Introdução: A obesidade pode se constituir como fator de risco para o uso de contraceptivos hormonais, especialmente aqueles contendo estrogênios, devido a possíveis efeitos metabólicos indesejados. As alterações metabólicas decorrentes do uso do sistema intrauterino liberador de levonorgestrel (SIU-LNG) foram bem descritas em mulheres com peso normal, mas não em mulheres obesas. Objetivo: Avaliar o efeito do sistema intrauterino liberador de levonorgestrel (SIU-LNG) sobre marcadores ultrassonográficos e laboratoriais de risco metabólico e doença cardiovascular em mulheres obesas. Casuística e Métodos: Estudo clínico randomizado aberto avaliando 106 mulheres obesas (30,0 Kg/m2 e <40 Kg/m2), com idade entre 18 e 40 anos, sem outras comorbidades. As pacientes foram avaliadas antes do início da contracepção e após um ano, sendo realizada randomização simples, para uso de SIU-LNG ou método não hormonal (a paciente poderia escolher entre dispositivo intrauterino de cobre ou preservativo). Foram avaliados: evolução ponderal; circunferência da cintura; volume uterino e ovariano; insulinemia e glicemia de jejum; perfil lipídico; testosterona; sex hormone binding globulin (SHBG); hemograma; aspartato aminotransferase (AST), a alanina aminotransferase (ALT), a fosfatase alcalina e gama glutamil transferase; índice de rigidez da carótida e espessura íntima-média (EIM); dilatação mediada por fluxo da artéria braquial (DMF) e doença hepática gordurosa não alcoólica (DHGNA). Resultados: Nenhuma diferença estatística foi observada na dilatação mediada por fluxo da artéria braquial entre as mulheres em uso de SIU-LNG e métodos não hormonais em um ano de observação. Observou-se uma redução do volume ovariano (-0,5&177;2,6 vs. 0,7&177;2,6 cm3, p=0,03). A hemoglobina aumentou nas usuárias de SIU-LNG (0,4&177;0,8 vs. -0,1&177;0,8 g/dL, p=0,00) juntamente com o hematocrito (1,8&177;2,2 vs. -0,0&177;2,3 %, p=0,00). Não houve alteração do perfil lipídico, glicêmico, da função hepática e doença hepática gordurosa não alcoolica no grupo das usuárias de SIU-LNG e nem das usuárias de métodos não hormonal. Conclusão: Concluiu-se que o SIU-LNG não apresentou efeito metabólico desfavorável comparado a métodos não hormonais após um ano, em mulheres obesas grau I e II, sem outras comorbidades. / Background: Obesity may be a risk factor for the use of hormonal contraceptives, especially those containing estrogens, due to possible unwanted metabolic effects. The metabolic effects of levonorgestrel-releasing intrauterine system (LNG-IUS) have been studied in normal-weight women but not in obese women. Objective: To evaluate the effect of levonorgestrel-releasing intrauterine system on multiple ultrasonographic and laboratorial markers of metabolic and cardiovascular disease risk in obese women. Methods: A randomized clinical trial study evaluating 106 obese women ( 30.0 kg/m2 and <40 kg/m2), aged between 18 and 40 years with desire contraception, without other co-morbidities. Patients were evaluated before the start of contraception and after a year, made simple randomization to use of LNG-IUS or nonhormonal method (the patient could choose between copper intrauterine device or condom). Were evaluated: weight gain; waist circumference; uterine and ovarian volumes; insulinemia and fasting glucose; lipid profile; testosterone; sex hormone binding globulin (SHBG); hemogram; aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase and gamma glutamyl transferase; stiffness index and carotid intima-media thickness (IMT); flow-mediated brachial artery dilatation (FMD) and nonalcoholic fatty liver disease (NAFLD). Results: No statistical difference was observed in flow-mediated brachial artery among women using the LNG-IUS and non-hormonal methods in one year of observation dilation. There was a volume reduction (-0.5 &177; 2.6 vs. 0.7 &177; 2.6 cm3, p=0.03). Hemoglobin increased in users of LNG-IUS (0.4 &177; 0.8 vs. -0.1 &177; 0.8 g/dL, p=0.00) together with the hematocrit (1.8 &177; 2.2 vs. -0.0 &177; 2.3%, p=0.00). There was no change in lipid profile, glucose, liver function and nonalcoholic fatty liver disease in the group of users of the LNG-IUS or the users of non-hormonal methods. Conclusion: We conclude that the LNG-IUS showed no adverse metabolic effect compared to non-hormonal methods after one year in grade I and II obese women without other comorbidities.