Objective: Insulin-like growth factor-I (IGF-I) has been suggested to be a prognostic marker for the development of cancer and, more recently, cardiovascular disease. These diseases are closely linked to obesity, but reports of the association of IGF-I with measures of obesity are divergent. In this study, we assessed the association of age-dependent IGF-I standard deviation scores with body mass index (BMI) and intra-abdominal fat accumulation in a large population. Design: A cross-sectional, epidemiological study. Methods: IGF-I levels were measured with an automated chemiluminescence assay system in 6282 patients from the DETECT study. Weight, height, and waist and hip circumference were measured according to the written instructions. Standard deviation scores (SDS), correcting IGF-I levels for age, were calculated and were used for further analyses. Results: An inverse U-shaped association of IGF-I SDS with BMI, waist circumference, and the ratio of waist circumference to height was found. BMI was positively associated with IGF-I SDS in normal weight subjects, and negatively associated in obese subjects. The highest mean IGF-I SDS were seen at a BMI of 22.5–25 kg/m2 in men (+0.08), and at a BMI of 27.5–30 kg/m2 in women (+0.21). Multiple linear regression models, controlling for different diseases, medications and risk conditions, revealed a significant negative association of BMI with IGF-I SDS. BMI contributed most to the additional explained variance to the other health conditions. Conclusions: IGF-I standard deviation scores are decreased in obesity and underweight subjects. These interactions should be taken into account when analyzing the association of IGF-I with diseases and risk conditions.

Magister Pharmaceuticae - MPharm / Cardiovascular diseases (CVDs) such as ischaemic heart diseases, heart failure and stroke remain a major cause of death globally. Various deep-rooted factors influence CVD development; these include but are not limited to elevated blood lipids, high blood pressure, obesity and diabetes. A considerable number of proteins are involved directly and indirectly in the transport, maintenance and elimination of plasma lipids, including high and low-density lipoprotein cholesterol (HDL-C and LDL-C). There are several mechanisms involved in the removal of LDL particles from systemic circulation. One such mechanism is associated with the gene that encodes proprotein convertase subtilisin/kexin type 9 (PCSK9), which has become an exciting therapeutic target for the reduction of residual risk of CVDs. Currently, statins are the mainstay treatment to reduce LDL-C, and a need exists to further develop more effective LDL-C-lowering drugs that might supplement statins. This study was aimed at contributing to the generation of knowledge regarding the effect of niacin in reducing LDL levels through PCSK9 interaction. The aims/objectives of this study were achieved by utilizing two approaches, which included animal intervention with niacin followed by genetic screening of five prioritized genes involved in cholesterol synthesis and regulation. For animal intervention, 16 vervet monkeys were divided into two groups of eight animals consisting of a control and an experimental (niacin) group. The control group was given a normal standard diet of pre-cooked maize meal throughout the study, while the experimental group received the same diet supplemented with 100 mg/kg of niacin (SR) for 12 weeks. During the niacin intervention, blood was collected at baseline, every four weeks during the treatment period and the end of the washout period. The collected blood was used for biochemical analysis (total cholesterol, triglycerides, LDL-C, and HDL-C) and downstream genetic applications. The second phase included the screening of PCSK9, LDLR, SREBP-2, CETP and APOB-100 using genotyping and gene expression. Niacin administration produced statistically significant increases in plasma HDL-C at fourtime points (T1, T2, T3 and T4), which resulted in an overall increase in plasma HDL-C. Additionally, niacin administration resulted in a slight reduction in LDL-C and total cholesterol levels. Furthermore, the genotyping analysis revealed 13 sequence variants identified in PCSK9, LDLR, SREBP-2, CETP and APOB-100 genes. Five of these variants were predicted to be disease-causing and correlated with gene expression patterns. Three identified PCSK9 variants (H177N, R148S, G635G) were categorized as LOF mutations, and this was supported by a decline in gene expression in animals harbouring these variants. The LDLR also had LOF variants that were the reason for its decreased mRNA expression. Additionally, SREBP-2 proved to be a key mediator of cholesterol pathways. Therefore, the findings of the study conclusively suggest that niacin does increase HDL-C and decrease LDL-C and total cholesterol. Moreover, an interaction between niacin administration and PCSK9 was observed which resulted in decreased gene expression.

