Cognitive vulnerability to depression during middle childhood: Stability and associations with maternal affective styles and parental depression

PubMed Central

Hayden, Elizabeth P.; Olino, Thomas M.; Mackrell, Sarah V.M.; Jordan, Patricia L.; Desjardins, Jasmine; Katsiroumbas, Patrice

2014-01-01

Theories of cognitive vulnerability to depression (CVD) imply that CVD is early-emerging and trait-like; however, little longitudinal work has tested this premise in middle childhood, or examined theoretically relevant predictors of child CVD. We examined test–retest correlations of self-referent encoding task performance and self-reported attributional styles and their associations with parental characteristics in 205 seven-year-olds. At baseline, child CVD was assessed, structured clinical interviews were conducted with parents, and ratings of observed maternal affective styles were made. Children’s CVD was re-assessed approximately one and two years later. Both measures of children’s CVD were prospectively and concurrently associated with children’s depressive symptoms and showed modest stability. Multilevel modeling indicated that maternal criticism and paternal depression were related to children’s CVD. Findings indicate that even early-emerging CVD is a valid marker of children’s depression risk. PMID:25392596

Initiated chemical vapor deposited nanoadhesive for bonding National Ignition Facility's targets

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Tom

Currently, the target fabrication scientists in National Ignition Facility Directorate at Lawrence Livermore National Laboratory (LLNL) is studying the propagation force resulted from laser impulses impacting a target. To best study this, they would like the adhesive used to glue the target substrates to be as thin as possible. The main objective of this research project is to create adhesive glue bonds for NIF’s targets that are ≤ 1 μm thick. Polyglycidylmethacrylate (PGMA) thin films were coated on various substrates using initiated chemical vapor deposition (iCVD). Film quality studies using white light interferometry reveal that the iCVD PGMA films weremore » smooth. The coated substrates were bonded at 150 °C under vacuum, with low inflow of Nitrogen. Success in bonding most of NIF’s mock targets at thicknesses ≤ 1 μm indicates that our process is feasible in bonding the real targets. Key parameters that are required for successful bonding were concluded from the bonding results. They include inert bonding atmosphere, sufficient contact between the PGMA films, and smooth substrates. Average bond strength of 0.60 MPa was obtained from mechanical shearing tests. The bonding failure mode of the sheared interfaces was observed to be cohesive. Future work on this project will include reattempt to bond silica aerogel to iCVD PGMA coated substrates, stabilize carbon nanotube forests with iCVD PGMA coating, and kinetics study of PGMA thermal crosslinking.« less

Economic cost of primary prevention of cardiovascular diseases in Tanzania

PubMed Central

Ngalesoni, Frida; Ruhago, George; Norheim, Ole F; Robberstad, Bjarne

2015-01-01

Tanzania is facing a double burden of disease, with non-communicable diseases being an increasingly important contributor. Evidence-based preventive measures are important to limit the growing financial burden. This article aims to estimate the cost of providing medical primary prevention interventions for cardiovascular disease (CVD) among at-risk patients, reflecting actual resource use and if the World Health Organization (WHO)’s CVD medical preventive guidelines are implemented in Tanzania. In addition, we estimate and explore the cost to patients of receiving these services. Cost data were collected in four health facilities located in both urban and rural settings. Providers’ costs were identified and measured using ingredients approach to costing and resource valuation followed the opportunity cost method. Unit costs were estimated using activity-based and step-down costing methodologies. The patient costs were obtained through a structured questionnaire. The unit cost of providing CVD medical primary prevention services ranged from US$30–41 to US$52–71 per patient per year at the health centre and hospital levels, respectively. Employing the WHO’s absolute risk approach guidelines will substantially increase these costs. The annual patient cost of receiving these services as currently practised was estimated to be US$118 and US$127 for urban and rural patients, respectively. Providers’ costs were estimated from two main viewpoints: ‘what is’, that is the current practice, and ‘what if’, reflecting a WHO guidelines scenario. The higher cost of implementing the WHO guidelines suggests the need for further evaluation of whether these added costs are reasonable relative to the added benefits. We also found considerably higher patient costs, implying that distributive and equity implications of access to care require more consideration. Facility location surfaced as the main explanatory variable for both direct and indirect patient costs in the regression analysis; further research on the influence of other provider characteristics on these costs is important. PMID:25113027

Surface structuring of boron doped CVD diamond by micro electrical discharge machining

NASA Astrophysics Data System (ADS)

Schubert, A.; Berger, T.; Martin, A.; Hackert-Oschätzchen, M.; Treffkorn, N.; Kühn, R.

2018-05-01

Boron doped diamond materials, which are generated by Chemical Vapor Deposition (CVD), offer a great potential for the application on highly stressed tools, e. g. in cutting or forming processes. As a result of the CVD process rough surfaces arise, which require a finishing treatment in particular for the application in forming tools. Cutting techniques such as milling and grinding are hardly applicable for the finish machining because of the high strength of diamond. Due to its process principle of ablating material by melting and evaporating, Electrical Discharge Machining (EDM) is independent of hardness, brittleness or toughness of the workpiece material. EDM is a suitable technology for machining and structuring CVD diamond, since boron doped CVD diamond is electrically conductive. In this study the ablation characteristics of boron doped CVD diamond by micro electrical discharge machining are investigated. Experiments were carried out to investigate the influence of different process parameters on the machining result. The impact of tool-polarity, voltage and discharge energy on the resulting erosion geometry and the tool wear was analyzed. A variation in path overlapping during the erosion of planar areas leads to different microstructures. The results show that micro EDM is a suitable technology for finishing of boron doped CVD diamond.

Alzheimer's disease with cerebrovascular disease: current status in the Asia-Pacific region.

PubMed

Chen, C; Homma, A; Mok, V C T; Krishnamoorthy, E; Alladi, S; Meguro, K; Abe, K; Dominguez, J; Marasigan, S; Kandiah, N; Kim, S Y; Lee, D Y; De Silva, H A; Yang, Y-H; Pai, M-C; Senanarong, V; Dash, A

2016-10-01

There is growing awareness of the coexistence of Alzheimer's disease and cerebrovascular disease (AD+CVD), however, due to lack of well-defined criteria and treatment guidelines AD+CVD may be underdiagnosed in Asia. Sixteen dementia specialists from nine Asia Pacific countries completed a survey in September 2014 and met in November 2014 to review the epidemiology, diagnosis and treatment of AD+CVD in Asia. A consensus was reached by discussion, with evidence provided by published studies when available. AD accounts for up to 60% and AD+CVD accounts for 10-20% of all dementia cases in Asia. The reasons for underdiagnosis of AD+CVD include lack of awareness as a result of a lack of diagnostic criteria, misdiagnosis as vascular dementia or AD, lack of diagnostic facilities, resource constraints and cost of investigations. There is variability in the tools used to diagnose AD+CVD in clinical practice. Diagnosis of AD+CVD should be performed in a stepwise manner of clinical evaluation followed by neuroimaging. Dementia patients should be assessed for cognition, behavioural and psychological symptoms, functional staging and instrumental activities of daily living. Neuroimaging should be performed using computed tomography or magnetic resonance imaging. The treatment goals are to stabilize or slow progression as well as to reduce behavioural and psychological symptoms, improve quality of life and reduce disease burden. First-line therapy is usually an acetylcholinesterase inhibitor such as donepezil. AD+CVD is likely to be under-recognised in Asia. Further research is needed to establish the true prevalence of this treatable and potentially preventable disease. © 2016 The Association for the Publication of the Journal of Internal Medicine.

Cardiovascular Disease Prevention: Training Opportunities, the Challenges, and Future Directions.

PubMed

Saeed, Anum; Dabhadkar, Kaustubh; Virani, Salim S; Jones, Peter H; Ballantyne, Christie M; Nambi, Vijay

2018-05-21

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide, necessitating major efforts in prevention. This review summarizes the currently available training opportunities in CVD prevention for fellows-in-training (FITs) and residents. We also highlight the challenges and future directions for CVD prevention as a field and propose a structure for an inclusive CVD prevention training program. At present, there is a lack of centralized training resources for FITs and residents interested in pursuing a career in CVD prevention. Training in CVD prevention is not an accredited subspecialty fellowship by the American Council of Graduate Medical Education (ACGME). Although there are several independent training programs under the broad umbrella of CVD prevention focusing on different aspects of prevention, there is no unified curriculum or training. More collaborative efforts are needed to identify CVD prevention as an ACGME-accredited subspecialty fellowship. Providing more resources can encourage and produce more leaders in this essential field.

Origins of Moiré Patterns in CVD-grown MoS2 Bilayer Structures at the Atomic Scales.

PubMed

Wang, Jin; Namburu, Raju; Dubey, Madan; Dongare, Avinash M

2018-06-21

The chemical vapor deposition (CVD)-grown two-dimensional molybdenum disulfide (MoS 2 ) structures comprise of flakes of few layers with different dimensions. The top layers are relatively smaller in size than the bottom layers, resulting in the formation of edges/steps across adjacent layers. The strain response of such few-layer terraced structures is therefore likely to be different from exfoliated few-layered structures with similar dimensions without any terraces. In this study, the strain response of CVD-grown few-layered MoS 2 terraced structures is investigated at the atomic scales using classic molecular dynamics (MD) simulations. MD simulations suggest that the strain relaxation of CVD-grown triangular terraced structures is observed in the vertical displacement of the atoms across the layers that results in the formation of Moiré patterns. The Moiré islands are observed to nucleate at the corners or edges of the few-layered structure and propagate inwards under both tensile and compressive strains. The nucleation of these islands is observed to happen at tensile strains of ~ 2% and at compressive strains of ~2.5%. The vertical displacements of the atoms and the dimensions of the Moiré islands predicted using the MD simulation are in excellent agreement with that observed experimentally.

Thermally Stable and Electrically Conductive, Vertically Aligned Carbon Nanotube/Silicon Infiltrated Composite Structures for High-Temperature Electrodes.

PubMed

Zou, Qi Ming; Deng, Lei Min; Li, Da Wei; Zhou, Yun Shen; Golgir, Hossein Rabiee; Keramatnejad, Kamran; Fan, Li Sha; Jiang, Lan; Silvain, Jean-Francois; Lu, Yong Feng

2017-10-25

Traditional ceramic-based, high-temperature electrode materials (e.g., lanthanum chromate) are severely limited due to their conditional electrical conductivity and poor stability under harsh circumstances. Advanced composite structures based on vertically aligned carbon nanotubes (VACNTs) and high-temperature ceramics are expected to address this grand challenge, in which ceramic serves as a shielding layer protecting the VACNTs from the oxidation and erosive environment, while the VACNTs work as a conductor. However, it is still a great challenge to fabricate VACNT/ceramic composite structures due to the limited diffusion of ceramics inside the VACNT arrays. In this work, we report on the controllable fabrication of infiltrated (and noninfiltrated) VACNT/silicon composite structures via thermal chemical vapor deposition (CVD) [and laser-assisted CVD]. In laser-assisted CVD, low-crystalline silicon (Si) was quickly deposited at the VACNT subsurfaces/surfaces followed by the formation of high-crystalline Si layers, thus resulting in noninfiltrated composite structures. Unlike laser-assisted CVD, thermal CVD activated the precursors inside and outside the VACNTs simultaneously, which realized uniform infiltrated VACNT/Si composite structures. The growth mechanisms for infiltrated and noninfiltrated VACNT/ceramic composites, which we attributed to the different temperature distributions and gas diffusion mechanism in VACNTs, were investigated. More importantly, the as-farbicated composite structures exhibited excellent multifunctional properties, such as excellent antioxidative ability (up to 1100 °C), high thermal stability (up to 1400 °C), good high velocity hot gas erosion resistance, and good electrical conductivity (∼8.95 Sm -1 at 823 K). The work presented here brings a simple, new approach to the fabrication of advanced composite structures for hot electrode applications.

The impact of a point-of-care testing device on CVD risk assessment completion in New Zealand primary-care practice: A cluster randomised controlled trial and qualitative investigation.

PubMed

Wells, Sue; Rafter, Natasha; Kenealy, Timothy; Herd, Geoff; Eggleton, Kyle; Lightfoot, Rose; Arcus, Kim; Wadham, Angela; Jiang, Yannan; Bullen, Chris

2017-01-01

To assess the effect of a point of care (POC) device for testing lipids and HbA1c in addition to testing by community laboratory facilities (usual practice) on the completion of cardiovascular disease (CVD) risk assessments in general practice. We conducted a pragmatic, cluster randomised controlled trial in 20 New Zealand general practices stratified by size and rurality and randomised to POC device plus usual practice or usual practice alone (controls). Patients aged 35-79 years were eligible if they met national guideline criteria for CVD risk assessment. Data on CVD risk assessments were aggregated using a web-based decision support programme common to each practice. Data entered into the on-line CVD risk assessment form could be saved pending blood test results. The primary outcome was the proportion of completed CVD risk assessments. Qualitative data on practice processes for CVD risk assessment and feasibility of POC testing were collected at the end of the study by interviews and questionnaire. The POC testing was supported by a comprehensive quality assurance programme. A CVD risk assessment entry was recorded for 7421 patients in 10 POC practices and 6217 patients in 10 control practices; 99.5% of CVD risk assessments had complete data in both groups (adjusted odds ratio 1.02 [95%CI 0.61-1.69]). There were major external influences that affected the trial: including a national performance target for CVD risk assessment and changes to CVD guidelines. All practices had invested in systems and dedicated staff time to identify and follow up patients to completion. However, the POC device was viewed by most as an additional tool rather than as an opportunity to review practice work flow and leverage the immediate test results for patient education and CVD risk management discussions. Shortly after commencement, the trial was halted due to a change in the HbA1c test assay performance. The trial restarted after the manufacturing issue was rectified but this affected the end use of the device. Performance incentives and external influences were more powerful modifiers of practice behaviours than the POC device in relation to CVD risk assessment completion. The promise of combining risk assessment, communication and management within one consultation was not realised. With shifts in policy focus, the utility of POC devices for patient engagement in CVD preventive care may be demonstrated if fully integrated into the clinical setting. Australian New Zealand Clinical Trials Registry ACTRN12613000607774.