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-03-29T13:45:50Z No. of bitstreams: 1 reginacoelimachado.pdf: 584182 bytes, checksum: 3aff2dbd317552baf0742fe28f1db537 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-03-30T11:21:05Z (GMT) No. of bitstreams: 1 reginacoelimachado.pdf: 584182 bytes, checksum: 3aff2dbd317552baf0742fe28f1db537 (MD5) / Made available in DSpace on 2017-03-30T11:21:05Z (GMT). No. of bitstreams: 1 reginacoelimachado.pdf: 584182 bytes, checksum: 3aff2dbd317552baf0742fe28f1db537 (MD5) Previous issue date: 2009-11-11 / Avalia risco cardiovascular na síndrome metabólica. Não existe consenso sobre o escore mais apropriado para detecção do RCV nesta população. O objetivo é avaliar o risco de doença arterial coronariana (DAC) em indivíduos não diabéticos portadores de SM, com base em três diferentes escores. Foram avaliados trinta e nove indivíduos portadores de SM, por meio do Escore de Risco de Framingham (ERF), pelo ERF modificado pela IV Diretriz Brasileira sobre Dislipidemias e Aterosclerose (ERF-mod) e pelo Prospective Cardiovascular Münster Study (PROCAM). Todos os indivíduos foram submetidos a avaliação clínica, eletrocardiograma de repouso, ecocardiograma, monitorização ambulatorial da pressão arterial, índice tibial-braquial (ITB) além de dosagens de glicose, creatinina, colesterol total, colesterol HDL, triglicérides e microalbuminúria. O LDL colesterol foi estimado pela fórmula de Friedwald. A média de idade foi de 4421,0 anos, com predomínio de mulheres (31/39). Seis (15,4%) indivíduos eram tabagistas e 21 (53,8%) eram hipertensos. O perfil lipídico mostrou níveis baixos de colesterol HDL em 35 (89,7%) dos casos e níveis elevados de triglicérides, colesterol total e colesterol LDL em 28 (71,8%), 19 (48,7%) e 15 (38,5%) dos casos, respectivamente. Microalbuminúria foi diagnosticada em 23 (59%) dos indivíduos, hipertrofia do ventrículo esquerdo (HVE) em três (7,7%) e doença vascular periférica em cinco (12,8%) pacientes. O risco estimado de DAC pelo ERF foi baixo (<10%) em 35 (89,7%) indivíduos e médio (10 a 20%) em quatro (10,3%), não sendo detectado alto risco em nenhum caso. Por outro lado, quando foram considerados fatores agravantes sugeridos pela IV Diretriz Brasileira sobre Dislipidemias e Aterosclerose, o ERF-mod detectou cinco casos (12,8%) de baixo risco, 30 (76,9%) casos de médio risco e quatro (10,3%) de alto risco. Quando se aplicou o PROCAM, 29 (74,4%) indivíduos continuaram na faixa de baixo risco (<10%), sete (17,9%) apresentaram médio risco (10-20%) e três (7,7%), alto risco para doença coronariana em 10 anos. A utilização do ERF parece subestimar o RCV em portadores de SM não diabéticos. Por outro lado, a utilização do ERF-mod ou, alternativamente, do PROCAM parecem mais adequados para a estimativa do RCV nessa população. / It evaluates cardiovascular risk (CVR) in metabolic syndrome. There is no agreement about the best score to estimate the CVR in this population. The objective is to assess the coronary heart disease (CHD) risk in non-diabetic patients with MS using three different scores. Thirty nine subjects with MS were evaluated by the Framingham Risk Score (FRS), FRS modified by IV Diretriz Brasileira sobre Dislipidemias e Aterosclerose (mod-FRS) and by Prospective Cardiovascular Münster Study (PROCAM). All the subjects were submitted to clinical evaluation, electrocardiogram, echocardiogram, ambulatorial blood pressure monitorization, ankle brachial index (ABI) and dosages of glucose, creatinine, total cholesterol, HDLcholesterol, triglycerides and microalbuminúria. LDL-cholesterol was estimated by Friedwald’s formula. Mean age was 4421.0 years and most of individuals were female (31/39). Six subjects (15,4%) were smokers and 21 (53,8%) were hypertensive. Low HDL-cholesterol was detected in 35 (89,7%) individuals and high triglycerides, total cholesterol and LDL-cholesterol levels were observed in 28 (71,8%), 19 (48,7%) e 15 (38,5%) individuals, respectively. Microalbuminuria was diagnosed in 23 (59%) subjects, left ventricular hypertrophy in three (7,7%) and peripheral vascular disease in five (12,8%). Based in the FRS the CHD risk in 10 years was considered low in 35 (89,7%) individuals and intermediate in four (10,3%), with no patient in high risk group. On the other hand, the mod-FRS detected five (12,8%) subjects in low risk, 30 (76,9%) in the intermediate and four (10,3%) individuals in the high risk group. According to PROCAM 29 (74,4%) individuals were in low risk, seven (17,9%) in the intermediate and three (7,7%) in high risk group. In non-diabetic subjects with MS the FRS underestimates the CHD risk, whereas the mod-FRS and alternatively, the PROCAM seem to be more accurate in estimating this risk.

