published_or_final_version / Sports Science / Master / Master of Science in Sports Science

published_or_final_version / Community Medicine / Master / Master of Philosophy

M.A. / Because of the high incidence of hypertension amongst South African blacks, many hypothesis have been forwarded to account for the relative higher index of hypertension amongst South African blacks when compared to whites. Because of the virtue lack of endemic proportions of hypertension in South African blacks at the beginning of this century, the often - quoted genetic hypothesis that hypertension is genetically determined would seem not to hold for South African situation. However, this was not yet tested as one of the risk factors or precursors to hypertension, namely the higher indices of cardiovascular reactivity had not been compared in the South African group between white and black subjects. This study investigated the hypothesis that the offspring of black hypertensive parents would show greater cardiovascular reactivity than those of black non-hypertensive parents, and also show greater cardiovascular reactivity than the children of white hypertensive parents as well as the children of white non-hypertensive parents. These hypotheses were partially supported. As expected the children of black hypertensives did show greater indices of cardiovascular reactivity when compared to both children of white hypertensives and the children of black non-hypertensives. An interesting finding however, was that the children of white hypertensives had shown greater indices of the psychological construct of state anxiety than the children of black hypertensive and black non-hypertensive subjects. Whereas this study supported the hypothesis that an inherited cardiovascular reactivity would and could account for the greater index of hypertension amongst South African blacks, it is also possible that the non-psychological expression of tension or cardiovascular reactivity in the form of state anxiety could partially account for the results herein obtained.

Persons with serious mental illness (SMI) are in worse physical health compared to persons in the general population and are more likely to develop medical conditions, such as obesity and diabetes, which place them at risk for cardiovascular disease (CVD). There is some evidence that Hispanics with serious mental illness are at greater risk for developing CVD risk factors compared to non-Hispanic Whites with SMI mainly due to health disparities. This study asks the questions: 1) What self-management behaviors do Hispanics with SMI and at risk of CVD engage in or attempt to engage in?, 2) How do measures of self-efficacy and patient activation correspond to self-management behaviors and barriers?, and 3) How do patients’ and stakeholders’ reports of barriers converge or diverge? Self-efficacy theory and social ecology theory were used as theoretical frameworks. Twenty four consumers were recruited from an outpatient mental health clinic. Seventeen stakeholders were recruited through various sites. A convergent mixed methods approach was used. Quantitative measures of self-efficacy and patient activation were compared to qualitative data on self-management behaviors and barriers to healthy living. Additionally, two sets of qualitative data on consumers’ and stakeholders’ perceptions of barriers to healthy living were compared to determine if they converged. Self-management behaviors identified included: healthy eating, seeking medical care, engaging in physical activity, involving others, self-motivation, use of faith, and engaging in structured and unstructured activities. Consumers with high levels of self-efficacy and patient activation tended to engage in more self-management behaviors regularly and perceived fewer barriers. Consumers with the lowest levels of self- efficacy and patient activation engaged in fewer self-management behaviors regularly and encountered more barriers. Consumer and stakeholder perceptions of barriers to healthy living experienced by consumers did converge, with the exception of the following additional barriers which were only identified by stakeholders: lack of health education, lack of formal education, consumer beliefs and fears, and body image. Using an ecological approach, barriers were identified at different environmental levels, often interacting. Overall, self-efficacy and patient activation may have an important influence on self-management behaviors among Hispanics with SMI and at risk for CVD. There is the possibility that barriers may moderate this relationship. Additionally, an ecological approach to understanding barriers to healthy living can be used to locate barriers and develop interventions which address them.

