The purpose of this thesis was to examine coronary heart disease (CHD) risk factors and secondary complications in individuals with spinal cord injury (SCI). In particular, this thesis was organized around the central theme of adiposity, which is a prevalent complication following SCI. Study 1 focused on understanding the relationships between activities of daily living (ADL) and CHD risk factors including central adiposity, lipoproteins, and triglycerides. Using generalized linear models, while controlling for pertinent covariates such as sex, age, and leisure time physical activity (LTPA), it was found that Mobility ADL (wheeling and transferring) were negatively associated with total and LDL-cholesterol. Study 2 examined whether individuals who considered themselves to be overweight subsequently had less favourable subjective well-being, and were more likely to report specific secondary complications than individuals who did not consider themselves to be overweight. Logistic regression analysis and partial correlations controlling for pertinent covariates such as sex, age, and injury severity, revealed that individuals who considered themselves to be overweight reported greater pain, depression, overuse injuries, and fatigue, and less satisfaction with life than individuals who did not consider themselves to be overweight. In summary, the findings suggest that a) participation in specific types of ADL (i.e. Mobility ADL) are associated with a lower CHD risk and should be further explored and that b) elevated perceived adiposity is associated with specific secondary complications and lower subjective well-being. Overall thesis findings support the overwhelming evidence of the benefits of daily physical activity and maintaining a healthy bodyweight in the SCI population. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2009-05-28 11:40:32.574

Recent research has shown that the combination of high triglyceride (TG) levels and low high density lipoprotein (HDL) levels, significantly increases the incidence of coronary artery disease (CAD). The incidence of CAD is also increased in abdominally obese individuals. To assess differences in postprandial TG clearance patterns between abdominally obese (AO) and controls (C), fourteen healthy, normolipidemic males (seven controls and seven abdominally obese) completed an oral fat loading test (78 grams of fat). Blood samples were collected every hour for eight hours. Abdominally obese individuals had significantly greater TG values, significantly lower total HDL and HDL2 values and significantly greater area under the TG curve (p = 0.03). Time to reach peak TG and time to reach baseline TG values did not differ between the two groups, even though fewer AO individuals reached baseline within eight hours. The data from the present investigation indicate that increased time to clear TG in AO individuals may be one pathway that increases the incidence of CAD in this group. / School of Physical Education

D.Phil. (Biokinetics) / Please refer to full text to view abstract

Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background: Coronary artery disease is a form of cardiovascular disease (CVD) which manifests itself in three ways: angina pectoris, acute coronary syndrome and cardiac death. Thirty-three people die daily of a myocardial infarction (cardiac death) and 7.5 million deaths annually are caused by CVD (51% from strokes and 45% from coronary artery disease) worldwide. Globally, the CVD death rate is a mere 4% compared to South Africa which has a 42% death rate. It is predicted that by the year 2030 there will be 25 million deaths annually from CVD, mainly in the form of strokes and heart disease. The WHO compared the death rates of high-income countries to those of low- and middle-income countries, like South Africa, and the results show that CVD deaths are declining in high-income countries but rapidly increasing in low- and middle-income countries. Although there are several risk prediction tools in use worldwide, to predict ischemic risk, South Africa does not use any of these tools. Current practice in South