Dramatic advances have been demonstrated over the past decade in the prevention and treatment of cardiovascular disease (CVD). Despite these major strides, CVD continues to be our nations most significant cause of morbidity and mortality. The risk status of persons without known CVD varies greatly and thus requires a range of intense screening and interventions. This dissertation focuses on subclinical CVD measures as well as a new methodology that will improve the evaluation of CVD in clinical trials and eventually improve primary prevention of CVD.
There are three related projects in this dissertation, each of which uses noninvasive subclinical methodologies to assess cardiovascular risk. The first project focuses on a high-risk population, the elderly, and evaluates the association calcified carotid plaques with cardiovascular outcomes. Carotid plaque characterization is a new focus of research across the nation and what makes one plaque more dangerous than another is unclear. We do know that as plaques age, the plaques often become more complicated and often calcify. However, the significance of calcification in the carotid arteries is poorly understood. In this project, I assess if carotid calcification is predictive of cardiovascular outcomes.
The second project focuses on another high cardiovascular risk population, women systemic lupus erythematosus (SLE). Women with SLE have a significantly high risk of myocardial infarction compared to women without SLE. The role that lupus-related risk factors have in cardiovascular disease progression above the traditional risk factors is unclear. Using carotid ultrasound, associations are evaluated between intima-media thickness and plaque with both cardiovascular and SLE-specific risk factors.
The third and final project is the development of a protocol that will allow new computerized assessment of carotid artery plaques. Over the past decade both ultrasound technology and computerized assessment tools have improved. This creates opportunity for improved plaque assessment in vivo. This methodology characterized plaque components, possibly identifying plaques that may be dangerous. Plaque characterization software is now available for use with ultrasound and I have developed the protocols to execute this technique in the Ultrasound Research Laboratory. The final project outlines the software and testing process development, staff training, worksheet design, quality control processes, and a pilot study to evaluate the reproducibility of the measure. This research will contribute to public health through new cardiovascular risk assessment techniques and may lead to improved primary prevention and research methods.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-04112006-102326 |
| Date | 08 June 2006 |
| Creators | Thompson, Trina |
| Contributors | Kim Sutton-Tyrrell DrPH, Vincent Arena PhD, Lewis H. Kuller MD DrPH, Daniel Edmundowicz, Sheryl Kelsey PhD, Susan Manzi MD MPH |
| 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-04112006-102326/ |
| 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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