Rheumatoid arthritis (RA) is a chronic disabling disease that is associated with a shortened life span. Cardiovascular disease (CVD) contributes to this increased mortality, and also to a great extent to the co-morbidity observed in patients with RA. This thesis aimed to investigate these issues further. The incidence of, and prognosis after an acute myocardial infarction (AMI) /or stroke in a cohort of RA patients was compared with that in the general population within the northern Sweden MONICA register. The standard incidence ratio (SIR) for AMI was 2.9 and for stroke 2.7 in RA patients compared with the general population (p<0.05 for both). During the first 10 years following an event, RA patients had a higher overall case fatality (CF) compared with controls (HR for AMI=1.67, 95%CI [1.02, 2.71], HR for stroke=1.65, 95%CI [1.03, 2.66]). An elevated level of homocysteine is regarded to be a risk marker for CVD. The effects of treatment with B vitamins on the homocysteine level in patients with RA were studied in a consecutive cohort of patients with RA. Sixty-two patients with RA having a homocysteine level of 12 mol were randomized to receive either a placebo or a combination of the vitamins B6, B12 and folic acid. The patients were treated and evaluated in a double-blind manner over 12 months. The homocysteine level was found to be significantly decreased in the B-vitamin treated patients compared with the placebo group (p<0.0001). To evaluate the progression of sub-clinical atherosclerosis in patients with very early RA compared with controls, all patients from the three most northern counties of Sweden newly diagnosed with RA and aged ≤60 years were consecutively recruited. Age and sex matched controls from the general population were also included. Intima media thickness (IMT) of the common carotid artery and endothelium dependent flow mediated dilation (ED-FMD) of the brachial artery were measured using ultrasonography. After 18 months the same measurements were undertaken in a sub-group of the patients with early RA and the relevant controls. There were no differences between patients with early RA and controls in terms of IMT or ED-FMD at inclusion into the study. However, after 18 months there was a significant increase in the IMT among the patients with early RA (p<0.05); no such increase occurred in the control group. Biomarkers of endothelial activation that may reflect the early atherosclerosis that occurs in RA were also evaluated. At inclusion, both IMT and ED-FMD among the patients with early RA related significantly to several of the biomarkers of endothelial activation. Furthermore, markers of inflammation (e.g., DAS28) were significantly related to biomarkers of endothelial activation. In conclusion, RA patients had a higher incidence of CVD and a higher CF after a CV event. The increased homocysteine level among patients with RA was as easy to decrease as in the general population. At the time of diagnosis of RA there were no differences in atherosclerosis between patients and controls, however the patients with RA had a more rapid progression of atherosclerosis than the control subjects. Moreover, there were implications of endothelial activation already in patients with very early RA. Taken together, these results emphasize the necessity of optimizing the preventive, diagnostic and caring strategies for CVD in patients with RA.

Pre-eclampsia is associated with increased risk of cardiovascular disease (CVD) later in life. The ‘gold standard’ for estimating cardiovascular risk - ultrasound assessment of the common carotid artery intima-media thickness (CCA-IMT) - does not convincingly demonstrate this increased risk. The aim of this thesis was to examine whether high-frequency (22 MHz) ultrasound assessment of the individual CCA intima and media layers and calculation of the intima/media (I/M) ratio - can indicate the increased cardiovascular risk after pre-eclampsia. After validation of the method in premenopausal women with systemic lupus erythematosus (SLE) who have a recognized increased risk of CVD, women during and after normal and preeclamptic pregnancies were investigated. Assessment of the individual artery wall layers reliably demonstrated the increased cardiovascular risk in premenopausal women with SLE, while CCA-IMT did not. The artery wall layer dimensions in women with SLE were comparable to those of postmenopausal women without SLE and were 30 years older. Among the women with normal pregnancies negative changes to the artery wall later on in the pregnancy were seen in those with lower serum estradiol, older age, higher body mass index or higher blood pressure early in the pregnancy. About one year postpartum, both the mean intima thickness and the I/M ratio had improved, compared to values during pregnancy. These findings support the theory that normal pregnancy is a stress on the vascular system. Women who developed pre-eclampsia (mean age 31 years) had thicker intima layers, thinner media layers and higher I/M ratios, both at diagnosis and one year postpartum, than women with normal pregnancies, indicating increased cardiovascular risk. Women with a history of severe pre-eclampsia (mean age 44 years; mean 11 years since the last delivery) had thicker intima layers and higher I/M ratios than women with a history of normal pregnancies, indicating long-standing negative vascular effects. Assessment of individual CCA wall layers, but not of CCA-IMT, provided clear evidence of the well-known increased cardiovascular risk in women with SLE or pre-eclampsia. The method has the potential to become an important tool in reducing cardiovascular morbidity and mortality in these women through early diagnosis and intervention.