Africa to diagnose acute coronary syndrome is the use of a physical examination, ECG changes and positive serum cardiac maker levels. Internationally the same practice is used to diagnose acute coronary syndrome but risk assessment tools are used additionally to this practise because of limitations of the ECG and serum cardiac markers when it comes to NSTE-ACS. Objective: The aim of this study was to systematically appraise evidence on the accuracy of acute coronary syndrome risk prediction tools in adults. Methods: An extensive literature search of studies published in English was undertaken. Electronic databases searched were Cochrane Library, MEDLINE, Embase and CINAHL. Other sources were also searched, and cross-sectional studies, cohort studies and randomised controlled trials were reviewed. All articles were screened for methodological quality by two reviewers independently with the QUADAS-2 tool which is a standardised instrument. Data was extracted using an adapted Cochrane data extraction tool. Data was entered in Review Manager 5.2 software for analysis. Sensitivity and specificity was calculated for each risk score and an SROC curve was created. This curve was used to evaluate and compare the prediction accuracy of each test. Results: A total of five studies met the inclusion criteria of this review. Two HEART studies and three GRACE studies were included. In all, 9 092 patients participated in the selected studies. Estimates of sensitivity for the HEART risks score (two studies, 3268 participants) were 0,51 (95% CI 0,46 to 0,56) and 0,68 (95% CI 0,60 to 0,75); specificity for the HEART risks score was 0,90 (95% CI 0,88 to 0,91) and 0,92 (95% CI 0,90 to 0,94). Estimates of sensitivity for the GRACE risk score (three studies, 5824 participants) were 0,03 (95% CI0,01 to 0,05); 0,20 (95% CI 0,14 to 0,29) and 0,79 (95% CI 0,58 to 0,93). The specificity was 1,00 (95% CI 0,99 to 1,00); 0,97 (95% CI 0,95 to 0,98) and 0,78 (95% CI 0,73 to 0,82). On the SROC curve analysis, there was a trend for the GRACE risk score to perform better than the HEART risk score in predicting acute coronary syndrome in adults. Conclusion: Both risk scores showed that they had value in accurately predicting the presence of acute coronary syndrome in adults. The GRACE showed a positive trend towards better prediction ability than the HEART risk score. / AFRIKAANSE OPSOMMING: Agtergrond: Koronêre bloedvatsiekte is ‘n vorm van kardiovaskulêre siekte. Koronêre hartsiekte manifesteer in drie maniere: angina pectoris, akute koronêre sindroom en hartdood. Drie-en-dertig mense sterf daagliks aan ‘n miokardiale infarksie (hartdood). Daar is 7,5 miljoen sterftes jaarliks as gevolg van kardiovaskulêre siektes (51% deur beroertes en 45% as gevolg van koronêre hartsiektes) wêreldwyd. Globaal is die sterfte syfer as gevolg van koronêre vaskulêre siekte net 4% in vergelyking met Suid Afrika, wat ‘n 42% sterfte syfer het. Dit word voorspel dat teen die jaar 2030 daar 25 miljoen sterfgevalle jaarliks sal wees, meestal toegeskryf aan kardiovaskulêre siektes. Die hoof oorsaak van sterfgevalle sal toegeskryf word aan beroertes en hart siektes. Die WHO het die sterf gevalle van hoeinkoms lande vergelyk met die van lae- en middel-inkoms lande, soos Suid Afrika, en die resultate het bewys dat sterf gevalle as gevolg van kardiovaskulêre siekte is besig om te daal in hoe-inkoms lande maar dit is besig om skerp te styg in lae- en middel-inkoms lande. Daar is verskeie risiko-voorspelling instrumente wat wêreldwyd gebruik word om isgemiese risiko te voorspel, maar Suid Afrika gebruik geen van die risiko-voorspelling instrumente nie. Huidiglik word akute koronêre sindroom gediagnoseer met die gebruik van n fisiese ondersoek, EKG verandering en positiewe serum kardiale merkers. Internationaal word die selfde gebruik maar risiko-voorspelling instrumente word aditioneel by gebruik omdat daar limitasies is met EKG en serum kardiale merkers as dit by NSTE-ACS kom. Doelwit: Die doel van hierdie sisematiese literatuuroorsig was om stelselmatig die bewyse te evalueer oor die akkuraatheid van akute koronêre sindroom