Browsing by Subject "Cardiovascular disease"

Now showing 1 - 8 of 8
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    Approaches to reducing cardiovascular disease risk and stress effects in underserved populations
    (2014-06) Witt, Dawn Renee
    Background: While the past decade has shown a decrease in mortality and morbidity due to cardiovascular disease (CVD), it remains the leading cause of death for both men and women in the US. The burden of CVD has been demonstrated to disproportionately affect underserved populations. The course and development of CVD has been shown to be affected by modifiable risk factors such as physical inactivity, poor nutrition, smoking, and the psychosocial risk factors of depression, anxiety and stress. Objective: This study sought to explore approaches to reducing cardiovascular disease risk and stress effects in underserved populations; Latina and African American women, and individuals living in a rural population in New Ulm, MN. Method: The first purpose of this dissertation was to describe the results from a secondary data analysis utilizing 2009 and 2011 screening data from the Heart of New Ulm Project (HONU) project. Secondly, we present the results of our recently published literature review that explored the use of motivational interviewing as a technique to reduce CVD risk among African American and Latina women. Results: Women reported higher levels of stress and had higher levels of C-reactive protein (CRP) compared to men at baseline. Men had a significantly higher diastolic blood pressure (DBP) and systolic blood pressure (SBP) and reported more physical activity (PA) and a greater history of heart disease compared to women at baseline. No significant difference was found between change in stress level and changes in SBP, PA or CRP for men; however change in stress level was associated with a change in SBP for women. The covariates of body mass index (BMI) and age demonstrated significant associations with the outcome variables for women; among men, smoking, BMI and education had significant association on the outcome measures.None of the community health promotion events were shown to have a direct effect on any of the outcome variables of interest. The female-specific, SBP model demonstrated a borderline significant indirect effect of stress in 2009 via PA and stress in 2011 on SBP in 2011. The female specific, less than moderate PA (< mod PA) and the greater than moderate PA (> mod PA) models both demonstrated significant indirect effects of stress in 2009 via PA and stress in 2011 on < mod PA and > mod PA, respectively. Additionally, stress for females in 2011 was associated with increased CRP in 2011. The male-specific models demonstrated a significant indirect effect of stress in 2009 on > mod PA and < mod PA in 2011 via PA and stress in 2011, respectively. We found that the use of MI in populations of African American and Latina women demonstrated that MI can be an effective technique to reduce CV risk (Witt et al., 2012). It was shown that positive effects were attained in increasing fruit and vegetable consumption, decreasing hypertension/lowering SBP, achieving weight loss goals, and improving knowledge of CVD risk modification among those receiving motivational interviewing. Conclusion: The results from this study provide compelling evidence that future work exploring the effects of stress on modifiable risk factors for CVD in underserved populations, particularly physical activity and blood pressure is warranted. The work presented here demonstrate that while the effects of stress on the outcomes of interest were small, more intensive, targeted interventions with individuals experiencing elevated stress may produce more substantive effects in mediating the relationship between stress and physical activity and blood pressure. The small effect sizes found in this study may be due to in part, to the lack of intensity of the interventions delivered via HONU programming and may also be attributed to the fact that the HONU interventions did not specifically have a stress reduction component. Use of behavioral interventions such as motivational interviewing have demonstrated efficacy in supporting positive behavior change and could be used as an adjunct component in CVD risk reduction interventions at the population level, particularly among underserved populations. The key is to deliver the intervention consistently and in a culturally appropriate manner.Recommendations for Future Research:Behavior change programs delivered at the population level and future CVD prevention programming in settings such as New Ulm should continue to build upon the lessons learned from community based projects like HONU, the Minnesota Heart Health Program (MHHP), Pawtucket, and the North Karelia Project. Additionally, more work is needed to determine how to support long-lasting behavior change using techniques such as motivational interviewing and ensure that the modifiable risk factors for CVD are addressed. Targeted interventions that address stress among those experiencing the highest levels of stress may prove to have the most impact in mitigating the effect of stress on other modifiable behaviors. As the results from behavior change interventions have demonstrated, uptake of healthy lifestyle and health promoting behaviors and adhering and maintaining those behaviors are a universal problem, regardless of race and sex. Use of behavioral interventions such as motivational interviewing have demonstrated efficacy in supporting and sustaining positive behavior change and could be used as an adjunct component in CVD risk reduction interventions at the population level, particularly among underserved populations. Developing and implementing targeted interventions that clearly address stress reduction among those at risk for CVD is warranted.