Patients with rheumatoid arthritis (RA) have a shorter life span than the general population. An increased death due to cardiovascular disease (CVD) has been reported. RA is characterized by synovitis and joint destruction accompanied by an acute phase reaction and systemic features. The present work investigates the epidemiology of CVD in patients with RA in the county of Västerbotten and the influence of inflammation on lipid metabolism and haemostasis. In a retrospective cohort study on 606 RA patients, the overall mortality was significantly higher than in the general population, with an excess death rate for CVD and for ishemic heart diseae (IHD) in both sexes. Multiple Cox regression, showed that male sex, higher age at disease onset and cardiovascular event increased the risk for death. Male sex, high age at disease onset and hypertension increased the risk for cardiovascular event. Diabetes mellitus, treatment with corticosteroids, disease modifying antirheumatic drugs and postmenopausal estrogen neither influenced survival nor the risk of cardiovascular event. In 93 patients with active RA, the levels of cholesterol, high density- (HDL) and low density (LDL) lipoprotein cholesterol were significantly lower, and Lipoprotein(a) was significantly higher compared to controls. In a follow-up on 53 patients, a relation between the change of Lp(a) and acute phase proteins was found only in patients with high levels of Lp(a). Preheparin lipoprotein lipase (LPL) activity and mass were significantly decreased in 17 postmenopausal women with active RA. Preheparin LPL mass correlated inversely to several acute phase proteins and interleukin-6. Low levels of LPL mass may implicate increased hepatic clearence but also increased macrophage ingestion of lipoproteins via the LDL receptor-related protein (LRP). Haemostasis of the circulation was investigated in 74 of the 93 patients with active RA. In patients with extraarticular disease, the release of tissue plasminogen activator (tPA) was significantly decreased, and its inhibitor (PAI-1) was significantly increased compared to patients with nonsystemic disease, implicating hypofibrinolysis. In a two year follow-up, patients with thromboembolic events had significantly elevated levels of von Willebrand factor, PAI-1, triglycerides and haptoglobin compared to event-free patients. In 29 RA patients and 18 spondylarthropathy patients with gonarthritis, radiological joint destruction correlated to PAI-1 antigen in synovial fluid and, inversely, to plasminogen. A relationship between activation of fibrin degrading proteolytic enzymes and joint destruction was implicated. In conclusion, several processes involved in lipid metabolism and haemostasis are influenced in active RA. In view of the increased death rate due to CVD, an efficient control of inflammation should be important, not only for reducing joint destruction, but also for reducing systemical atherogenic and thrombogenic effects. / <p>s. 1-54: sammanfattning, s. 55-133: 6 uppsatser</p> / digitalisering@umu.se

Magister Public Health - MPH / Introduction: In recent years, cardiovascular disease (CVD) has emerged as a leading cause of death in developing countries. It is important to identify and target people who are at risk,given that a third of all deaths are expected to be due to CVD by 2020. Studies have shown socio-economic patterning in the prevalence of risk factors for CVD, including obesity,smoking and lipid profile. In developed countries, the association between socio-economic status (SES) and CVD risk factors is negative, with a higher prevalence of CVD risk factors among people of lower SES. However, findings from studies in developing countries on this including South Africa has been inconsistent. In addition, there is scant information on differences in socio-economic patterning of CVD risk factors between urban and rural areas in South Africa.Aim: To examine the association between SES indicators and CVD risk factors among an adult population cohort of Black South Africans living in a rural and urban community.Study design: Quantitative cross-sectional analytical study of baseline data of a populationbased cohort of 2000 Black South African men and women aged 30-70 years who are part of the Cape Town arm of the Prospective Urban and Rural Epidemiology (PURE) Study. The study cohort has been established in Mount Frere, Eastern Cape (rural) and Langa, Cape Town(urban) since 2009 and the current work is secondary analysis of the baseline study data.Data collection/synthesis: SES indicators including income, employment status, marital status and completed education were gleaned from the baseline data of the PURE Cape Town study for all study participants. Then CVD risk factors including obesity, hypertension, selfreported diabetes, consumption of tobacco and alcohol consumption were also determined for the same participants. Data analysis: Data was analysed using SPSS version 20 for Windows. Descriptive statistics including frequency counts, percentages, mean and standard deviations (where normal distribution) and median and interquartile range (where non-normal) were used to summarise data on SES and CVD risk factors. This was performed separately for rural and urban study participants. Analytical statistics was used to examine associations between SES indicators and CVD risk factors with risk factors as both dichotomous and multi-level categorical variables. Kendall’s τ rank correlation coefficient was obtained to assess the relationship between the three indicators of SES. Prevalence rates reported with 95% confidence intervals was determined for risk factors across categories of SES indicators. P-values for trends in CVD risk factors were obtained by treating the SES indicators as categorical variables in logistic regression analyses. Multiple logistic regression analysis to estimate independent effects of the different SES indicators on risk factors was performed. In all analyses, P-values < 0.05 were regarded as significant.Results: There was a significant difference in the socioeconomic and CVD risk factors profile of urban and rural participants. Except for hypertension and tobacco use with insignificant higher prevalence in the urban location, all CVD risk factors were significantly higher