Context: Little is known about body image and its relationship with physical activity (PA) among people living with heart disease. Purpose: To determine the prevalence and stability of body image issues over time in heart patients, and to determine the bi-directional relationship between body image and PA over time. Method: Participants who completed cardiac rehabilitation (CR; n = 31), and who declined CR (n = 28) were recruited. Participants completed self-report questionnaires assessing body image and PA at two time intervals, three months apart. Results: Up to 9.7% of participants in CR and 10.7% of those not in CR reported high body image concerns. Repeated measures ANOVAs revealed body image changed over time in people not in CR (body surveillance, Wilk’s ? = .768, F = 8.15, p = .008; control beliefs, Wilk’s ? = .837, F = 5.28, p = .030). Linear regressions showed that minutes of moderate PA predicted body image (body shame, ? = -.372, t = -.2.12, p = .043) in people in CR, and that body image (control beliefs) predicted minutes of moderate PA (? = .384, t =2.12, p = .044) in people not in CR. Conclusion/Implications: This research has the potential to lead to the development of more effective PA interventions, thus improving the longevity and quality of life of heart patients.

Background: Normative values of VO2max have been developed or updated based on the estimated VO2max, but measured normative values of VO2max have not been developed yet. VO2max has been reported to relate to coronary heart disease (CHD) risk factors, yet most of the studies have used estimated VO2max to compare CHD risk factors. Therefore, the purpose of this study was to develop norms for VO2max from the Ball State University (BSU) Adult Physical Fitness Program cohort that represented percentiles based on the measured VO2max. In addition, this study evaluated the relationship between measured VO2max and six coronary heart disease (CHD) risk factors, which include Body Bass Index (BMI), high density lipoprotein cholesterol (HDL-C), glucose, triglyceride (TG), total cholesterol (TC) and resting blood pressure (BP).Methods: Subjects were healthy men (N=1,867) and women (N=1,253), ranging in age from 19 to 75 years, who completed the standard BSU Adult Physical Fitness Program quiet and exercise testing sessions between 1971 and 2000, with the graded exercise testing (GXT) conducted with one of the following protocols including modified walking, running, Balke, Bruce, and BSU/Bruce ramp. To be included, subjects had to achieve respiratory exchange ratio (RER) >1.0 during their exercise test.Results: All subjects were classified into ten group determined by deciles of VO2max for each decade of age for males and females respectively. A linear regression showed that VO2max decreased 10.1% per decade (0.44 mi.kg'•min'•yr') for men and 9.7% per decade (0.32 ml•kg-l.min-l.yr') for women. There was no significant difference in the rate of agerelated decline in VO2max per decade between men and women or between deciles of VO2max. Also, the percent of subjects with an exercise history code >5 (regularly participate in exercise at least 3 days per week) was higher in the higher VO2max deciles. In addition, five positive CHD risk factors were inversely related to VO2max, and one negative CHD risk factor was directly related to VO2max. As expected, the higher CRF groups had a more favorable CHD risk factor profile. Also, the mean of VO2max decreased with the greater number of CHD risk factors.Conclusion: This study developed normative values of the VO2max based on measured VO2max. VO2max was significantly correlated to CHD risk factors. / School of Physical Education, Sport, and Exercise Science