Cardiovascular disease (CVD) is the leading cause of death among women in the US, and African American women (AAW) have a disproportionately high rate of deaths from CVD. Physical inactivity plays a major role in CVD development. It has been reported that some rural women have low rates of physical activity; 39% of White women and 57% of women of color are reported to be physically inactive. Rural AAW have a high mortality and morbidity rate related to CVD and a high rate of physical inactivity. The purpose of this study was to describe rural AAW’s perception of wellness in conjunction with their stage of change for engaging in exercise. A questionnaire was designed to obtain demographic information and reliable and valid questionnaires were used to measure perceived wellness and current stage of change for exercise. Using a descriptive, cross-sectional design, a convenience sample of 162 rural AAW was recruited from four rural churches in Selma, Alabama. A one-time meeting was conducted and questionnaires were completed by the participants. Statistical analyses including independent samples t-tests and one-way and two-way ANOVA’s were conducted to determine if there were associations among demographic characteristics, self-reported presence of CVD, perceived wellness, and stage of change for exercise. Findings indicated that there was no relationship between perceived wellness and stages of change for exercise among rural AAW; no relationship was found between perceived wellness and CVD, or CVD and stage of change for exercise. However, 51.3% of the sample reported they were physically active, and 21.6% planned to increase their activity within 30 days. Annual household income and employment status were positively correlated with perceived wellness, suggesting a greater sense of wellness is related to income and employment among these rural AAW. These findings have implications for nursing practice in the areas of facilitating health promoting behaviors and development of exercise and wellness programs for rural AAW.

Syftet med denna studie var att undersöka samband mellan bukaorta aneurysm hos 65-åriga män och riskfaktorer såsom rökning, BMI>25, kosttillskott, hypertoni, hyperlipidemi, ett stillasittande yrke samt hereditet. Kvantitativ ansats med deskriptiv och korrelativ design användes, 3854 65-åriga män från två årskullar som screenats för AAA ingick och uppgifter hämtades från ett dataregister. Resultat: Antalet personer med bukaorta aneurysm var 2,4 %, 65 % var/hade varit rökare, 67 % hade övervikt, 49 % stillasittande arbete, 41 % hypertoni, 25 % hyperlipidemi, 17 % åt kosttillskott och 4 % hade hereditet. Rökning, hypertoni och hyperlipidemi visade signifikant samband med och ökade risken för att utveckla AAA. Störst riskfaktor var rökning. Övriga riskfaktorer visade inte signifikant betydelse. Riskfaktorerna tillsammans förklarade variationen i AAA med 5 %. Konklusion: Tidigare kända riskfaktorers betydelse bekräftades för uppkomst av AAA. För män med AAA ses ett behov av hälsoförebyggande insatser. Sjuksköterskan har ansvar för och kunskaper om preventiva åtgärder, kan och bör därför användas som stöd till män med nyupptäckt AAA.

Non-communicable disease (NCD) (particular by cardiovascular disease, CVD) is the leading cause of death in most countries including OECD countries. WHO (World Health Organization, 2002) has emphasized the trend of disease patterns shifting from communicable diseases towards to non-communicable diseases globally. However, globalization drives economic activities vigorously and alternates work conditions, such as prolonger or irregular working time, changing patterns of job. And then, more sweating, stress and occupational safety of labors after globalization were noted by many worldwide scholars. ¡§Karoshi¡¨ (death from overwork) is a controversial issue of occupational matters in these years all over the world. According to past empirical literatures, CVD was also the major medical cause of death from overwork. Hence, we collect panel data of CVD mortality, working hours of labor and KOF index of globalization covering 19 OECD countries from a period of 1980 to 2007, and measure by panel cointegration analysis and fully modified OLS (FMOLS) to estimate the reciprocal relationship among these variables. The evidence findings show significant influence on CVD mortality if increasing working hours of labor, especially at age groups of 15 to 24 year. While significant effect on CVD mortality through by globalization was found at age group 25 to 54 year and elders, particular in social globalization.

