The purpose of the present study was to explore the relationship between internalized racism, stereotype threat, self-handicapping, test performance, and cardiovascular responses in Black individuals. Stereotype threat, or apprehension about confirming a negative stereotype, has been shown to lead to self-handicapping, poor academic performance, as well as increased cardiovascular reactivity. Internalized racism, or the acceptance of negative stereotypes about one's group, is a factor that may moderate these relationships. One-hundred nine (84% female, 16% male) Black undergraduates participated in a laboratory study. Half of the participants were put in a stereotype-threatened condition and the other half were in a neutral condition. The participants were permitted unlimited time in which to practice for a verbal test and then were tested on their verbal ability while their blood pressure was monitored. Results indicated that internalized racism moderates the relationship between stereotype threat and systolic blood pressure, but not diastolic blood pressure or heart rate. However, the moderating effect of internalized racism in the relationship between stereotype threat and self-handicapping or test performance was not significant. It seems that individuals who do not accept the negative stereotypes about Blacks as a group experienced increased systolic blood pressure responses in stereotype-threatened situations compared to Black individuals who do accept the negative stereotypes. The implication is that Black individuals who challenge negative stereotypes will feel more stress when placed in situations where they are at risk of confirming those negative stereotypes. This study provides insight into reasons for the variability of cardiovascular disease among Black Americans, who typically experience a higher incidence overall compared to other ethnic groups.

Baigiamajame magistriniame darbe nagrinėjama kardiologinių rodiklių priklausomybė nuo žmogaus amžiaus ir fizinės apkrovos. Pateikta kardiologinių rodiklių kriterijų analizė. Išnagrinėti pagrindiniai kardiologiniai rodikliai trijose skirtingose amžiaus grupėse, pateikta jų lyginamoji analizė. Išnagrinėjus teorinius ir praktinius kardiologinių rodiklių vertinimo aspektus, pateikiamos baigiamojo darbo išvados. / In this final master thesis are research cardiovascular parameters dependence of human purchasing power and age. There are given test analysis of cardiovascular parameters. It was research the main cardiovascular parameters in three different groups of age and was given comparable analysis of parameters. All theoretical and practical results are given in conclusion.

SUMMARY Purpose of work: Ascertain and estimate the change of arterial blood pressure in the areas of arm, wrist, finger and the change of heart��s systole frequency using static and dynamic strain for all kinds of groups: different age and sex. Goals: 1. Ascertain the effect of static and dynamic strain for arterial blood pressure and for heart‘s systole frequency. 2. Examine the phenomenon of blood repartition and the arterial blood pressure registering investigative groups of different age and sex. 3. Estimate the effect of static exercise for the change of arterial blood pressure in different investigative groups. 4. Estimate the effect of dynamic exercise for the change of arterial blood pressure in different investigative groups. Contingent of investigative and the methods of investigation: The contingent of investigative is constituted by 67 sound investigative, without any clinical complaints: 38 are men and 29 – women. 15 men and 16 women, they performed the static exercise to fortify the muscles of back. 23 men and 13 women, they performed the dynamic exercise to fortify the muscles of shoulders. To estimate functional rate of heart we were using the measurers of arterial blood pressure OMRON. The measurers were registered 2 times: before the exercise and 60s after the exercise. Arterial blood pressure was measured in 3 places of left hand-in the areas of arm, wrist and finger registering systolic and diastolic blood pressure. The systole frequency of heart... [to full text]

No description available.