Thesis (MPH.) -- University of Limpopo, 2019 / The purpose of this study was to profile selected cardiovascular disease risk factors among HIV patients on ART in Bushbuckridge sub-district. Quantitative, crosssectional research was conducted to describe cardiovascular disease risk factors among HIV patients on ART in Bushbuckridge Sub-district. Data collection was done using researcher-administered questionnaires. Adult HIV patient on ART participated in the study (n=328). The study has highlighted cardiovascular disease risk factors and prevalence of cardiovascular disease risk factors among HIV patients on ART. The findings revealed the prevalence of hypertension is 34.6% among HIV patients on ART and men had a higher prevalence compared to women. There is an increase in body mass index and it is seen mostly among women. Alcohol consumption is highest in the young adults (18 to 24 years) both men and women. Health promotion and policymaking interventions need to improve strategies on management and prevention of cardiovascular disease risk factors. Key concepts HIV, ART, cardiovascular disease risk factors, prevalence, body mass index, Bushbuckridge

Cardiovascular disease is the main cause of death in the United States. Although it is recognized that moderate intensity long-term exercise can decrease the chances of dying from cardiovascular disease by favorably modifying risk factors such as hypertension, obesity, hyperlipidemia, and insulin resistance, physical activity also enhances longevity by mechanisms independent of these risk factors. This review briefly summarizes what is known about the inflammatory nature of atherosclerosis and how long-term aerobic exercise can reduce the atherogenic activity of endothelial cells, blood mononuclear cells, and adipose tissue.

No description available.

Hintergrund: Nicht nur in Deutschland, sondern auch weltweit sind Herz-Kreislauf-Erkrankungen die häufigste Todesursache. Auf Platz vier folgen psychische und Verhaltensstörungen (Statistisches Bundesamt, 2020). Verschiedene Studien zeigen, dass Straßenverkehrslärm das Risiko erhöht, an Herz-Kreislauf-Erkrankungen oder an einer Depression zu erkranken (Seidler et al., 2017; WHO, 2018). Zunehmend betrachten Studien die Auswirkungen von Straßenverkehrslärm und Luftschadstoffen auf die Gesundheit unter Berücksichtigung der jeweiligen anderen Exposition (Sørensen et al., 2014; Zijlema et al., 2016). Systematische Übersichtsarbeiten, die den Einfluss der Berücksichtigung des potenziellen Confoundings durch Luftschadstoffe auf Krankheitsrisiken durch Straßenverkehrslärm untersuchen, gibt es bisher kaum. Lediglich die systematischen Reviews von Tétreault et al. (2013) und Vienneau et al. (2015) untersuchten die eventuelle Verzerrung der Risikoschätzer durch die jeweilige andere Exposition. Aufgrund der Zunahme der Studien zu dieser Fragestellung seit 2013 und den aktuellen Leitlinien der WHO für Umgebungslärm, die Lärmbelastung zu den wichtigsten umweltbedingten Gefahren für die Gesundheit zählen, soll mit Methoden der evidenzbasierten Medizin die Frage nach den „isolierten“ gesundheitlichen Auswirkungen von Straßenverkehrslärm auf Herz-Kreislauf-Erkrankungen und Depressionen untersucht werden. Forschungsanliegen: Die verkehrslärmbedingten Risiken für Herz-Kreislauf-Erkrankungen und depressive Erkrankungen sollen unter der Berücksichtigung des Einflusses von Luftschadstoffen mit einem systematischen Review mit Metaanalyse untersucht werden. Methode: Zunächst wurde mittels eines Rapid Reviews der aktuelle Forschungsstand zum Zusammenhang zwischen Straßenverkehrslärm und Herzkreislauferkrankungen sowie Depressionen zusammengefasst. Die Literaturrecherche wurde in der Datenbank PubMed durchgeführt, und die AMSTAR 2 Checkliste wurde zur Qualitätsbewertung der