Graphene growth from reduced graphene oxide by chemical vapour deposition: seeded growth accompanied by restoration

NASA Astrophysics Data System (ADS)

Chang, Sung-Jin; Hyun, Moon Seop; Myung, Sung; Kang, Min-A.; Yoo, Jung Ho; Lee, Kyoung G.; Choi, Bong Gill; Cho, Youngji; Lee, Gaehang; Park, Tae Jung

2016-03-01

Understanding the underlying mechanisms involved in graphene growth via chemical vapour deposition (CVD) is critical for precise control of the characteristics of graphene. Despite much effort, the actual processes behind graphene synthesis still remain to be elucidated in a large number of aspects. Herein, we report the evolution of graphene properties during in-plane growth of graphene from reduced graphene oxide (RGO) on copper (Cu) via methane CVD. While graphene is laterally grown from RGO flakes on Cu foils up to a few hundred nanometres during CVD process, it shows appreciable improvement in structural quality. The monotonous enhancement of the structural quality of the graphene with increasing length of the graphene growth from RGO suggests that seeded CVD growth of graphene from RGO on Cu surface is accompanied by the restoration of graphitic structure. The finding provides insight into graphene growth and defect reconstruction useful for the production of tailored carbon nanostructures with required properties.

Graphene growth from reduced graphene oxide by chemical vapour deposition: seeded growth accompanied by restoration.

PubMed

Chang, Sung-Jin; Hyun, Moon Seop; Myung, Sung; Kang, Min-A; Yoo, Jung Ho; Lee, Kyoung G; Choi, Bong Gill; Cho, Youngji; Lee, Gaehang; Park, Tae Jung

2016-03-10

Understanding the underlying mechanisms involved in graphene growth via chemical vapour deposition (CVD) is critical for precise control of the characteristics of graphene. Despite much effort, the actual processes behind graphene synthesis still remain to be elucidated in a large number of aspects. Herein, we report the evolution of graphene properties during in-plane growth of graphene from reduced graphene oxide (RGO) on copper (Cu) via methane CVD. While graphene is laterally grown from RGO flakes on Cu foils up to a few hundred nanometres during CVD process, it shows appreciable improvement in structural quality. The monotonous enhancement of the structural quality of the graphene with increasing length of the graphene growth from RGO suggests that seeded CVD growth of graphene from RGO on Cu surface is accompanied by the restoration of graphitic structure. The finding provides insight into graphene growth and defect reconstruction useful for the production of tailored carbon nanostructures with required properties.

Graphene growth from reduced graphene oxide by chemical vapour deposition: seeded growth accompanied by restoration

PubMed Central

Chang, Sung-Jin; Hyun, Moon Seop; Myung, Sung; Kang, Min-A; Yoo, Jung Ho; Lee, Kyoung G.; Choi, Bong Gill; Cho, Youngji; Lee, Gaehang; Park, Tae Jung

2016-01-01

Understanding the underlying mechanisms involved in graphene growth via chemical vapour deposition (CVD) is critical for precise control of the characteristics of graphene. Despite much effort, the actual processes behind graphene synthesis still remain to be elucidated in a large number of aspects. Herein, we report the evolution of graphene properties during in-plane growth of graphene from reduced graphene oxide (RGO) on copper (Cu) via methane CVD. While graphene is laterally grown from RGO flakes on Cu foils up to a few hundred nanometres during CVD process, it shows appreciable improvement in structural quality. The monotonous enhancement of the structural quality of the graphene with increasing length of the graphene growth from RGO suggests that seeded CVD growth of graphene from RGO on Cu surface is accompanied by the restoration of graphitic structure. The finding provides insight into graphene growth and defect reconstruction useful for the production of tailored carbon nanostructures with required properties. PMID:26961409

Liquid impact and fracture of free-standing CVD diamond

NASA Astrophysics Data System (ADS)

Kennedy, Claire F.; Telling, Robert H.; Field, John E.

1999-07-01

The Cavendish Laboratory has developed extensive facilities for studies of liquid and solid particle erosion. This paper describes the high-speed liquid impact erosion of thin CVD diamond discs and the variation with grain sizes of the absolute damage threshold velocity (ADTV), viz., the threshold below which the specimen shows no damage. All specimens fail by rear surface cracking and there is shown to be a shallow dependence of rear surface ADTV on grain size. Fracture propagation in CVD diamond has also been monitored using a specially-designed double-torsion apparatus and data for K1C are presented. Tentatively, the results suggest that finer-grained CVD diamond exhibits a higher fracture toughness, although the differences are slight even over a fourfold variation in the mean grain size. No preference for intergranular fracture was observed and one may conclude from this that the grain boundaries themselves do not seriously weaken the material. The large pre-existing flaws, both within and between grains, whose size varies the grain size are believed to be the dominant source of weakness.

EULAR task force recommendations on annual cardiovascular risk assessment for patients with rheumatoid arthritis: an audit of the success of implementation in a rheumatology outpatient clinic.

PubMed

Ikdahl, Eirik; Rollefstad, Silvia; Olsen, Inge C; Kvien, Tore K; Hansen, Inger Johanne Widding; Soldal, Dag Magnar; Haugeberg, Glenn; Semb, Anne Grete

2015-01-01

EULAR recommendations for cardiovascular disease (CVD) risk management include annual CVD risk assessments for patients with rheumatoid arthritis (RA). We evaluated the recording of CVD risk factors (CVD-RF) in a rheumatology outpatient clinic, where EULAR recommendations had been implemented. Further, we compared CVD-RF recordings between a regular rheumatology outpatient clinic (RegROC) and a structured arthritis clinic (AC). In 2012, 1142 RA patients visited the rheumatology outpatient clinic: 612 attended RegROC and 530 attended AC. We conducted a search in the patient journals to ascertain the rate of CVD-RF recording. The overall CVD-RF recording rate was 40.1% in the rheumatology outpatient clinic, reflecting a recording rate of 59.1% in the AC and 23.6% in the RegROC. The odds ratios for having CVD-RFs recorded for patients attending AC compared to RegROC were as follows: blood pressure: 12.4, lipids: 5.0-6.0, glucose: 9.1, HbA1c: 6.1, smoking: 1.4, and for having all the CVD-RFs needed to calculate the CVD risk by the systematic coronary risk evaluation (SCORE): 21.0. The CVD-RF recording rate was low in a rheumatology outpatient clinic. However, a systematic team-based model was superior compared to a RegROC. Further measures are warranted to improve CVD-RF recording in RA patients.

A platform for large-scale graphene electronics--CVD growth of single-layer graphene on CVD-grown hexagonal boron nitride.

PubMed

Wang, Min; Jang, Sung Kyu; Jang, Won-Jun; Kim, Minwoo; Park, Seong-Yong; Kim, Sang-Woo; Kahng, Se-Jong; Choi, Jae-Young; Ruoff, Rodney S; Song, Young Jae; Lee, Sungjoo

2013-05-21

Direct chemical vapor deposition (CVD) growth of single-layer graphene on CVD-grown hexagonal boron nitride (h-BN) film can suggest a large-scale and high-quality graphene/h-BN film hybrid structure with a defect-free interface. This sequentially grown graphene/h-BN film shows better electronic properties than that of graphene/SiO2 or graphene transferred on h-BN film, and suggests a new promising template for graphene device fabrication. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Low-energy nuclear reactions in crystal structures

NASA Astrophysics Data System (ADS)

Bagulya, A. V.; Dalkarov, O. D.; Negodaev, M. A.; Rusetskii, A. S.

2017-09-01

Results of studying low-energy nuclear reactions at the HELIS facility (LPI) are presented. Investigations of yields from DD reactions in deuterated crystal structures at deuteron energies of 10 to 25 keV show a considerable enhancement effect. It is shown that exposure of the deuterated targets to the H+ (proton) and Ne+ beams with energies from 10 to 25 keV and an X-ray beam with the energy of 20 to 30 keV stimulates DD reaction yields. For the CVD diamond target, it is shown that its orientation with respect to the deuteron beam affects the neutron yield. The D+ beam is shown to cause much higher heat release in the TiDx target than the H+ and Ne+ beams, and this heat release depends on the deuterium concentration in the target and the current density of the deuteron beam.

Theory of coherent van der Waals matter.

PubMed

Kulić, Igor M; Kulić, Miodrag L

2014-12-01

We explain in depth the previously proposed theory of the coherent van der Waals (cvdW) interaction, the counterpart of van der Waals (vdW) force, emerging in spatially coherently fluctuating electromagnetic fields. We show that cvdW driven matter is dominated by many-body interactions, which are significantly stronger than those found in standard van der Waals (vdW) systems. Remarkably, the leading two- and three-body interactions are of the same order with respect to the distance (∝R(-6)), in contrast to the usually weak vdW three-body effects (∝R(-9)). From a microscopic theory we show that the anisotropic cvdW many-body interactions drive the formation of low-dimensional structures such as chains, membranes, and vesicles with very unusual, nonlocal properties. In particular, cvdW chains display a logarithmically growing stiffness with the chain length, while cvdW membranes have a bending modulus growing linearly with their size. We argue that the cvdW anisotropic many-body forces cause local cohesion but also a negative effective "surface tension." We conclude by deriving the equation of state for cvdW materials and propose experiments to test the theory, in particular the unusual three-body nature of cvdW.

Theory of coherent van der Waals matter

NASA Astrophysics Data System (ADS)

Kulić, Igor M.; Kulić, Miodrag L.

2014-12-01

We explain in depth the previously proposed theory of the coherent van der Waals (cvdW) interaction, the counterpart of van der Waals (vdW) force, emerging in spatially coherently fluctuating electromagnetic fields. We show that cvdW driven matter is dominated by many-body interactions, which are significantly stronger than those found in standard van der Waals (vdW) systems. Remarkably, the leading two- and three-body interactions are of the same order with respect to the distance (∝R-6) , in contrast to the usually weak vdW three-body effects (∝R-9 ). From a microscopic theory we show that the anisotropic cvdW many-body interactions drive the formation of low-dimensional structures such as chains, membranes, and vesicles with very unusual, nonlocal properties. In particular, cvdW chains display a logarithmically growing stiffness with the chain length, while cvdW membranes have a bending modulus growing linearly with their size. We argue that the cvdW anisotropic many-body forces cause local cohesion but also a negative effective "surface tension." We conclude by deriving the equation of state for cvdW materials and propose experiments to test the theory, in particular the unusual three-body nature of cvdW.

Chemical vapor deposition growth

NASA Technical Reports Server (NTRS)

Ruth, R. P.; Manasevit, H. M.; Kenty, J. L.; Moudy, L. A.; Simpson, W. I.; Yang, J. J.

1976-01-01

The chemical vapor deposition (CVD) method for the growth of Si sheet on inexpensive substrate materials is investigated. The objective is to develop CVD techniques for producing large areas of Si sheet on inexpensive substrate materials, with sheet properties suitable for fabricating solar cells meeting the technical goals of the Low Cost Silicon Solar Array Project. Specific areas covered include: (1) modification and test of existing CVD reactor system; (2) identification and/or development of suitable inexpensive substrate materials; (3) experimental investigation of CVD process parameters using various candidate substrate materials; (4) preparation of Si sheet samples for various special studies, including solar cell fabrication; (5) evaluation of the properties of the Si sheet material produced by the CVD process; and (6) fabrication and evaluation of experimental solar cell structures, using standard and near-standard processing techniques.

Properties of the carbon-palladium nanocomposites studied by Raman spectroscopy method

NASA Astrophysics Data System (ADS)

Belka, Radosław; Suchańska, Małgorzata

2013-10-01

In this paper, the results for thin carbon-palladium (C-Pd) nanocomposites obtained by PVD (Physical Vapour Deposition) and PVD/CVD (Chemical Vapour Deposition) method, carried out using Raman spectroscopy method are presented. Studies reveal the dominance of fullerene-like structure for PVD samples and graphite-like structures for CVD samples. The type of substrate and metal content have great impact on spectra shapes.

Association Between Lipid Biomarkers, Physical Activity, and Socioeconomic Status in a Population-Based Cross-Sectional Study in the UK.

PubMed

Brown, Heather; Becker, Frauke; Antwi, Kofi

Cardiovascular disease (CVD) is the leading cause of global death. Physical activity can help individuals reduce their CVD risk. However, the biological mechanisms explaining the link between physical activity and CVD risk and how they may be mediated by socioeconomic status are not well understood. We use cross-sectional data from 2010/2011 of the Understanding Society Survey, UK, to investigate the association between two biomarkers for CVD risk: cholesterol ratio and triglyceride levels and four different measures of physical activity: moderate, mild, self-reported activity rating, and walking 30 min or more a week using multivariate logistic regression. The analysis investigates if this association is mediated by socioeconomic status and difficulty accessing sports facilities. Results from multivariate regressions show that moderate and self-reported activity rating are significantly associated with cholesterol ratio and triglycerides for both men and women. A weaker association was found for walking 30 min or more a week. No association was found between mild physical activity and the two biomarkers. There is some evidence that socioeconomic status mediates the relationship between the biomarkers and physical activity. A significant association between socioeconomic status variables and the biomarkers was found only for women. We provide some evidence of the mechanisms explaining the link between CVD risk and physical activity by finding an association with traditional lipid biomarkers. We also find that intensity of physical activity matters. Socioeconomic status especially for women is important which may explain some of the inequalities in CVD risk.

Cardiovascular disease medication health literacy among Indigenous peoples: design and protocol of an intervention trial in Indigenous primary care services.

