No description available.

Background: Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and venlafaxine have the potential to exert beneficial effects on the heart via serotonin mediated antiplatelet activity. However, previous evidence regarding the cardiovascular effects of these agents has been conflicting. There is a need for further investigation into the risks and benefits of these drugs. Objective: To assess the risk of acute MI and cardiac death associated the use of various classes of antidepressants, and determine whether this risk is modified by the presence of predisposing factors. Methods: We identified a population-based, retrospective cohort study of 71,253 elderly persons initiating treatment with an antidepressant between 1997 and 2004. The cohort was analyzed using nested case-control approach with each case of acute MI or cardiac death matched with up to 20 controls according to age (±1 year), duration of follow-up, and year of cohort entry. Rate ratios for acute MI and cardiac death associated with the current use of various antidepressants were estimated using conditional logistic regression and adjusted for potential confounders. Results: Compared with the current use of atypical antidepressants, current use of venlafaxine was associated with a significant reduction in the risk of MI and cardiac death (rate ratio [RR] 0.80 [95% CI 0.66 to 0.97]) that was more pronounced in persons with established cardiovascular disease (CVD) (RR 0.65 [CI 0.50 to 0.86]). We found no clear evidence of a benefit or harm associated with the use of SSRIs (RR 0.92 [CI 0.79 to 1.06]), although there was the suggestion of a clinically important benefit from treatment with SSRIs for individuals who had history of MI (RR 0.68 [CI 0.44 to 1.07]). No benefit or harm was observed with other classes of antidepressants. Conclusions: These results demonstrate a reduced risk for acute MI and cardiac death associated with current use of venlafaxine among elderly persons. This beneficial effect appears to be more pronounced in those with established cardiovascular disease. No clear evidence of benefit on CV outcomes was associated with the current use of SSRIs, although results suggest a potential benefit for use in persons with a previous MI. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2007-09-04 14:46:14.571

No description available.

No / Objective To conduct a systematic review and meta-analysis of randomised control trials that examined the effect of walking on risk factors for cardiovascular disease. Methods Four electronic databases and reference lists were searched (Jan 1971–June 2012). Two authors identified randomised control trials of interventions ≥ 4 weeks in duration that included at least one group with walking as the only treatment and a no-exercise comparator group. Participants were inactive at baseline. Pooled results were reported as weighted mean treatment effects and 95% confidence intervals using a random effects model. Results 32 articles reported the effects of walking interventions on cardiovascular disease risk factors. Walking increased aerobic capacity (3.04 mL/kg/min, 95% CI 2.48 to 3.60) and reduced systolic (− 3.58 mm Hg, 95% CI − 5.19 to − 1.97) and diastolic (− 1.54 mm Hg, 95% CI − 2.83 to − 0.26) blood pressure, waist circumference (− 1.51 cm, 95% CI − 2.34 to − 0.68), weight (− 1.37 kg, 95% CI − 1.75 to − 1.00), percentage body fat (− 1.22%, 95% CI − 1.70 to − 0.73) and body mass index (− 0.53 kg/m2, 95% CI − 0.72 to − 0.35) but failed to alter blood lipids. Conclusions Walking interventions improve many risk factors for cardiovascular disease. This underscores the central role of walking in physical activity for health promotion.

The use of cardiovascular risk scores remains the foundation for risk stratification to guide clinical management. Clinicians have access to several cardiovascular risk scores in practice settings. While having several risk scores with different risk factors may provide more information, it does not imply accuracy of the cardiovascular risk score used to calculate individual patient cardiovascular risk. The objective of this study was to compare the Framingham Risk score, Reynolds Risk scores, and the Pooled Cohort Risk Equation (3 commonly used equations) scores with respect to ability to predict cardiovascular events in a diverse ethnic population. Additionally, the potential predictive utility of three novel risk factors (carotid intima media thickness, peripheral arterial tonometry and vasa vasorum) was examined in relation to ability to improve 10-year cardiovascular risk prediction. A secondary analysis of the longitudinal prospective study cohort known as Heart Strategies Concentrating On Risk Evaluation (Heart SCORE) was conducted. The cardiovascular risk scores of study participants who did and did not experience a cardiovascular event composite index consisting of myocardial infarction, death, stroke, acute ischemic stroke, or revascularization were assessed using methods of calibration and discrimination overall and by race and gender. When examining performance of the 3 risk scores, the overall 10-year absolute predicted cardiovascular risk varied substantially (e.g. approximately 2-fold) and this wide variation in predicted 10-year cardiovascular risk was present across race and gender. Nonetheless, despite the wide variation in estimates of absolute risk, the 3 cardiovascular risk score equations were strongly associated with future cardiovascular risk overall and by race and gender. There was some indication that the Reynolds risk score was the most accurate measure of future cardiovascular risk. The 3 novel risk factors examined did not significantly improve 10-year cardiovascular risk prediction above and beyond the standard demographic and clinical variables used in these well-known equations.