systematischen Reviews genutzt. Anschließend wurde ein originäres systematisches Review durchgeführt, eng angelehnt an die Arbeitsschritte, die vom Cochrane-Netzwerk entwickelt wurden. Demnach wurde nach dem Erstellen eines Studienprotokolls, dem Festlegen der Ein- und Ausschlusskriterien und der Entwicklung eines Suchstrings eine systematische Literaturrecherche in den Datenbanken PubMed, EMBASE und PsycInfo durchgeführt. Es folgte die Titel-/Abstract-Sichtung sowie eine anschließende Volltextsichtung durch zwei Reviewerinnen unabhängig voneinander. Zusätzlich wurde das „Risk of Bias“ (RoB) der eingeschlossenen Studien bewertet. Anschließend wurde geprüft, ob eine Metaanalyse durchgeführt werden kann. Zur Ermittlung der Verzerrung des Risikoschätzers für Straßenverkehrslärm durch Luftschadstoffe wurde mit dem Change-in-Estimate-Verfahren (CIE-Verfahren) der adjustierte Effektschätzer (mit Adjustierung für Luftschadstoffe) mit dem nicht für Luftschadstoffe adjustierten straßenlärmbezogenen Effektschätzer verglichen. Es wurden zur Berechnung des CIE-Wertes drei Hauptanalysen durchgeführt, bei denen drei unterschiedliche Rechenwege (1. nach Tétreault et al. (2013), 2. nach Floud et al. (2013) und 3. unter Anwendung der selbst abgeleiteten Methode der Exzess-Risiko-Veränderung) genutzt wurden. Weiterhin wurden zwei Sensitivitätsanalysen durchgeführt, die die Stabilität des CIE-Wertes gegenüber Veränderungen der Expositionsmetriken untersuchen sollten. Zur besseren Vergleichbarkeit wurden die Risikoschätzer der einbezogenen Primärstudien auf einen kontinuierlichen Straßenverkehrslärmanstieg pro 10 dB umgerechnet und je nach Outcome-Definition einer Haupt- und vier Nebenanalysen unterzogen. In der Hauptanalyse wurden die Risikoschätzer der Inzidenz- und Prävalenzstudien zu MI, KHK und Schlaganfall zusammengefasst. Abschließend wurden die GRADE-Kriterien im Sinne einer Bewertung der Vertrauenswürdigkeit der Evidenz verwendet (Guyatt et al., 2011). Ergebnisse: Im Zuge des Rapid Reviews wurden 14 systematische Reviews eingeschlossen. In dieser Arbeit konnten die Ergebnisse von drei qualitativ hochwertigen Reviews zur Einschätzung der Erkenntnislage zu den Auswirkungen von Straßenverkehrslärm auf Herz-Kreislauf-Erkrankungen genutzt werden. Auf Grundlage der qualitativ hochwertigen Reviews zeigte sich ein relevanter Einfluss von Straßenverkehrslärm auf Herzkreislauferkrankungen (RR: 1,08 pro 10 dB (LDEN); 95 % Konfidenzintervall (KI): 1,01–1,15 (Van Kempen et al., 2018)) und nur eine geringe Risikoerhöhung für eine Hypertonie (Dzhambov & Dimitrova, 2017, 2018). Zwei systematische Reviews betrachteten die Auswirkungen von Straßenverkehrslärm auf Depression und konnten keinen wesentlichen Einfluss von Straßenverkehrslärm aufzeigen. In das systematische Review konnten 22 Primärstudien eingeschlossen werden. Von diesen konnten sechs Inzidenzstudien, drei Prävalenzstudien und vier Mortalitätsstudien in die Metaanalyse einbezogen werden. Drei dieser Inzidenzstudien erhielten im Zuge der RoB-Bewertung eine hohe Qualitätsbewertung. Die Hauptanalyse zeigte für die Diagnose eines MI, einer KHK und eines Schlaganfalls eine statistisch signifikante Risikoerhöhung um 3 % pro 10 dB Erhöhung des Straßenverkehrslärmpegels nach Adjustierung für Luftschadstoffe. Die Ergebnisse zeigten, dass je nach verwendeter Methode die CIE-Werte stark variierten. Die von Tétreault et al. (2013) angewandte Methode sollte zukünftig nicht mehr verwendet werden, da sie bei einem linearen Risikoverlauf in Abhängigkeit von der Wahl des Nenners der Steigung (z.B. pro 10 dB, pro 30 dB) unterschiedliche CIE-Werte liefert. Bei allen Metaanalysen der Inzidenz- und Prävalenzstudien waren die für Luftschadstoff adjustierten gepoolten Risikoschätzer etwas größer als die gepoolten unadjustierten