PubMed

Crengle, Sue; Smylie, Janet; Kelaher, Margaret; Lambert, Michelle; Reid, Susan; Luke, Joanne; Anderson, Ian; Harré Hindmarsh, Jennie; Harwood, Matire

2014-07-12

Cardiovascular diseases (CVD) are leading causes of mortality and morbidity among Indigenous people in New Zealand, Australia and Canada and are a major driver of the inequities in life expectancy between Indigenous and non-Indigenous people in these countries. Evidence-based pharmaceutical management of CVD can significantly reduce mortality and morbidity for persons diagnosed with CVD or for those at intermediate or high risk of CVD. Health literacy has been identified as a major barrier in the communication and implementation of appropriate pharmaceutical management plans for CVD. Addressing health literacy is particularly relevant in Indigenous populations where there are unique health and adult literacy challenges. This study will examine the effect of a customized, structured CVD medication programme, delivered by health professionals, on the health literacy of Indigenous people with, or at risk, of CVD. Primary outcomes are patient's knowledge about CVD medications; secondary outcomes examine changes in health literacy skills and practices. The study will employ a multi-site pre-post design with multiple measurement points to assess intervention efficacy. Participants will be recruited from four Indigenous primary care services in Australia, Canada and New Zealand. Three educational sessions will be delivered over four weeks. A tablet application will support the education sessions and produce a customized pill card for each participant. Participants will be provided with written information about CVD medications. Medication knowledge scores, and specific health literacy skills and practices will be assessed before and after the three sessions. Statistical analyses will identify significant changes in outcomes over each session, and from the pre-session one to post-session three time points. This study will make an important contribution to understanding the effect of a structured primary care-based intervention on CVD health literacy in Indigenous populations. The study also illustrates the incorporation of Indigenous health research principles and processes in clinical trials and provides insights that may be useful in other contexts. Australian and New Zealand Clinical Trials Register (ACTRN12612001309875; date of registration 18/12/2012).

Effect of Cumulating Exposure to Abacavir on the Risk of Cardiovascular Disease Events in Patients From the Swiss HIV Cohort Study.

PubMed

Young, Jim; Xiao, Yongling; Moodie, Erica E M; Abrahamowicz, Michal; Klein, Marina B; Bernasconi, Enos; Schmid, Patrick; Calmy, Alexandra; Cavassini, Matthias; Cusini, Alexia; Weber, Rainer; Bucher, Heiner C

2015-08-01

Patients with HIV exposed to the antiretroviral drug abacavir may have an increased risk of cardiovascular disease (CVD). There is concern that this association arises because of a channeling bias. Even if exposure is a risk, it is not clear how that risk changes as exposure cumulates. We assess the effect of exposure to abacavir on the risk of CVD events in the Swiss HIV Cohort Study. We use a new marginal structural Cox model to estimate the effect of abacavir as a flexible function of past exposures while accounting for risk factors that potentially lie on a causal pathway between exposure to abacavir and CVD. A total of 11,856 patients were followed for a median of 6.6 years; 365 patients had a CVD event (4.6 events per 1000 patient-years). In a conventional Cox model, recent--but not cumulative--exposure to abacavir increased the risk of a CVD event. In the new marginal structural Cox model, continued exposure to abacavir during the past 4 years increased the risk of a CVD event (hazard ratio = 2.06; 95% confidence interval: 1.43 to 2.98). The estimated function for the effect of past exposures suggests that exposure during the past 6-36 months caused the greatest increase in risk. Abacavir increases the risk of a CVD event: the effect of exposure is not immediate, rather the risk increases as exposure cumulates over the past few years. This gradual increase in risk is not consistent with a rapidly acting mechanism, such as acute inflammation.

Australian community pharmacists' awareness and practice in supporting secondary prevention of cardiovascular disease.

PubMed

Puspitasari, Hanni Prihhastuti; Aslani, Parisa; Krass, Ines

2013-12-01

Pharmacists are well placed to identify, prevent and resolve medicine related problems as well as monitor the effectiveness of treatments in cardiovascular disease (CVD). Pharmacists' interventions in CVD secondary prevention have been shown to improve outcomes for clients with established CVD. To explore the scope of pharmacists' activities in supporting CVD secondary prevention. Community pharmacies in New South Wales, Australia. Twenty-one in-depth, semi-structured interviews with a range of community pharmacists were conducted. All interviews were audio-recorded and transcribed ad verbatim. Data were analyzed using a 'grounded-theory' approach by applying methods of constant comparison. Community pharmacists' awareness and current practice in supporting secondary prevention of CVD. Four key themes identified included 'awareness', 'patient counselling', 'patient monitoring', and 'perceptions of the role of pharmacists in CVD secondary prevention'. The pharmacists demonstrated a moderate understanding of CVD secondary prevention. There was considerable variability in the scope of practice among the participants, ranging from counselling only about medicines to providing continuity of care. A minority of pharmacists who had negative beliefs about their roles in CVD secondary prevention offered limited support to their clients. The majority of pharmacists, however, believed that they have an important role to play in supporting clients with established CVD. Community pharmacists in Australia make a contribution to the care of clients with established CVD despite the gap in their knowledge and understanding of CVD secondary prevention. The scope of practice in CVD secondary prevention ranged from only counselling about medicines to offering continuity of care. The extent of pharmacists' involvement in offering disease management appears to be influenced by their beliefs regarding what is required within their scope of practice.

Environmental Determinants of Cardiovascular Diseases Risk Factors: A Qualitative Directed Content Analysis

PubMed Central

Sabzmakan, Leila; Mohammadi, Eesa; Morowatisharifabad, Mohammad Ali; Afaghi, Ahmad; Naseri, Mohammad Hassan; Mirzaei, Masoud

2014-01-01

Background: Cardiovascular diseases (CVDs) are the number one cause of death in the world. In most analyses of health problems, environment plays a significant and modifiable role in causing the problem either directly or indirectly through behavior. Objectives: This study aims to understand the patients and healthcare providers’ experiences about the environmental determinants of CVD risk factors based on the Precede Model. Patients and Methods: This qualitative study conducted over six months in 2012 at Diabetes Units of Health Centers associated with Alborz University of Medical Sciences and Health Services which is located in Karaj, Iran. The data were collected based on individual semi-structured interviews with 50 patients and 12 healthcare providers. Data analysis was performed simultaneous with data collection using the content analysis directed method. Results: Lack of behaviors like stress control, healthy eating and physical activity were the roots of the risk factors for CVD. The environmental factor is one of the barriers for conducting these behaviors. The environmental barriers included of structural environment including “availability and accessibility of health resources”, “new skills”, and “law and policies” which are located in enabling category and social environment including “social support”, “motivation to comply” and “consequences of behavior” which are located in reinforcing category. The most barriers to performing health behaviors were often structural. Conclusions: The environmental factors were barriers for doing healthy behaviors. These factors need to be considered to design health promotion interventions. Policymakers should not only focus on patients’ education but also should provide specific facilities to enhance economic, social and cultural status. PMID:25031848

Anisotropic electrical conduction and reduction in dangling-bond density for polycrystalline Si films prepared by catalytic chemical vapor deposition

NASA Astrophysics Data System (ADS)

Niikura, Chisato; Masuda, Atsushi; Matsumura, Hideki

1999-07-01

Polycrystalline Si (poly-Si) films with high crystalline fraction and low dangling-bond density were prepared by catalytic chemical vapor deposition (Cat-CVD), often called hot-wire CVD. Directional anisotropy in electrical conduction, probably due to structural anisotropy, was observed for Cat-CVD poly-Si films. A novel method to separately characterize both crystalline and amorphous phases in poly-Si films using anisotropic electrical conduction was proposed. On the basis of results obtained by the proposed method and electron spin resonance measurements, reduction in dangling-bond density for Cat-CVD poly-Si films was achieved using the condition to make the quality of the included amorphous phase high. The properties of Cat-CVD poly-Si films are found to be promising in solar-cell applications.

Variability in Chemical Vapor Deposited Zinc Sulfide: Assessment of Legacy and International CVD ZnS Materials

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCloy, John S.; Korenstein, Ralph

2009-10-06

Samples of CVD ZnS from the United States, Germany, Israel, and China were evaluated using transmission spectroscopy, x-ray diffraction, photoluminescence, and biaxial flexure testing. Visible and near-infrared scattering, 6 μm absorption, and ultraviolet cut-on edge varied substantially in tested materials. Crystallographic hexagonality and texture was determined and correlated with optical scattering. Transmission cut-on (ultraviolet edge) blue-shifts with annealing and corresponds to visible color but not the 6 μm absorption. Photoluminescence results suggest that CVD ZnS exhibits a complex suite of electronic bandgap defects. All CVD ZnS tested with biaxial flexure exhibit similar fracture strength values and Weibull moduli. This surveymore » suggests that technical understanding of the structure and optical properties CVD ZnS is still in its infancy.« less

75 FR 74773 - Mandatory Reporting of Greenhouse Gases: Additional Sources of Fluorinated GHGs

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-01

..., Methods for Estimating Air Emissions from Chemical Manufacturing Facilities; Protocol for Equipment Leak... chemical vapor deposition process (CVD) or other manufacturing processes use N 2 O. Production processes.... N 2 O emissions from chemical vapor deposition and other electronics manufacturing processes...

Charging effect at grain boundaries of MoS2

NASA Astrophysics Data System (ADS)

Yan, Chenhui; Dong, Xi; Li, Connie H.; Li, Lian

2018-05-01

Grain boundaries (GBs) are inherent extended defects in chemical vapor deposited (CVD) transition metal dichalcogenide (TMD) films. Characterization of the atomic structure and electronic properties of these GBs is crucial for understanding and controlling the properties of TMDs via defect engineering. Here, we report the atomic and electronic structure of GBs in CVD grown MoS2 on epitaxial graphene/SiC(0001). Using scanning tunneling microscopy/spectroscopy, we find that GBs mostly consist of arrays of dislocation cores, where the presence of mid-gap states shifts both conduction and valence band edges by up to 1 eV. Our findings demonstrate the first charging effect near GBs in CVD grown MoS2, providing insights into the significant impact GBs can have on materials properties.

Synthesis and Characterization of Three Dimensional Nanostructures Based on Interconnected Carbon Nanomaterials

NASA Astrophysics Data System (ADS)

Koizumi, Ryota

This thesis addresses various types of synthetic methods for novel three dimensional nanomaterials and nanostructures based on interconnected carbon nanomaterials using solution chemistry and chemical vapor deposition (CVD) methods. Carbon nanotube (CNT) spheres with porous and scaffold structures consisting of interconnected CNTs were synthesized by solution chemistry followed by freeze-drying, which have high elasticity under nano-indentation tests. This allows the CNT spheres to be potentially applied to mechanical dampers. CNTs were also grown on two dimensional materials--such as reduced graphene oxide (rGO) and hexagonal boron nitride (h-BN)--by CVD methods, which are chemically interconnected. CNTs on rGO and h-BN interconnected structures performed well as electrodes for supercapacitors. Furthermore, unique interconnected flake structures of alpha-phase molybdenum carbide were developed by a CVD method. The molybdenum carbide can be used for a catalyst of hydrogen evolution reaction activity as well as an electrode for supercapacitors.

Left Ventricular Structure and Risk of Cardiovascular Events: A Framingham Heart Study Cardiac Magnetic Resonance Study

PubMed Central

Tsao, Connie W; Gona, Philimon N; Salton, Carol J; Chuang, Michael L; Levy, Daniel; Manning, Warren J; O’Donnell, Christopher J

2015-01-01

Background Elevated left ventricular mass index (LVMI) and concentric left ventricular (LV) remodeling are related to adverse cardiovascular disease (CVD) events. The predictive utility of LV concentric remodeling and LV mass in the prediction of CVD events is not well characterized. Methods and Results Framingham Heart Study Offspring Cohort members without prevalent CVD (n=1715, 50% men, aged 65±9 years) underwent cardiovascular magnetic resonance for LVMI and geometry (2002–2006) and were prospectively followed for incident CVD (myocardial infarction, coronary insufficiency, heart failure, stroke) or CVD death. Over 13 808 person-years of follow-up (median 8.4, range 0.0 to 10.5 years), 85 CVD events occurred. In multivariable-adjusted proportional hazards regression models, each 10-g/m2 increment in LVMI and each 0.1 unit in relative wall thickness was associated with 33% and 59% increased risk for CVD, respectively (P=0.004 and P=0.009, respectively). The association between LV mass/LV end-diastolic volume and incident CVD was borderline significant (P=0.053). Multivariable-adjusted risk reclassification models showed a modest improvement in CVD risk prediction with the incorporation of cardiovascular magnetic resonance LVMI and measures of LV concentricity (C-statistic 0.71 [95% CI 0.65 to 0.78] for the model with traditional risk factors only, improved to 0.74 [95% CI 0.68 to 0.80] for the risk factor model additionally including LVMI and relative wall thickness). Conclusions Among adults free of prevalent CVD in the community, greater LVMI and LV concentric hypertrophy are associated with a marked increase in adverse incident CVD events. The potential benefit of aggressive primary prevention to modify LV mass and geometry in these adults requires further investigation. PMID:26374295

Health Care Resource Utilization for Outpatient Cardiovascular Disease and Diabetes Care Delivery Among Advanced Practice Providers and Physician Providers in Primary Care.

PubMed

Virani, Salim S; Akeroyd, Julia M; Ramsey, David J; Deswal, Anita; Nasir, Khurram; Rajan, Suja S; Ballantyne, Christie M; Petersen, Laura A

2018-06-01

Although effectiveness of diabetes or cardiovascular disease (CVD) care delivery between physicians and advanced practice providers (APPs) has been shown to be comparable, health care resource utilization between these 2 provider types in primary care is unknown. This study compared health care resource utilization between patients with diabetes or CVD receiving care from APPs or physicians. Diabetes (n = 1,022,588) or CVD (n = 1,187,035) patients with a primary care visit between October 2013 and September 2014 in 130 Veterans Affairs facilities were identified. Using hierarchical regression adjusting for covariates including patient illness burden, the authors compared number of primary or specialty care visits and number of lipid panels and hemoglobinA1c (HbA1c) tests among diabetes patients, and number of primary or specialty care visits and number of lipid panels and cardiac stress tests among CVD patients receiving care from physicians and APPs. Physicians had significantly larger patient panels compared with APPs. In adjusted analyses, diabetes patients receiving care from APPs received fewer primary and specialty care visits and a greater number of lipid panels and HbA1c tests compared with patients receiving care from physicians. CVD patients receiving care from APPs received more frequent lipid testing and fewer primary and specialty care visits compared with those receiving care from physicians, with no differences in the number of stress tests. Most of these differences, although statistically significant, were numerically small. Health care resource utilization among diabetes or CVD patients receiving care from APPs or physicians appears comparable, although physicians work with larger patient panels.

Twelve-Year Follow-Up of American Women’s Awareness of Cardiovascular Disease Risk and Barriers to Heart Health

PubMed Central

Mosca, Lori; Mochari-Greenberger, Heidi; Dolor, Rowena J.; Newby, L. Kristin; Robb, Karen J.