The purpose of the study was to gather empirical data on the relationship of stress provoking aspects of the administrative role and the presence of selected risk factors in coronary heart disease.The population of the study consisted of 181 administrative persons working in the areas serviced by the East Central Indiana School Study Council and the Northeast Indiana School Study Council. The testing was done at educational workshops, away from the place of employment. The testing period extended through January, February, and March of 1976.)Four instruments were used in the study. The first, instrument, Biographical Information, was used to gather data about medical conditions for which the respondents were currently receiving treatment. The second instrument, the Stressful Situation Scale, was used to collect data about the number of stressful situations the respondents recently had experienced. The third instrument, the Perceived Occupational Stress Scale, was designed by Dr. Robert L. Kahn and his associates at the University of Michigan. The scale was used with the permission of Dr. Kahn and measured the amount of stress the administrative personnel felt. The fourth instrument, the Behavioral Risk Factor Analysis, was used to obtain data about the daily activities of the respondents that may have caused a predisposition to coronary heart disease.The analysis of variance was utilized to test the first null hypothesis that no statistically significant relationship existed between the number of stressful situations experienced and the presence of selected physiological coronary heart disease risk factors. The chi square statistic attempted to test the second null hypothesis that no statistically significant relationship existed between the number of stressful situations experienced and the presence of selected behavioral risk factors of coronary heart disease. The chi square statistic was not operational due to an insufficient spread in the cells.The following findings and conclusions were based on a review of the literature as presented in the study and the results of the analysis of data:1. The number of stressful situations experienced were statistically significant when compared with pulse rate.2. The number of stressful situations experienced were statistically significant when compared with systolic blood pressure. 3. The number of stressful situations experienced were statistically significant when compared with diastolic blood pressure.4. The number of stressful situations experienced were statistically significant when compared with perceived occupational stress. 5. The assistant superintendent group had the highest mean value for pulse rate.6. The assistant superintendent group had the highest mean value for systolic blood pressure. 7.The assistant superintendent group had the highest mean value for diastolic blood pressure.8.The assistant superintendent group had the highest mean value for perceived occupational stress.9.Principals had the greatest mean number of years in the employment category.10. Assistant superintendents had the fewest mean number of years in the employment category.11. Assistant principals had the lowest mean age of administrative personnel.12. Superintendents had the highest mean age of administrative personnel.13. Hypertension was a significant medical problem for administrative personnel in schools.14.Problems with athletic teams presented a significant problem for school administrators.15. Conflict with subordinates and superordinates presented a major problem for school administrators.16. The Occupational Safety and Health Administration had not presented major problems for school administrators.17. Few administrators in the public schools reported feeling unqualified.18. Few administrators in the public schools reported feeling hesitant or upset about having to make decisions.

There is no abstract available for this dissertation. / Department of Counseling Psychology and Guidance Services

Motivation Cardiovascular disease (CVD) is one of the most important causes of mortality and morbidity in South Africa. The major risk factors are prevalent in both the developed and developing areas of the world, among all social classes, and are of similar public health significance in all countries regardless of their level of development. This indicates that much scope remains for further reducing coronary heart disease (CHD) death rates in developed countries and for preventing the emerging CHD epidemic in poorer nations. This study aims at identifying the beliefs of the South African adult population regarding food and cardiovascular health and to therefore identify target groups for education programs. Objectives To investigate the beliefs of South African adults towards the importance of the link between food and cardiovascular health, especially between the different races, living standards, age and gender groups. Also to determine whether this population looks for the Heart Foundation symbol on food products, as well as where the link between food and heart disease ranks in terms of importance compared to other highly prevalent diseases. Method The design of the study was a randomized cross-sectional study. Trained field workers administrated questionnaires by conducting face-to-face interviews with consumers in the language of their choice. Two thousand South African individuals (1 6 years and older) were randomly selected from metropolitan areas in South Africa. The data was weighted to be representative of the total South African metropolitan consumer population, based on gender, age and race distribution (n=10 695 000). The total population was representative of both genders (5 423 000 men and 5 272 000 women) and major race groups (2 615 000 whites, 6 252 000 blacks, 1 255 000 coloureds and 573 000 Indians), from different age and living standards groups. The market research group, MARKINOR, was contracted to collect the data. Quantitive data was statistically analysed in order to generate the relevant descriptive statistics, cross tabulations and statistical tests. Results The majority of the population found the link between food and cardiovascular risk related health issues to be important, especially the higher LSM groups within the different race groups. The link between food and weight loss was considered the least important compared to other cardiovascular risk factors (cholesterol, blood pressure, diabetes, healthy blood vessels). Only 35% of the study population agreed with the statement that they look for the Heart Foundation symbol, while 46% disagreed with the statement. There was a greater tendency for the higher LSM groups to look for the Heart Foundation symbol than the lower LSM groups. Heart disease was considered just as important and in some cases more important when compared with HIVIAIDS and cancer. Conclusions This study shows that the metropolitan South African adult population is aware of the importance of food on CVD. Nutritional education needs to be aimed at both genders and all ages of the lower socio-economic groups of South Africa. The reasons why such a large percentage of the South African metropolitan adults do not look for the Heart Foundation symbol, or are undecided about it, needs to be investigated and addressed. Prevention programs promoting a healthy lifestyle, which would address the risk factors associated with CVD, should be received with a positive attitude. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2005.