Risikoschätzer, lediglich bei den gepoolten Risikoschätzern der Mortalitätsstudien waren die adjustierten Risikoschätzer etwas kleiner als die nicht adjustierten. In keiner Analyse konnte ein statistisch signifikanter Unterschied zwischen adjustierten und nicht adjustierten Risikoschätzern gefunden werden. Es fand-sich somit kein Anhalt für eine Überschätzung der Risiken von Straßenverkehrslärm durch einen konkurrierenden Effekt von Luftschadstoffen. Für Depressionen erlaubte die Studienlage keine Aussage dazu, ob die straßenverkehrslärmbezogenen Risiken bei fehlender Berücksichtigung eines potenziellen Confoundings durch Luftschadstoffe überschätzt werden. Schlussfolgerung: Zusammenfassend konnte mit Methoden der evidenzbasierten Medizin (Meta-Review in Form eines Rapid Reviews, systematisches Review mit Metaanalyse) ein Anstieg des Risikos für spezifische Herz-Kreislauf-Erkrankungen (MI, KHK und Schlaganfall) um 3 % pro 10 dB Straßenverkehrslärm gefunden werden. Der vorgenannte Risikoschätzer berücksichtigt Luftschadstoffe als potenzielle Confounder. Eine fehlende Adjustierung für Luftschadstoffe führt in der Tendenz zu einem etwas geringeren straßenlärmbezogenen Risikoschätzer; der Unterschied zwischen adjustiertem und nicht adjustiertem Risikoschätzer ist allerdings statistisch nicht signifikant. Aus den Ergebnissen der vorliegenden Arbeit kann geschlussfolgert werden, dass straßenverkehrslärmbezogene Risiken nicht zur Überschätzung tendieren, wenn nicht für Luftschadstoffe adjustiert wird. Studien und Reviews der letzten Jahre haben gezeigt, dass Menschen mit einem niedrigeren sozioökonomischen Status die am stärksten exponierte Gruppe bezüglich Umweltfaktoren darstellen (Hoffimann et al., 2017; Seidler et al., 2019; WHO, 2019a). Maßnahmen zur Reduktion des Straßenverkehrslärms können das Risiko für Herzkreislauf-Erkrankungen und auch für Depressionen verringern; die Planung solcher Maßnahmen sollte den Aspekt der Umweltgerechtigkeit berücksichtigen.:Abbildungsverzeichnis Tabellenverzeichnis Formelverzeichnis Abkürzungsverzeichnis 1 Einleitung 1.1 Hintergrund 1.1.1 Betrachtete Krankheitsbilder 1.1.1.1 Herz-Kreislauf-Erkrankungen 1.1.1.2 Depression 1.1.2 Soziale Determinanten von Gesundheit 1.1.3 (Mögliche) pathophysiologische Auswirkungen der Straßenverkehrslärmexposition 1.1.4 (Mögliche) pathophysiologische Auswirkungen der Luftschadstoffe 1.1.5 Lärm 1.1.5.1 Straßenverkehrslärm 1.1.5.2 Maße und Erhebung 1.1.6 Luftschadstoffe 1.1.6.1 Definition 1.1.6.2 Maße und Erhebung 1.1.7 Potenzieller konkurrierender Effekt von Luftschadstoffen auf die Auswirkungen von Straßenverkehrslärm auf Herz-Kreislauf-Erkrankung und Depression 1.1.8 Konkurrierende Faktoren bzw. Confounding 1.2 Intention und Bedeutung des Reviews 1.3 Definition des Forschungsanliegens 2 Methoden 2.1 Rapid Review 2.1.1 Grundlegendes 2.1.2 Studienprotokoll 2.1.3 Formulierung der Forschungsfrage 2.1.4 Definition der Ein- und Ausschlusskriterien 2.1.4.1 Population 2.1.4.2 Exposition 2.1.4.3 Outcome 2.1.4.4 Design 2.1.5 Sprache und Zeitraum 2.1.6 Literaturrecherche und Erstellen eines Suchstrings 2.1.7 Sichtung und Auswahl der systematischen Reviews 2.1.8 Datenextraktion der Systematischen Reviews 2.1.9 AMSTAR 2–Instrument 2.2 Systematisches Review 2.2.1 Grundlegendes 2.2.2 Studienprotokoll 2.2.3 Formulierung der Forschungsfrage 2.2.4 Definition der Ein- und Ausschlusskriterien 2.2.4.1 Population 2.2.4.2 Exposition 2.2.4.3 Outcome 2.2.4.4 Design 2.2.5 Sprache und Zeitraum 2.2.6 Entwicklung eines Suchstrings 2.2.7 Elektronische Datenbanken 2.2.8 Ergänzende Suchstrategie 2.2.9 Studienselektion 2.2.10 Datenextraktion 2.2.11 Bewertung der Studienqualität 2.2.12 Statistische Auswertung 2.2.12.1 Betrachtung des möglichen konkurrierenden Effektes und Change-in-Estimate 2.2.12.2 Berechnung des CIE 