2010-01-01

Background Awareness of cardiovascular disease (CVD) risk has been linked to taking preventive action in women. The purpose of this study was to assess contemporary awareness of CVD risk and barriers to prevention in a nationally representative sample of women and to evaluate trends since 1997 from similar triennial surveys. Methods and Results A standardized survey about awareness of CVD risk was completed in 2009 by 1142 women ≥25 years of age, contacted through random digit dialing oversampled for racial/ethnic minorities, and by 1158 women contacted online. There was a significant increase in the proportion of women aware that CVD is the leading cause of death since 1997 (P for trend=<0.0001). Awareness among telephone participants was greater in 2009 compared with 1997 (54% versus 30%, P<0.0001) but not different from 2006 (57%). In multivariate analysis, African American and Hispanic women were significantly less aware than white women, although the gap has narrowed since 1997. Only 53% of women said they would call 9-1-1 if they thought they were having symptoms of a heart attack. The majority of women cited therapies to prevent CVD that are not evidence-based. Common barriers to prevention were family/caretaking responsibilities (51%) and confusion in the media (42%). Community-level changes women thought would be helpful were access to healthy foods (91%), public recreation facilities (80%), and nutrition information in restaurants (79%). Conclusions Awareness of CVD as the leading cause of death among women has nearly doubled since 1997 but is stabilizing and continues to lag in racial/ethnic minorities. Numerous misperceptions and barriers to prevention persist and women strongly favored environmental approaches to facilitate preventive action. PMID:20147489

Dry contact transfer printing of aligned carbon nanotube patterns and characterization of their optical properties for diameter distribution and alignment.

PubMed

Pint, Cary L; Xu, Ya-Qiong; Moghazy, Sharief; Cherukuri, Tonya; Alvarez, Noe T; Haroz, Erik H; Mahzooni, Salma; Doorn, Stephen K; Kono, Junichiro; Pasquali, Matteo; Hauge, Robert H

2010-02-23

A scalable and facile approach is demonstrated where as-grown patterns of well-aligned structures composed of single-walled carbon nanotubes (SWNT) synthesized via water-assisted chemical vapor deposition (CVD) can be transferred, or printed, to any host surface in a single dry, room-temperature step using the growth substrate as a stamp. We demonstrate compatibility of this process with multiple transfers for large-scale device and specifically tailored pattern fabrication. Utilizing this transfer approach, anisotropic optical properties of the SWNT films are probed via polarized absorption, Raman, and photoluminescence spectroscopies. Using a simple model to describe optical transitions in the large SWNT species present in the aligned samples, polarized absorption data are demonstrated as an effective tool for accurate assignment of the diameter distribution from broad absorption features located in the infrared. This can be performed on either well-aligned samples or unaligned doped samples, allowing simple and rapid feedback of the SWNT diameter distribution that can be challenging and time-consuming to obtain in other optical methods. Furthermore, we discuss challenges in accurately characterizing alignment in structures of long versus short carbon nanotubes through optical techniques, where SWNT length makes a difference in the information obtained in such measurements. This work provides new insight to the efficient transfer and optical properties of an emerging class of long, large diameter SWNT species typically produced in the CVD process.

Spent nuclear fuel project cold vacuum drying facility operations manual

DOE Office of Scientific and Technical Information (OSTI.GOV)

IRWIN, J.J.

This document provides the Operations Manual for the Cold Vacuum Drying Facility (CVDF). The Manual was developed in conjunction with HNF-SD-SNF-SAR-002, Safety Analysis Report for the Cold Vacuum Drying Facility, Phase 2, Supporting Installation of Processing Systems (Garvin 1998) and, the HNF-SD-SNF-DRD-002, 1997, Cold Vacuum Drying Facility Design Requirements, Rev. 3a. The Operations Manual contains general descriptions of all the process, safety and facility systems in the CVDF, a general CVD operations sequence, and has been developed for the SNFP Operations Organization and shall be updated, expanded, and revised in accordance with future design, construction and startup phases of themore » CVDF until the CVDF final ORR is approved.« less

The Role of Family in a Dietary Risk Reduction Intervention for Cardiovascular Disease.

PubMed

Schumacher, Tracy L; Burrows, Tracy L; Thompson, Deborah I; Callister, Robin; Spratt, Neil J; Collins, Clare E

2016-09-30

Diet is an essential strategy for the prevention of primary and secondary cardiovascular disease (CVD) events. The objectives were to examine: how families at increased risk of CVD perceived personal risk, their motivations to make dietary changes, their understanding of diet, and the influence of other family members. Individuals (>18 years) who completed an Australian family-based CVD risk reduction program were invited to a semi-structured telephone interview. Responses were recorded, transcribed verbatim and analysed using a systematic deductive approach with coding derived from key concepts developed as part of the interview structure. Seventeen participants from eight families were interviewed (aged 18-70 years, 47% male, five with CVD diagnosis). Key themes indicated both intrinsic and extrinsic motivations to improve heart health, variations in risk perception, recognition of the role diet plays in heart health, and the extent of family influences on eating patterns. Discrepancies between perceived and actual CVD risk perception impacted on perceived "need" to modify current dietary patterns towards heart health recommendations. Therefore, strategies not reliant on risk perception are needed to engage those with low risk perception. This could involve identifying and accessing the family "ringleader" to influence involvement and capitalising on personal accountability to other family members.

CVD-diamond-based position sensitive photoconductive detector for high-flux x-rays and gamma rays.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shu, D.

1999-04-19

A position-sensitive photoconductive detector (PSPCD) using insulating-type CVD diamond as its substrate material has been developed at the Advanced Photon Source (APS). Several different configurations, including a quadrant pattern for a x-ray-transmitting beam position monitor (TBPM) and 1-D and 2-D arrays for PSPCD beam profilers, have been developed. Tests on different PSPCD devices with high-heat-flux undulator white x-ray beam, as well as with gamma-ray beams from {sup 60}Co sources have been done at the APS and National Institute of Standards and Technology (NIST). It was proven that the insulating-type CVD diamond can be used to make a hard x-ray andmore » gamma-ray position-sensitive detector that acts as a solid-state ion chamber. These detectors are based on the photoconductivity principle. A total of eleven of these TBPMs have been installed on the APS front ends for commissioning use. The linear array PSPCD beam profiler has been routinely used for direct measurements of the undulator white beam profile. More tests with hard x-rays and gamma rays are planned for the CVD-diamond 2-D imaging PSPCD. Potential applications include a high-dose-rate beam profiler for fourth-generation synchrotrons radiation facilities, such as free-electron lasers.« less

Communicating cardiovascular disease risk: an interview study of General Practitioners' use of absolute risk within tailored communication strategies.

PubMed

Bonner, Carissa; Jansen, Jesse; McKinn, Shannon; Irwig, Les; Doust, Jenny; Glasziou, Paul; McCaffery, Kirsten

2014-05-29

Cardiovascular disease (CVD) prevention guidelines encourage assessment of absolute CVD risk - the probability of a CVD event within a fixed time period, based on the most predictive risk factors. However, few General Practitioners (GPs) use absolute CVD risk consistently, and communication difficulties have been identified as a barrier to changing practice. This study aimed to explore GPs' descriptions of their CVD risk communication strategies, including the role of absolute risk. Semi-structured interviews were conducted with a purposive sample of 25 GPs in New South Wales, Australia. Transcribed audio-recordings were thematically coded, using the Framework Analysis method to ensure rigour. GPs used absolute CVD risk within three different communication strategies: 'positive', 'scare tactic', and 'indirect'. A 'positive' strategy, which aimed to reassure and motivate, was used for patients with low risk, determination to change lifestyle, and some concern about CVD risk. Absolute risk was used to show how they could reduce risk. A 'scare tactic' strategy was used for patients with high risk, lack of motivation, and a dismissive attitude. Absolute risk was used to 'scare' them into taking action. An 'indirect' strategy, where CVD risk was not the main focus, was used for patients with low risk but some lifestyle risk factors, high anxiety, high resistance to change, or difficulty understanding probabilities. Non-quantitative absolute risk formats were found to be helpful in these situations. This study demonstrated how GPs use three different communication strategies to address the issue of CVD risk, depending on their perception of patient risk, motivation and anxiety. Absolute risk played a different role within each strategy. Providing GPs with alternative ways of explaining absolute risk, in order to achieve different communication aims, may improve their use of absolute CVD risk assessment in practice.

A Path Analysis of a Randomized "Promotora de Salud" Cardiovascular Disease-Prevention Trial among At-Risk Hispanic Adults

ERIC Educational Resources Information Center

de Heer, Hendrik Dirk; Balcazar, Hector G.; Castro, Felipe; Schulz, Leslie

2012-01-01

This study assessed effectiveness of an educational community intervention taught by "promotoras de salud" in reducing cardiovascular disease (CVD) risk among Hispanics using a structural equation modeling (SEM) approach. Model development was guided by a social ecological framework proposing CVD risk reduction through improvement of…

Analysis of Online Information Searching for Cardiovascular Diseases on a Consumer Health Information Portal

PubMed Central

Jadhav, Ashutosh; Sheth, Amit; Pathak, Jyotishman

2014-01-01

Since the early 2000’s, Internet usage for health information searching has increased significantly. Studying search queries can help us to understand users “information need” and how do they formulate search queries (“expression of information need”). Although cardiovascular diseases (CVD) affect a large percentage of the population, few studies have investigated how and what users search for CVD. We address this knowledge gap in the community by analyzing a large corpus of 10 million CVD related search queries from MayoClinic.com. Using UMLS MetaMap and UMLS semantic types/concepts, we developed a rule-based approach to categorize the queries into 14 health categories. We analyzed structural properties, types (keyword-based/Wh-questions/Yes-No questions) and linguistic structure of the queries. Our results show that the most searched health categories are ‘Diseases/Conditions’, ‘Vital-Sings’, ‘Symptoms’ and ‘Living-with’. CVD queries are longer and are predominantly keyword-based. This study extends our knowledge about online health information searching and provides useful insights for Web search engines and health websites. PMID:25954380

Heuristics and biases in cardiovascular disease prevention: How can we improve communication about risk, benefits and harms?

PubMed

Bonner, Carissa; McKinn, Shannon; Lau, Annie; Jansen, Jesse; Doust, Jenny; Trevena, Lyndal; McCaffery, Kirsten

2018-05-01

Cardiovascular disease (CVD) prevention guidelines recommend medication based on the probability of a heart attack/stroke in the next 5-10 years. However, heuristics and biases make risk communication challenging for doctors. This study explored how patients interpret personalised CVD risk results presented in varying formats and timeframes. GPs recruited 25 patients with CVD risk factors and varying medication history. Participants were asked to 'think aloud' while using two CVD risk calculators that present probabilistic risk in different ways, within a semi-structured interview. Transcribed audio-recordings were coded using Framework Analysis. Key themes were: 1) numbers lack meaning without a reference point; 2) risk results need to be both credible and novel; 3) selective attention to intervention effects. Risk categories (low/moderate/high) provided meaningful context, but short-term risk results were not credible if they didn't match expectations. Colour-coded icon arrays showing the effect of age and interventions were seen as novel and motivating. Those on medication focused on benefits, while others focused on harms. CVD risk formats need to be tailored to patient expectations and experiences in order to counteract heuristics and biases. Doctors need access to multiple CVD risk formats to communicate effectively about CVD prevention. Copyright © 2017 Elsevier B.V. All rights reserved.

[Effects of a cardiocerebrovascular disease prevention education program for postmenopausal middle-aged women].

PubMed

Choi, Soo Kyung; Kim, In Sook

2015-02-01

This study was conducted to examine effects of a cardiocerebrovascular disease (CVD) prevention education program on knowledge, self-efficacy and health behavior among postmenopausal middle-aged women. A non-equivalent control group pretest-posttest design was used. Participants were 53 postmenopausal middle-aged women who registered in two community culture centers in G metropolitan city. Experimental group (n=26) received a CVD prevention education program 8 times over 8 weeks. Knowledge, self-efficacy and health behavior of the participants were examined with self-report structured questionaries. Data were collected between October 15 and December 11, 2013, and were analyzed using chi-square test, Fisher's exact test, independent t-test, and analysis of covariance with SPSS/PC version 21.0. After the intervention the experimental group showed significant increases in the knowledge of CVD symptoms (p<.001) and CVD risk factors (p<.001), level of self-efficacy (p=.028) and health behavior (p<.001) compared to the control group. However, no significant difference was found between groups for knowledge of CVD prevention (p<.133). Results suggest that a CVD prevention education program can be an effective strategy to improve knowledge on CVD symptoms and risk factors, self-efficacy and health behavior for postmenopausal middle-aged women.

Cardiovascular and psychiatric characteristics associated with oxidative stress markers among adolescents with bipolar disorder.

PubMed

Hatch, Jessica; Andreazza, Ana; Olowoyeye, Omodele; Rezin, Gislane Tezza; Moody, Alan; Goldstein, Benjamin I

2015-09-01

In the field of bipolar disorder (BD) research there is an absence of validated biomarkers and limited understanding of the biology underlying excessive and premature cardiovascular disease (CVD). Oxidative stress is a potential biomarker in both BD and CVD. To examine psychiatric and cardiovascular characteristics associated with peripheral oxidative stress markers among adolescents with BD, who are at high risk for CVD. Participants were 30 adolescents, 13-19years old, with BD and without CVD. Ultrasonography was used to evaluate vascular function and structure. Traditional CVD risk factors were also measured. Psychiatric assessments were conducted via semi-structured interview. Serum levels of oxidative stress (lipid hydroperoxides (LPH) and protein carbonylation (PC)) were assayed. Compared to published data on adults with BD, adolescents had significantly lower levels of LPH and PC (t52(11.34), p<0.0001; t58(29.68), p<0.0001, respectively). Thicker mean and maximum carotid intima media thickness was associated with greater levels of LPH (r=.455, p=.015; r=.620, p<0.0001, respectively). LPH was associated with diastolic blood pressure (r=-.488, p=0.008) and pulse pressure (r=.543, p=0.003). Mood symptoms and medication were not significantly associated with oxidative stress. Adolescents with BD have lower levels of oxidative stress compared to adults with BD, supporting prevailing illness staging theories for BD. Oxidative stress is robustly associated with a proxy measure of atherosclerosis and may explain in part the increased risk of CVD in BD. Copyright © 2015 Elsevier Inc. All rights reserved.