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    Early Pubertal Development and Cardiometabolic Risk: A Life Course Approach
    (2013-09) Dreyfus, Jill
    A number of reports have linked early pubertal development to adverse health conditions among women. Despite race disparities in pubertal timing and later cardiovascular disease (CVD)-related health in adulthood, few studies have investigated if associations of early maturation with cardiometabolic risk factors differ for African-American and white women. Furthermore, there are limited longitudinal data tracking the trajectory of change in cardiometabolic risk factors after puberty and into adolescence and adulthood. The three primary aims of this thesis were to 1) examine the relationship between earlier age at menarche and CVD risk factors at different points in the life course, 2) account for the role of adiposity in associations, and 3) explore possible race differences in associations. These aims were explored using data from three prospective cohort studies that included different age groups: the National Growth and Health Study (NGHS) for ages 9-19 years, the Coronary Artery Risk Development in Young Adults (CARDIA) study for ages 18-54 years, and the Atherosclerosis Risk in Communities (ARIC) study for ages 45-75 years. The results from the three manuscripts included in this thesis suggested that earlier age at menarche was associated with a more adverse cardiometabolic profile over the life course, but higher lifetime accumulated adiposity among early maturing women explained most associations. Earlier menarche was more strongly related to adulthood adiposity and metabolic syndrome among white compared with African-American women, but there were no other differences by race. Targeted efforts to prevent obesity starting before puberty, as well as among early maturing girls even if normal weight, might be helpful for primordial prevention of cardiovascular disease.
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    The fatty acids - inflammation relationship across the lifecycle
    (2011-10) Wang, Huifen
    Dietary fatty acid intake, reflected by the endogenous fatty acid profile, has been associated with the pathogenesis and progression of cardiovascular diseases (CVD). Additional evidence is needed about the specific roles of individual fatty acids in the pathogenesis of inflammation, which is closely linked to CVD risk factors and interwined with oxidative stress and hemostatic dysfunction. It is also important to explore such relationships across the lifecycle. This dissertation, which includes four manuscripts, investigates the relations between fatty acids, biomarkers of inflammation (and oxidative stress and hemostasis), and cardiovascular health among different age groups. Specifically, the influences of adiposity and a genetic variant on the fatty acid/inflammation relations were also explored. The first manuscript used data from a study of obesity, insulin resistance and CVD risk factors in adolescents. A cross-sectional analysis was conducted to examine whether overweight status modified the relations between serum phospholipid fatty acids from dairy fats (i.e. 15:0 and 17:0 fatty acids) and inflammation/oxidative stress among adolescents with a mean age of 15 years. Inverse associations were found between dairy fatty acids and three biomarkers of inflammation and oxidative stress among overweight adolescents, but not their normal weight counterparts. In additional analyses, we further examined the same study question on other fatty acids and observed similar effect modification of adiposity. Only in overweight adolescents, but not in normal adolescents, 18:0 and 20:3ù6 fatty acids were positively, while 20:4ù6 and 22:6ù3 fatty acids were inversely, related to inflammation/oxidative stress. The second manuscript examined whether the cross-sectional relations between dietary intakes of polyunsaturated fatty acids (PUFA) and inflammation differed by genetic variant, peroxisome proliferator-activated receptor gamma (PPARã) Pro12Ala polymorphism. A biracial cohort of middle-aged adults enrolled in the year-20 exam of the Coronary Artery Risk Development in Young Adults (CARDIA) study was studied. In women, higher dietary intakes of 20:4ù6, 20:5ù3 and 22:6ù3 fatty acids were related to lower levels of IL-6 (an inflammatory biomarker) among Ala allele carriers. In contrast, these PUFA/IL-6 relations were positive among male Ala carriers, and absent among female Pro homozygotes. Male Pro homozygotes who consumed more 20:5ù3 and 22:6ù3 fatty acids tended to have a lower IL-6 level. The last two manuscripts were both prospective studies using data from the Atherosclerosis Risk in Communities (ARIC) study, which enrolled middle-aged adults. This cohort has been followed since year 1987-89. Manuscript 3 examined the interactions between dietary fatty acid intake and inflammatory/hemostatic factors in relation to incident coronary heart disease (CHD) and ischemic stroke (IS). Dietary intakes of 18:2ù6 and 20:4ù6 fatty acids were found to modify the associations between serum albumin and incident CHD/IS. The prediction of low serum albumin level, a potential inflammatory biomarker, on incident CHD/IS was attenuated with increasing intake of 18:2ù6 fatty acid or decreasing intake of 20:4ù6 fatty acid. Manuscript 4 included 3,715 ARIC participants enrolled at the Minnesota field center who had plasma phospholipid fatty acid measurements. In manuscript 4, the focuse was to determine whether inflammation/hemostasis mediated the relation of phospholipid fatty acids with incident CHD and IS. Inflammation and hemostasis, represented by levels of factor VIIIc (VIIIc), white blood cell count (WBC) and fibrinogen, mediated the positive associations of 18:0 and 20:3ù6 fatty acids with incident CHD. A similar but less significant pattern was found for 16:1ù7 in relation to incident IS. Lower WBC, but not VIIIc or fibrinogen, partially explained the inverse relations of 17:0 and 20:4ù6 fatty acids with incident CHD. In conclusion, this dissertation documents the associations between diverse fatty acids, inflammation and the development of CVD among different age-groups. The findings have enhanced the understanding of the health effects of individual fatty acids and the underlying mechanisms of fatty acid-inflammation-CVD relations, which are useful for advising food manufacturers and guiding CVD prevention.