2.2.12.3 Metaanalyse 2.2.13 Bewertung der Vertrauenswürdigkeit der Evidenz 3 Ergebnisse 3.1 Rapid Review 3.1.1 Literaturrecherche 3.1.2 Flussdiagramm 3.1.3 Charakteristika der eingeschlossenen Reviews und AMSTAR 2-Bewertung 3.1.4 Effekte der Exposition auf das Outcome 3.1.5 Primärstudien (NORAH-Studie zu Krankheitsrisiken) 3.1.6 Zusammenfassung der Ergebnisse mit Bezug zur Forschungsfrage des Rapid Reviews 3.2 Systematisches Review 3.2.1 Ergebnisse der Literaturrecherche 3.2.1.1 Elektronische Datenbanksuche 3.2.1.2 Flussdiagramm 3.2.1.3 Ergänzende Suchstrategie 3.2.1.4 Kontaktieren der Autor*innen 3.2.2 Verlauf der Studienselektion 3.2.3 Allgemeine Studien Merkmale 3.2.3.1 Publikationsjahre 3.2.3.2 Länder und Stichprobengrößen 3.2.3.3 Einzelstudien 3.2.4 Qualitätsbewertung der Studien – Risk of Bias 3.2.5 Effekte der Exposition auf das Outcome 3.2.5.1 Inzidenzenzstudien zum Zusammenhang zwischen Straßenverkehrslärm und kardiovaskulären Erkrankungen 3.2.5.2 Inzidenzenzstudien zum Zusammenhang zwischen Straßenverkehrslärm und Myokardinfarkt 3.2.5.3 Inzidenzenzstudien zum Zusammenhang zwischen Straßenverkehrslärm und Schlaganfall 3.2.5.4 Prävalenzstudien zum Zusammenhang zwischen Straßenverkehrslärm und Herz-Kreislauf-Erkrankungen 3.2.5.5 Mortalitätsstudien zu den Auswirkungen von Straßenverkehrslärm auf Herz-Kreislauf-Erkrankungen 3.2.5.6 Inzidenzstudien zum Zusammenhang zwischen Straßenverkehrslärm und Depression 3.2.6 Metaanalyse 3.2.6.1 Zusammenfassung der Ergebnisse 3.2.6.2 Change-in-Estimate-Berechnung 3.2.7 Publikationsbias 3.2.8 Bewertung der Vertrauenswürdigkeit der Evidenz 3.2.9 Beantwortung der Forschungsfragen 3.2.9.1 Gibt es einen Zusammenhang zwischen Straßenverkehrslärm und Herzkreislauf-Erkrankung sowie Depression, wenn gleichzeitig die Exposition gegenüber Luftschadstoffen (z.B. NOX; PM2.5; PM10) berücksichtigt wird? 3.2.9.2 Was ist die Expositions-Risiko-Beziehung von Straßenverkehrslärm und Herz-Kreislauf-Erkrankung und Depression, wenn die Exposition gegenüber Luftschadstoffen berücksichtigt wird? 4 Diskussion 4.1 Rapid Review 4.1.1 Interpretation 4.1.2 Stärken und Limitationen 4.2 Systematisches Review 4.2.1 Ergebnisdarstellung vor dem Hintergrund der aktuellen Literatur 4.2.2 Interpretation der Ergebnisse 4.2.2.1 Zusammenhang zwischen Straßenverkehrslärm und Herz-Kreislauf-Erkrankungen unter der Berücksichtigung von Luftschadstoffen 4.2.3 Stärken und Limitationen 4.2.3.1 Stärken 4.2.3.2 Mögliche Fehlerquellen und Limitationen 4.2.4 Publikationsbias 4.2.5 Bewertung der Vertrauenswürdigkeit der Evidenz 4.3 Schlussfolgerung und Ausblick Zusammenfassung Summary Literaturverzeichnis Anhang Danksagung Anlagen

Background. AHA guidelines have been established to reduce Acute Coronary Syndrome (ACS)-related morbidity, mortality and recurrent events post-discharge. These recommendations emphasize the patient as an engaged member of the health care team in secondary prevention efforts. Patients with high levels of activation are more likely to perform activities that will promote their own health and are more likely to have their health care needs met. Despite evidence and strong expert consensus supporting patients as active collaborators in their own ACS care, the complexity and unexpected realities of self-managing one’s care at home are often underestimated. This study seeks to examine the correlates of patient activation at hospital discharge and then identifies activation trajectories in this same cohort in subsequent months. Lastly, this study examines the association between patient activation and health care utilization in the year subsequent to an ACS event. Methods. This study incorporates three aims: Aim 1, identification of the correlates of low patient activation post-discharge; Aim 2, identification of patient activation