Gender- and Race-Specific Metabolic Score and Cardiovascular Disease Mortality in Adults: A Structural Equation Modeling Approach—United States, 1988–2006

PubMed Central

Mercado, Carla I.; Yang, Quanhe; Ford, Earl S.; Gregg, Edward; Valderrama, Amy L.

2017-01-01

Objective Consider all metabolic syndrome (MetS) components [systolic (SBP) and diastolic (DBP) blood pressures, waist circumference, HDL cholesterol, triglycerides (TG), and fasting glucose] and gender/race differential risk when assessing cardiovascular disease (CVD) risk. Methods We estimated a gender- and race-specific continuous MetS score using structural equation modeling and tested its association with CVD mortality using data from National Health and Nutrition Examination Survey III linked with the National Death Index. Cox proportional hazard regression tested the association adjusted for sociodemographic and behavior characteristics. Results For men, continuous MetS components associated with CVD mortality were SBP (hazard ratio =1.50, 95% confidence interval =1.14–1.96), DBP (1.48, 1.16–1.90), and TG (1.15, 1.12–1.16). In women, SBP (1.44, 1.27–1.63) and DBP (1.24, 1.02–1.51) were associated with CVD mortality. MetS score was not significantly associated with CVD mortality in men; but significant associations were found for all women (1.34, 1.06–1.68), non-Hispanic white women (1.29, 1.01–1.64), non-Hispanic black women (2.03, 1.12–3.69), and Mexican-American women (3.57, 2.21–5.76). Goodness-of-fit and concordance were overall better for models with the MetS score than MetS (yes/no). Conclusions When assessing CVD mortality risk, MetS score provided additional information than MetS (yes/no). PMID:26308480

A comparative study of the thermoluminescent response to beta irradiation of CVD diamond and LiF dosimeters

NASA Astrophysics Data System (ADS)

Bogani, F.; Borchi, E.; Bruzzi, M.; Leroy, C.; Sciortino, S.

1997-02-01

The thermoluminescent (TL) response of Chemical Vapour Deposited (CVD) diamond films to beta irradiation has been investigated. A numerical curve-fitting procedure, calibrated by means of a set of LiF TLD100 experimental spectra, has been developed to deconvolute the complex structured TL glow curves. The values of the activation energy and of the frequency factor related to each of the TL peaks involved have been determined. The TL response of the CVD diamond films to beta irradiation has been compared with the TL response of a set of LiF TLD100 and TLD700 dosimeters. The results have been discussed and compared in view of an assessment of the efficiency of CVD diamond films in future applications as in vivo dosimeters.

High-performance ultraviolet photodetectors based on solution-grown ZnS nanobelts sandwiched between graphene layers

PubMed Central

Kim, Yeonho; Kim, Sang Jin; Cho, Sung-Pyo; Hong, Byung Hee; Jang, Du-Jeon

2015-01-01

Ultraviolet (UV) light photodetectors constructed from solely inorganic semiconductors still remain unsatisfactory because of their low electrical performances. To overcome this limitation, the hybridization is one of the key approaches that have been recently adopted to enhance the photocurrent. High-performance UV photodetectors showing stable on-off switching and excellent spectral selectivity have been fabricated based on the hybrid structure of solution-grown ZnS nanobelts and CVD-grown graphene. Sandwiched structures and multilayer stacking strategies have been applied to expand effective junction between graphene and photoactive ZnS nanobelts. A multiply sandwich-structured photodetector of graphene/ZnS has shown a photocurrent of 0.115 mA under illumination of 1.2 mWcm−2 in air at a bias of 1.0 V, which is higher 107 times than literature values. The multiple-sandwich structure of UV-light sensors with graphene having high conductivity, flexibility, and impermeability is suggested to be beneficial for the facile fabrication of UV photodetectors with extremely efficient performances. PMID:26197784

CREATE Wellness: A multi-component behavioral intervention for patients not responding to traditional Cardiovascular disease management.

PubMed

Miller-Rosales, Chris; Sterling, Stacy A; Wood, Sabrina B; Ross, Thekla; Makki, Mojdeh; Zamudio, Cindy; Kane, Irene M; Richardson, Megan C; Samayoa, Claudia; Charvat-Aguilar, Nancy; Lu, Wendy Y; Vo, Michelle; Whelan, Kimberly; Uratsu, Connie S; Grant, Richard W

2017-12-01

Cardiovascular disease (CVD) is the leading cause of death in the US. Many patients do not benefit from traditional disease management approaches to CVD risk reduction. Here we describe the rationale, development, and implementation of a multi-component behavioral intervention targeting patients who have persistently not met goals of CVD risk factor control. Informed by published evidence, relevant theoretical frameworks, stakeholder advice, and patient input, we developed a group-based intervention (Changing Results: Engage and Activate to Enhance Wellness; "CREATE Wellness") to address the complex needs of patients with elevated or unmeasured CVD-related risk factors. We are testing this intervention in a randomized trial among patients with persistent (i.e > 2 years) sub-optimal risk factor control despite being enrolled in an advanced and highly successful CVD disease management program. The CREATE Wellness intervention is designed as a 3 session, group-based intervention combining proven elements of patient activation, health system engagement skills training, shared decision making, care planning, and identification of lifestyle change barriers. Our key learnings in designing the intervention included the value of multi-level stakeholder input and the importance of pragmatic skills training to address barriers to care. The CREATE Wellness intervention represents an evidence-based, patient-centered approach for patients not responding to traditional disease management. The trial is currently underway at three medical facilities within Kaiser Permanente Northern California and next steps include an evaluation of efficacy, adaptation for non-English speaking patient populations, and modification of the curriculum for web- or phone-based versions. NCT02302612.

Left Ventricular Structure and Risk of Cardiovascular Events: A Framingham Heart Study Cardiac Magnetic Resonance Study.

PubMed

Tsao, Connie W; Gona, Philimon N; Salton, Carol J; Chuang, Michael L; Levy, Daniel; Manning, Warren J; O'Donnell, Christopher J

2015-09-15

Elevated left ventricular mass index (LVMI) and concentric left ventricular (LV) remodeling are related to adverse cardiovascular disease (CVD) events. The predictive utility of LV concentric remodeling and LV mass in the prediction of CVD events is not well characterized. Framingham Heart Study Offspring Cohort members without prevalent CVD (n=1715, 50% men, aged 65±9 years) underwent cardiovascular magnetic resonance for LVMI and geometry (2002-2006) and were prospectively followed for incident CVD (myocardial infarction, coronary insufficiency, heart failure, stroke) or CVD death. Over 13 808 person-years of follow-up (median 8.4, range 0.0 to 10.5 years), 85 CVD events occurred. In multivariable-adjusted proportional hazards regression models, each 10-g/m(2) increment in LVMI and each 0.1 unit in relative wall thickness was associated with 33% and 59% increased risk for CVD, respectively (P=0.004 and P=0.009, respectively). The association between LV mass/LV end-diastolic volume and incident CVD was borderline significant (P=0.053). Multivariable-adjusted risk reclassification models showed a modest improvement in CVD risk prediction with the incorporation of cardiovascular magnetic resonance LVMI and measures of LV concentricity (C-statistic 0.71 [95% CI 0.65 to 0.78] for the model with traditional risk factors only, improved to 0.74 [95% CI 0.68 to 0.80] for the risk factor model additionally including LVMI and relative wall thickness). Among adults free of prevalent CVD in the community, greater LVMI and LV concentric hypertrophy are associated with a marked increase in adverse incident CVD events. The potential benefit of aggressive primary prevention to modify LV mass and geometry in these adults requires further investigation. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

SPE-LEEM Studies on the Surface and Electronic Structure of 2-D Transition Metal Dichalcogenides

NASA Astrophysics Data System (ADS)

Yeh, Po-Chun; Jin, Wencan; Zaki, Nader; Zhang, Datong; Sadowski, Jerzy; Al-Mahboob, Abdullah; van de Zande, Arend; Chenet, Daniel; Dadap, Jerry; Herman, Irving; Sutter, Petter; Hone, James; Osgood, Richard

2014-03-01

In this work, we studied the surface and electronic structure of monolayer and few-layer exfoliated MoS2 and WSe2, as well as chemical-vapor-deposition (CVD) grown MoS2, using Spectroscopic Photoemission and Low Energy Electron Microscope (SPE-LEEM). LEEM measurements reveal that, unlike exfoliated MoS2, CVD-grown MoS2 exhibits grain-boundary alterations due to surface strain. However, LEEM and micro-probe low energy electron diffraction show that the quality of CVD-grown MoS2 is comparable to that of exfoliated MoS2. Micrometer-scale angle-resolved photoemission spectroscopy (ARPES) measurement on exfoliated MoS2 and WSe2 single-crystals provides direct evidence for the shifting of the valence band maximum from Γ to K, when the layer number is thinned down to one, as predicted by density functional theory. Our measurements of the k-space resolved electronic structure allow for further comparison with other theoretical predictions and with transport measurements. Session I and II

Environmental Determinants of Cardiovascular Disease.

PubMed

Bhatnagar, Aruni

2017-07-07

Many features of the environment have been found to exert an important influence on cardiovascular disease (CVD) risk, progression, and severity. Changes in the environment because of migration to different geographic locations, modifications in lifestyle choices, and shifts in social policies and cultural practices alter CVD risk, even in the absence of genetic changes. Nevertheless, the cumulative impact of the environment on CVD risk has been difficult to assess and the mechanisms by which some environment factors influence CVD remain obscure. Human environments are complex, and their natural, social, and personal domains are highly variable because of diversity in human ecosystems, evolutionary histories, social structures, and individual choices. Accumulating evidence supports the notion that ecological features such as the diurnal cycles of light and day, sunlight exposure, seasons, and geographic characteristics of the natural environment such as altitude, latitude, and greenspaces are important determinants of cardiovascular health and CVD risk. In highly developed societies, the influence of the natural environment is moderated by the physical characteristics of the social environments such as the built environment and pollution, as well as by socioeconomic status and social networks. These attributes of the social environment shape lifestyle choices that significantly modify CVD risk. An understanding of how different domains of the environment, individually and collectively, affect CVD risk could lead to a better appraisal of CVD and aid in the development of new preventive and therapeutic strategies to limit the increasingly high global burden of heart disease and stroke. © 2017 American Heart Association, Inc.

Facile synthesis and lithium storage properties of a porous NiSi2/Si/carbon composite anode material for lithium-ion batteries.

PubMed

Jia, Haiping; Stock, Christoph; Kloepsch, Richard; He, Xin; Badillo, Juan Pablo; Fromm, Olga; Vortmann, Britta; Winter, Martin; Placke, Tobias

2015-01-28

In this work, a novel, porous structured NiSi2/Si composite material with a core-shell morphology was successfully prepared using a facile ball-milling method. Furthermore, the chemical vapor deposition (CVD) method is deployed to coat the NiSi2/Si phase with a thin carbon layer to further enhance the surface electronic conductivity and to mechanically stabilize the whole composite structure. The morphology and porosity of the composite material was evaluated by scanning electron microscopy (SEM), transmission electron microscopy (TEM), and nitrogen adsorption measurements (BJH analysis). The as-prepared composite material consists of NiSi2, silicon, and carbon phases, in which the NiSi2 phase is embedded in a silicon matrix having homogeneously distributed pores, while the surface of this composite is coated with a carbon layer. The electrochemical characterization shows that the porous and core-shell structure of the composite anode material can effectively absorb and buffer the immense volume changes of silicon during the lithiation/delithiation process. The obtained NiSi2/Si/carbon composite anode material displays an outstanding electrochemical performance, which gives a stable capacity of 1272 mAh g(-1) for 200 cycles at a charge/discharge rate of 1C and a good rate capability with a reversible capacity of 740 mAh g(-1) at a rate of 5C.

CVD Growth of Carbon Nanotubes: Structure, Catalyst, and Growth

NASA Technical Reports Server (NTRS)

Delzeit, Lance

2003-01-01

Carbon nanotubes (CNTs) exhibit extraordinary mechanical and unique electronic properties and hence have been receiving much attention in recent years for their potential in nanoelectronics, field emission devices, scanning probes, high strength composites and many more applications. Catalytic decomposition of hydrocarbon feedstock with the aid of supported transition metal catalysts - also known as chemical vapor deposition (CVD) - has become popular to produce single-walled and multi-walled nanotubes (SWNTs, MWNTs) and multiwalled nanofibers (MWNFs). The ability to grow CNTs on patterned substrates and in vertically aligned arrays, and the simplicity of the process, has made CVD growth of CNTs an attractive approach.

Development, Testing, and Implementation of a Training Curriculum for Nonphysician Health Workers to Reduce Cardiovascular Disease.