risiko-voorspelling instrumente vir volwassenes. Metodes: 'n Uitgebreide literatuursoektog van studies wat in Engels gepubliseer is was onderneem. Cochrane biblioteek, MEDLINE, Embase en CINAHL databases was deursoek. Ander bronne is ook deursoek. Die tiepe studies ingesluit was deurnsee-studies, kohortstudies en verewekansigde gekontroleerde studies. Alle artikels is onafhanklik vir die metodologiese kwaliteit gekeur deur twee beoordeelaars met die gebruik van die QUADAS-2 instrument, ‘n gestandaardiseerde instrument. ‘n Aangepaste Cochrane data instrument is gebruik om data te onttrek. Data is opgeneem in Review Manager 5.2 sagteware vir ontleding. Sensitiwiteit en spesifisiteit is bereken vir elke risiko instrument en ‘n SROC kurwe is geskep. Die SROC kurwe is gebruik om die akkuraatheid van voorspelling van elke instrument te evalueer en te toets. Resultate: Twee HEART studies en drie GRACE studies is ingesluit. In total was daar 9 092 patiente wat deelgeneeem het in die gekose studies. Skattings van sensitiwiteit vir die HEART risiko instrument (twee studies, 3268 deelnemers) was 0,51 (95% CI 0,47 to 0,56) en 0,68 (95% CI 0,60 to 0,75) spesifisiteit vir die HEART risiko instrument was 0,89 (95% CI 0,88 to 0,91) en 0,92 (95% CI 0,90 to 0,94). Skattings van sensitiwiteit vir die GRACE risiko instrument (drie studies, 5824 deelnemers) was 0,28 (95% CI 0,13 to 0,53); 0,20 (95% CI 0,14 to 0,29) en 0,79 (95% CI 0,58 to 0,93). Die spesifisiteit vir die GRACE risiko instrument was 0,97 (95% CI 0,95 to 0,99); 0,97 (95% CI 0,95 to 0,98) en 0,78 (95% CI 0,73 to 0,82). Met die SROC kurwe ontleding was daar ‘n tendens vir die GRACE risiko instrument om beter te vaar as die HEART risiko instrument in die voorspelling van akute koronêre sindroom in volwassenes. Gevolgtrekking: Altwee risiko instrumente toon aan dat albei instrumente van waarde is. Albei het die vermoë om die teenwoordigheid van akute koronêre sindroom in volwassenes te voorspel. Die GRACE toon ‘n positiewe tendens teenoor beter voorspelling vermoë as die HEART risiko instrument.

Thesis (MScSportSc)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: Numerous studies have shown that coronary artery disease (CAD) has its origin in childhood. Several risk factors that increase a person's risk for the development of CAD are prevalent amongst children. South African statistics concerning the prevalence of these risk factors are limited. Research has shown that early intervention to eliminate risk factors can decrease the risk for the development of CAD. The purpose of this study was to determine the prevalence of certain coronary risk factors amongst children aged 11 to 13 years in certain Western Cape schools. Certain selected factors were tested. These included obesity, lack of physical activity, hypertension, low physical fitness (V02max), a family history associated with an increased risk, exposure to cigarette smoke, prevalence of diabetes mellitus and an unhealthy diet. The sample consisted out of 288 children and was made up by 154 boys and 134 girls. Certain anthropometrical measurements (stature, weight, skinfoids, waist and hip circumferences) were taken. Activity levels, family history, exposure to cigarette smoke, prevalence of diabetes mellitus and diet, were measured by means of questionnaires. Physical fitness (V02max) was tested with a three-minute step-test. A sphygmomanometer was used to measure blood pressure. Depending on the circumference of the child's arm, a paediatric or adult size cuff was used. The results of the study showed that 22.01% of the boys and 59.7% of the girls had a percentage body fat so high that it was considered a coronary risk factor. Physical fitness levels were considered risk factors in 2.6% of the boys and 9% of the girls. A very high percentage of the children tested had a family history associated with an increased risk for the development of CAD (73.38% of the boys and 78.36% of the girls). Systolic hypertension was prevalent among 22.01% of the boys and 23.13% of the girls. Diastolic hypertension was only prevalent among 5.19% of the boys and 5.97% of the girls. Low