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    Implementation of a Pharmacist-Directed Cardiovascular Risk and Medication Management Program for Participants in a Construction Trade Benefit Trust Fund
    (University of Minnesota, College of Pharmacy, 2010) Liu, Yifei; McDonough, Randal P.; Carruthers, Kara M.; Doucette, William R.; Miller, Kathleen
    Objectives: (1) To report the results of a pharmacist-directed cardiovascular risk management program; and (2) to identify obstacles faced by the pharmacists in the program implementation. Methods: The collaborators in this study included two local unions, a health benefit consulting company, and a community pharmacy. A total of 750 union workers with cardiovascular risk were informed about the cardiovascular risk management program. The program lasted six months, and the participation was voluntary. There were three group educational sessions with each session followed by a medication management service. A staff person of the health benefit consulting company and two pharmacists were interviewed via telephone. The interview questions were created according to the Gaps Model of Service Quality. The Gaps Model theorizes five gaps among consumer expectations, consumer perceptions, management perceptions of consumer expectations, service quality, service delivery, and external communications to consumers. The following data were collected: (1) types and quantity of drug therapy problems, (2) pharmacists’ recommendations and prescribers' response, (3) patients’ quality of life, disability days, and sick days, and (4) the experience of involved parties. Descriptive statistics were calculated. Results: Fifteen union workers participated in the program. For the participants, 35 drug-related problems were identified, with “need for additional therapy” and “dose too low” being the most common problems. To address these drug-related problems, pharmacists made 33 recommendations to prescribers, and prescribers accepted 55% of the recommendations. According to the interviews, there were three barriers faced by pharmacists to implement the program: lack of consensus about the recruitment, union workers’ unawareness of the program’s benefits, and limited support from the unions and the health benefit consulting company. Conclusions: It was difficult to recruit participants into the program. Clear agreement among collaborators on both the program’s benefits and the specific roles of each collaborator may be the key to successfully implement similar programs in the future.
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    Manganese superoxide dismutase and cardiovascular aging phenotypes in mice
    (2012-09) Ross, Carolyn Marie
    Reactive oxygen species (ROS) have been implicated in the pathogenesis of a number of cardiovascular diseases. Furthermore, recent data from in vitro model systems suggests that mitochondrial ROS production may initiate a vicious cycle termed ROS-induced ROS-release (RI-RR). Whether this phenomenon occurs in vivo or is amplified by aging is not known. We hypothesized that induction of RI-RR by experimentally reducing manganese superoxide dismutase (a mitochondrial antioxidant enzyme) impairs aortic endothelial function and aortic valve function with aging, and that these functional changes would be associated with transcriptional repression of sirtuin family genes, which are known to be associated with aging and age-related diseases. For our studies, we used young (2 mo) and old (>18 mo) MnSOD wild-type (WT) and MnSOD-deficient (HET) mice. In aorta, increasing age significantly impaired vasomotor function (isolated organ chamber baths) in WT mice, but endothelial function was not further impaired in HET mice. Inhibition of NAD(P)H oxidase significantly improved endothelial function in aged WT mice. NAD(P)H oxidase inhibition in HET mice, however, paradoxically worsened endothelial function in young and old animals. Aortic valve function (echocardiography) was unaffected by aging in both WT and HET mice. Interestingly, expression of antioxidant enzymes and multiple sirtuin isoforms (quantitative real-time RT-PCR) were slightly reduced by aging in aorta, but were dramatically reduced in aortic valve. These transcriptional changes were not amplified in either aorta or aortic valve from HET mice. Collectively, our data demonstrate that the transcriptional responses and phenotypes elicited by aging and alterations in mitochondrial antioxidant capacity differ dramatically between aorta and aortic valve. We conclude that reductions in mitochondrial antioxidant capacity do not independently contribute to development of overt cardiovascular disease, and instead suggest that oxidative stress may play a modulatory role in cellular and organismal responses to pathophysiological stimuli that drive age-related cardiovascular disease.