in urban than rural participants. Some CVD risk factors (hypertension and diabetes) were positively associated with high SES (income) and some others (tobacco use) were negatively associated with employment status. Highest income earners had the highest risk of hypertension (AOR= 2.4, 95% CI 1.5-3.9) and diabetes (AOR= 2.2, 95% CI 1.2-4.1) after adjusting for age, sex and other SES variables. Marital status however showed the most consistent association across all CVD risk factors; widowed participants had a high risk of hypertension (OR=2.1, 95% CI 1.2-3.7) and diabetes (OR=2.0, 95% CI 1.1-3.7), but had the lowest risk of tobacco (OR=0.3, 95% CI 0.14-0.66) and alcohol use (OR=0.3, 95% CI 0.15-0.72). The distribution of CVD risk factors by SES gradient showed inconsistent patterning and difference between the urban and rural participants.Conclusion: In this cohort of adult Black South Africans, high income earning and widowed marital status were associated with higher hypertension and diabetes prevalence, while unemployment was associated with higher tobacco use.Recommendations: CVD risk reduction interventions that recognise the differential susceptibility of individuals in different SES group need to be designed and implemented.Widows and widowers should be given focussed attention in health screening as they may have increased vulnerability to diseases especially CVDs. There is however need for more research to establish the pathway through which SES factors predispose or protect individuals from CVDs.

Magister Public Health - MPH / Introduction: In recent years, cardiovascular disease (CVD) has emerged as a leading cause of death in developing countries. It is important to identify and target people who are at risk,given that a third of all deaths are expected to be due to CVD by 2020. Studies have shown socio-economic patterning in the prevalence of risk factors for CVD, including obesity,smoking and lipid profile. In developed countries, the association between socio-economic status (SES) and CVD risk factors is negative, with a higher prevalence of CVD risk factors among people of lower SES. However, findings from studies in developing countries on this including South Africa has been inconsistent. In addition, there is scant information on differences in socio-economic patterning of CVD risk factors between urban and rural areas in South Africa.Aim: To examine the association between SES indicators and CVD risk factors among an adult population cohort of Black South Africans living in a rural and urban community.Study design: Quantitative cross-sectional analytical study of baseline data of a populationbased cohort of 2000 Black South African men and women aged 30-70 years who are part of the Cape Town arm of the Prospective Urban and Rural Epidemiology (PURE) Study. The study cohort has been established in Mount Frere, Eastern Cape (rural) and Langa, Cape Town(urban) since 2009 and the current work is secondary analysis of the baseline study data.Data collection/synthesis: SES indicators including income, employment status, marital status and completed education were gleaned from the baseline data of the PURE Cape Town study for all study participants. Then CVD risk factors including obesity, hypertension, selfreported diabetes, consumption of tobacco and alcohol consumption were also determined for the same participants. Data analysis: Data was analysed using SPSS version 20 for Windows. Descriptive statistics including frequency counts, percentages, mean and standard deviations (where normal distribution) and median and interquartile range (where non-normal) were used to summarise data on SES and CVD risk factors. This was performed separately for rural and urban study participants. Analytical statistics was used to examine associations between SES indicators and CVD risk factors with risk factors as both dichotomous and multi-level categorical variables.Kendall’s τ rank correlation coefficient was obtained to assess the relationship between the three indicators of SES. Prevalence rates reported with 95% confidence intervals was determined for risk factors across categories of SES indicators. P-values for trends in CVD risk factors were obtained by treating the SES indicators as categorical variables in logistic regression analyses. Multiple logistic regression analysis to estimate independent effects of the different SES indicators on risk factors was performed. In all analyses, P-values< 0.05 were regarded as significant.Results: There was a significant difference in the socioeconomic and CVD risk factors profile of urban and rural participants. Except for hypertension and tobacco use with insignificant higher prevalence in the urban location, all CVD risk factors were significantly higher in urban than rural participants. Some CVD risk factors (hypertension and diabetes) were positively associated with high SES (income) and some others (tobacco use) were negatively associated with employment status. Highest income earners had the highest risk of hypertension (AOR= 2.4, 95% CI 1.5-3.9) and diabetes (AOR= 2.2, 95% CI 1.2-4.1) after adjusting for age, sex and other SES variables. Marital status however showed the most consistent association across all CVD risk factors; widowed participants had a high risk of hypertension (OR=2.1, 95% CI 1.2-3.7) and diabetes (OR=2.0, 95% CI 1.1-3.7), but had the lowest risk of tobacco (OR=0.3, 95% CI 0.14-0.66) and alcohol use (OR=0.3, 95% CI 0.15-0.72). The distribution of CVD risk factors by SES gradient showed inconsistent patterning and difference between the urban and rural participants.Conclusion: In this cohort of adult Black South Africans, high income earning and widowed marital status were associated with higher hypertension and diabetes prevalence, while unemployment was associated with higher tobacco use.Recommendations: CVD risk reduction interventions that recognise the differential susceptibility of individuals in different SES group need to be designed and implemented.Widows and widowers should be given focussed attention in health screening as they may have increased vulnerability to diseases especially CVDs. There is however need for more research to establish the pathway through which SES factors predispose or protect individuals from CVDs.