activity levels were considered a risk factor in 31.17% of the boys and 39.55% of the girls. Out of all the subjects, 32.47% of the boys and 37.31% of the girls were exposed to cigarette smoke on a daily basis. The results of this study shows that certain coronary risk factors are quite common amongst children. Prevention programmes that focuses on elimination of coronary risk factors, such as hypertension, inactivity and obesity, is essential for the prevention of subsequent coronary artery disease in adults. / AFRIKAANSE OPSOMMING: Verskeie studies het al bewys dat koronêre hartvatsiekte (KHS) reeds sy ontstaan het in kinders van baie jong ouderdomme. Verskeie risikofaktore wat tot die latere ontstaan van KHS lei kom ook onder jong kinders voor. Statistiek ten opsigte van die voorkoms van hierdie risikofaktore onder kinders in Suid-Afrika is egter baie beperk. Verskeie navorsing toon dat vroeë intervensie kan lei tot "n verlaging in risiko vir die ontwikkeling van KHS op "n latere stadium. Die doel van die studie was om die voorkoms van sekere koronêre risikofaktore in kinders in Suid-Afrika te ondersoek. Sekere risikofaktore is ondersoek, dit het ingesluit, obesiteit, lae fisieke aktiwitietsvlakke, hipertensie, lae fisieke fiksheid (V02maks), 'n familie geskiedenis wat geassosieer word met "n verhoogte risiko, blootstelling aan sigaret rook, die voorkoms van diabetes mellitus en "n swak dieet. Die steekproef het bestaan uit 288 kinders waarvan 134 meisies en 154 seuns was. Verskeie antropometriese meetings (lengte, massa, velvoue, middel- en heup omtrekmates) is geneem. Aktiwiteitsvlakke, familiegeskiedenis, blootstelling aan sigarette rook, voorkoms van diabetes mellitus en dieet is deur middel van vraelyste vasgestel. Fisieke fiksheid (V02maks) is deur middel van "n drie-minuut-opstaptoets vasgestel. Bloeddruk is met "n sfigmomanometer gemeet. Afhangend van die omtrek van die kind se arm is "n pediatries- of volwasse-grootte drukband gebruik. Persentasie liggaamsvet was by 22.01% van die seuns en 59.7% van die meisies so hoog dat dit as "n risikofaktor beskou kan word. Fisieke fiksheidsvlakke kan by 2.6% van die seuns en 9% van die meisies as "n risikofaktor beskou word. "n Baie hoë persentasie van die kinders het "n familiegeskiedenis gehad wat geassosieer word met "n verhoogde risiko vir die ontwikkeling van KHS (73.38% van die seuns en 78.36% van die meisies). Sistoliese hipertensie het onder 22.01% van die seuns en 23.13% van die meisies voorgekom. Diastoliese hipertensie het baie minder voorgekom as sistoliese hipertensie (5.19% van die seuns en 5.97% van die meisies). Lae aktiwiteitsvlakke het onder 31.17% van die seuns en 39.55% van die meisies voorgekom. 'n Redelike hoë persentasie van die kinders word daagliks aan sigaretrook van hulouers of oppassers blootgestel (32.47% van die seuns en 37.31% van die meisies.) Die resultate van die studie dui aan dat daar 'n redelike hoë voorkoms van sekere koronêre risikofaktore onder kinders is. Ondersoek moet ingestel word na moontlike, goed gestruktureerde intervensieprogramme.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2006. / OBJECTIVE: The primary aim of the study was to determine the nutritional status of vegetarian and non-vegetarian students in relation to their dietary preferences and risk factors (dietary, physical inactivity and obesity) for CHD. DESIGN: Cross-sectional analytical study. Setting: The Adventist International Institute of Advanced Studies (AIIAS) situated in the province of Cavite, Philippines. METHODS: The sampling frame was all graduate students at AIIAS (n=203). Of these students 153 returned the distributed dietary questionnaires which determined dietary practices, thus yielding a stratified random sample of 70 registered students (≥20y and ≤50y) who met the inclusion criteria of the study. Three 24-hour recalls and a self-administered food frequency questionnaire assessed dietary practices. Lifestyle was assessed by means of questionnaires, which also included the socio-demographic characteristics of the subjects. Anthropometric measurements included height, weight and waist