Background The prevalence and incidence of stroke are known to increase with age, which, combined with demographic change, means that very old patients with stroke are a growing patient group. Risk factors for incident stroke among very old people have not been widely investigated. The impact of depression on mortality in very old people who have had a stroke also remains unclear.  The aim of this thesis was to investigate the risk factors for incident stroke, the epidemiology of stroke and depression, and the consequences of having had a stroke regarding the risk of depression and mortality among very old people. Methods A randomly selected half of 85-, all 90-, and all ≥95-year-olds in certain municipalities in Västerbotten County, Sweden, and Pohjanmaa County, Finland were targeted in a population-based cohort study from 2000-2012. The 65-, 70-, 75-, and 80-year-olds in all the rural and random samples from the urban municipalities in the same counties were furthermore targeted in a survey in 2010. In the cohort study patients were assessed in their homes, by means of the 15-item Geriatric Depression Scale (GDS-15) and other assessment scales, as well as blood pressure measurements, several physical tests, and a review of medical diagnoses appearing in the medical charts. Incident stroke data were collected from medical charts guided by hospital registry records, cause of death records, and reassessments after 5 years. Depression was defined as a GDS-15 score ≥5. A clinical definition of all depressive disorders, based on assessment scale scores and review of medical charts was also used. A specialist in geriatric medicine evaluated the diagnoses. The survey included yes/no questions about stroke and depression status, and the 4-item Geriatric Depression Scale. Associations with mortality and incident stroke were tested using Cox proportional-hazard models.  Results In the ≥85-year-olds examined in 2005-2007 (n=601), the stroke prevalence was 21.5%, the prevalence of all depressive disorders was 37.8% and stroke was independently associated with depressive disorders (odds ratio 1.644, p=0.038). The prevalence of depression according to GDS-15 scores was 43.2% in people with stroke compared with 25.0% in people without stroke (p=0.001). However, in ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, depression was not independently associated with incident stroke.  In ≥65-year-olds who responded to a survey in 2010 (n=6098), the stroke prevalence rose with age from 4.7% among the 65- to 11.6% among the 80-year-olds (p<0.001). The prevalence of depression rose from 11.0% among the 65- to 18.1% among the 80-year-olds (p<0.001). In the group with stroke, depression was independently associated with dependence in personal activities of daily living and having a life crisis the preceding year, while in the non-stroke group, depression was independently associated with several additional demographic, social and health factors. In ≥85-year-olds examined in 2005-2007 with valid GDS-15 tests (n=452), having had a stroke was associated with increased 5-year mortality [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.15-2.03]. Having had a stroke and depression was associated with increased 5-year mortality compared with having only stroke (HR 1.90, 95% CI 1.15-3.13), having only depression (HR 1.59, 95% CI 1.03-2.45), and compared with having neither stroke nor depression (HR 2.50, 95% CI 1.69-3.69). Having only stroke without a depression did not increase mortality compared with having neither stroke nor depression. In ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, the stroke incidence was 33.8/1000 person-years during a mean follow-up period of about three years. In a comprehensive multivariate model, atrial fibrillation (HR 1.85, 95% CI 1.07–3.19) and higher systolic blood pressure (SBP; HR 1.19, 95% CI 1.08–1.30 per 10-mmHg increase) were associated with incident stroke overall. In additional multivariate models, diastolic blood pressure (DBP) ≥90 mmHg (HR 2.45, 95% CI 1.47–4.08) and SBP ≥160 mmHg (v. <140 mmHg; HR 2.80, 95% CI 1.53–5.14) were associated with incident stroke. Conclusion The prevalence of both stroke and depression increased with age, and rates were especially high among very old people. Having had a stroke was independently associated with a higher prevalence of depression among very old people, however, depression was not independently associated with a higher incidence of stroke. Having had a stroke was associated with increased all-cause mortality among very old people, but only among those who were also depressed. High SBP (≥160 mmHg), DBP (≥90 mmHg) and atrial fibrillation were the only consistent independent risk factors for incident stroke among very old people. / I västvärlden inklusive Sverige så ökar gruppen av människor som uppnår åldern 80 år eller äldre. Människorna som uppnår denna mycket höga ålder har en hög förekomst av kardiovaskulära riskfaktorer, har ofta flera samtidiga sjukdomar och ofta funktionsnedsättningar. Medicinska