Les maladies cardiovasculaires, conséquence de l’athérosclérose, sont la première cause de morbi-mortalité dans le monde et voient leur incidence et sévérité augmenter avec l’expansion de leurs principaux facteurs de risque, tels que l’âge, l’obésité et le diabète. La sténose valvulaire aortique, valvulopathie la plus fréquemment rencontrée dans les pays occidentaux essentiellement chez le sujet vieillissant, partage de fortes similitudes avec l’athérosclérose vasculaire. En effet, les plaques athéroscléreuses et les lésions valvulaires sont le siège de processus d’inflammation, d’angiogenèse, de fibrose et de calcification. Les macrophages, issus de la différenciation tissulaire des monocytes infiltrés, jouent un rôle clé dans l’apparition des lésions athéroscléreuses vasculaires et leur devenir. Leur rôle dans l’état inflammatoire des lésions est aujourd’hui bien établi avec de récentes publications qui font état des propriétés plastiques des macrophages, selon leur microenvironnement. Deux principaux sous types de macrophages ont été décrits dans les plaques athéroscléreuses, les macrophages M1 dit « classiques » et M2 dits « alternatifs ». Leur rôle respectif dans la thrombogénécité, la protéolyse et l’angiogenèse, processus impliqués dans l’instabilité de la plaque, ont été moins étudiés. En revanche, les macrophages sont peu décrits dans la valve, à l’inverse des cellules interstitielles de valves (VIC), qui sont cruciales pour le maintien de l’homéostasie et la fonction valvulaire et sont impliquées dans la fibrose et la rigidité des feuillets valvulaires. Mon travail de thèse a pour objectif d’étudier les rôles des macrophages M1/M2 dans les pathologies vasculaires et valvulaires chez l’homme. Nous nous sommes focalisés sur leurs rôles dans l’instabilité de la plaque athéroscléreuse (processus de coagulation et de remodelage vasculaire) et dans la fibrose valvulaire ainsi que sur leur modulation phénotypique par d’autres types cellulaires présents dans les lésions, les polynucléaires neutrophiles dans la plaque ou les VIC dans la valve.Nos résultats suggèrent que les macrophages M1 et M2 pourraient moduler différemment des processus physiopathologiques majeurs de l'athérosclérose. Par ailleurs, les macrophages M1 de patients diabétiques présentent un phénotype délétère qui pourrait expliquer la plus grande vulnérabilité des plaques d’athérosclérose observée chez ces sujets. Concernant la pathologie valvulaire, après avoir caractérisé par analyse histologique les M1/M2 dans les valves aortiques humaines, nous avons montré que les macrophages M1 sont impliqués dans la progression de la fibrose via la modulation de leur répertoire sécrétoire par les VIC.Cette thèse apporte de nouveaux indices sur les processus physiopathologiques impliqués dans les maladies vasculaires et valvulaires. Elle met l’accent sur le rôle délétère des macrophages M1 chez les sujets diabétiques en pathologie vasculaire et identifie également une fonction jusque-là méconnue des M1 dans la progression de la fibrose, associée au « cross-talk » avec les VIC. Il conviendra par la suite d’identifier les mécanismes moléculaires sous-jacents à ces intéractions, ce qui devrait permettre d’envisager de nouvelles voies thérapeutiques visant à moduler l’effet de ce sous-type cellulaire dans ces pathologies. / Cardiovascular disease, as a result of atherosclerosis, are the main cause of morbidity and mortality in the world and see their incidence and severity increase with the expansion of their major risk factors, such as age, obesity and diabetes. Aortic valve stenosis, valve disease most frequently encountered in Western countries mainly in the old subject, shares strong similarities with vascular atherosclerosis. Indeed, atherosclerotic plaques and valvular lesions are the site of inflammation, angiogenesis, fibrosis and calcification processes. Macrophages, from monocytes infiltrated tissue differentiation, play a key role in the development of vascular atherosclerotic lesions and their future. Their role in the inflammatory state of the lesions is now well established with recent publications that report on plastic properties of macrophages, according to their microenvironment. Two major subtypes of macrophages have been described in the atherosclerotic plaques, classically (M1) or alternatively (M2) activated macrophages. Their respective role in thrombogenicity, proteolysis and angiogenesis processes involved in plaque instability, have been less studied. In contrast, macrophages are not disclosed in the valve, compared to the valvular interstitial cells (VIC), which are crucial for the maintenance of homeostasis and the valvular function and are involved in the fibrosis and rigidity of the valvular leaflets. My thesis aims to study the roles of macrophages M1/M2 in vascular and valvular pathologies in humans. We focused on their roles in the instability of atherosclerotic plaque (haemostatic or clotting process and vascular remodeling) and valvular fibrosis and their phenotypic modulation by other cell types present in the lesions, neutrophils (PNN) in the plaque or VIC in the valve.Our results suggest that the M1 and M2 macrophages may differently modulate major pathophysiological processes of atherosclerosis. In addition, M1 macrophages from diabetic patients have a