Cardiovascular disease remains one of the leading causes of mortality globally. Innovative techniques are required to tackle its anticipated rise due to rising obesity, diabetes and an ageing population. Personalised electronic coaching (eb coaching) using the Internet and emails may help motivate healthier living and be of clinical benefit in complementing current programmes for cardiovascular risk reduction. I investigated whether personalised ebcoaching on top of SOC was more clinically effective than SOC alone, in reducing cardiovascular risk in asymptomatic individuals with high cardiovascular risk. I lead a randomised controlled trial of 402 participants using robust surrogate markers to identify change over 6 months. I assessed the feasibility of using cardiovascular magnetic resonance surrogate markers to guide their use in future studies of lifestyle interventions. I performed systematic reviews to identify 1) similarities and differences among leading primary prevention guidelines that address cardiovascular screening and risk assessment and 2) guideline recommendations on lifestyle advice and interventions to identify how ebcoaching could be used and what advice to incorporate in ebcoaching platforms. I found modest but statistically significant improvements in both ebcoaching and SOC groups to a similar level. Personalised ebcoaching did not show additional benefit in a highbrisk primary prevention cohort. It is feasible to use cardiovascular surrogate markers derived from cardiovascular magnetic resonance in lifestyle interventions studies. However, further studies correlating change in these markers with longbterm outcomes are required. Considerable discrepancies exist in the guidelines on risk on cardiovascular screening and risk assessment, with no consensus on optimum screening strategies or classification of high risk thus affecting treatment threshold. Guidelines did highlight the importance of lifestyle interventions in primary prevention and generally provided similar advice. Ebcoaching should not be incorporated into current prevention programmes for high risk populations unless the tools are improved and effectiveness is proven.

M.Sc.(Med.), Faculty of Health Sciences, University of the Witwatersrand, 2009. / Leptin is a substance that is released from adipose tissue and although it is primarily employed to modify body size, it also targets a number of other tissues, including the myocardium. Although plasma leptin concentrations may predict cardiovascular risk beyond conventional measurements, it is uncertain whether this may be explained by an independent effect on left ventricular mass (LVM) and geometry. Previous clinical studies evaluating the independent relationship between plasma leptin concentrations and LVM have been conducted in either small study samples (n=31-55), in severely obese participants only, in select subgroups (with insulin resistance) or in population samples with a relatively low mean body mass index (BMI). In the present dissertation I therefore assessed whether plasma leptin concentrations are associated with LVM and LV mean wall thickness independent of adiposity indices in 378 adults of African descent randomly recruited from a population sample with ~63% of people whom were either overweight or obese. LVM was determined using two-dimensional directed M-mode echocardiography and indexed to height2.7 (LVMI). ~28% of the sample had LV hypertrophy. Marked differences in plasma leptin concentrations were noted between men and women. Thus, multivariate regression analysis was employed to identify independent relations between plasma leptin concentrations and either LVMI or LV mean wall thickness in sex-specific groups. Before adjustments for potential confounders, plasma leptin concentrations were associated with LVMI in both women (r=0.25, p<0.0001) and in men (r=0.20, p=0.017) as well as with LV mean wall thickness in both women (r=0.22, p<0.001) and in men (r=0.27, p=0.002). Moreover, participants with LV hypertrophy defined as an LVM index of >51 g/m2 had markedly greater plasma leptin concentrations than those participants without LV hypertrophy. However, plasma leptin concentrations were also associated with age, conventional systolic blood pressure and with adiposity indices (p<0.0001), factors that had robust relationships with LVMI and LV mean wall thickness. In multivariate regression models with plasma leptin concentrations, adiposity indices, age, systolic blood pressure and a number of alternative potential confounders in the same regression model, although adiposity indices were strong independent predictors of both LVMI and LV mean wall thickness in both women and men (p<0.002-p<0.0001), plasma leptin concentrations were not independently related to either LVMI (p=0.32-0.96), or LV mean wall thickness (p=0.33-0.81). In conclusion, plasma leptin concentrations, although associated with, are not independent predictors of LVMI beyond adiposity indices and other related factors in a population sample with a high prevalence of excess adiposity. Therefore, plasma leptin concentrations are unlikely to predict cardiovascular risk beyond conventional risk measurements because of an impact on LVM.