Although blood viscosity is an important component in determining vascular function, it is often assumed constant. Emerging evidence linking individual differences in viscosity to cardiovascular disease casts doubt on this assumption. The purpose of this study was to determine the contribution of whole blood viscosity to key measures of vascular function. To address this aim as comprehensively as possible, first, whole blood viscosity was compared with traditional risk factors for cardiovascular disease. Then flow-mediated dilation (FMD), carotid-femoral pulse wave velocity (cfPWV), and carotid artery compliance were calculated either with or without blood viscosity taken into account. Lastly, we tested whether the removal of blood viscosity could influence well-established associations between age and vascular function. Blood viscosity and vascular function were measured in 97 adults ranging in age from 18-63 years. No significant differences were observed between whole blood viscosity and traditional risk factors for cardiovascular disease. Whole blood viscosity was not significantly correlated with FMD, cfPWV, and carotid compliance. As expected, age was positively correlated with cfPWV (r=0.65, p<0.001) and negatively correlated with FMD (r=-0.21, p<0.05) and carotid compliance (r=-0.45, p<0.01). Even after controlling for viscosity, these relationships remained statistically significant (cfPWV r=0.65, p<0.001; FMD r=-0.24, p<0.05; carotid compliance r=-0.44, p<0.05). These results indicate that whole blood viscosity does not appear to significantly impact measures of vascular function and that the rationale for including whole blood viscosity in the calculation of vascular function remains weak. / text

Darbe yra analizuojama sveikatos kontrolės lokuso, depresiškumo, agresyvumo tarpusavio sasąjos bei skirtumai sergančiųjų širdies ir kraujagyslių ligomis bei sveikų suaugusiųjų grupėse. Tyrime dalyvavo 203 tiriamieji, t.y. 100 širdies ir kraujagyslių ligomis sergančių, stacionare besigydančių pacientų, ir 103 sveiki suaugę, kurie sudarė kontrolinę grupę. Apklausti 88 vyrai (43,3 proc.) ir 115 moterų (56,7 proc.) kurių amžiaus pasiskirstymas 35-89 metai, o vidurkis 62,21 metų (SD.=10,855). Sveikatos kontrolės lokusas nustatytas Daugiamate sveikatos kontrolės lokuso skale, A forma (MHLC-Multidimensional Health Locus of Control Scale; Wallston, Wallston, DeVellis, 1978), depresiškumas įvertintas Beko depresijos klausimynu (BDI-Beck Depression Inventory; Beck, Ward, Mendelson, Mock, Erbaugh, 1961), agresyvumas - Perkeltos agresijos klausimynu (DAQ- The Displaced Aggression Questionnaire; Denson, Pedersen, Miller, 2006). Sergantys širdies ir kraujagyslių ligomis labiau, nei sveiki pasižymi depresiškumu ir agresyvumu emociniame bei kognityviniame lygmenyse. Pacientams labiau būdingas išorinis kitų poveikio, o vyrams ir vidinis sveikatos kontrolės lokusas. Moterims būdingas stipriau išreikštas agresyvumas emociniame lygmenyje bei kitų poveikio sveikatos kontrolės lokusas lyginant su vyrais. Jaunesnis pacientų amžius susijęs su aukštesniu agresyvumo lygiu, tačiau vyresni vyrai, priešingai, stipriau išreiškia agresyvumą elgesiu, o moterys – depresiškumą. Priklausomai nuo šeimyninės... [toliau žr. visą tekstą] / The aim of this study is to analyse health locus of control, depressiveness and aggressivness interface and comparison between cardiovascular disease patients and healthy population. There were 203 participants in this study, 100 were in-patients with cardiovascular disease and 103 control group healthy adults. 88 of them were men (43,3 %) and 115 women (56,7 %) between 35 and 89 years of age, mean of age is 62,21 years (SD.=10,855). Health locus of control was assassed with Multidimesional Health Locus of Control Scale, A form (MHLC; Wallston, Wallston, DeVellis, 1978). Depessiveness was assessed with Beck Depression Inventory (BD; Beck, Ward, Mendelson, Mock, Erbaugh, 1961) and aggressiveness - with The Displaced Aggression Questionnaire (DAQ; Denson, Pedersen, Miller, 2006). Patients with cardiovascular disease are more depressive and express more aggressiveness in affective and cognitive dimensions comparing with healthy population. Patients are more prone to external powerful others health locus of control, also men – to inner health locus of control. Women express higher scores in affective dimension agressiveness and powerful others health locus of control in comparison to men. Lower age is related with higher expressed aggressiveness in patients group, but, conversely, older men express higher behavioral displaced aggression, and women – depressiveness. There were no significant differences according to family state, in contrast to healthy population, what shows that... [to full text]