deleterious phenotype that could explain the increased vulnerability of atherosclerotic plaques observed in these subjects. About valvular pathology, after characterized histologically M1/M2 in human aortic valves, we have shown that the M1 macrophages are involved in the progression of fibrosis through the modulation of their secretory repertoire by VIC.This work provides new clues about the pathophysiological processes involved in vascular and valvular diseases. It focuses on the deleterious role of M1 macrophages in diabetic subjects in vascular pathology and also identifies an unknown function of M1 in the progression of fibrosis associated with "cross-talk" with VIC. It will be necessary later to identify the molecular mechanisms underlying these interactions, which is expected to consider new therapeutic approaches to modulate the effect of this cell subtype in these diseases.

Medication non-compliance has become one of the most prevalent reasons for hospitalization and doctor's visits by the elderly. As the elderly population is more likely to have decreased cognitive abilities, it is suggested that neuropsychological factors, especially executive function, are more influential in medication non-compliance than once thought. This study looked at executive function performance on a traditional battery of neuropsychological tests, self-report of perceived ability to perform executive function tasks, and the newly developed Pillbox Test, a performance based IADL measure. The Pillbox Test is designed to replicate a type of medication-management specific IADL as a means to asses executive function. Standard executive function measures only tap a portion of executive function, but it is believed that the Pillbox Test incorporates all four theoretical domains of executive function. The multiple measures of executive function performance were compared in three prevalent subgroups of the elderly population (mixed neurological group, cardiac medical-control group, and healthy community-control group). Results found significant differences, where the community-control and cardiac groups outperformed the mixed neurological group on the large majority of executive function tasks. Smaller differences were also noted between the community-control and cardiac groups and between the cardiac and mixed neurological groups. Together, these findings provide support for the diagnostic prevalence of mild cognitive impairment in the older adult cardiac population. Results also indicated the level of executive dysfunction on standardized neuropsychological measures was highly correlated with performance on both the Pillbox Test and the IADL based Direct Assessment of Functional Status measure. Finally, the Pillbox Test has moderate to strong ecological validity with 75% sensitivity and 87.5% specificity for five or more errors on this test.

As doenças cardiovasculares (DCV) representam a principal causa de mortalidade e de incapacidade, em ambos os gêneros, no Brasil e no mundo. O padrão de consumo alimentar está tanto positiva como negativamente associado aos principais fatores de risco para DCV, entre eles diabetes, hipertensão, obesidade e hipertrigliceridemia, todos componentes da síndrome metabólica. Este estudo tem como objetivos identificar os padrões alimentares em indivíduos com DCV, considerando a densidade de energia, a gordura saturada, a fibra, o sódio e o potássio consumidos, e investigar sua associação com fatores de risco de DCV e síndrome metabólica. Trata-se de um estudo transversal. Foram utilizados dados do estudo DICA Br. A amostra foi composta de indivíduos com DCV, com idade superior a 45 anos, de todas as regiões brasileiras. O consumo alimentar foi obtido por recordatório alimentar de 24h e os padrões alimentares obtidos pela regressão por posto reduzido (RPR). Para a RPR, utilizaram-se 28 grupos alimentares como preditores e como variáveis respostas componentes dietéticos. O teste de Mann Whitney foi utilizado para testar as diferenças entre as médias dos escores. Foram obtidos dados de 1.047 participantes; 95% apresentavam doença arterial coronariana; em sua maioria, eram idosos, da classe econômica C1 e C2 e estudaram até o ensino médio. A prevalência de síndrome metabólica foi de 58%. Foram extraídos dois padrões alimentares. O primeiro foi marcado pelo maior consumo de fibra alimentar e potássio, composto por arroz e feijão, frutas e sucos naturais com ou sem açúcar, legumes, carne bovina ou processada, verduras, raízes e tubérculos. O segundo padrão caracterizou-se pelo consumo de gordura saturada e maior densidade energética, representado por panificados salgados, gorduras, carne bovina e processada, doces caseiros, pizza, salgadinhos de pacote ou festa, sanduíche e alimento salgado pronto para consumo. Houve associação significativa entre o padrão alimentar 1 com medida da circunferência da cintura e nível de HDL adequados e com o padrão 2 e HDL adequado. A adoção do padrão alimentar 1 pode estar associada à proteção contra alguns dos componentes da síndrome metabólica. / Cardiovascular diseases (CVD) are the leading cause of mortality and disability in both genders in Brazil and worldwide. The dietary pattern is at the same time positive and negatively associated with the main risk factors for CVD, including diabetes, hypertension, obesity