O crescente aumento no número de idosos na população mundial aumenta a preocupação, pelos profissionais da saúde, com relação à prevenção e manejo de doenças associadas ao envelhecimento. A demência, uma das doenças mais comuns e mais devastadoras em idosos, incide em 4,6 milhões de casos em todo o mundo e manifesta-se em idosos acima de 65 anos e principalmente acima de 85 anos de idade. Os dois tipos mais comuns de demência é a doença de Alzheimer (DA), seguida da demência vascular (DV), as quais partilham muitas características comuns patológicas, sintomáticas e neuroquímicas. Entre os principais fatores de risco para demência estão a idade, baixa escolaridade, hipertensão (HAS), cardiopatias, dislipidemias (DLP), sobrepeso/obesidade, genética, tabagismo, etilismo, acidente vascular cerebral (AVC) e o diabetes. Diante da sobreposição de causas e fatores de risco para as demências mais comuns, a identificação das alterações cognitivas associada à identificação de doenças cardiovasculares, seria extremamente importante. A associação dos principais fatores de risco cardiovasculares (FRCV) com a idade e o tipo das demências foi avaliada neste estudo, em 2 grupos de idosos diabéticos com DA (n=47) e demência mista ou vascular (n=49). Os resultados foram obtidos pelo teste t-student, qui-quadrado e apresentados os valores de Odds Ratio Bruto e Ajustado. O controle glicêmico não apresentou diferença entre os indivíduos das duas demências nem relação com a idade do caso novo. A presença de hipertensão e dislipidemia foram os principais FRCV encontrados. Estes e outros fatores como obesidade, tabagismo e fibrilação atrial não demonstraram associação com a idade e o tipo da demência. O AVC e o gênero masculino tiveram associação com a demência vascular. A presença marcante de FRCV além do diabetes nos dois tipos principais de demência, reforça a hipótese de sobreposição de causas e das formas de manifestação das demências e a dificuldade em identificá-las. / The increase in the number of elderly in the world population increases concern by health professionals, regarding prevention and management of diseases associated with aging. Dementia , one of the most common and devastating diseases in the elderly, falls at 4.6 million cases worldwide and is manifested in the elderly over 65 and mostly above 85 years of age. The two most common types of dementia is Alzheimer\'s disease (AD), followed by vascular dementia ( VD), which share many common pathological features, symptomatic and neurochemical. Among the main risk factors for dementia are age, low education, hypertension( HBP) , heart disease , dyslipidemia( DLP ) , overweight / obesity, genetics, smoking, alcoholism, cerebral vascular accidents (CVA) and diabetes. Given the overlapping causes and risk factors for the most common dementia, identification of cognitive changes associated with identification of cardiovascular diseases would be extremely important. The association of major cardiovascular risk factors (CVRF) with age and type of dementia was assessed in this study in two groups of elderly diabetic patients with AD ( n = 47 ) and mixed or vascular ( n = 49 ) dementia. The results were obtained by Student\'s t test , chi-square values and presented Adjusted Odds Ratio . Glycemic control did not differ between individuals of the two dementias or relationship with the age of the diagnosis. The presence of hypertension and dyslipidemia were the main CVRF found. These and other factors such as obesity, smoking and atrial fibrillation showed no association with age and type of dementia . The CVA and male gender were associated with vascular dementia. The striking presence of CVRF besides diabetes in the two main types of dementia reinforces the hypothesis of overlapping causes and manifestations of dementia and the difficulty in identifying them.