PubMed

Khan, Maheer; Lamelas, Pablo; Musa, Hadi; Paty, Jared; McCready, Tara; Nieuwlaat, Robby; Ng, Eleonor; Lopez-Jaramillo, Patricio; Lopez-Lopez, Jose; Yusoff, Khalid; Majid, Fadhlina A; Ng, Kien Keat; Garis, Len; Onuma, Oyere; Yusuf, Salim; Schwalm, Jon-David

2018-01-10

Cardiovascular disease (CVD) is the leading cause of death worldwide. The need to address CVD is greatest in low- and middle-income countries where there is a shortage of trained health workers in CVD detection, prevention, and control. Based on the growing evidence that many elements of chronic disease management can be shifted to nonphysician health care workers (NPHW), the HOPE-4 (Heart Outcomes Prevention and Evaluation Program) aimed to develop, test, and implement a training curriculum on CVD prevention and control in Colombia, Malaysia, and low-resource settings in Canada. Curriculum development followed an iterative and phased approach where evidence-based guidelines, revised blood pressure treatment algorithms, and culturally relevant risk factor counseling were incorporated. Through a pilot-training process with high school students in Canada, the curriculum was further refined. Implementation of the curriculum in Colombia, Malaysia, and Canada occurred through partner organizations as the HOPE-4 team coordinated the program from Hamilton, Ontario, Canada. In addition to content on the burden of disease, cardiovascular system pathophysiology, and CVD risk factors, the curriculum also included evaluations such as module tests, in-class exercises, and observed structured clinical examinations, which were administered by the local partner organizations. These evaluations served as indicators of adequate uptake of curriculum content as well as readiness to work as an NPHW in the field. Overall, 51 NPHW successfully completed the training curriculum with an average score of 93.19% on module tests and 84.76% on the observed structured clinical examinations. Since implementation, the curriculum has also been adapted to the World Health Organization's HEARTS Technical Package, which was launched in 2016 to improve management of CVD in primary health care. The robust curriculum development, testing, and implementation process described affirm that NPHW in diverse settings can be trained in implementing measures for CVD prevention and control. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Fabrication of efficient planar perovskite solar cells using a one-step chemical vapor deposition method

PubMed Central

Tavakoli, Mohammad Mahdi; Gu, Leilei; Gao, Yuan; Reckmeier, Claas; He, Jin; Rogach, Andrey L.; Yao, Yan; Fan, Zhiyong

2015-01-01

Organometallic trihalide perovskites are promising materials for photovoltaic applications, which have demonstrated a rapid rise in photovoltaic performance in a short period of time. We report a facile one-step method to fabricate planar heterojunction perovskite solar cells by chemical vapor deposition (CVD), with a solar power conversion efficiency of up to 11.1%. We performed a systematic optimization of CVD parameters such as temperature and growth time to obtain high quality films of CH3NH3PbI3 and CH3NH3PbI3-xClx perovskite. Scanning electron microscopy and time resolved photoluminescence data showed that the perovskite films have a large grain size of more than 1 micrometer, and carrier life-times of 10 ns and 120 ns for CH3NH3PbI3 and CH3NH3PbI3-xClx, respectively. This is the first demonstration of a highly efficient perovskite solar cell using one step CVD and there is likely room for significant improvement of device efficiency. PMID:26392200

Retinal vascular imaging in early life: insights into processes and risk of cardiovascular disease

PubMed Central

Li, Ling‐Jun; Ikram, Mohammad Kamran

2015-01-01

Abstract Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. In recent years, studies have shown that the origins of CVD may be traced to vascular and metabolic processes in early life. Retinal vascular imaging is a new technology that allows detailed non‐invasive in vivo assessment and monitoring of the microvasculature. In this systematic review, we described the application of retinal vascular imaging in children and adolescents, and we examined the use of retinal vascular imaging in understanding CVD risk in early life. We reviewed all publications with quantitative retinal vascular assessment in two databases: PubMed and Scopus. Early life CVD risk factors were classified into four groups: birth risk factors, environmental risk factors, systemic risk factors and conditions linked to future CVD development. Retinal vascular changes were associated with lower birth weight, shorter gestational age, low‐fibre and high‐sugar diet, lesser physical activity, parental hypertension history, childhood hypertension, childhood overweight/obesity, childhood depression/anxiety and childhood type 1 diabetes mellitus. In summary, there is increasing evidence supporting the view that structural changes in the retinal microvasculature are associated with CVD risk factors in early life. Thus, the retina is a useful site for pre‐clinical assessment of microvascular processes that may underlie the future development of CVD in adulthood. PMID:26435039

Photoinitiated chemical vapor deposition of cytocompatible poly(2-hydroxyethyl methacrylate) films.

PubMed

McMahon, Brian J; Pfluger, Courtney A; Sun, Bing; Ziemer, Katherine S; Burkey, Daniel D; Carrier, Rebecca L

2014-07-01

Poly(2-hydroxyethyl methacrylate) (pHEMA) is a widely utilized biomaterial due to lack of toxicity and suitable mechanical properties; conformal thin pHEMA films produced via chemical vapor deposition (CVD) would thus have broad biomedical applications. Thin films of pHEMA were deposited using photoinitiated CVD (piCVD). Incorporation of ethylene glycol diacrylate (EGDA) into the pHEMA polymer film as a crosslinker, confirmed via Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy, resulted in varied swelling and degradation behavior. 2-Hydroxyethyl methacrylate-only films showed significant thickness loss (up to 40%), possibly due to extraction of low-molecular-weight species or erosion, after 24 h in aqueous solution, whereas films crosslinked with EGDA (9.25-12.4%) were stable for up to 21 days. These results differ significantly from those obtained with plasma-polymerized pHEMA, which degraded steadily over a 21-day period, even with crosslinking. This suggests that the piCVD films differ structurally from those fabricated via plasma polymerization (plasma-enhanced CVD). piCVD pHEMA coatings proved to be good cell culture materials, with Caco-2 cell attachment and viability comparable to results obtained on tissue-culture polystyrene. Thus, thin film CVD pHEMA offers the advantage of enabling conformal coating of a cell culture substrate with tunable properties depending on method of preparation and incorporation of crosslinking agents. © 2013 Wiley Periodicals, Inc.

Number of recent stressful life events and incident cardiovascular disease: Moderation by lifetime depressive disorder.

PubMed

Berntson, Jessica; Patel, Jay S; Stewart, Jesse C

2017-08-01

We investigated whether number of recent stressful life events is associated with incident cardiovascular disease (CVD) and whether this relationship is stronger in adults with a history of clinical depression. Prospective data from 28,583 U.S. adults (mean age=45years) initially free of CVD who participated in Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were examined. Number of past-year stressful life events (Wave 1), lifetime depressive disorder (Wave 1), and incident CVD (Wave 2) were determined by structured interviews. There were 1069 cases of incident CVD. Each additional stressful life event was associated with a 15% increased odds of incident CVD [Odds Ratio (OR)=1.15, 95% Confidence Interval (CI): 1.11, 1.19]. As hypothesized, a stressful life events by lifetime depressive disorder interaction was detected (P=0.003). Stratified analyses indicated that stressful life events had a stronger association with incident CVD among adults with (OR=1.18, 95% CI: 1.10, 1.27, n=4908) versus without (OR=1.10, 95% CI: 1.07, 1.14, n=23,675) a lifetime depressive disorder. Our findings suggest that a greater number of recent stressful life events elevate the risk of new-onset CVD and that this risk is potentiated in adults with a history of clinical depression. Copyright © 2017 Elsevier Inc. All rights reserved.

Superhydrophobic Copper Surfaces with Anticorrosion Properties Fabricated by Solventless CVD Methods.

PubMed

Vilaró, Ignasi; Yagüe, Jose L; Borrós, Salvador

2017-01-11

Due to continuous miniaturization and increasing number of electrical components in electronics, copper interconnections have become critical for the design of 3D integrated circuits. However, corrosion attack on the copper metal can affect the electronic performance of the material. Superhydrophobic coatings are a commonly used strategy to prevent this undesired effect. In this work, a solventless two-steps process was developed to fabricate superhydrophobic copper surfaces using chemical vapor deposition (CVD) methods. The superhydrophobic state was achieved through the design of a hierarchical structure, combining micro-/nanoscale domains. In the first step, O 2 - and Ar-plasma etchings were performed on the copper substrate to generate microroughness. Afterward, a conformal copolymer, 1H,1H,2H,2H-perfluorodecyl acrylate-ethylene glycol diacrylate [p(PFDA-co-EGDA)], was deposited on top of the metal via initiated CVD (iCVD) to lower the surface energy of the surface. The copolymer topography exhibited a very characteristic and unique nanoworm-like structure. The combination of the nanofeatures of the polymer with the microroughness of the copper led to achievement of the superhydrophobic state. AFM, SEM, and XPS were used to characterize the evolution in topography and chemical composition during the CVD processes. The modified copper showed water contact angles as high as 163° and hysteresis as low as 1°. The coating withstood exposure to aggressive media for extended periods of time. Tafel analysis was used to compare the corrosion rates between bare and modified copper. Results indicated that iCVD-coated copper corrodes 3 orders of magnitude slower than untreated copper. The surface modification process yielded repeatable and robust superhydrophobic coatings with remarkable anticorrosion properties.

Room Temperature Sensing Achieved by GaAs Nanowires and oCVD Polymer Coating.

PubMed

Wang, Xiaoxue; Ermez, Sema; Goktas, Hilal; Gradečak, Silvija; Gleason, Karen

2017-06-01

Novel structures comprised of GaAs nanowire arrays conformally coated with conducting polymers (poly(3,4-ethylenedioxythiophene) (PEDOT) or poly(3,4-ethylenedioxythiophene-co-3-thiophene acetic acid) display both sensitivity and selectivity to a variety of volatile organic chemicals. A key feature is room temperature operation, so that neither a heater nor the power it would consume, is required. It is a distinct difference from traditional metal oxide sensors, which typically require elevated operational temperature. The GaAs nanowires are prepared directly via self-seeded metal-organic chemical deposition, and conducting polymers are deposited on GaAs nanowires using oxidative chemical vapor deposition (oCVD). The range of thickness for the oCVD layer is between 100 and 200 nm, which is controlled by changing the deposition time. X-ray diffraction analysis indicates an edge-on alignment of the crystalline structure of the PEDOT coating layer on GaAs nanowires. In addition, the positive correlation between the improvement of sensitivity and the increasing nanowire density is demonstrated. Furthermore, the effect of different oCVD coating materials is studied. The sensing mechanism is also discussed with studies considering both nanowire density and polymer types. Overall, the novel structure exhibits good sensitivity and selectivity in gas sensing, and provides a promising platform for future sensor design. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis.

PubMed

Watkins, David A; Olson, Zachary D; Verguet, Stéphane; Nugent, Rachel A; Jamison, Dean T

2016-02-01

The South African Government recently set targets to reduce cardiovascular disease (CVD) by lowering salt consumption. We conducted an extended cost-effectiveness analysis (ECEA) to model the potential health and economic impacts of this salt policy. We used surveys and epidemiologic studies to estimate reductions in CVD resulting from lower salt intake. We calculated the average out-of-pocket (OOP) cost of CVD care, using facility fee schedules and drug prices. We estimated the reduction in OOP expenditures and government subsidies due to the policy. We estimated public and private sector costs of policy implementation. We estimated financial risk protection (FRP) from the policy as (1) cases of catastrophic health expenditure (CHE) averted or (2) cases of poverty averted. We also performed a sensitivity analysis. We found that the salt policy could reduce CVD deaths by 11%, with similar health gains across income quintiles. The policy could save households US$ 4.06 million (2012) in OOP expenditures (US$ 0.29 per capita) and save the government US$ 51.25 million in healthcare subsidies (US$ 2.52 per capita) each year. The cost to the government would be only US$ 0.01 per capita; hence, the policy would be cost saving. If the private sector food reformulation costs were passed on to consumers, food expenditures would increase by <0.2% across all income quintiles. Preventing CVD could avert 2400 cases of CHE or 2000 cases of poverty yearly. Our results were sensitive to baseline CVD mortality rates and the cost of treatment. We conclude that, in addition to health gains, population salt reduction can have positive economic impacts-substantially reducing OOP expenditures and providing FRP, particularly for the middle class. The policy could also provide large government savings on health care. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Use of medications and lifestyles of hypertensive patients with high risk of cardiovascular disease in rural China.

PubMed

Zou, Guanyang; Zhang, Zhitong; Walley, John; Gong, Weiwei; Yu, Yunxian; Hu, Ruying; Yin, Jia; Yu, Min; Wei, Xiaolin

2015-01-01

Hypertension, with a global prevalence of 40%, is a risk factor for cardiovascular diseases (CVD). We conducted an exploratory study in Zhejiang China to understand the prevention of CVD among hypertensive patients with a 10 year CVD risk of 20% or higher. We assessed current practices in a rural 'township hospital' (a primary care facility), and compared them with international evidence-based practice. A questionnaire survey was conducted to examine the use of modern drugs (antihypertensive drugs, statins and aspirin) and traditional drugs, compliance to medications and lifestyle among 274 hypertensive patients aged 40-74, with a CVD risk of 20% or higher (using the Asian Equation). The majority (72%) were diagnosed with hypertension at township hospitals. Only 15% of study participants used two anti-hypertensive drugs, 0.7% took statin and 2.9% aspirin. Only 2.9% combined two types of modern drugs, while 0.4% combined three types (antihypertensives, statins and aspirin). Herbal compounds, sometimes with internationally rarely recommended drugs such as Reserpine were taken by 44%. Analysis of drug adherence showed that 9.8% had discontinued their drug therapy by themselves. 16% had missed doses and these were on less anti-hypertensive drugs than those who did not (t=-5.217, P=0.003). Of all participants, 28% currently smoked, 39% drank regularly and only 21% exercised frequently. The average salt intake per day was 7.1 (±3.8) g, while the national recommended level is 6g. The study revealed outdated and inadequate treatment and health education for hypertensive patients, especially for those who have high risk scores for CVD. There is a need to review the community-based guidelines for hypertension management. Health providers and patients should make a transition from solely treating hypertension, towards prevention of CVD. Health system issues need addressing including improving rural health insurance cover and primary care doctors' capacity to manage chronic disease patients.

75 FR 31763 - Foreign-Trade Zone 29; Application for Subzone Authority; Dow Corning Corporation; Invitation for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-04

... ripple effect on silicon metal suppliers could be significant and the likely resulting impact would be a... to the U.S. market and resulting price effect would likely be significant. In part due to the AD/CVD... domestic facilities. The preliminary recommendation also reflects the cumulative effect on domestic silicon...

