Systemic inflammatory diseases, including those of rheumatology and dermatology, are associated with increased cardiovascular events. Evidence demonstrates that the chronic systemic inflammation associated with these diseases plays a pivotal role in all stages of atherosclerotic plaque formation, from initiation of the fatty streak to plaque rupture and consequent acute coronary syndrome. Although a number of studies have evaluated the cardiovascular manifestations in systemic inflammatory disease, this thesis offers additional observations, including the vascular atherosclerotic pattern, the pathogenesis of premature atherosclerosis and the use of coronary calcification as a predictor of adverse cardiovascular outcome. The work is divided into four sections. Section I provides an overview of the cardiovascular manifestation of systemic inflammatory diseases and the patients and methods of the current thesis. The objective of Section II is to evaluate the pattern of cardiovascular manifestation, in particular systemic vascular calcification and cardiac valve calcification in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and psoriasis, using multi-detector computed tomography (MDCT) and carotid intima-media thickness (c-IMT). It was found that both patients with RA, SLE and psoriasis had a greater prevalence and extent of vascular calcification compared with age and gender matched controls. Moreover, both aortic valve calcification (AVC), mitral valve calcification (MVC) was found to be more prevalent in patients with RA and SLE than controls. Interestingly, the presence of MVC, but not AVC, independently predicted the occurrence of premature atherosclerosis with arterial calcification in these patients. Section III evaluates the potential underlying mechanisms that lead to cardiovascular manifestations in patients with systemic inflammatory disease. Bone marrow-derived endothelial progenitor cells (EPCs) play an important role in the maintenance of endothelial integrity and hemostasis. The relationship between the circulating EPCs and subclinical coronary atherosclerosis as determined by coronary calcification in RA patients nonetheless remains unclear. The study results demonstrated that RA patients with coronary atherosclerosis have significantly lower levels of CD133/KDR+ and CD133+ EPCs than those without. In addition to older age, lower levels of circulating CD133/KDR+ EPCs also predicted occurrence of coronary atherosclerosis. As with RA and SLE, psoriasis is associated with premature atherosclerosis, although the underlying mechanism remains unclear. The aim of the study was therefore to investigate the relationship of disease activity and systemic inflammation with macrovascular and microvascular function in patients with psoriasis. The results demonstrated that patients with psoriasis have increased arterial stiffness, but not microvascular dysfunction compared with healthy controls. More importantly, high-sensitivity C reactive protein positively correlated with, and independently predicted, arterial stiffness. Section IV explores the prognostic value of a surrogate marker of atherosclerosis, coronary calcium score (CCS), in patients with RA and SLE. A total of 152 patients with RA (n=85) and SLE (n=69), and 106 healthy controls underwent MDCT to measure CCS. All patients were prospectively followed up for major cardiovascular events for a mean period of 4.3 years. The result demonstrated that presence of CCS >100 predicted the occurrence of a major cardiovascular event independent of other risk factors in RA and SLE patients. / published_or_final_version / Medicine / Master / Doctor of Medicine

Kardiologiniai ligoniai po kardiochirurginės operacijos ar esant jos būtinybei dažnai susiduria su potrauminio streso, nerimo ir depresijos simptomais,kurie gali turėti neigiamų rezultatų kardiologinėsligos gydyme. Darbo tikslas: įvertinti kardiologinių ligonių psichologinius ypatumus ir streso įveikos būdus. Darbo uždaviniai: Ištirti potrauminio streso sutrikimo, nerimo ir depresijos simptomų paplitimą atsižvelgiant į kardiologinių ligonių lytį ir amžių; nustatyti su potrauminio streso sutrikimo, nerimo ir depresijos simptomais susijusius kardiologinės ligos simptomų intensyvumą atspindinčius rodiklius; nustatyti, ar hospitalizacijos metu jaučami nerimo ir depresijos simptomai siejosi su potrauminio streso simptomų išsivystimu praėjus vienam mėnesiui po ligonių hospitalizacijos; nustatyti ligonių streso įveikos būdų naudojimą priklausomai nuo lyties, amžiaus, išsilavinimo; įvertinti potrauminio streso simptomų pasireiškimą priklausomai nuo ligonių naudojamo streso įveikos būdo. Tyrimo