trajectories among this same cohort in the months following hospitalization; and Aim 3, examination of the association between patient activation and health utilization, post-discharge. Results. Fifty-nine percent of ACS patients identified as being at the lowest two activation stages at the time of hospital discharge. Perceived stress (pidentified post-discharge: low, stable (T1), high, sharp decline (T2), and sharp improvement (T3). The majority of patients (67%) identified as being in T1. Those patients of older age (OR: 2.22; CI 1.4- 3.5), identifying as Black in race (OR: 2.14: CI 1.1- 4.3), and reporting moderate/high perceived stress (OR: 2.54: CI 1.4- 4.5) had increased odds of being in the low, stable trajectory. The bivariate analysis indicated a significant association (P=0.008) between low patient activation and self-reported hospital readmissions in the months following discharge. In the final model, moderate to severe depression (OR: 1.60; CI 1.1- 2.3) was the strongest predictor of readmissions in the 12 months subsequent to discharge. Conclusions: Patients reported low activation at hospital discharge after an ACS event indicated that these patients were not prepared to take an active role in their own care. Correlates of low activation at discharge include moderate to high perceived stress, depression, and low social support. Furthermore, in the months following hospital discharge, the majority of these patients followed either a low/stable or a sharp decline activation trajectory. Hence, these results suggest that over time patients feel less and less confident to take an active role in self-management. Lastly, we found that patient activation may impact healthcare utilization in the year subsequent to hospital discharge, although patient self-reported depression appears to be the strongest predictor of utilization in the subsequent year. Future research is needed to better understand the relationship(s) among patient activation, depression, and health care utilization.

An emerging framework, the Identity Pathology (IP) model, partially addresses persistent uncertainties about the primary causes of disparities in cardiovascular health (CVH) between black and white women and men through outlining how identity beliefs associated with social group membership lead to predictable differences in the health-damaging effects of discrimination exposure. Using data from the CARDIA cohort, this doctoral thesis seeks to: 1) propose a novel psychosocial characteristic, identity pathology, that drives the distribution of reported race and gender discrimination in health-relevant ways, 2) assess whether there are group differences in the effects of multiple versus single forms of discrimination on future CVH, and 3) assess variation between these groups in the relationships of reported racial and gender discrimination in a variety of daily life settings with future CVH. The IP framework suggests that beliefs about identity unique to each gendered race group influence the perception of discrimination and whether reported exposure will be associated with CVH. Simultaneous reports of racial and gender discrimination in multiple settings (compared with no discrimination) were negatively associated with future CVH only among white men. Further, the setting in which discrimination was reported appeared to be a significant indicator of whether experiencing multiple forms of discrimination negatively impacted CVH in each group. Our findings contribute to the literature through introducing a novel framework for assessing the effects of interpersonal discrimination. This work also provides preliminary evidence that compounded experiences of interpersonal racial and gender discrimination may not substantially contribute to poorer CVH among black women.