Background: The relationship between average alcohol consumption and heart disease is well researched, showing a substantial cardioprotective association. This dissertation examined the epidemiological evidence for an effect of heavy episodic drinking (HED) over and above the effect of average alcohol consumption on heart disease. Methods: Electronic databases were systematically searched for epidemiological studies on the effect of HED on heart disease and identified articles were quantitatively summarized in a meta-analysis. Meta-regression models were used to examine the effect of characteristics of primary studies. Using individual-level data, semi-parametric Cox regression models were used to investigate HED exposure within narrow categories of average alcohol consumption in a US national population sample (n = 9,937) in relation to heart disease mortality in an 11-22 year follow-up. Frequency of heavy drinking episodes was used to identify latent classes of drinking history using growth mixture modeling in a sub-sample of this US cohort. Retrieved classes were used as independent variables in Cox regression models with heart disease mortality as the outcome event. Results: A pooled relative risk of 1.45 (95% confidence interval (CI): 1.24-1.70) for HED compared with non-HED drinkers with average alcohol consumption between 0.1-60 g/day was derived in a meta-analysis. A strong and consistent association with HED was found among current drinkers consuming an average of 1-2 drinks per day in the US cohort. There was no evidence of increased heart disease mortality resulting from the frequency of heavy drinking episodes before the age of forty. Conclusions: There is reasonable and consistent evidence for an association of HED and heart disease in current drinkers, negating any beneficial effect from alcohol consumption on heart health. History of frequency of heavy drinking episodes, however, showed no evidence for such an effect modification.

Background: Premenopausal black women have a 2-3 fold greater rate of coronary heart disease (CHD) than premenopausal white women. The purpose of this study was to provide insight into the reasons for this difference. Methods and Results: We compared CHD risk factors in 100 black and 100 white, healthy premenopausal women age 18-45 years and of relatively advantaged socioeconomic status. Black women consumed diets higher in saturated fat and cholesterol (12% of kcal as saturated fat and 360 mg of cholesterol per day) than did white women (10% of kcal and 290 mg/day) (p=0.008). Black women also had a higher body mass index (BMI) (32.0±9.2 vs. 29.0±9.4 kg/m², p=0.021), and higher systolic (124±17 vs. 115±14 mmHg, p<0.0001), and diastolic (79±14 vs. 75±11 mmHg, p=0.048) blood pressures. The mean plasma Lp(a) concentration was higher in the black women (40.2±31.3 mg/dl) than in the white women (19.2±23.7 mg/dl)(p<0.0001). The black women, however, had lower plasma triglyceride levels (0.91±0.46 vs. 1.22±0.60 mmol/L, p<0.0001), and a trend toward higher HDL cholesterol levels (1.37±0.34 vs. 1.29±0.31 mmol/L, p=0.064) than the white women. Plasma total and LDL cholesterol levels were similar. Rates of cigarette smoking and alcohol intake were low and similar between the races. Black women additionally had higher levels of plasma total homocysteine (8.80 vs. 7.81 μmol/L, p=0.013), lower plasma folates (3.52 vs. 5.23 ng/ml, p<0.0001), and higher vitamin B₁₂ levels (522 vs. 417 pg/ml, p<0.0001) than white women. More white women than black women took a multivitamin supplement (42.4% vs. 24.7%, p=0.019). When adjusted for multivitamin use, homocysteine levels did not differ, but plasma folate remained significantly lower in black women. Sixty-eight percent of black women carried the wild-type methylenetetrahydrofolate reductase genotype, 32.0% were heterozygotes, and none were homozygotes. Of the white women, 47.4% were wild-type, 40.3% heterozygotes, and 12.3% homozygotes (p=0.013). Conclusions: Premenopausal black women consumed more saturated fat and cholesterol and had a higher mean body mass index, blood pressure, Lp(a), and plasma total homocysteine levels than white women. These differences in coronary risk factors may explain the higher incidence of CHD in premenopausal black compared to white women. / Graduation date: 1998

Thesis (Ph. D.)--University of Hawaii at Manoa, 1993. / Microfiche. / ix, 211 leaves, bound 29 cm

