Contexte : Les maladies cardiovasculaires dont l'angine et l'infarctus sont un fléau grandissant pour les Canadiens. En 2008, les femmes canadiennes sont 16% plus susceptibles de succomber à un infarctus que les hommes. Pour améliorer la qualité de vie des patients souffrant d'angine ou d'infarctus, la perfusion transluminale per cutanée (PTCA) s'avère le traitement de choix. Suite à celle-ci, il est recommandé d'effectuer des modifications d'habitudes de vie. Cependant, les femmes cardiaques devant modifier leurs habitudes de vie ont une perception de la maladie différente des hommes mais les caractéristiques présentes lors de changement d'habitude de vie ne sont pas connues. Le nouveau contexte de la PTCA n'est pas adapté à cette population grandissante. Objectif: Décrire les caractéristiques présentes lors d'un changement dans le processus de modification de comportements à risque des femmes ayant subi une PTCA. Méthodologie : Cette étude descriptive. L'échantillon non probabiliste de convenance est composé de 22 femmes (X= 65.4 ans) ayant subi une PTCA au CHUS-Fleurimont. Toutes les participantes complétaient le même questionnaire à 1- 2 semaines (Tl) et à 4 mois post-PTCA (T2) lors d'une rencontre à leur domicile. Les questions évaluaient les trois habitudes de vie en lien avec l'alimentation, l'activité physique et le tabagisme ainsi que les principales caractéristiques pouvant être présentes lors d'une modification de comportement à risque (soutien des proches, perception de la maladie, fatigue, dépression, stress, optimisme, variables sociodémographiques, facilitants et barrières perçues par les participantes). Des statistiques descriptives ont été réalisées. Des tests non paramétriques (a = 0.05) ont été faits pour comparer les participantes entre le Tl et le T2 (Wilcoxon) puis des sous-groupes de celles-ci en fonction de leur motivation à modifier leurs comportements à risque à T2 (Mann-Withney et Krustall-Wallis). Les données qualitatives ont été regroupées par catégorie à l'aide d'une analyse de contenu. Résultats : Les femmes de l'étude identifient plus de symptômes de la maladie, sont plus fatiguées (p=0.01) et plus stressées (p=0.04) au Tl (p=0.000) qu'au T2. Celles-ci perçoivent leur maladie cardiaque comme chronique (p=0.006) et ont une meilleure compréhension de celle-ci (p=0.007) 4 mois suivant la PTCA. Le soutien des professionnels de la santé ainsi que les programmes de réadaptation cardiaque sont perçus comme des facilitants à la modification de comportement au même titre que celui de la famille et des amis. Les symptômes physiques (douleurs aux jambes, au dos, etc.) et les symptômes dépressifs sont identifiés comme des barrières à la modification de comportement. Conclusion : Cette étude a permis de faire ressortir certaines caractéristiques présentes tant en post-PTCA que lors d'un changement dans le processus de modification de comportement. D'autres études doivent cependant être conduite afin de valider ces caractéristiques auprès d'un plus grand échantillon et ainsi pouvoir proposer des interventions infirmières d'enseignements solides et structurés à partir de solides assises sur les caractéristiques associées aux femmes ayant subi une PTCA.

Acute myocardial infarction (AMI) results in the activation of the innate immune system with monocytes playing critical roles in both the initial inflammation following myocardial ischaemia and subsequent recovery. Monocytes are a heterogeneous cell population and observations from experimental models demonstrate that immediately following myocardial injury, classical inflammatory monocytes, which are highly phagocytic, are recruited to ischaemic myocardium from the bone marrow and spleen and peak at 48 hours. This is followed by the recruitment of non-classical monocytes that are involved in repair and healing, peaking at day 5. The monocyte response in humans following AMI is currently poorly understood. Due to their central role in the pathogenesis of AMI, monocytes are attractive both as potential biomarkers to inform of extent of myocardial injury (and recovery) and also as therapeutic targets with the specific targeting of monocytes in experimental models resulting in reduced infarction size and improved LV remodelling. However, in spite of these promising results and our greater understanding of the pathogenesis of AMI, no immune-modulating therapeutic has been translated into routine clinical practice. We therefore hypothesized that characterisation of the monocyte response to AMI by flow cytometry and gene expression profiling in both experimental models and humans would give novel insights into underlying biological processes and function (both locally in the myocardium and systemically), identify novel therapeutic targets, enable their use as cellular biomarkers of disease, and test conservation between species validating the experimental model for future investigation. Classical inflammatory monocytes were found to significantly increase in the peripheral blood 48 hours following AMI in both mice and humans, with the magnitude of the monocyte response correlating with the extent of myocardial injury in both species. Gene expression profiling of peripheral circulating monocytes following AMI identified a number of candidate genes, biological pathways and upstream regulators that were conserved between species and that could represent novel therapeutic targets. Furthermore, in an experimental model of AMI, leukocytes appeared to have effects beyond the ischaemic myocardium, with leukocyte recruitment in remote myocardium and in kidneys associated with elevated inflammatory markers and endothelial activation.