Thesis (M. Sc. (Physiology)) --University of Limpopo, 2019 / Introduction: There is an increased trend in the prevalence of hypertension in children and adolescents in African countries. There are complications in diagnosing hypertension in children and adolescents due to the variation of blood pressure (BP) values with age, gender and height. The progression of the health transition with non-communicable diseases (NCDs) adds significantly to the disease burden, despite infectious diseases and undernutrition remaining persistent in both low and middle-income countries. Metabolic syndrome (MetS) is a global problem associated with the clustering of several cardiovascular risk factors. South African evidence suggests an upsurge of NCDs amidst the existence of communicable diseases (CDs) such as HIV/AIDS and tuberculosis. Moreover, NCDs and CDs in the country are influenced by socio-demographic factors; and thus tend to be more prominent in certain segments of the population. Aim and Objectives: The aim of this study was to perform blood pressure to height ratio and to determine lifestyle risk factors associated with metabolic syndrome among the Ellisras rural population aged 6-30 years, who are part of the ELS. Methods and materials: The current study is based on secondary data analysis of the Ellisras Longitudinal Study (ELS) and was conducted in two phases. Phase 1 included data analysis of all the participants in the ELS. This sample included a total number of 9002 children and adolescents (4678 boys and 4324 girls), aged 6-17 years. Parents or guardians provided written informed consent. Phase 2 consisted of biochemical analysis from a subsample of participants in the ELS. The subsample included 624 participants (306 males and 318 females) aged 18-30 years at the time the study was conducted. All participants underwent a series of anthropometric measurements (waist circumference and height) according to the standard of the International Society for the Advancement of Kinanthropometry (ISAK). The waist circumference (WC) measurements were taken to the nearest 0.1 cm, using a soft measuring tape. Metabolic syndrome was defined according to the International Diabetes Federation (IDF) criteria. Metabolic syndrome risk factors included total cholesterol (TCHOL), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), elevated fasting blood glucose (FBG), elevated blood pressure (BP) and high waist circumference (WC). A dietary intake questionnaire was also administered to each participant and self‑administered questionnaire was used to collect data on lifestyle factors, including smoking and alcohol intake. Dietary intake variables used in the linear regression method were log transformed prior to analysis because of their skewed distribution. Receiver-operating characteristic (ROC) curve was used to assess the accuracy of BPHR to screen children with prehypertension and hypertension. The optimal systolic BPHR (SBPHR) and diastolic BPHR (DBPHR) cut-off points for hypertension were determined. Sensitivity/specificity, positive predictive values and negative predictive values were calculated. Results: The optimal thresholds for defining prehypertension was 0.77 in children aged 6-10 years and 0.73 in adolescents aged between 11 and 17 years for systolic BPHR and 0.55 in children and 0.53 in adolescents for diastolic BPHR, respectively. The corresponding values for hypertension stage 1 were 0.76 and 0.73 for SBPHR and 0.50 and 0.58 for DBPHR, respectively. The BPHR is an accurate tool for screening elevated BP in Ellisras children aged 6-17 years. This can help to prevent the misclassification of children and adolescent hypertension. Furthermore, this tool can be used to screen children before the development of prehypertension and hypertension. Moreover, it can be used to manage hypertension in Ellisras children, ultimately reducing the risks of developing hypertension and associated cardiovascular disease in adulthood. Overall, the prevalence of metS was 23.1% (8.6% males and 36.8% females). Females appeared to have higher mean values for WC, FBG, TCHOL and LDL-C than males (82.14, 5.62, 4.62 and 2.97, respectively). The only significant gender difference observed was on WC (p<0.001). Males on the other hand had higher mean values for HDL-C, TG, SBP and DBP than females (1.20, 1.06, 125.91 and 71.44, respectively). The only significant difference observed in this case was on SBP (p<0.001). No significant age group differences were observed in all the metabolic risk factors with the exception of DBP where the older (25-30 years) participants presented with high SBP than the younger age group (18-24 years) (70.96 mmHg vs 68.78 mmHg, p<0.05). While, majority of females had significantly high WC, elevated total