behandlingsåtgärder är ofta mindre effektiva och förknippade med biverkningar i åldersgruppen. Stroke är en sjukdom som beror på skada av hjärnvävnad till följd av minskad blodtillhörsel till delar av hjärnan. Det är känt att såväl förekomsten av och insjuknandet i stroke ökar med stigande ålder. Den som drabbas av stroke löper risk att få en bestående funktionsnedsättning och att dö i förtid. En vanlig komplikation efter att ha drabbats av stroke är nedstämdhet eller depression. Vetenskapliga studier om stroke har tidigare negligerat mycket gamla människor, vilket i takt med den pågående demografiska utvecklingen framstått som allt mer orimligt. Det är ej helt klarlagt vilka riskfaktorer som leder till att insjukna med stroke i mycket hög ålder. Överdödligheten förknippad med att drabbas av depression efter stroke är också oklar i åldersgruppen. Det är också oklart vad som skiljer depression efter stroke från depression bland den övriga befolkningen av åldrade människor. Den populations-baserade kohortstudien GErontologisk Regional DAtabas (GERDA) inleddes år 2000 för att kartlägga faktorer förknippade med gott åldrande bland mycket gamla människor. Hälften av 85-åringarna, alla 90-åringar och alla ≥95-åringar i utvalda kommuner i Västerbotten erbjöds att delta i studien. Därefter har återbesök hos tidigare deltagare i sina nya åldersgrupper och rekrytering av nya deltagare genomförts vart femte år. Studien utvidgades med utvalda kommuner i Österbotten, Finland vid den första femårsuppföljningen. Datainsamlingen i studien bestod av demografiska frågor, skattningsskalor, blodtrycksmätning och kognitiva test genomförda vid ett hembesök i deltagarens hem, samt genomgång av journalhandlingar. År 2010 skickades även en enkät ut till 65-, 70-, 75- och 80-åringar i alla kommuner i Västerbotten och Österbotten. Enkäten innehöll frågor om demografi, hälsa, sjukdomar och intressen. Bland deltagarna i kohortstudien bestämdes förekomsten av tidigare stroke baserat på genomgång av journaluppgifter och uppgifter från hembesöken. Förekomsten av depression bestämdes baserat på poängsättning från en validerad skattningsskala för depression, samt baserat på en sammanvägning av journaluppgifter och skattningsskalor. En specialist i geriatrik fattade det slutliga beslutet om diagnoser. Insjuknande i stroke bestämdes baserat på journalgenomgång av individer med stroke-relaterade diagnoskoder i sjukhusregistret, i dödsorsaksregistret eller uppgift om stroke vid femårsuppföljningen i studien. Bland deltagarna i enkätstudien bestämdes förekomsten av tidigare stroke baserat på självrapportering, och förekomsten av depression bestämdes baserat på en sammanvägning av självrapportering och en skattningsskala för depression.  Förekomsten av stroke i enkätstudien steg med ålder, från 4.7% bland 65-åringar till 11.6% bland 80-åringar. Förekomsten av stroke var omkring 20% bland ≥85-åringar, med minimal variation mellan 85-, 90- och ≥95-åringar. Förekomsten av depression var högre bland dem med stroke jämfört med de övriga deltagarna, både gällande den sammavägda diagnosen och baserat endast på poängsättning. Stroke och sömnproblem var oberoende associerade med depression. Bland ≥65-åringar i enkätstudien var funktionsnedsättning och genomgången livskris associerade med depression hos dem med en tidigare stroke. Bland deltagare utan stroke var ett antal ytterligare externa faktorer, inklusive subjektiv upplevelse av dålig ekonomi och att inte ha någon att anförtro sig till, associerade med depression. Både stroke och depression var associerade med ökad dödlighet bland ≥85-åringar. De med stroke utan depression hade en dödlighet i linje med normalbefolkningen utan stroke eller depression. Förekomsten av samtidig stroke och depression var associerad med högre dödlighet än normalbefolkningen, jämfört med dem med enbart stroke eller enbart depression. Högt systoliskt blodtryck (≥160 mmHg), högt diastoliskt blodtryck (≥90 mmHg) och förmaksflimmer var oberoende riskfaktorer för att insjukna i stroke bland ≥85-åringarna. Sambandet mellan blodtryck och strokerisk försvagades ej hos människor med kognitiv eller funktionell nedsättning. Tidigare stroke, hjärtsvikt, kognitiv nedsättning, näringsbrist, depressiva symtom och låg gånghastighet var också associerade med att insjukna i stroke, men ej oberoende av varandra. Sammanfattningsvis så stiger förekomsten av stroke med åldern och är särskilt hög bland mycket gamla människor. Depression är betydligt vanligare hos mycket gamla människor med stroke, även justerat för störningsfaktorer. Depression är främst associerat med funktions-nedsättning hos människor med stroke, men med ett större antal externa faktorer hos människor utan stroke. Mycket gamla människor med stroke har särskilt hög dödlighet om de samtidigt är deprimerade, men en dödlighet i linje med normalbefolkningen om de inte är deprimerade. Högt systoliskt och diastoliskt blodtryck samt förmaksflimmer är viktiga och behandlingsbara orsaker till att drabbas av stroke i mycket hög ålder.