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-17T18:43:17Z No. of bitstreams: 1 SuramaSousa.pdf: 1969308 bytes, checksum: c138cabc7138f8f84f270091f116db73 (MD5) / Made available in DSpace on 2017-05-17T18:43:17Z (GMT). No. of bitstreams: 1 SuramaSousa.pdf: 1969308 bytes, checksum: c138cabc7138f8f84f270091f116db73 (MD5) Previous issue date: 2014-11-21 / Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA) / Introduction: Cardiovascular disease is the leading cause of morbidity and mortality worldwide and in Brazil. Women from the climateric have increased cardiovascular risk and atherosclerosis. Evaluation methods of noninvasive atherosclerosis are important to detect early changes. Objectives: compare the methods intima-media thickness of the carotid, ankle brachial index, scores of risk stratification and Framingham Global Risk Score with coronary angiography for detection of atherosclerosis in the climacteric. Methods: A cross-sectional study with 51 climacteric women undergoing coronary angiography, the Hemodynamic Service of the University Hospital of Federal University of Maranhão, covering the period from January to December 2013. It was performed coronary angiography for medical evaluation and was considered normal, examination with obstructive lesion <29% of stenosis. We collected sociodemographic and health information, laboratory tests including ultrasensitive C-reactive protein, carotid ultrasound and ankle-brachial index were performed. We applied the Framingham risk score, score of overall risk, and we evaluated the presence of metabolic syndrome. The sample was divided into two groups by the presence or absence of coronary artery disease. We analyzed the data with the Fisher exact test or chi-square and Mann-Whitney or Test-t, with p <0.05%. Results: Thirty-five percent of participants had confirmed coronary artery disease. There was an association between coronary artery disease and ankle brachial index, p value = 0.004, there was no association between carotid intimal media thickness, C-reactive protein and metabolic syndrome with coronary artery disease. In the assessment by Framingham risk score were predominant findings in low-risk (94.12%) and average risk (5.88%), the overall risk score that included the aggravating risk factors ranked (72.55%) in high risk (21.57%) at average risk, and (5.88%) at low risk. Conclusion: In this population there was association between the change in ankle brachial index and the presence of coronary artery disease. / Introdução: As doenças cardiovasculares são a principal causa de morbimortalidade no mundo e no Brasil. As mulheres, a partir do climatério, apresentam aumento do risco cardiovascular e aterosclerose. Os métodos de avaliação de aterosclerose não invasivos são importantes para detectar alterações precocemente. Objetivos: comparar os métodos espessura médio-intimal de carótidas, índice tornozelo braquial, escores de estratificação de risco de Framingham e Escore de risco Global com a cinecoronariografia na detecção de aterosclerose no climatério. Métodos: Estudo transversal analítico, com 51 mulheres no climatério submetidas à cinecoronariografia, no Serviço de hemodinâmica do Hospital Universitário da Universidade Federal do Maranhão, compreendendo o período de janeiro a dezembro de 2013. Realizou-se a cinecoronariografia por indicação médica e foi considerado normal o exame com lesão obstrutiva <29% de estenose. Coletou-se informações sociodemográficas e de saúde, realizou-se exames laboratoriais incluindo proteína C reativa ultrassensível, ultrassonografia de carótidas e índice tornozelo-braquial. Aplicou-se o escore de risco de Framingham, escore de risco global, e avaliou-se a presença de síndrome metabólica. Dividiu–se a amostra em dois grupos pela presença ou não de doença coronariana. Analisou-se os dados com o teste exato de Fisher ou qui quadrado e Mann-Whitney ou Test –t, com valor de p<0,05%. Resultados: Trinta e cinco por cento das participantes tiveram doença arterial coronariana confirmada. Houve associação entre doença arterial coronariana e o índice tornozelo braquial, p=0,004, não houve associação entre espessura média intimal de carótida, proteína C reativa e síndrome metabólica com doença arterial coronariana. Na avaliação pelo escore de risco de Framingham houve predomínio de conclusões em baixo risco (94,12%) e médio risco (5,88%), o escore risco global que incluiu os fatores agravantes de risco classificou (72,55 %) em alto risco, (21,57%) em médio risco, e (5,88%) em baixo risco. Conclusão: Na população estudada houve associação entre a alteração do índice tornozelo braquial e a presença de doença arterial coronariana.