Several cardiovascular disease risk factors including, dyslipidemia, high blood pressure, and diabetes have been proposed as important modifiable risk factors for cognitive decline and dementia. These risk factors often co-occur and their aggregation is associated with increased risk of cardiovascular disease and dementia. However, studies of composite measures of cardiovascular disease risk in relation to cognitive outcomes in non-elderly populations are scarce. The aim of this thesis was to examine composite measures of risk in relation to cognition and longitudinal cognitive change amongmiddle-aged adults. Data from the Whitehall II study were used to study the associations between the metabolic syndrome, two Framingham risk scores; the Framingham stroke and general cardiovascular disease risk scores, and cognition, based on three cognitive assessments over 10 years. In addition, these two (cardio)vascular risk scores were compared with the CAIDE dementia risk score. Of all composite measures of risk examined, the two Framingham risk scores were the best predictors of 10-year cognitive decline. Higher cardiovascular risk was associated with faster 10-year decline inmultiple cognitive tests including verbal fluency, vocabulary and global cognition. These results suggest that multiple cardiovascular disease risk factors contribute to cognitive decline starting in midlife and that multi-risk factor models such as cardiovascular risk scores may be better suited to assessing risk of cognitive decline. Early identification and treatment of cardiovascular disease risk factors may offer the possibility of markedly delaying or preventing cognitive decline.

Whole yellow pea flour (WPF) and fractionated yellow pea flour (FPF) are novel functional food ingredients that vary in nutritional composition. Consequently, the health benefits of WPF and FPF remain undefined. The purpose of this research was to identify the effects of WPF and FPF on risk factors and morbidities associated with cardiovascular disease, diabetes and obesity as well as the gastrointestinal microbiome. Using USDA recommended dosages of WPF and FPF, clinical endpoints and the colonic microbiome were investigated using a human clinical trial engaging a cross-over design and a diet and energy controlled paradigm. Humans were also utilized to investigate post-prandial glycemic responses and sensory characteristics of novel functional foods formulated with WPF. Finally, Golden Syrian hamsters were used to assess the impact of high doses of WPF and FPF on clinical endpoints and caecal microbial abundance. Results reveal that USDA recommended dosages of WPF and FPF in humans decreased (p<0.05) fasting insulin and estimates of insulin resistance compared to white wheat flour (WF). Android-to-gynoid fat ratios in women were lower (p=0.027) in the WPF group compared to the WF group. FPF decreased (p<0.05) post-prandial energy expenditure alongside a tendency (p<0.075) to reduce carbohydrate oxidation. Novel biscotti and banana bread formulated with WPF induced low post-prandial glycemic responses which were similar to boiled whole yellow peas and significantly lower (p<0.05) than white bread. Sensory analysis of novel WPF biscotti and banana bread demonstrated that WPF-based food products are palatable and acceptable for human consumption. Hamsters consuming diets containing 10% WPF and FPF induced similar reductions (p<0.05) in fasting insulin levels compared to controls. However, animals consuming WPF increased (p<0.05) oxygen consumption while FPF decreased (p<0.05) fasting glucose levels. In addition, terminal restriction fragment length polymorphism analysis revealed that WPF and FPF induced distinct shifts in caecal microbial populations within the phyla Firmicutes. Finally, pyrosequencing analysis of human fecal microbiota demonstrated that FPF and WPF induced shifts in bacterial genera, primarily within Bacteroidetes and Firmicutes. In conclusion, whole and fractionated yellow pea flours are functional food ingredients and can be utilized to manage risk factors for lifestyle-related diseases in humans.

The objective was to conduct a systematic review and meta-analysis of randomized feeding trials to assess the effect of dietary pulses (beans, chickpeas, lentils, peas) on established lipid targets of cardiovascular disease (CVD) and perform a secondary analysis of our randomized feeding trial to assess whether dietary pulses as a means of lowering the glycemic index offer further CVD protection by reducing oxidative stress. The meta-analysis of 26 trials (n=1013) found dietary pulse interventions significantly lowered LDL-C compared with isocaloric control interventions (mean difference=-0.17mmol/L [95% CI: -0.25, -0.09]; p<0.0001). No treatment effects were observed for Apo-B and non-HDL-C. Our feeding trial found no significant differences between the high-dietary pulse diet and high-fibre control diet on markers of oxidative stress, including thiobarbituric acid reactive substances (TBARS), conjugated dienes (CDs), and protein thiols. Overall, the results suggest dietary pulses reduce LDL-C but not oxidative stress as a means of reducing cardiovascular risk.