Xu Liying. / "April 2004." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (p. 159-175) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Conclusions. The growing epidemic of type 2 diabetes and its cardiorenal complications place a major burden on our health care system. Diabetic kidney disease is of particular importance in Asian populations including Chinese. In this series of studies, using a large prospective cohort established since 1995, I confirmed the powerful predictive value of albuminuria on cardio-renal complications. Inhibition of the RAAS interacted with both modifiable and genetic factors, notably the ACE I/D polymorphism, on the development of cardio-renal complications. In addition, it was found that CKD predicts CVD independent of albuminuria. Based on two prospective studies, I confirmed the effectiveness of global risk-factor control using structured care protocol to prevent these devastating complications. (Abstract shortened by UMI.) / I then examined the possible independent and interactive effects of CKD and albuminuria on cardio-renal outcomes in the original cohort of 5,004 patients. Glomerular filtration rate was estimated (eGFR) by the Modification of Diet in Renal Disease equation. The frequency of CKD as defined by eGFR <60ml/min/1.73m 2 was 15.8% in the cohort at baseline, when 6% of patients had serum creatinine ≥150mumol/L. / In collaboration with colleagues, I have conducted a series of studies to examine the prognostic factors for cardio-renal complications in Chinese type 2 diabetic patients. The modulating effects of RAAS inhibition and the effectiveness of rnuitidisciplinary care to prevent ESRD are also examined. / Research Hypotheses. (1) Albuminuria is a prognostic factor on cardio-renal outcomes in type 2 diabetes patients; (2) Chronic Kidney Disease is associated with other metabolic risk factors and phenotypes and is a prognostic factor on cardio-renal outcomes in type 2 diabetes patients; (3) Angiotensin-converting-enzyme insertion/deletion polymorphism is a prognostic factor on cardio-renal outcomes in type 2 diabetes patients, and has an effect on treatment responses with RAAS blockage with ACE inhibitors; (4) Structured care models by risk stratification using various prognostic factors and adherence to care protocol can improve cardio-renal outcome in type 2 diabetes patients. / Results. In a prospective cohort of 5,004 patients, I examined the effect of albuminuria and ACE inhibition on survival and cardio-renal outcomes in 3,773 patients who had been observed for at least 6 months with a mean follow up period of 35.8 months. / Taken together, measurement of serum creatinine alone without GFR estimation may underestimate the frequency of CKD in Chinese type 2 diabetic patients. Estimated GFR was inversely associated wit-29h an increasing frequency of micro- and macrovascular complications cross-sectionally and an increased risk of all-cause mortality prospectively, independent of albuminuria and metabolic control. / So Wing Yee. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3422. / Thesis (M.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 203-243). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

After adjusted for the effect of baseline MCE risk and reduction in SBP, the multivariate meta-regression showed baseline SBP was not significantly related to the RD for all the relevant outcomes examined (p>0.22) except MCE (p=0.0226). However, the baseline MCE risk remained significantly related to the RD for all the outcomes (p<0.01) except CHD (p=0.1011). The reduction in SBP remained significantly related to the RD for deaths due to CVD, MCE, CHF and stroke (p<0.01) but not to the RD for all-cause death (p=0.3788) and CHD (p=0.8755). / Conclusions. This study showed that baseline CVD risk and reduction in blood pressure were strongly and consistently related to the absolute effect of treatment and surprisingly the baseline blood pressure was not. The findings lend direct support to the overall risk approach to primary prevention and suggest that contrary to conventional wisdom and current practice, the overall CVD risk rather than blood pressure alone should be used to identify and treat people to prevent major CVD events through anti-hypertensive drugs. These findings suggest that anti-hypertensive drugs should be given to those who have a high future CVD risk rather than high blood pressure alone so as to achieve better cost-effectiveness of anti-hypertensive drugs for primary prevention. / Data extraction and analyses: Two reviewers independently abstracted data on baseline variables, variables that determine methodological quality, and outcomes. The following main outcomes were assessed: all-cause deaths, deaths due to cardiovascular disease, death due to causes other than CVD, major cardiovascular events (MCE), congestive heart failure (CHF), stroke, and coronary heart disease (CHD). / Key words. hypertension, antihypertensive drugs, cardiovascular disease, meta-analysis, systematic review, randomized controlled trial, primary prevention, baseline risk, evidence based medicine / Meta-analysis was used to obtain the overall odds ratio (OR) and risk difference (RD). Forest plots, bubble plots and funnel plots were used to show the results