Pre-clinical studies suggest that granulocyte-colony stimulating factor (GCSF) holds promise for the treatment of ischaemic heart disease (IHD). However, its safety and efficacy in this setting, and in particular in patients with chronic refractory 'no-option' IHD, is unclear. Therefore, a clinical study was initiated in 20 such 'no-option' patients, with the aim of assessing the safety and efficacy of both G-CSF administration, and also, that of an intracoronary infusion of G-CSF mobilised CD133+ cells. The study involved initial baseline cardiac ischaemia assessment (symptom based questionnaire, exercise stress test (EST), nuclear Sestamibi (MIBI) and dobutamine stress echocardiographic (DSE) imaging). Stable 'no-option' IHD patients then received open-label G-CSF commencing at 10μg/kg s/c for five days, with an EST on days four and six (to facilitate myocardial cytokine generation and stem cell trafficking). After three months, cardiac ischaemia assessment and the same regimen of G-CSF and ESTs were repeated, but in addition, leukapheresis and then a randomised double-blinded intracoronary infusion of CD133+ or unselected cells were performed. Final cardiac ischaemia assessment was three months thereafter. Eighteen male and two female subjects (mean age 62.4) were enrolled. Eight events occurred that fulfilled pre-specified 'adverse event' criteria: four ischaemic (troponin positive) episodes, two episodes of transient thrombocytopaenia (one profound), one episode of gout and one unscheduled hospitalisation for exhaustion. Troponin was positive on 17 further occasions (all CK-MB negative), however, at these instances angina severity was identical to baseline. Importantly, no adverse event(s) resulted in any detectable long-term adverse sequelae for any subject. From baseline to final follow-up, the administration of two cycles of G-CSF was associated with statistically significant improvements in a range of subjective outcomes, including anginal symptoms, quality of life and EST performance (all p < 0.005). However, the objective MIBI and DSE scans showed only trends towards improvement (all p > 0.1). Compared to unselected cells, an intracoronary infusion of CD133+ cells did not improve either subjective or objective outcomes. In conclusion, administering G-CSF to patients with refractory 'no-option' IHD warrants careful monitoring, but may be performed with safety. A larger, randomised double-blind placebo-controlled trial of G-CSF in these patients appears warranted.

Congenital heart disease is the most common form of birth defect, affecting approximately 1% of liveborn babies. Secundum atrial septal defect (ASD) is the second most common form of congenital heart disease (CHD). Most cases have no known cause. Chromosomal, syndromal and teratogenic causes account for a minority of cases. The hypothesis that mutations in the ASD genes NKX2-5 and GATA4 may cause apparently sporadic ASD was tested by sequencing them in unrelated probands with ASD. In this study, 1/102 individuals with ASD had an NKX2-5 mutation, and 1/129 had a deletion of the GATA4 gene. The cardiac transcription factor TBX20 interacts with other ASD genes but had not previously been associated with human disease. Of 352 individuals with CHD, including 175 with ASD, 2 individuals, each with a family history of CHD, had pathogenic mutations in TBX20. Phenotypes included ASD, VSD, valvular abnormalities and dilated cardiomyopathy. These studies of NKX2-5, GATA4 and TBX20 indicate that dominant ASD genes account for a small minority of cases of ASD, and emphasize the considerable genetic heterogeneity in dominant ASD (also caused by mutations in MYH6 and ACTC). A new syndrome of dominant ASD and the Marcus Gunn jaw winking phenomenon is reported. Linkage to known loci was excluded, extending this heterogeneity, but a whole genome scan did not identify a candidate locus for this disorder. Previous studies of inbred laboratory mice showed an association between patent foramen ovale (PFO) and measures of atrial septal morphology, particularly septum primum length (???flap valve length??? or FVL). In humans, PFO is associated with cryptogenic stroke and migraine, and is regarded as being in a pathological contiuum with ASD. Twelve inbred strains, including 129T2/SvEms and QSi5, were studied, with generation of [129T2/SvEms x QSi5] F1, F2 and F14 mice. Studies of atrial morphology in 3017 mice confirmed the relationship between FVL and PFO but revealed considerable complexity. An F2 mapping study identified 7 significant and 6 suggestive quantitative trait loci (QTL), affecting FVL and two other traits, foramen ovale width (FOW) and crescent width (CRW). Binary analysis of PFO supported four of these.