Niacin has been in clinical use for over 50 years and was the first drug shown in a randomized trial to improve outcomes after MI, but substantial uncertainty remains about its efficacy and safety in the context of current standard medical therapy. This thesis explores the biochemical efficacy, tolerability and safety of extended release (ER) niacin/laropiprant in the large, randomized HPS2-THRIVE trial. Laropiprant is a prostaglandin D₂ receptor (DP1) antagonist which reduces the main adverse effect of niacin, namely “flushing” (an unpleasant cutaneous vasodilation) that makes a large trial of niacin practicable. ER niacin/laropiprant increases high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1, and reduces low density lipoprotein cholesterol (LDL-C), apolipoprotein B, triglycerides and lipoprotein (a), consistent with previous studies of ER niacin. The reasons for stopping ER niacin/laropiprant reflected the known adverse effect profile of ER niacin, although unlike previous trials flushing was not the most frequent reason for stopping. Skin (pruritus and rash), gastrointestinal (nausea, pain and diarrhoea) and diabetes-related (hyperglycaemia) adverse events were the most common reasons for stopping ER niacin/laropiprant during 3.9 years’ follow-up. The analyses presented here identified three major previously unknown hazards of ER niacin. ER niacin/laropiprant increased the risk of statin-related myopathy almost five-fold, and this effect was greater among participants in China than Europe. ER niacin/laropiprant also increased the risk of bleeding (intracranial, gastrointestinal and other sites) and infection. Compared to placebo there was an absolute excess of 3.1% of serious adverse events (excluding cancer and major vascular events [MVEs]) among participants assigned ER niacin/laropiprant. ER niacin/laropiprant did not significantly reduce MVEs. These findings suggest that the use of niacin to reduce vascular risk should now be reconsidered.

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Cardiovascular disease (CVD) is a major health problem among women worldwide. In Thailand, risk factors of CVD in rural Thai women have not yet been examined. The purpose of this predictive correlational study was to examine risk factors of CVD in rural Thai women. Non-modifiable risk factors, modifiable risk factors (physiological, behavioral, and psychological risk factors), contextual risk factors, as well as, coping were conceptualized as major variables in this study.The sample consisted of 149 rural Thai women who had been diagnosed with CVD and resided in rural northern Thailand. A set of questionnaires and physiological measures were used to obtain data. The Chi-square test and the Pearson correlation technique, as well as the Multiple regression were used for data analysis.The results revealed that age, hypertension, cigarette smoking, stress, depression, and poverty had positive relationships with the severity of CVD. BMI, physical activity, education level, and family income were inversely related to the severity of CVD. However, total cholesterol, diabetes mellitus, menopause status, alcohol consumption, distance to hospital, transportation to health care, and coping had no relationship to the severity of CVD. A few of the physiological and behavioral risk factors were significant predictors of the severity of CVD in rural Thai women. These included high blood pressure, cigarette smoking, and physical inactivity. Notably, psychological stress and the contextual risk factors of income and poverty were also significant predictors of the severity of CVD in these women. Moreover, there were the significant moderator effects in predicting to the severity of CVD: total serum cholesterol and family income, diabetes and distance to a hospital, BMI and transportation, menopause and income, cigarette smoking and transportation, and depression and poverty.In conclusion, the findings from this study suggested that few of traditional risk factors of CVD were significant risk factors for CVD. Noteworthy findings demonstrated that psychological stress and contextual risk factors played an important role in contributing to CVD in rural Thai women. It is suggested that specific and effective interventions are needed for these women in order to reduce their morbidity and mortality rates of CVD.

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