Sub-10-nm patterning via directed self-assembly of block copolymer films with a vapour-phase deposited topcoat

DOE Office of Scientific and Technical Information (OSTI.GOV)

Suh, Hyo Seon; Kim, Do Han; Moni, Priya

2017-03-27

Directed self-assembly (DSA) of the domain structure in block copolymer (BCP) thin films is a promising approach for sub-10-nm surface patterning. DSA requires the control of interfacial properties on both interfaces of a BCP film to induce the formation of domains that traverse the entire film with a perpendicular orientation. Here we show a methodology to control the interfacial properties of BCP films that uses a polymer topcoat deposited by initiated chemical vapour deposition (iCVD). The iCVD topcoat forms a crosslinked network that grafts to and immobilizes BCP chains to create an interface that is equally attractive to both blocksmore » of the underlying copolymer. The topcoat, in conjunction with a chemically patterned substrate, directs the assembly of the grating structures in BCP films with a half-pitch dimension of 9.3 nm. As the iCVD topcoat can be as thin as 7 nm, it is amenable to pattern transfer without removal. As a result, the ease of vapour-phase deposition, applicability to high-resolution BCP systems and integration with pattern-transfer schemes are attractive properties of iCVD topcoats for industrial applications.« less

Communicating cardiovascular disease risk: an interview study of General Practitioners’ use of absolute risk within tailored communication strategies

PubMed Central

2014-01-01

Background Cardiovascular disease (CVD) prevention guidelines encourage assessment of absolute CVD risk - the probability of a CVD event within a fixed time period, based on the most predictive risk factors. However, few General Practitioners (GPs) use absolute CVD risk consistently, and communication difficulties have been identified as a barrier to changing practice. This study aimed to explore GPs’ descriptions of their CVD risk communication strategies, including the role of absolute risk. Methods Semi-structured interviews were conducted with a purposive sample of 25 GPs in New South Wales, Australia. Transcribed audio-recordings were thematically coded, using the Framework Analysis method to ensure rigour. Results GPs used absolute CVD risk within three different communication strategies: ‘positive’, ‘scare tactic’, and ‘indirect’. A ‘positive’ strategy, which aimed to reassure and motivate, was used for patients with low risk, determination to change lifestyle, and some concern about CVD risk. Absolute risk was used to show how they could reduce risk. A ‘scare tactic’ strategy was used for patients with high risk, lack of motivation, and a dismissive attitude. Absolute risk was used to ‘scare’ them into taking action. An ‘indirect’ strategy, where CVD risk was not the main focus, was used for patients with low risk but some lifestyle risk factors, high anxiety, high resistance to change, or difficulty understanding probabilities. Non-quantitative absolute risk formats were found to be helpful in these situations. Conclusions This study demonstrated how GPs use three different communication strategies to address the issue of CVD risk, depending on their perception of patient risk, motivation and anxiety. Absolute risk played a different role within each strategy. Providing GPs with alternative ways of explaining absolute risk, in order to achieve different communication aims, may improve their use of absolute CVD risk assessment in practice. PMID:24885409

An explanatory model of community pharmacists' support in the secondary prevention of cardiovascular disease.

PubMed

Puspitasari, Hanni P; Costa, Daniel S J; Aslani, Parisa; Krass, Ines

2016-01-01

Community pharmacists have faced ongoing challenges in the delivery of clinical pharmacy services. Various attitudinal and environmental factors have been found to be associated with the provision of general clinical pharmacy services or services which focus on a specific condition, including cardiovascular disease (CVD). However, the interrelationship and relative influence of explanatory factors has not been investigated. To develop a model illustrating influences on CVD support provision by community pharmacists. Mail surveys were sent to a random sample of 1350 Australian community pharmacies to investigate determinants of CVD support provision. A theoretical model modified from the Theory of Planned Behavior (TPB) was used as a framework for the survey instrument. Structural equation modeling was used to determine how pharmacists' attitudes and environmental factors influence CVD support. A response rate of 15.8% (209/1320) was obtained. The model for CVD support provision by community pharmacists demonstrated good fit: χ(2)/df = 1.403, RMSEA = 0.047 (90% CI = 0.031-0.062), CFI = 0.962, TLI = 0.955 and WRMR = 0.838. Factors found to predict CVD support included: two attitudinal latent factors ("subjective norms of pharmacists' role in CVD support" and "pharmacists' perceived responsibilities in CVD support") and environmental factors i.e. pharmacy infrastructure (documentation and a private area), workload, location; government funded pharmacy practice programs; and pharmacists' involvement with Continuing Professional Development and attendance at CVD courses. Pharmacists' attitudes appeared to be the strongest predictor of CVD support provision. The TPB framework was useful in identifying "subjective norms" and "pharmacists' beliefs" as key constructs of community pharmacists' attitudes. Community pharmacies would be able to provide such an advanced clinical service if they strongly believed that this was an acknowledged part of their scope of practice, had adequate infrastructure and employed sufficient numbers of pharmacists with appropriate and relevant knowledge. Copyright © 2016 Elsevier Inc. All rights reserved.

Type and Proximity of Green Spaces Are Important for Preventing Cardiovascular Morbidity and Diabetes—A Cross-Sectional Study for Quebec, Canada

PubMed Central

Ngom, Roland; Gosselin, Pierre; Blais, Claudia; Rochette, Louis

2016-01-01

This study aimed at determining the role of proximity to specific types of green spaces (GSes) as well as their spatial location in the relationship with the most morbid cardiovascular diseases (CVD) and diabetes. We measured the accessibility to various types of GS and used a cross-sectional approach at census Dissemination Area (DA) levels in the Montreal and Quebec City metropolitan zones for the period 2006–2011. Poisson and negative binomial regression models were fitted to quantify the relationship between distances to specific types of GS and CVD morbidity as well as some risk factors (diabetes and hypertension) while controlling for several social and environmental confounders. GSes that have sports facilities showed a significant relationship to cerebrovascular diseases: the most distant population had an 11% higher prevalence rate ratio (PRR) compared to the nearest, as well as higher diabetes risk (PRR 9%) than the nearest. However, the overall model performance and the understanding of the role of GSes with sport facilities may be substantially achieved with lifestyle factors. Significantly higher prevalence of diabetes and cerebrovascular diseases as well as lower access to GSes equipped with sports facilities were found in suburban areas. GSes can advantageously be used to prevent some CVDs and their risk factors, but there may be a need to reconsider their types and location. PMID:27089356

'Extra information a bit further down the line': rheumatoid arthritis patients' perceptions of developing educational material about the cardiovascular disease risk.

PubMed

John, Holly; Hale, Elizabeth D; Treharne, Gareth J; Carroll, Douglas; Kitas, George D

2009-12-01

There are no patient education programmes addressing the increased risk of cardiovascular disease (CVD) associated with rheumatoid arthritis (RA). This is the second in a pair of studies exploring stakeholder perceptions of developing such educational material. Healthcare professionals' perceptions were explored in the first study; here, we explore the perceptions of people with RA. Semi-structured interviews were held individually with 18 people with RA, purposively sampled to include participants with no co-morbid history of CVD, those with CVD risk factors and those who had experienced a CVD event. The interview transcripts were analysed using interpretative phenomenological analysis. Four superordinate themes were identified: experiences of living with RA; reactions to learning about co-morbid CVD; implementing lifestyle changes; and expectations of education. Participants found being diagnosed with RA a devastating experience and were mostly unaware of their increased risk of CVD co-morbidity. They explained how information about CVD would be overwhelming and irrelevant at diagnosis, but they would have coped with 'extra information a bit further down the line'. There is a need to develop educational material or programmes. Their design must consider factors which facilitate lifestyle change, such as motivation or receiving personalized advice, and factors that inhibit change, such as depression or fatalism. Emphasizing the positive effects that some CVD lifestyle changes may have on RA symptom control may be particularly persuasive. Group education would be a popular format. These findings can be directly translated into clinical practice. Copyright (c) 2009 John Wiley & Sons, Ltd.

Carbon-carbon primary structure for SSTO vehicles

NASA Astrophysics Data System (ADS)

Croop, Harold C.; Lowndes, Holland B.

1997-01-01

A hot structures development program is nearing completion to validate use of carbon-carbon composite structure for primary load carrying members in a single-stage-to-orbit, or SSTO, vehicle. A four phase program was pursued which involved design development and fabrication of a full-scale wing torque box demonstration component. The design development included vehicle and component selection, design criteria and approach, design data development, demonstration component design and analysis, test fixture design and analysis, demonstration component test planning, and high temperature test instrumentation development. The fabrication effort encompassed fabrication of structural elements for mechanical property verification as well as fabrication of the demonstration component itself and associated test fixturing. The demonstration component features 3D woven graphite preforms, integral spars, oxidation inhibited matrix, chemical vapor deposited (CVD) SiC oxidation protection coating, and ceramic matrix composite fasteners. The demonstration component has been delivered to the United States Air Force (USAF) for testing in the Wright Laboratory Structural Test Facility, WPAFB, OH. Multiple thermal-mechanical load cycles will be applied simulating two atmospheric cruise missions and one orbital mission. This paper discusses the overall approach to validation testing of the wing box component and presents some preliminary analytical test predictions.

Revealing the microscopic CVD growth mechanism of MoSe2 and the role of hydrogen gas during the growth procedure.

PubMed

Wang, Hulian; Zhu, Dancheng; Jiang, Feng; Zhao, Pei; Wang, Hongtao; Zhang, Ze; Chen, Xin; Jin, Chuanhong

2018-08-03

Understanding the microscopic mechanisms for the nucleation and growth of two-dimensional molybdenum diselenide (2D MoSe 2 ) via chemical vapor deposition (CVD) is crucial towards the precisely controlled growth of the 2D material. In this work, we employed a joint use of transmission electron microscopy and CVD, in which the 2D MoSe 2 were directly grown on a graphene membrane based on grids, that enables the microstructural characterization of as-grown MoSe 2 flakes. We further explore the role of hydrogen gas and find: in an argon ambient, the primary products are few-layer MoSe 2 flakes, along with MoO x nanoparticles; while with the introduction of H 2 , single-layer MoSe 2 became the dominant product during the CVD growth. Quantitative analysis of the effects of H 2 flow rate on the flake sizes, and areal coverage was also given. Nevertheless, we further illuminated the evolution of shape morphology and edge structures of single-layer MoSe 2 , and proposed the associated growth routes during a typical CVD process.

Electronic structure of polycrystalline CVD-graphene revealed by Nano-ARPES

NASA Astrophysics Data System (ADS)

Chen, Chaoyu; Avila, José; Asensio, Maria C.

2017-06-01

The ability to explore electronic structure and their role in determining material’s macroscopic behaviour is essential to explain and engineer functions of material and device. Since its debut in 2004, graphene has attracted global research interest due to its unique properties. Chemical vapor deposition (CVD) has emerged as an important method for the massive preparation and production of graphene for various applications. Here by employing angle-resolved photoemission spectroscopy with nanoscale spatial resolution ˜ 100 nm (Nano-ARPES), we describe the approach to measure the electronic structure of polycrystalline graphene on copper foils, demonstrating the power of Nano-ARPES to detect the electronic structure of microscopic single crystalline domains, being fully compatible with conventional ARPES. Similar analysis could be employed to other microscopic materials

Mechanisms of vascular aging: What can we learn from Hutchinson-Gilford progeria syndrome?

PubMed

Del Campo, Lara; Hamczyk, Magda R; Andrés, Vicente; Martínez-González, José; Rodríguez, Cristina

Aging is the main risk factor for cardiovascular disease (CVD). The increased prevalence of CVD is partly due to the global increase in life expectancy. In this context, it is essential to identify the mechanisms by which aging induces CVD, with the ultimate aim of reducing its incidence. Both atherosclerosis and heart failure significantly contribute to age-associated CVD morbidity and mortality. Hutchinson-Gilford progeria syndrome (HGPS) is a rare genetic disorder caused by the synthesis of progerin, which is noted for accelerated aging and CVD. This mutant form of prelamin A induces generalised atherosclerosis, vascular calcification, and cardiac electrophysiological abnormalities, leading to premature aging and death, mainly due to myocardial infarction and stroke. This review discusses the main vascular structural and functional abnormalities during physiological and premature aging, as well as the mechanisms involved in the exacerbated CVD and accelerated aging induced by the accumulation of progerin and prelamin A. Both proteins are expressed in non-HGPS individuals, and physiological aging shares many features of progeria. Research into HGPS could therefore shed light on novel mechanisms involved in the physiological aging of the cardiovascular system. Copyright © 2018 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

Iridium-coated rhenium thrusters by CVD

NASA Technical Reports Server (NTRS)

Harding, J. T.; Kazaroff, J. M.; Appel, M. A.

1989-01-01

Operation of spacecraft thrusters at increased temperature reduces propellant requirements. Inasmuch as propellant comprises the bulk of a satellite's mass, even a small percentage reduction makes possible a significant enhancement of the mission in terms of increased payload. Because of its excellent high temperature strength, rhenium is often the structural material of choice. It can be fabricated into free-standing shapes by chemical vapor deposition (CVD) onto an expendable mandrel. What rhenium lacks is oxidation resistance, but this can be provided by a coating of iridium, also by CVD. This paper describes the process used by Ultramet to fabricate 22-N (5-lbf) and, more recently, 445-N (100-lbf) Ir/Re thrusters; characterizes the CVD-deposited materials; and summarizes the materials effects of firing these thrusters. Optimal propellant mixture ratios can be employed because the materials withstand an oxidizing environment up to the melting temperature of iridium, 2400 C (4350 F).

Iridium-coated rhenium thrusters by CVD

NASA Technical Reports Server (NTRS)

Harding, John T.; Kazaroff, John M.; Appel, Marshall A.

1988-01-01

Operation of spacecraft thrusters at increased temperature reduces propellant requirements. Inasmuch as propellant comprises the bulk of a satellite's mass, even a small percentage reduction makes possible a significant enhancement of the mission in terms of increased payload. Because of its excellent high temperature strength, rhenium is often the structural material of choice. It can be fabricated into free-standing shapes by chemical vapor deposition (CVD) onto an expendable mandrel. What rhenium lacks is oxidation resistance, but this can be provided by a coating of iridium, also by CVD. This paper describes the process used by Ultramet to fabricate 22-N (5-lbf) and, more recently, 445-N (100-lbf) Ir/Re thrusters; characterizes the CVD-deposited materials; and summarizes the materials effects of firing these thrusters. Optimal propellant mixture ratios can be employed because the materials withstand an oxidizing environment up to the meltimg temperature of iridium, 2400 C (4350 F).

Ion beam figuring of CVD silicon carbide mirrors

NASA Astrophysics Data System (ADS)

Gailly, P.; Collette, J.-P.; Fleury Frenette, K.; Jamar, C.

2017-11-01

Optical and structural elements made of silicon carbide are increasingly found in space instruments. Chemical vapor deposited silicon carbide (CVD-SiC) is used as a reflective coating on SiC optics in reason of its good behavior under polishing. The advantage of applying ion beam figuring (IBF) to CVD-SiC over other surface figure-improving techniques is discussed herein. The results of an IBF sequence performed at the Centre Spatial de Liège on a 100 mm CVD-SiC mirror are reported. The process allowed to reduce the mirror surface errors from 243 nm to 13 nm rms . Beside the surface figure, roughness is another critical feature to consider in order to preserve the optical quality of CVD-SiC . Thus, experiments focusing on the evolution of roughness were performed in various ion beam etching conditions. The roughness of samples etched at different depths down to 3 ≠m was determined with an optical profilometer. These measurements emphasize the importance of selecting the right combination of gas and beam energy to keep roughness at a low level. Kaufman-type ion sources are generally used to perform IBF but the performance of an end-Hall ion source in figuring CVD-SiC mirrors was also evaluated in this study. In order to do so, ion beam etching profiles obtained with the end-Hall source on CVD-SiC were measured and used as a basis for IBF simulations.