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    The “Midlife Study" mindfulness as an intervention to change health behaviors in midlife women.
    (2009-12) Frisvold, Melissa Hanner
    Forty subjects were enrolled in this study at Baseline and thirty-eight were enrolled at Week 16. At Baseline, there were no statistically significant differences between the mindfulness based stress reduction (MBSR) and the active control health education (HE) groups on any of the demographic, psychosocial or physiologic measures. Attendance was better for the MBSR group than HE and was statistically significant. The purpose of Aim 1 was to determine if a program of MBSR would increase weight loss and reduce BMI. These changes would occur through a program of diet and exercise with increased commitment through being "mindful." In order to determine if there was a treatment effect based on group assignment, a spline linear mixed effects model was tested. The results of this testing found no statistically significant treatment effects on weight or BMI. The purpose of Aim 2 was to determine if a program of MBSR would improve symptoms of psychosocial stress, depression, anxiety, poor sleep quality and increase mindfulness. Another purpose of Aim 2 was to determine if a program of MBSR would result in lower cortisol, fasting glucose, hs-CRP, hip-to-waist ratio, and BP relative to the active control group. A spline linear mixed model was tested to determine if there was a treatment effect based on group assignment on any of the psychosocial measures. There were no statistically significant differences between the two groups on any of the psychosocial measures. One-way ANOVAs found no statistical significant differences post study based on group assignment on any of the physiologic markers. There was an apparent reduction from Baseline to Week 16 (program end) in both groups in weight, BMI, perceived stress, depressive symptoms, anxiety, and improvements in sleep quality and mindfulness (statistical significance not tested). Several recommendations are made for future research. The program could be tested combining simultaneous engagement in mindfulness (or health education) and the diet and exercise portion. The program was safe and feasible and may be implemented in practice. However, the content and protocol processes need to be refined with data to support their efficacy, and the outcomes be closely evaluated.
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    Molecular mechanism of the anti-inflammatory effect of fenofibrate.
    (2010-04) Ford, Kristen A.
    Summary abstract not available.
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    Statin Medication Adverse Event Detection and Prediction to Help Optimize Cardiovascular Therapy
    (2022-08) KIOGOU, SEBASTIEN
    As lipid-lowering drugs, statin medications have been shown to be effective therapies, especially for cardiovascular patients. However, patients cannot take full advantage of the benefits statin drugs offer due to statin related adverse drug events (ADE) that often foster medication non-adherence and add to patients’ morbidity and mortality. On the other hand, the increasing availability of EHR data in electronic repositories along with the advancement in data management and integration represent substantial opportunities for scientists to practically investigate unanswered questions including those of statin related ADEs. In particular, we can ask ourselves: based on available electronic medical record data, how could we identify patients taking statin drugs who are at risk of developing symptomatic adverse events?The current thesis set forth methodologies and scientific artifacts to help with clinical decision support for both general adverse drug events and statin related adverse drug events in particular. We defined methods for clinical data cohort quality assessment and improvement, compiled a list of drugs with the potential of statin to drug interactions, identified common co-morbidities that affect statin users, elaborated on advanced data science methods for clinical data cohort mining and machine leaning, built predictive models for statin related adverse events detection and surveillance, and defined contexts in which these tools can be used for health care decision support. This contribution is significant because it has the advantage of not only reducing the occurrence of statin related ADEs but also propagating a feasible and replicable EHR solution for general ADE reporting. Healthcare organizations can rely on an easy to implement EHR solution to significantly reduce statin related ADEs, save on health care resources, and improve patient management. Local and state governments could reduce their healthcare expenditures. Healthcare quality indices such as number of hospitalizations, length of stay in hospital, re-admission, medication non-adherence, and CVD mortality could be improved. A greater capacity for broader ADE mitigation efforts could also be set forth, which could have a beneficial impact on human health.