and hypertriglyceridemia, all components of the metabolic syndrome. This study aims to identify dietary patterns in individuals with CVD, considering the energy density, and the amount of saturated fatty acid, fiber, sodium and potassium of the diet, and to investigate its association with CVD risk factors and metabolic syndrome. This is a cross-sectional study, data were used from \"DICA Br\" study. The sample consisted of individuals with CVD, over 45 years old, residents from all Brazilian regions. Food consumption was obtained by one 24-hours diet recall and dietary patterns by reduced rank regression (RRR). In the RRR, 28 food groups were included as predictors and dietary components was chosen as the response variable. The Mann-Whitney test was used to test the differences between the factors scores\' means. Data of 1047 participants were analyzed. 95% have coronary artery disease, most are elderly, economical class most observed are C1 and C2. Also, most of them and studied up to high school. The prevalence of metabolic syndrome was 58%. Two dietary patterns were extracted: the first one is higher in dietary fiber and potassium, which is composed by rice, beans, fruits and natural juices with or without sugar, vegetables, beef or processed meat, roots and tubers. The second pattern is higher in saturated fatty acid and energy density, represented by breads, fats, and processed meat, homemade pastries, pizza, snacks or party package, sandwich and salty food ready for consumption. There was a significant association between dietary pattern 1 and low waist circumference and adequate high density cholesterol blood concentration. There was a significant association between dietary pattern 2 and adequate high density cholesterol blood concentration. We suggest that the adoption of the dietary pattern 1 may be associated with protection against some of the components of metabolic syndrome.

Bakgrund: Under år 2016 dog 17.9 miljoner människor av hjärt- och kärlsjukdomar vilket innebär 31 procent av alla dödsorsaker i hela världen. Hjärt-och kärlsjukdomar var den vanligaste dödsorsaken i Sverige år 2018 bland både män och kvinnor. Att informera om risker ingår i sjuksköterskans roll och syftar till att förbättra livskvalitén, förlänga livet och förhindra komplikationer. Empowerment handlar om att överföra makt, möjliggöra samt skänka förmåga till patienten. Empowerment beskrivs som ett positivt begrepp där patientens styrka och rättigheter betonas.Syfte: Syftet med denna litteraturöversikt är att beskriva förutsättningar som patienter med hjärt- och kärlsjukdomar behöver för egna möjligheter till egenvård.Metod: En litteraturöversikt baserat på 16 vetenskapliga artiklar.Resultat: Resultatet baserar på tre huvudteman och sju subteman. Dessa huvudteman är: medvetenhet om egen förmåga, betydelsen av omgivningens stöd och förändrade levnadsvanor och livsinsikt. De sju subteman är: tilltro till egen förmåga, bidragande personliga egenskaper för optimal egenvård, familjestöd och äktenskap påverkan, sjuksköterskans kunskapsstöd, vikten av socialt sammanhang, fysisk aktivitet trots rädsla och otillräcklig egenförmåga och självinsikt och förväntningarna på utökad livskvaliteSlutsats: Denna litteraturöversikt visar att patientens förutsättningar för egna möjligheter till egenvård med hjärt-kärlsjukdomar påverkas av både personliga och yttre faktorer. Som sjuksköterska är det viktigt att vara medveten om patientens egen förmåga, betydelsen av omgivningens stöd och att få förändrade levnadsvanor och livsinsikt. Stöd från hälso-och sjukvårdspersonal och anhöriga är viktigt för att lyckas förändra livsstil. / Background: Cardiovascular disease was the most common cause of death in Sweden in 2018 among both men and women. Informing about risks is part of the nurse's role and aims to improve the quality of life, prolong life and prevent complications. Empowerment is about transferring power, enabling and giving the ability to the patient. Empowerment is described as a positive concept where the patient's strength and rights are emphasized.Aim: The purpose of this literature review is to describe the conditions that patients with cardiovascular disease need for their own opportunities for self-care.Method: A literature review based on 16 scientific articles.Result: The result is based on three main themes and seven sub-themes. The central themes are: awareness of one's own ability, the importance of the support of the environment and changed lifestyles and insight into life. The seven sub-themes are: confidence in one's own ability, contributing personal qualities for optimal self-care, family support and marriage influence, the nurse's knowledge support, the importance of social context, physical activity despite fear and insufficient self-efficacy and self-awareness and expectations of increased quality of life.Conclusion: This literature review shows that the patient's conditions for their own opportunities for self-care with cardiovascular disease are affected by both personal and external factors. As a nurse, it is important to be aware of the patient's own ability, the importance of the environment's support and to gain changed lifestyles and insight into life. Support from health care professionals and relatives is important to succeed in changing lifestyles.