Les auto-tensiomètres (AT) sont parmi les dispositifs les plus utilisés en clinique et à domicile pour la mesure de la pression artérielle (PA). Ces appareils utilisent deux algorithmes heuristiques (Height-Based/HB et Slope-Based/SB) pour déterminer les pressions artérielles systoliques (PAS) et diastoliques (PAD) à partir de l'enregistrement de la pression oscillométrique dans le brassard. La mise sur le marché de ces appareils est actuellement assujettie à la directive 93/42/CE, qui nécessite une étude clinique basée sur une comparaison avec des mesures de la PA par auscultation. Cette méthode, qui consiste à détecter des sons de Korotkoff dans l'artère auscultée, présente l'inconvénient d'être praticien dépendante et engendre une incertitude sur la mesure de la PAS et de la PAD. Il est donc nécessaire de s'assurer de la fiabilité de ces instruments en proposant un dispositif expérimental de référence permettant en outre de pallier l'étude clinique qui s'avère longue et coûteuse. Cette thèse est dédiée à la mise en place de ce dispositif ou chaîne de référence, qui associe un banc d'essai permettant la validation des auto-tensiomètres et une base de données de mesure de PA. Afin de réaliser notre objectif, une étude clinique a été réalisée à l'hôpital Nord de Marseille à l'issue d'un examen de coronarographie. L'étude, réalisée sur 115 patients, compare des mesures de pression invasives (mesures de référence) à des mesures de pression non-invasives : des mesures auscultatoires, des mesures via un auto-tensiomètre commercial et des mesures oscillométriques. Ces dernières ont été réalisées concomitamment avec la PA invasive. / Automated blood pressure (ABP) devices are among the most commonly used devices for diagnosis arterial blood pressure (BP) for clinical and home use. These devices use two heuristic algorithms (Height-Based/HB and Slope-Based/SB) to determine the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) from the recording of an oscillometric pressure signal collected using an inflatable cuff. Currently ABP are in the scope of Directive 93/42/CE, which requires a clinical study based on a comparison of BP measurements using auscultatory method. Unfortunately auscultatory measurements have the disadvantage of the uncertainties related to perception of Korotkoff sounds, leading to an uncertainty of measuring SBP and DBP. Therefore it is necessary to ensure the reliability of these instruments and to propose an experimental reference chain to validate ABP devices without returning to expensive and long clinical campaign. The purpose of this thesis is to create and develop a calibration chain for measuring arterial BP, which is composed of database of arterial BP measurements and a patient simulator for regenerating oscillometric measurements. To achieve our target, a clinical study was conducted at the northern hospital of Marseille (l'hôpital Nord) after a coronary exam. The clinical study of 115 patients compares invasive blood pressure measurements (reference measurements) and non-invasive blood pressure measurements: auscultatory measurements, measurements using a commercial automated blood pressure device and oscillometric measurements. The latter were carried out simultaneously with the invasive BP measurements.

No description available.