visually or to check biases. Meta-regression was used to identify factors that may independently determine the effect of antihypertensive drugs. The control CVD risk, initial mean blood pressure and reduction in blood pressure were examined. / Method. Identification of studies: The databases searched included ACP Journal Club, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Cumulative Index to Nursing & Allied Health Literature, Chinese Medical Current Contents to identify relevant studies between 1966 and 2005. We also examined references from relevant trials, reviews and meta-analyses. For trials to be included in this review, they have to have the following characteristics: (1) essential hypertension in patients of any age, sex and race; (2) treatment intervention is antihypertensive drugs; (3) control intervention is a placebo or no treatment; (4) endpoint outcomes are all-cause death and major cardiovascular events; and (5) randomized controlled trials. / Objective. Although the overall risk approach to cardiovascular disease (CVD) primary prevention has been widely adopted, direct evidence that supports this policy is however weak and in some aspects lacking. Importantly, there is no direct evidence to show, between blood pressure and CVD risk, which is a better predictor of the absolute benefit from anti-hypertensive drugs. The evidence that the absolute benefit increases as the future CVD risk increases does not necessarily mean that treating high risk people will be more cost-effective than treating hypertensive people as blood pressure may also be positively related to treatment benefit. The high risk approach would be preferable only when we can show with strong evidence that blood pressure is not related to the absolute benefit of treatment or the CVD risk is much more strongly related to the benefit than blood pressure. We thus conducted this systematic review to examine the evidence from randomized controlled trials to directly show how blood pressure and CVD risk are related to the absolute benefit from anti-hypertensive drugs and compare the capability of the two factors in predicting the benefit. The stronger predictor should be a better indicator for identifying those who should be treated with anti-hypertensive drugs. / Results. Twenty-two eligible randomized controlled trials with a total of 55,448 participants were identified from 1967 to 2004. The average follow-up was 45.6 months ranging from 13 to 84 months. The combined RD and OR for all-cause deaths, deaths due to CVD, MCE, CHF, Stroke and CHD were all statistically significant, showing a consistent and considerable reduction in the risk of these outcomes due to the treatment of anti-hypertensive drugs (p<0.01). / Jiang, Yu. / "September 2007." / Adviser: Jin Ling Tang. / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4657. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 107-115). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Although the clinical efficacy of statins has been well established, there is a wide inter-individual variation in the lipid responses to statins. Pharmacogenetic studies have identified some genetic differences that contribute to the variation, but overall the results have been disappointing. The studies described in this thesis were performed to examine whether certain genetic variants predicted the lipid responses to rosuvastatin in Chinese patients. Over 400 Chinese patients with increased risk of cardiovascular disease (CVD) who were treated with rosuvastatin 10 mg daily for at least 4 weeks (more than 97% of patients had at least 6 weeks treatment) were studied, including 166 having familial hypercholesterolaemia (FH) and 36 having rheumatoid arthritis (RA). They were genotyped for 135 polymorphisms in 62 candidate genes/loci potentially related to pharmacokinetics or pharmacodynamics of statins and lipid metabolism. Associations between genetic polymorphisms and the lipid responses to rosuvastatin were analyzed in 386 patients with good compliance. The associations between genetic polymorphisms and some risk factors for CVD including baseline lipid levels, high-sensitivity C-reactive protein (hsCRP), uric acid and bilirubin levels were also analyzed. / Some novel genetic determinants of the LDL-C response to rosuvastatin treatment have been identified in this study. The responses in HDL-C and triglycerides were related more closely to the baseline levels of these lipids than to any of the polymorphisms examined. Genetic associations with baseline lipid parameters, hsCRP, uric acid and bilirubin were identified and generally correspond with some of the previous reports of studies in Chinese and other ethnic groups. / The key findings of the study are as follows: 1. The polymorphisms most highly associated with the low-density lipoprotein cholesterol (LDL-C) response were 421C>A in the ATP-binding cassette G2 (ABCG2) gene (P=9.2x10 -7), followed by 18281G>A (V257M) in the flavin-containing monooxygenase 3 (FMO3) gene (P=0.0002), 1421C>G in the lipoprotein lipase (LPL) gene (P=0.002), and rs4420638 in the apolipoprotein E/C-I/C-IV/C-II (APOE/C1/C4/C2) gene cluster (P=0.004). These genetic polymorphisms and having FH totally explained 13.6% of the variance in percentage change in LDL-C in response to rosuvastatin. The greater percentage reduction in LDL-C in patients with the ABCG2 421AA genotype compared to those with the ABCG2 421CC genotype was equivalent to at least doubling the dose of rosuvastatin. 