circumferences. RESULTS: Seventy subjects participated in the study [non-vegetarian (n=38) and vegetarian (n=32)]. The mean age of subjects was 33.3 [(SD) 1.6] and 38.4 (1.9) years for non-vegetarian and vegetarian males respectively, with the respective means for females being 35.7 (2.0) and 33.2 (2.1) years. The majority of the vegetarians’ income was insignificantly below $10.000 as compared with that of non-vegetarians’, in whom annual income earned was within the $10.000- $50.000 range per year. Variations in level of education between the dietary groups were small and inconsistent, most of whom were characterized by a high education level. Within this cohort, mean BMI and WC were insignificantly lower in the vegetarians when compared with the non-vegetarians. For males, the prevalence of overweight, pre-obese and obese (p>0.05) for non-vegetarians was insignificantly higher than vegetarians. Insignificantly, female vegetarians were more pre-obese than non-vegetarians. As far as waist circumference was concerned, the prevalence of subjects observed in the alerting (≥94cm) and action zone (≥102cm) (p≤0.05) was 21% and 4% for non-vegetarian males, while 0% and 6% for vegetarian males. For females, more vegetarians were insignificantly prevalent in the alerting zone (≥80cm) as compared to the nonvegetarians. Both dietary cohorts illustrated no considerable differences that exemplified moderate to a high level of physical activity. All subjects, regardless of dietary preference, were non-smokers and consumed no alcohol (p>0.05). Overall, mean daily nutrient intake met current recommendations and there was no statistically significant difference between the two cohorts, except for fat and saturated fatty acids (SFA), which was higher among the non-vegetarians. Carbohydrate and fiber consumption was greater in the vegetarians. According to the DRIs, there were no intakes above the UL, however inadequate intakes of calcium and zinc posed possible risk of deficiency for both dietary groups. CONCLUSIONS: A small percentage of subjects in both cohorts were at risk of CHD morbidity. Both groups followed good lifestyle habits with dietary choices being of greater concern among non-vegetarians.

Congenital Heart Disease (CHD) is one of the most common birth defects. It is the single most modifiable cause of infant mortality under one year of age. Therefore, the causes of CHD have been extensively researched in the past but the etiology remains largely unknown. Environmental risks, particularly maternal risk factors for congenital cardiac malformation have been evaluated in the original BWIS previously. However, in this research we examined one of the additional risk factors. We sought to determine whether maternal headache during six months prior to conception and throughout gestation until birth is a risk factor for CHD in the BWIS dataset. Among 3274 singleton cases and 3519 controls, a maternal report of headache was found to be associated with a nearly 20% increase in the risk of a congenital heart defect (OR= 1.2 p=0.001). Moreover, any medications use for headache 1-6 months prior to conception increased the risk of abnormal cardiac development by 1.3 fold (OR = 1.3, p=0.0004). Aspirin or aspirin containing analgesics were found to increase the risk for CHD at the defined risk period. According to subgroup analysis, aspirin or aspirin containing analgesics and acetaminophen or acetaminophen containing analgesics were found to be the risk factor for CTD i.e. Conotruncal defects. Furthermore, aspirin or aspirin containing analgesics increased the risk for PVSD i.e. Peri-membranous Ventricular Defect in offspring when the mother uses these drugs 1-6 months prior to conception. Additionally, the risk for CVD i.e. critical valve disease were found to be increased when women were exposed to aspirin or aspirin containing analgesics during third trimester after pregnancy. In conclusion, maternal headache increased the risk for CHD by 20% and the use of headache medications specifically pain relievers during 1-6 months prior to conception modulated type of defect was observed.