analysis. This study of the relationship between gene expression variation and various measurements of coronary artery disease delivered compelling results showing strong association between two transcriptional Axes and incident of myocardial infarction. 244 transcripts closely correlated with death by cardiovascular disease related events were also showing clear association with those two transcriptional Axes. These results suggest potential transcripts for use in risk prediction for the advent of myocardial infarction and cardiac death.

Access to abstract permanently restricted to Ball State community only / Access to thesis permanently restricted to Ball State community only / School of Physical Education, Sport, and Exercise Science

Obesity is a major epidemic and is increasing in prevalence worldwide. The health problems and consequences of obesity include cardiovascular disease (CVD) risk factors, such as hypertension, hyperlipidemia, glucose intolerance and diabetes mellitus. Each of these abnormalities directly promotes atherosclerosis. More recently, visceral obesity has been shown to be independently associated with abnormalities of both the ventricular and vascular structure and function. The mechanisms by which they occur remain incompletely defined. Cardiovascular magnetic resonance imaging (CMR) offers several advantages for evaluation of cardiac structure and function in the obese. The high accuracy and reproducibility of the technique allows for detection of very small changes in ventricular volumes, mass, ejection fraction, and cardiac output with a relatively small sample size, as compared with echocardiography. In this thesis we investigated whether cardiovascular magnetic resonance imaging can better characterize possible cardiac abnormalities associated with obesity, in the absence of other confounding comorbidities. Obesity is associated with myocardial and vascular function, the extent of reversibility of these abnormalities with rapid acute weight loss remains uncertain. Therefore the first aim of the study was to (i) determine the relationship between obesity and left ventricular structure and function using magnetic resonance imaging, and (ii) the acute effects of rapid diet-induced weight loss on cardiac and vascular function in normal obese and obese diabetic men. Erectile dysfunction is related to cardiovascular risk factors such as obesity by an impairment of endothelial function. Therefore, symptoms of erectile dysfunction are probably to precede cardiovascular disease and events. The second aim of this study was to (i) determine the relationship between obesity and erectile function (EF), sexual desire (SD), lower urinary tract symptoms (LUTS) and quality of life (QOL) measures in obese males, and (ii) determine the effects of rapid diet-induced weight loss on EF, SD, LUTS and QOL measures in normal obese and obese diabetic men. In this group of men, obesity was associated with mild/moderate erectile dysfunction, and significant LUTS, which together with sexual desire improved following rapid diet induced weight loss, but was not directly related to the amount of weight loss or changes in measured metabolic state. Pericardial adipose tissue (PAT) covers 80% of the heart and constitutes 20% of its weight. PAT mass is related to the amount of abdominal fat and the risk of coronary atherosclerosis. Epicardial fat mass may be a sensitive indicator of cardiovascular risk. The third aim of this study was to (i) determine the relationship between obesity and PAT volume and (ii) effectively evaluate the impact of caloric restriction and associated weight reduction on epicardical fat volume via cardiac magnetic resonance imaging (CMR). This is the first study to show a reduction in PAT volume is associated with caloric restriction. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352389 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2009