2. Three SNPs (glucokinase regulator [ GCKR] rs1260326, apolipoprotein AS [APOA5] -1131T>C and the solute carrier organic anion transporter 1B1 [SLCO1B1] 521T>C) tended to be associated with percentage changes in high-density lipoprotein cholesterol (HDL-C) (P<0.05), but none of these reached the overall significance level. In multivariate stepwise regression analysis, baseline HDL-C (P=1.6x10 -6), having diabetes (P=0.0004) or RA (P=0.002) and the SLCO1B1 521T>C polymorphism (P=0.03) were determinants of HDL-C responses, contributing 9.9% of the variance in percentage change in HDL-C, but the genetic factors only contributed to 0.8% of the variance. 3. The triglyceride response to rosuvastatin was highly variable and was strongly related to baseline levels. The diacylglycerol acyltransferase-2 (DGAT2) rs10899113 C>T polymorphism tended to be associated with reduced triglyceride response in a gene-dose dependent manner. However, in multivariate stepwise regression analysis, baseline triglyceride level was the only factor that strongly related to the triglyceride response, explaining 14.4% of the variance. 4. This study has also analyzed relationships between on-treatment plasma hsCRP concentrations and cardiovascular risk factors and 14 single nucleotide polymorphisms in CRP and other candidate genes, which showed that central obesity, low HDL-C and CRP polymorphisms are major determinants of higher hsCRP levels in Chinese patients on treatment with rosuvastatin. 5. The association between genetic polymorphisms and lipid traits were analyzed in FH and non-FH patients separately due to their different lipid profiles. The analysis has shown that there were different genetic predictors of lipid levels in patients with and without FH and that more genetic factors appeared to affect the baseline lipid levels in patients with FH compared to non-FH patients, suggesting complex interactions between genetic and environmental factors and plasma cholesterol levels in patients with and without FH. 6. The SLC2A9 (solute carrier family 2, member 9) rs1014290 T>C was significantly associated with plasma uric acid levels in a gene-dose dependent manner (P=1.0x10-5) and the relationship was more pronounced in women or in patients without hypertension than in men or patients with hypertension. The ABCG2 421 C>A did not show a significant effect on uric acid levels. 7. The UGT1A1 (uridine diphosphate glucuronosyltransferases family, polypeptide A1) variants *28 (P=1.5x10 -9) and *6 (P=2.2x10-7) were independently associated with increased baseline bilirubin levels. Polymorphisms in SLCO1B1 did not appear to affect bilirubin levels in this study. / Hu, Miao. / Adviser: Brian Tomlinson. / Source: Dissertation Abstracts International, Volume: 72-04, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 230-264). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Xiao, Kang. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 83-103). / Abstracts in English and Chinese. / Abstract --- p.I / 摘要 --- p.VI / Chapter Chapter 1 --- Background --- p.1 / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- Albuminuria --- p.3 / Chapter 1.2.1 --- Definition --- p.3 / Chapter 1.2.2 --- Albuminuria in adolescents/children --- p.6 / Chapter 1.2.3 --- Prevalence of albuminuria in adults and adolescents --- p.8 / Chapter 1.2.4 --- Pathogenesis of albuminuria --- p.10 / Chapter 1.3 --- CVD and risk factors --- p.12 / Chapter 1.4 --- The associations between microalbuminuria and CVD risk factors --- p.17 / Chapter 1.5 --- Heavy metals --- p.18 / Chapter 1.5.1 --- Definition of heavy metals --- p.18 / Chapter 1.5.2 --- Adverse effects of heavy metals --- p.19 / Chapter 1.5.3 --- Heavy metals exposure In Hong Kong population: the local scene --- p.28 / Chapter 1.6 --- MicroRNAs --- p.29 / Chapter 1.6.1 --- The discovery of microRNAs --- p.29 / Chapter 1.6.2 --- The biogenesis of microRNAs --- p.30 / Chapter 1.6.3 --- The function of microRNAs --- p.31 / Chapter 1.7 --- Hypothesis --- p.40 / Chapter Chapter 2 --- Methodology --- p.41 / Chapter 2.1 --- Population --- p.41 / Chapter 2.2 --- Laboratory assays --- p.42 / Chapter 2.3 --- Statistical analysis --- p.44 / Chapter Chapter 3 --- Results --- p.46 / Chapter 3.1 --- Demographic and baseline clinical data --- p.46 / Chapter 3.2 --- Microalbuminuria and cardiovascular risk factors --- p.48 / Chapter 3.3 --- Microalbuminuria and heavy metals --- p.51 / Chapter 3.4 --- Microalbuminuria and miRNAs --- p.54 / Chapter 3.5 --- "Microalbuminuria, miRNAs, heavy metals and cardiovascular risk factors" --- p.57 / Chapter 3.6 --- miRNAs and heavy metals --- p.60 / Chapter Chapter 4 --- Discussion --- p.62 / Chapter 4.1 --- Heavy metals and microalbuminuria --- p.62 / Chapter 4.2 --- Heavy metals and CVD risk factors --- p.68 / Chapter 4.3 --- Microalbuminuria and CVD risk factors --- p.75 / Chapter 4.4 --- miRNAs and Heavy metals --- p.76 / Chapter 4.5 --- miRNAs and microalbuminuria --- p.77 / Chapter 4.6 --- Conclusion --- p.79 / Acknowledgement --- p.82 / References --- p.83

Abstract not available