Tight control of blood glucose and blood pressure (BP) reduces cardiovascular risk in early Type 1 diabetes mellitus (T1DM). Increased BP normally increases renal medullary perfusion and sodium excretion. This is called acute pressure natriuresis. Inadequate acute pressure natriuresis disrupts circadian regulation of BP, which predicts hypertension. The peptide, endothelin-1 (ET-1), regulates BP via ETA and ETB receptors. ETA receptor antagonists reduce BP and restore its circadian rhythm. Two hypotheses were investigated. First, that acute pressure natriuresis is impaired in early T1DM, prior to established nephropathy, and this is associated with elevated BP. Second, that the mechanism is an ETA receptor-mediated blunting of medullary perfusion which can be reversed with insulin and ETA receptor antagonism. Experimental acute pressure natriuresis was induced in young, early T1DM (2-3 weeks post streptozotocin) Sprague Dawley rats and healthy controls. Despite maintaining glomerular filtration rate, early T1DM suppressed urinary flow (UV, 22.9±2.9 v. 93.7±11.1μl/min/gkw) and sodium excretion (UNaV, 3.2±0.7 v. 22.7±3.3μmol/min/gkw) rates by >80%, and reduced gradients of pressure diuresis (linear, 1.9 to 0.3) and natriuresis (non-linear k, 0.05 to 0.01) curves. Insulin treatment lowered blood glucose (16.8±1.8 to 9.3±0.6mmol/l) and restored gradients of the responses. Tissue and urine analyses did not suggest structural nephropathy. In early T1DM rats, changes in BP on radiotelemetry were consistent with impaired circadian regulation of BP and precursors of hypertension: 24-hour diastolic BP rose (92.3±0.4 to 97.1±0.5mmHg), and the circadian dip in diastolic BP fell (6±1 to 2±1%). Atrasentan (ETA receptor antagonist, 5mg/kg/day orally) reduced diastolic dipping in early T1DM (3±1 to 1±1%) while additional ETB receptor antagonism (A-192621, 10mg/kg/day orally) reversed this, suggesting that ETA, and not ETB receptors, mediate impairment of acute pressure natriuresis. To address this, renal blood flow was measured during experimental acute pressure natriuresis and ET receptor antagonism. Early T1DM suppressed the normal rise in medullary perfusion (flux, 227.2±26.7 v. 115.4±10.3%) by ~90%. Suppressed medullary flux was unaffected by insulin (112.2±6.8%), despite restoration of UV and UNaV. In controls, atrasentan reduced UV (15.7±4.9 v. 38.6±6.2μl/min/gkw), UNaV (1.7±0.5 v. 16.7±1.4μmol/min/gkw), FENa (3.4±1.4 v. 15.0±2.4%) and medullary flux (122.2±26.7%) by 60 to 90% of control values, while A-192621 increased UNaV (26.6±6.9μmol/min/gkw) and FENa (21.6±3.4%), but not medullary flux, by ~50%. ET receptor antagonism did not modify early T1DM+/-insulin effects. Diabetic status had no effect on renal ET-1 and ET receptor expression. These results support the first hypothesis but disprove the second. Early T1DM blunts medullary perfusion and acute pressure natriuresis, and increases diastolic BP. Insulin restores natriuresis but not medullary flow. Therefore, targeting medullary perfusion may reduce cardiovascular risk in early T1DM, but this is not achievable with selective ETA receptor antagonists. Novel natriuretic (ETA) and anti-natriuretic (ETB) roles for ET receptors, which are not apparent in early T1DM during severe, experimental rises in BP, appear to contribute to daily regulation of BP, and may preclude the use of selective ETA receptor antagonists in T1DM prior to nephropathy.