Age, male sex, hypertension, smoking, diabetes, dyslipidaemia, and obesity are considered as established risk factors for cardiovascular diseases. Several of these established cardiovascular risk factors are strongly influenced by lifestyle. Novel biomarkers from different mechanistic pathways have been associated with cardiovascular risk, but their clinical utility is still uncertain. The overall objective of the thesis was to evaluate the associations between certain lifestyle factors (physical activity and snuff use), biomarkers reflecting the haemostatic and the inflammatory systems and risk of a future first-ever myocardial infarction.  A prospective incident nested case-control study design was used with a total of 651 cases of myocardial infarction and 2238 matched controls from the population-based Northern Sweden Health and Disease Study.  The effects of commuting activity, occupational and leisure time physical activity on risk of myocardial infarction were studied. A clearly increased risk of myocardial infarction was found for car commuting compared to active commuting (walking, cycling or going by bus). High versus low leisure time physical activity was associated with decreased risk of myocardial infarction. Low occupational physical activity was associated with risk of myocardial infarction in men.  The risk of myocardial infarction or sudden cardiac death was studied in male snuff users compared to non-tobacco users. No increased risk was found for myocardial infarction or sudden cardiac death among snuff users without a previous history of smoking. However, for sudden cardiac death the study did not have statistical power to detect small differences in risk.  Plasma levels of haemostatic markers have previously shown to be associated with risk of myocardial infarction, but as haemostatic markers are also acute-phase reactants, it is not clear if their association with myocardial infarction is independent of inflammatory markers. In the present study, the haemostatic markers D-dimer, von Willebrand factor (VWF), tissue plasminogen activator (t-PA), and tissue plasminogen activator/plasminogen activator inhibitor-1 complex (t-PA/PAI-1 complex) were associated with risk of myocardial infarction after adjustment for established risk factors and the inflammatory markers C-reactive protein (CRP) and interleukin 6 (IL-6). Furthermore, the addition of eight haemostatic and inflammatory markers could improve the predictive ability for future myocardial infarction beyond that of a model utilizing only established risk factors.  Established risk factors and novel biomarkers were explored as potential mediators of the reduced risk of myocardial infarction related to active commuting. A combination of established risk factors, haemostatic and inflammatory markers appeared to explain a substantial proportion (40%) of the difference in risk for myocardial infarction between active commuters and car commuters. IL-6, t-PA, t-PA/PAI-1 complex, apo B/apo A-1 ratio, and BMI seemed to be the largest potential mediators when tested individually. In conclusion, regular physical activity such as active commuting is associated with reduced risk of a first-ever myocardial infarction. This effect could in part be mediated through a beneficial influence on haemostasis and inflammation, as well as a positive impact on established risk factors. Several haemostatic markers are associated with risk of myocardial infarction independent of established risk factors and inflammatory markers. The combination of haemostatic and inflammatory markers may enhance predictive ability beyond established risk factors. Our findings do not support the hypothesis that snuff use increases the risk of myocardial infarction.

Tikslas: įvertinti profesinio ir laisvalaikio fizinio aktyvumo reikšmę streso ir įtampos darbe poveikiui vidutinio amžiaus dirbančių asmenų grupėje. Tyrimo objektas: laisvalaikio bei profesinio fizinio aktyvumo ir patiriamo streso darbe priklausomybė vidutinio amžiaus dirbančių asmenų grupėje. Hipotezė: laisvalaikiu fiziškai aktyvesni aukštesnės kvalifikacijos ir protinį darbą dirbantys asmenys; laisvalaikiu fiziškai aktyvesni asmenys patiria mažesnį streso ir įtampos poveikį darbe. Darbo uždaviniai: 1. Įvertinti laisvalaikio ir profesinį fizinį aktyvumą bei ryšius su socialiniais ir demografiniais rodikliais vidutinio amžiaus dirbančių asmenų grupėje. 2. Nustatyti ryšį tarp 30-60 m. asmenų profesinio ir laisvalaikio fizinio aktyvumo ir sveikatos nusiskundimų bei polinkio į priklausomybę alkoholiui sąsajas. 3. Atskleisti fizinio aktyvumo reikšmę streso ir įtampos darbe poveikiui 30-60 m. dirbančių asmenų grupėje. 4. Išskirti veiksnius, reikšmingai susijusius su laisvalaikio fiziniu aktyvumu ir įtampa darbe. Išvados: 1. Laisvalaikiu pakankamai fiziškai aktyvių tiriamųjų buvo 44,8 proc. Labiau fiziškai aktyvūs buvo vyrai (48,9 proc.) nei moterys (41,7 proc.; p>0,05) ir miesto (48,4 proc.) nei rajono (35,3 proc.; p<0,05) gyventojai. Laisvalaikio fizinis aktyvumas buvo tiesiogiai susijęs su išsilavinimu, pajamomis poreikiams patenkinti, aukštesne profesine kvalifikacija (p<0,05) ir atvirkščiai susijęs su amžiumi ir profesiniu fiziniu aktyvumu (p<0,05). 2. Tarp apklaustų... [toliau žr. visą tekstą] / Subject – the relationships between occupational and leisure-time physical activity and stress experience at work in the middle-aged employees group. Aim of the study: to assess the influence of occupational and leisure-time physical activity on stress and job strain in the middle-aged employees group. Hypothesis: employees who are more physically active at leisure time are highly skilled and usually are working mental jobs; employees who are more physically active at leisure time experience lower impact of stress and job strain at work. Objectives: 1. Evaluate occupational and leisure-time physical activity and its associations with social and demographic indicators in the middle-aged employees group. 2. Determine the relationships between occupational, leisure-time physical activity, health complaints and alcohol abuse in people aged 30 to 60. 3. Reveal the value of physical activity on the impact of stress and job strain in the employees group aged 30 to 60. 4. Identify factors that are significantly associated with leisure-time physical activity and stress at work. Conclusions 1. Only 44.8% of the respondents were sufficiently physically active during leisure time. Higher proportions of sufficiently physically active respondents were determined in men (48.9 %) than women group (41.7 %, p>0.05) and in the urban (48.4 %) as compared to the rural district group (35.3 %, p<0.05). Leisure-time physical activity was directly related to higher education, sufficient income... [to full text]

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