Les maladies complexes telles que les maladies cardio-Vasculaires (MCV) sont influencées par des facteurs génétiques et environnementaux. L’estimation du risque cardio-Vasculaire chez un individu est généralement évaluée par la sommation des facteurs de risque reconnu des MCV (p. ex. l’âge, le sexe, le tabac, la pression artérielle et le cholestérol). Dernièrement, plusieurs bio-Marqueurs ont été examiné pour leur aptitude à améliorer la prédiction des maladies cardio-Vasculaires au-Delà des facteurs de risques traditionnels. L’intérêt de découvrir de nouveaux loci est incité notamment par les découvertes qui émergent des études d'association pangénomique (GWAS) qui permettent de tester l’association de variation génétique au risque de contracter une maladie commune. Les GWAS ont considérablement amélioré notre connaissance de l'architecture génétique des maladies cardio-Vasculaires, à ce jour plus de 50 variations génétiques sont formellement associées à des maladies cardio-Vasculaires, de même plus de 200 marqueurs génétiques seraient associés à des facteurs de risque cardiovasculaire traditionnels (p. ex. le taux sanguin des lipides, la pression artérielle, l’indice de masse corporelle et le diabète de type 2). Le succès remarquable de ces études d’association, qui a permis l’identification de nombreux bio-Marqueurs, a conduit à une réévaluation des données génétiques dans le but de définir des informations cliniquement utiles pour limiter et mieux prédire les risques de maladies, grâce à une application plus efficace des stratégies de prévention. Dans cette thèse, nous examinons tout d'abord une nouvelle approche pour étudier l'architecture génétique de l'hypertension artérielle (HTA; facteur de risque majeur des maladies cardiovasculaires prématurées), puis nous avons constitué plusieurs modèles pour prédire le risque de développer une maladie coronarienne (MC; type le plus commun de MCV), enfin nous avons déterminé une base génétique commune du principal prédicteur de complications cliniques des maladies coronariennes – l'athérosclérose subclinique - afin d'ajouter une valeur pronostique supplémentaire en plus des scores de risque traditionnels à différents âges. Nous avons estimé l'héritabilité de la première mesure de la pression artérielle systolique (PAS) à ~25%/~45% et à ~30%/~37% pour la pression artérielle diastolique (PAD) chez les sujets d’origine Européenne (N = 8901) et d’origine Africaine (N = 2860) faisant respectivement partie de la cohorte Atherosclerosis Risk in Communities (ARIC), en accord avec les études antérieures. Par ailleurs, nous avons développé un moyen de combiner un score de risque génétique (SRC) – somme des effets génétiques parmi un ensemble de marqueurs – avec une évaluation indépendante du risque clinique, en utilisant un système d'équations log-Linéaire. Nous avons employé cet outil à la prédiction de la maladie coronarienne (MC) dans la cohorte ARIC. L'ajout d'un score de risque génétique (SRG) à un score de risque clinique (SRC) améliore à la fois la discrimination et l'étalonnage des maladies coronariennes dans la cohorte ARIC, et révèle par la même comment cette information génétique influence l'évaluation des risques ainsi que l’approche clinique. Enfin, parmi 1561 cas et 5068 contrôles (de la présence ou non de calcifications coronaires), faisant partie de plusieurs ensembles de données cliniques et génétiques disponibles via la base de données NCBI de Génotypes et Phénotypes (dbGAP), nous avons constaté qu’une augmentation d'un écart-Type dans le score de risque génétique de 49 bio-Marqueurs de MC est associée à 28 % d’augmentation de risque de développer une athérosclérose coronarienne subclinique diagnostiquée à un stade avancé (p=1.43x10-16). Cette augmentation du risque est significative dans chaque catégorie d'âge (de 15 ans en 15 ans) (0,01 > p > 9.4x10-7) et a été remarquablement similaire dans toutes les catégories d'âge (test d'hétérogénéité p = 0.98). (...) / Complex diseases such as cardiovascular disease (CVD) are influenced by both genetic and environmental factors. Estimation of an individual’s cardiovascular risk usually involves measurement of risk factors correlated with risk of CVD (e.g. age, sex, smoking, blood pressure, and total cholesterol). Lately, several biomarkers have been evaluated for their ability to improve prediction of cardiovascular disease beyond traditional risk factors. The interest in novel loci is propelled notably by emerging discoveries from the advent of genome-Wide association studies (GWAS) of genetic variants associated with risk for common diseases. GWAS has greatly enhanced our knowledge of the genetic architecture of cardiovascular disease, yielding over 50 variants confirmed to be associated with CVD to date, as well as over 200 associated with traditional cardiovascular risk factors (e.g. lipids, blood pressure, body mass index, and type 2 diabetes mellitus). This recent and