metodika: Anoniminei apklausai atlikti naudoti šie klausimynai: hospitalinė nerimo ir depresijos skalė (HAD), potrauminio streso sutrikimo simptomų skalė, streso įveikos strategijų klausimynas (COPE), Kardiologinių simptomų intensyvumo skalė. Tyrime dalyvavo 201 respondentas: 138 kardiologiniai ligoniai, neturėję chirurginių intervencijų, ir 63 kardiochirurginiai ligoniai, turėję chirurginių intervencijų. Anketiniai duomenys apdoroti ir analizuoti naudojant statistinį paketą SSPS 13.0... [toliau žr. visą tekstą] / In necessity of or after cardiological surgery cardiological patients are often faced with post-traumatic stress, anxiety and depression symptoms, which may have negative results for the treatment of cardiological disease. Aim of the study: to evaluate psychological characteristics and coping with stress techniques of cardiological patients. Objectives: to investigate the occurence of post-traumatic stress disorder, anxiety and depression symptoms depending on gender and age of cardiological patients; to determine indicators reflecting the intensity of cardiological disease symptoms associated with post-traumatic stress disorder, anxiety and depression symptoms; to determine whether anxiety and depression symptoms faced during hospitalization were associated with the development of post-traumatic stress symptoms within one month after hospitalization; to evaluate the use of stress coping techniques depending on gender, age, education; to assess the occurrence of post-traumatic stress symptoms depending on the method of coping with stress used by patients. Methods. The following questionnaires used to carry out an anonymous survey: Hospital Anxiety and Depression Scale (HAD), Post-traumatic Stress Disorder Symptoms Scale, Stress Coping Strategies Questionnaire (COPE), Cardiac Symptoms Intensity Scale. The survey included 201 respondents: 138 cardiological patients who did not have surgical interventions and 63 cardiological patients who had surgical interventions. The data... [to full text]

Indiana University-Purdue University Indianapolis (IUPUI) / Medication adherence remains a problem among Type-2 diabetes (T2D) patients despite availability of effective treatments. Three analyses of extant data sets were conducted to examine barriers to using medication as prescribed as an alternate method to assess medication adherence: 1) development and psychometric evaluation of the Murage-Marrero-Monahan-Medication barriers (4M) scale to assess patients’ perceived barriers; 2) patient demographic factors associated with barriers to using medication as prescribed, and 3) the association between patients’ perceived barriers to medication use and cardiovascular disease (CVD) risk factor control.Twelve focus groups and a cross-sectional study of 362 T2D patients contributed to develop and evaluate psychometric properties of the 4M scale. A cross-sectional survey of 964 T2D patients was used for the other two studies. Analysis of covariance identified demographic factors associated with reported barriers. Multivariable logistic regression was used to identify barriers associated with CVD risk factors (glucose, blood pressure and lipids) categorized as either poor or good control. Exploratory factor analysis with Varimax rotation resulted in a 19-item 4M scale with acceptable psychometric properties. As a five-domain (or single-domain) structure, coefficient alpha ranged from 0.70 to 0.83 (0.92). Both structures demonstrated discriminant validity and known-group validity. Age was inversely associated with all identified barriers while income was inversely associated with poor communication with providers and side effects. A unit increase in the overall barrier mean score on the 4M scale was associated with 92% increase in the odds of having poor control of two or more CVD risk factors compared to good control of all three risk factors (adjusted OR=1.92, 95% CI: 1.16–3.17; p<0.05). The 4M scale demonstrated acceptable psychometric properties in assessing barriers to using medication among T2D patients. Poor medication adherence has been previously associated with CVD risk. In this study, greater barriers were associated with poorer control of CVD risk factors making barriers a potential alternative to medication adherence, whose current assessment methods are limited. The 4M scale has the advantage to identify specific barriers inhibiting medication use that can facilitate patient-provider discussions and the development of targeted interventions. / Some parts of this dissertation work were jointly funded by Program Announcement 04005 from the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency(s).