Les maladies cardiovasculaires (MCV) représentent la première cause de mortalité dans le Monde et en Europe. Le diagnostic et la prédiction de l’évolution des MCV reposent actuellement sur l’utilisation de biomarqueurs protéiques, mais doivent être améliorés pour optimiser la prise en charge des patients. Le transcriptome sanguin comprend l’ensemble des molécules ARN circulantes, qui sont présentes dans les cellules sanguines et libres dans le sang. Parmi elles, les ARN messagers (ARNm) codent pour des protéines alors que de petits ARN non codants, les microARNs (miARNs), répriment l’expression de leurs gènes cibles. Nous avons émis l’hypothèse que le transcriptome sanguin, et en particulier les ARNm et les miARNs, avaient un potentiel de biomarqueur, diagnostique ou pronostique, dans les MCV. En premier lieu, nous avons montré que l’héparine endogène pouvait induire une inhibition de la transcription inverse couplée à la PCR quantitative lors de la mesure des miARNs circulants et que ce paramètre devait être pris en compte lors de l’étude du transcriptome sanguin. Nous avons ensuite montré que 3 transcrits (codants pour les gènes LMNB1, LTBP4, TGFBR1) exprimés dans le sang total, étaient des prédicteurs indépendants de l’altération de la fonction cardiaque à 4 mois post-IM. De plus, l’ajout de ces 3 transcrits dans un modèle de prédiction contenant des variables cliniques augmente la valeur prédictive de ce modèle. Dans une troisième étude, nous avons montré que les niveaux circulants de miR-574-5p étaient capables de discriminer les patients porteurs d’un AAT des personnes saines. De plus, le miR-574-5p est encapsulé dans des vésicules extracellulaires dans le sang, suggérant un rôle paracrine. Au cours des quatrième et cinquième études, nous avons montré que les niveaux circulants de miR-122-5p étaient des prédicteurs indépendants de l’évolution neurologique et de la survie à moyen terme post-AC, et capable d’améliorer les modèles de prédiction existants. Nous avons également identifié le miR-574-5p comme prédicteur indépendant de l’évolution neurologique post-AC, spécifiquement chez les femmes. En conclusion, ce travail de thèse a permis la découverte ou la confirmation de la valeur de biomarqueurs potentiels de transcrits et miARNs dans différentes MCV. Cependant, leur capacité de biomarqueur devra être validée dans d’autres études à grande échelle et à l’aide d’autres techniques avant d’envisager leur utilisation en clinique / Cardiovascular disease (CVD) is the main cause of mortality in the World and in Europe. Diagnosis and prediction of outcome of CVD currently rely on the use of protein biomarkers, but should be improved to optimize patient healthcare. Blood transcriptome contains all RNA molecules present in blood cells and in the acellular compartment. Among them, messenger RNA (mRNA) code for proteins whereas small non coding RNA, microRNA (miRNA), have a regulatory function by repressing the expression of their target genes. We hypothesized that blood transcriptome, mRNA and miRNA in particular, had a potential as biomarker, diagnostic or prognostic, in CVD. In a first study, we showed that endogenous heparin could lead to an inhibition of reverse transcription and quantitative PCR reaction used to measure miRNAs expressed in the blood, and that this parameter should be considered for studies on blood transcriptome. Secondly, we showed that 3 transcripts (coding for genes LMNB1, LTBP4, TGFBR1) expressed in whole blood, were independent predictors of cardiac function alteration at 4 months post-MI. Furthermore, the inclusion of these 3 transcripts in a prediction model containing clinical variables had an incremental predictive value. In a third study, we showed that circulating levels of miR-574-5p were able to discriminate patients with TAA from healthy controls. Furthermore, miR-574-5p was encapsulated in extracellular vesicles in the blood, suggesting a paracrine role. In the fourth and fifth studies, we showed that circulating levels of miR-122-5p were independent predictors of neurological outcome and survival at middle term post-CA, and were able to increase the prediction value of existing models. We also identified miR-574-5p as an independent predictor of neurological outcome post-CA, specifically in women. To conclude, this work allowed the discovery or the confirmation of the potential biomarker value of transcripts and miRNAs in different CVD. However, their biomarker value should be validated in other large scale studies and with other methods of measurement before foreseeing their clinical utilization