continuing success in discovering increasing numbers of robustly associated genetic markers has led to reassessment of whether genetic data can provide clinically useful information by refining risk prediction and moderating disease risk through a more efficient application of prevention strategies. In this thesis, we first address novel approach to survey the genetic architecture of hypertension (i.e. major risk factor for premature CVD), then construct risk prediction models for coronary artery disease (CAD; i.e. most common type of CVD) and finally establish a common genetic basis of the strongest predictor of clinical complications of CAD, subclinical atherosclerosis, to add incremental prognostic value above traditional risk scores across a range of ages. We show that, for first visit measurements, the heritability is ~25%/~45% and ~30%/~37% for systolic (SBP) and diastolic blood pressure (DBP) in European (N=8,901) and African (N=2,860) ancestry individuals from the Atherosclerosis Risk in Communities (ARIC) cohort, respectively, in accord with prior studies. Then we present a means to combine a polygenic risk score - genetic effects among an ensemble of markers - with an independent assessment of clinical risk using a log-Link function. We apply the method to the prediction of coronary heart disease (CHD) in the ARIC cohort. The addition of a genetic risk score (GRS) to a clinical risk score (CRS) improves both discrimination and calibration for CHD in ARIC and subsequently reveal how this genetic information influences risk assessment and thus potentially clinical management. Finally, Among 1561 cases and 5068 controls, from several clinical and genetic datasets available through the NCBI's database of Genotypes and Phenotypes (dbGAP), we found a one SD increase in the genetic risk score of 49 CAD SNPs was associated with a 28% increased risk of having advanced subclinical coronary atherosclerosis (p = 1.43 x 10-16). This increase in risk was significant in every 15-Year age stratum (.01 > p > 9.4 x 10-7) and was remarkably similar across all age strata (p test of heterogeneity = 0.98). We obtained near identical results and levels of significance when we restricted the genetic risk score to 32 SNPs not associated with traditional risk factors. Accordingly, common variation largely recapitulates the known heritability of blood pressure traits. The vast majority of this heritability varies by chromosome, depending on its length, and is largely concentrated in intronic and intergenic regions of the genome but widely distributed across the common allele frequency spectrum. Respectively, our proposed method to combine genetic information at established susceptibility loci with a nongenetic risk prediction tool facilitates the standardized incorporation of a GRS in risk assessment. (...)

BACKGROUND: Clinical evidence shows that diabetes may provoke uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of diabetes with uncontrolled BP outcomes among diagnosed hypertensive patients have not been evaluated. METHODS: A total of 6,134 diagnosed hypertensive subjects aged ≥ 20 years were collected from the National Health and Nutrition Examination Survey 1999-2008 with a stratified multistage design. Odds ratios (ORs) and relative ORs of uncontrolled BP and effect differences in continuous BP for diabetes over race/ethnicity were derived using weighted logistic regression and linear regression models. RESULTS: Compared with participants who did not have diabetes, non-Hispanic black participants with diabetes had a 138% higher chance of having uncontrolled BP, Mexican participants with diabetes had a 60% higher chance of having uncontrolled BP, and non-Hispanic white participants with diabetes had a 161% higher chances of having uncontrolled BP. The association of diabetes with uncontrolled BP was lower in Mexican Americans than in non-Hispanic blacks and whites (Mexican Americans vs. non-Hispanic blacks: relative OR = 0.55, 95% confidence interval (CI) = 0.37-0.82; Mexican Americans vs. non-Hispanic whites: relative OR = 0.53, 95% CI = 0.35-0.80) and the association of diabetes with isolated uncontrolled systolic BP was lower in Mexican Americans than in non-Hispanic whites (Mexican Americans vs. non-Hispanic whites: relative OR = 0.62, 95% CI = 0.40-0.96). Mexican Americans have a stronger association of diabetes with decreased systolic BP and diastolic BP than non-Hispanic whites, and a stronger association of diabetes with decreased diastolic BP than non-Hispanic blacks. CONCLUSIONS: The association of diabetes with uncontrolled BP outcomes is lower despite higher prevalence of diabetes in Mexican Americans than in non-Hispanic whites. The stronger association of diabetes with BP outcomes in whites should be of clinical concern, considering they account for the majority of the hypertensive population in the United States.

The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.