Preventing, delaying and managing morbidities is critical to sustain a strong economy and health care system as the proportion of adults over 65 years increases. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Americans. Signs of CVD are apparent in the vasculature before symptoms of clinical disease are present. Subclinical disease can be measured using non-invasive B-mode ultrasound to assess carotid-femoral pulse wave velocity, common carotid artery intima media thickness, adventitial diameter and lumen diameter. Vascular aging is a natural process that can be modified by lifestyle and pharmacologic interventions. The purpose of this dissertation is to evaluate the impact of lifestyle factors on vascular aging.
Hormone therapy use in early postmenopausal women was associated with significantly smaller adventitial and lumen diameter than those who did not use hormone therapy after adjustment for traditional CVD risk factors. These results concur with findings from another study in which higher levels of endogenous estrogen was related to smaller adventitial diameters. Together, these results suggest endogenous and exogenous estrogen have similar effects on adventitial diameter.
Sedentary, overweight and obese male young adults at low risk of sleep apnea, and non-snorers had better vascular health, reflected in smaller adventitial and lumen diameters, than those at high risk for sleep apnea and snorers in a cross-sectional study. Results were robust after adjustment for age and systolic blood pressure and add to the literature linking CVD with sleep disordered breathing.
Sedentary older adults who participated in a 6-month physical activity intervention had a clinically relevant decline in arterial stiffness, but greater increases in adventitial and lumen diameters compared to control participants. These findings support that it is never too late to gain cardiovascular benefit from physical activity. Research is needed to understand the implications of arterial diameter following introduction of physical activity to sedentary older adults.
Together these studies support the public health importance of lifestyle factors contribution to subclinical CVD. Each study also provides evidence that measurement of adventitial diameter is critical for a comprehensive understanding of the vascular remodeling processes that accompany these lifestyle changes across the vascular aging continuum.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-04052010-145936 |
| Date | 28 June 2010 |
| Creators | Lloyd, Kelly D. |
| Contributors | Wendy King, PhD, Lewis Kuller, MD, DrPh, Kim Sutton-Tyrrell, DrPH, Anne B. Newman, MD, MPH, Charlotte Brown, PhD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-04052010-145936/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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