cholesterol and LDL-C, and reduced HDL-C; majority of males had elevated BP, SBP and DBP. No significant age and gender differences were observed on dietary intake. However, according to the linear regression analysis, no association between log total energy, log added sugar, log SFA and log MUFA with metabolic risk factors. There was a low and negative significant association between log fibre with SBP and DBP (β:-0.004, p=0.003 and β:-0.004, p=0.046), respectively, crude. After adjusting for the potential confounding factors, log fibre was also associated with FBG (β:-0.028, p=0.046). Log PUFAs was inversely associated with FBG, HDL-C and SBP crude. Log trans fatty acids was inversely associated with WC, HDL-C and SBP crude. Both log PUFAs and log trans fatty acids were not associated with any metabolic risk factors after adjusting for potential cofounding factors. Log protein was inversely associated with SBP both crude and adjusted for potential cofounding factors. On predicting the actual risk using the logistic regression analysis, participants who had high dietary energy intake were significantly less likely to present with larger WC, low HDL-C and high LDL-C (OR: 0.250 95%CI [0.161;0.389], OR: 0.306 95%CI [0.220;0.425] and OR: 0.583 95%CI [0.418;0.812], respectively), but more likely to presents with elevated FBG, high TCHOL, high TG and hypertension (OR: 1.01 95%CI [0.735;1.386], OR: 1.039 95%CI [0.575;1.337], OR: 1.186 95%CI [0.695;2.023], OR: 5.205 95%CI [3.156;8.585], respectively) crude. After adjusting for age, gender, smoking and alcohol status, high energy intake was more likely to increase two times high the large WC and elevated FBG among study participants (OR: 2.766 95%CI [0.863;3.477] and OR: 2.227 95%CI [1.051;3.328], respectively). Furthermore, low dietary fibre intake was nearly four times more likely to increase the low HDL-C, crude (OR: 3.864 95%CI [1.067;13.988]) crude. Those participants who consumed high trans fats were more likely to present with high FBG (OR:1.424 95%CI [0.985;2.060]), but less likely to present with LDL-C (OR: 0.540 95%CI [0.321;0.906]) crude. However, after adding potential cofounding factors, participants with high fatty acid were less likely to present with high FBG (OR: 0.672 95%CI [0.441;1.023]). Conclusions: MetS is prevalent in young adults in Ellisras and is differentiated by age and gender with more females at an increased rate by virtue of their body size status, reduced HDL-C, elevated FBG and high LDL-C and the diet they consume that is in most cases high energy, more carbohydrates, high added sugar and SFA. Therefore, identifying groups that are at an increased risk and those that are in their early stages of MetS will help improve and prevent the increase of the metS in the future. These results have high policy implications. KEY CONCEPTS Metabolic syndrome; risk factors; blood pressure; blood pressure to height ratio; cardiovascular disease; dietary intake; rural South African.

An increase in cellular inflammatory biomarkers directly increases the risk of cardiovascular disease (CVD). Using the social ecological and biomedical theories, the study examined quantitatively how specific inflammatory biomarkers are associated with cardiorenal syndrome (CRS), a potential complication of hypertension and diabetes, and how sociodemographic factors modify this association in the U.S. adult population. A retrospective secondary data analysis of the data collected from National Health and Nutrition Examination Survey (NHANES) 1999-2010 was utilized to evaluate these hypotheses. High sensitivity C-reactive protein, homocysteine (hcy), and fibrinogen had a modifying effect on Type 4 (chronic reno-cardiac etiology), Type 2 CRS (chronic cardio-renal etiology), and a significant additive effect on CRS even after controlling for known CVD and Chronic Kidney Disease (CKD) risk factors. For Type 4 CRS, the adjusted Odds Ratio of CVD in individuals with CKD was elevated, 2.29 (Confidence Interval [CI] 1.17-3.64, p < 0.05), among individuals with elevated hcy levels but close to 1.0 (0.65 CI 0.28-1.53, p > 0.05) among patients with normal hcy after the results were controlled for medical and demographic risk factors. Finally, race modified the effect of inflammatory markers on CRS. Out of all the biomarkers, income only modified the effect of hcy on CRS. Education level modified the effect of every inflammatory marker on CRS. While Ferritin-to-Transferrin ratio (F/T ratio) had a non-significant additive effect, due to the lack of adequate subjects, the modifying effect of F/T ratio could not be tested. This study can help initiate social change by urging healthcare professionals to monitor these biomarkers as a part of preventing hypertension, diabetes, and CRS.