Use of Abacavir and Risk of Cardiovascular Disease Among HIV-Infected Individuals.

PubMed

Marcus, Julia L; Neugebauer, Romain S; Leyden, Wendy A; Chao, Chun R; Xu, Lanfang; Quesenberry, Charles P; Klein, Daniel B; Towner, William J; Horberg, Michael A; Silverberg, Michael J

2016-04-01

Evidence is conflicting about the association of abacavir use and cardiovascular disease (CVD) among HIV-infected individuals. Previous studies may have been biased by the preferential initiation or continuation of abacavir in patients with renal dysfunction. We conducted a cohort study in Kaiser Permanente California during 1998-2011, following HIV-infected adults initiating antiretroviral therapy until the earliest of CVD (ie, coronary heart disease or ischemic stroke), health plan disenrollment, death, or end of study. We used inverse-probability weighting to fit marginal structural models to estimate hazard ratios (HRs) for CVD comparing regimens with and without abacavir. Propensity score models included demographics, HIV-specific factors, and CVD risk factors, including alcohol/drug use, smoking, overweight/obesity, diabetes, lipid-lowering and hypertension therapy, and renal dysfunction (ie, estimated glomerular filtration rate <60 mL·min·1.73 m). Among 8154 subjects, 178 had ≥1 CVD event, with 24/704 (3.4%) in the abacavir group and 154/7450 (2.1%) in the group initiating regimens without abacavir. Abacavir users had more renal dysfunction at antiretroviral therapy initiation (7.0% vs. 3.3%, P < 0.001). Compared with patients initiating regimens without abacavir, abacavir users had a 2.2-fold higher risk of CVD in intention-to-treat analysis [HR 2.2, 95% confidence interval (CI): 1.4 to 3.5], a 2.7-fold higher risk when remaining on their initial regimens for ≥1 year (HR 2.7, 95% CI: 1.5 to 5.0), and a 2.1-fold higher risk in per-protocol analysis (HR 2.1, 95% CI: 0.9 to 5.0). Abacavir was associated with an over 2-fold increased risk of CVD, which was not explained by renal dysfunction or other CVD risk factors.

Diffusion mechanisms in chemical vapor-deposited iridium coated on chemical vapor-deposited rhenium

NASA Technical Reports Server (NTRS)

Hamilton, J. C.; Yang, N. Y. C.; Clift, W. M.; Boehme, D. R.; Mccarty, K. F.; Franklin, J. E.

1992-01-01

Radiation-cooled rocket thruster chambers have been developed which use CVD Re coated with CVD Ir on the interior surface that is exposed to hot combustion gases. The Ir serves as an oxidation barrier which protects the structural integrity-maintaining Re at elevated temperatures. The diffusion kinetics of CVD materials at elevated temperatures is presently studied with a view to the prediction and extension of these thrusters' performance limits. Line scans for Ir and Re were fit on the basis of a diffusion model, in order to extract relevant diffusion constants; the fastest diffusion process is grain-boundary diffusion, where Re diffuses down grain boundaries in the Ir overlayer.

The research on endothelial function in women and men at risk for cardiovascular disease (REWARD) study: methodology

PubMed Central

2011-01-01

Background Endothelial function has been shown to be a highly sensitive marker for the overall cardiovascular risk of an individual. Furthermore, there is evidence of important sex differences in endothelial function that may underlie the differential presentation of cardiovascular disease (CVD) in women relative to men. As such, measuring endothelial function may have sex-specific prognostic value for the prediction of CVD events, thus improving risk stratification for the overall prediction of CVD in both men and women. The primary objective of this study is to assess the clinical utility of the forearm hyperaemic reactivity (FHR) test (a proxy measure of endothelial function) for the prediction of CVD events in men vs. women using a novel, noninvasive nuclear medicine -based approach. It is hypothesised that: 1) endothelial dysfunction will be a significant predictor of 5-year CVD events independent of baseline stress test results, clinical, demographic, and psychological variables in both men and women; and 2) endothelial dysfunction will be a better predictor of 5-year CVD events in women compared to men. Methods/Design A total of 1972 patients (812 men and 1160 women) undergoing a dipyridamole stress testing were recruited. Medical history, CVD risk factors, health behaviours, psychological status, and gender identity were assessed via structured interview or self-report questionnaires at baseline. In addition, FHR was assessed, as well as levels of sex hormones via blood draw. Patients will be followed for 5 years to assess major CVD events (cardiac mortality, non-fatal MI, revascularization procedures, and cerebrovascular events). Discussion This is the first study to determine the extent and nature of any sex differences in the ability of endothelial function to predict CVD events. We believe the results of this study will provide data that will better inform the choice of diagnostic tests in men and women and bring the quality of risk stratification in women on par with that of men. PMID:21831309

Characterization of nephelium mutabile blume-like structure of carbon nanotubes prepared from palm oil by CVD method

NASA Astrophysics Data System (ADS)

Maryam, M.; Shamsudin, M. S.; Rusop, M.

2017-09-01

A new structure of carbon nanotube was produced from the Single furnace Aerosol-assisted Catalytic CVD (SFAACVD) method using Palm Oil (PO) as the precursor and Ferrocene (Fe) as the catalyst. A nephelium mutabile blume (rambutan)-like structure of CNTs was found from the black substance collected from the Alumina boat substrate placed inside the furnace. Temperature of furnace which was heated at 600 °C - 800 °C plays an important role in determining the formation of structure. The formation rambutan-like structure of CNTs was optimized at 700 °C and the samples collected were characterized by Field Emission Scanning Electron Microscope (FE-SEM) to obtain the surface morphologies. Raman Spectroscopy (RS) and Thermogravimetric Analysis (TGA) were then used to further study the Raman Spectra and purity of samples.

Interface properties of SiO2/GaN structures formed by chemical vapor deposition with remote oxygen plasma mixed with Ar or He

NASA Astrophysics Data System (ADS)

Truyen, Nguyen Xuan; Taoka, Noriyuki; Ohta, Akio; Makihara, Katsunori; Yamada, Hisashi; Takahashi, Tokio; Ikeda, Mitsuhisa; Shimizu, Mitsuaki; Miyazaki, Seiichi

2018-06-01

The impacts of noble gas species (Ar and He) on the formation of a SiO2/GaN structure formed by a remote oxygen plasma-enhanced chemical vapor deposition (ROPE-CVD) method were systematically investigated. Atomic force microscopy revealed that ROPE-CVD with He leads to a smooth SiO2 surface compared with the case of Ar. We found that no obvious oxidations of the GaN surfaces after the SiO2 depositions with the both Ar and He cases were observed. The capacitance–voltage (C–V) curves of the GaN MOS capacitors formed by ROPE-CVD with the Ar and He dilutions show good interface properties with no hysteresis and good agreement with the ideal C–V curves even after post deposition annealing at 800 °C. Besides, we found that the current density–oxide electric field characteristics shows a gate leakage current for the Ar case lower than the He case.

Composition and Morphology Control of Metal Dichalcogenides via Chemical Vapor Deposition for Photovoltaic and Nanoelectronic Applications

NASA Astrophysics Data System (ADS)

Samad, Leith L. J.

The body of work reviewed here encompasses a variety of metal dichalcogenides all synthesized using chemical vapor deposition (CVD) for solar and electronics applications. The first reported phase-pure CVD synthesis of iron pyrite thin films is presented with detailed structural and electrochemical analysis. The phase-pure thin film and improved crystal growth on a metallic backing material represents one of the best options for potential solar applications using iron pyrite. Large tin-sulfur-selenide solid solution plates with tunable bandgaps were also synthesized via CVD as single-crystals with a thin film geometry. Solid solution tin-sulfur-selenide plates were demonstrated to be a new material for solar cells with the first observed solar conversion efficiencies up to 3.1%. Finally, a low temperature molybdenum disulfide vertical heterostructure CVD synthesis with layered controlled growth was achieved with preferential growth enabled by Van der Waals epitaxy. Through recognition of additional reaction parameters, a fully regulated CVD synthesis enabled the controlled growth of 1-6 molybdenum disulfide monolayers for nanoelectronic applications. The improvements in synthesis and materials presented here were all enabled by the control afforded by CVD such that advances in phase purity, growth, and composition control of several metal dichalcogenides were achieved. Further work will be able to take full advantage of these advances for future solar and electronics technologies.

General Practitioners’ Decision Making about Primary Prevention of Cardiovascular Disease in Older Adults: A Qualitative Study

PubMed Central

Jansen, Jesse; Bonner, Carissa; Irwig, Les; Doust, Jenny; Glasziou, Paul; Bell, Katy; Naganathan, Vasi; McCaffery, Kirsten

2017-01-01

Background Primary cardiovascular disease (CVD) prevention in older people is challenging as they are a diverse group with varying needs, frequent presence of comorbidities, and are more susceptible to treatment harms. Moreover the potential benefits and harms of preventive medication for older people are uncertain. We explored GPs’ decision making about primary CVD prevention in patients aged 75 years and older. Method 25 GPs participated in semi-structured interviews in New South Wales, Australia. Transcribed audio-recordings were thematically coded and Framework Analysis was used. Results Analysis identified factors that are likely to contribute to variation in the management of CVD risk in older people. Some GPs based CVD prevention on guidelines regardless of patient age. Others tailored management based on factors such as perceptions of prevention in older age, knowledge of limited evidence, comorbidities, polypharmacy, frailty, and life expectancy. GPs were more confident about: 1) medication and lifestyle change for fit/healthy older patients, and 2) stopping or avoiding medication for frail/nursing home patients. Decision making for older patients outside of these categories was less clear. Conclusion Older patients receive different care depending on their GP’s perceptions of ageing and CVD prevention, and their knowledge of available evidence. GPs consider CVD prevention for older patients challenging and would welcome more guidance in this area. PMID:28085944

Surface modification for interaction study with bacteria and preosteoblast cells

NASA Astrophysics Data System (ADS)

Song, Qing

Surface modification plays a pivotal role in bioengineering. Polymer coatings can provide biocompatibility and biofunctionalities to biomaterials through surface modification. In this dissertation, initiated chemical vapor deposition (iCVD) was utilized to coat two-dimensional (2D) and three-dimensional (3D) substrates with differently charged polyelectrolytes in order to generate antimicrobial and osteocompatible biomaterials. ICVD is a modified CVD technique that enables surface modification in an all-dry condition without substrate damage and solvent contamination. The free-radical polymerization allows the vinyl polymers to conformally coat on various micro- and nano-structured substrates and maintains the delicate structure of the functional groups. The vapor deposition of polycations provided antimicrobial activity to planar and porous substrates through destroying the negatively charged bacterial membrane and brought about high contact-killing efficiency (99.99%) against Gram-positive Bacillus subtilis and Gram-negative Escherichia coli. Additionally, the polyampholytes synthesized by iCVD exhibited excellent antifouling performance against the adhesion of Gram-positive Listeria innocua and Gram-negative E. coli in phosphate buffered saline (PBS). Their antifouling activities were attributed to the electrostatic interaction and hydration layers that served as physical and energetic barriers to prevent bacterial adhesion. The contact-killing and antifouling polymers synthesized by iCVD can be applied to surface modification of food processing equipment and medical devices with the aim of reducing foodborne diseases and medical infections. Moreover, the charged polyelectrolyte modified 2D polystyrene surfaces displayed good osteocompatibility and enhanced osteogenesis of preosteoblast cells than the un-modified polystyrene surface. In order to promote osteoinduction of hydroxyapatite (HA) scaffolds, bioinspired polymer-controlled mineralization was conducted on the polyelectrolyte modified HA scaffolds. The mineralized scaffolds stimulated osteogenesis of preosteoblast cells compared with the control HA scaffolds. Therefore, the surface modification through vapor deposition of polyelectrolytes and polymer-controlled mineralization can improve osteoinduction of bone materials. In summary, the iCVD-mediated surface modification is a simple and promising approach to biofunctionalizing various structured substrates and generating antimicrobial and biocompatible biomaterials.

Cumulative impact of axial, structural, and repolarization ECG findings on long-term cardiovascular mortality among healthy individuals in Japan: National Integrated Project for Prospective Observation of Non-Communicable Disease and its Trends in the Aged, 1980 and 1990.

PubMed

Inohara, Taku; Kohsaka, Shun; Okamura, Tomonori; Watanabe, Makoto; Nakamura, Yasuyuki; Higashiyama, Aya; Kadota, Aya; Okuda, Nagako; Murakami, Yoshitaka; Ohkubo, Takayoshi; Miura, Katsuyuki; Okayama, Akira; Ueshima, Hirotsugu

2014-12-01

Various cohort studies have shown a close association between long-term cardiovascular disease (CVD) outcomes and individual electrocardiographic (ECG) abnormalities such as axial, structural, and repolarization changes. The combined effect of these ECG abnormalities, each assumed to be benign, has not been thoroughly investigated. Community-dwelling Japanese residents from the National Integrated Project for Perspective Observation of Non-Communicable Disease and its Trends in the Aged, 1980-2004 and 1990-2005 (NIPPON DATA80 and 90), were included in this study. Baseline ECG findings were classified using the Minnesota Code and categorized into axial (left axis deviation, clockwise rotation), structural (left ventricular hypertrophy, atrial enlargement), and repolarization (minor and major ST-T changes) abnormalities. The hazard ratios of the cumulative impacts of ECG findings on long-term CVD death were estimated by stratified Cox proportional hazard models, including adjustments for cohort strata. In all, 16,816 participants were evaluated. The average age was 51.2 ± 13.5 years; 42.7% participants were male. The duration of follow up was 300,924 person-years (mean 17.9 ± 5.8 years); there were 1218 CVD deaths during that time. Overall, 4203 participants (25.0%) had one or more categorical ECG abnormalities: 3648 (21.7%) had a single abnormality, and 555 (3.3%) had two or more. The risk of CVD mortality increased as the number of abnormalities accumulated (single abnormality HR 1.29, 95% CI 1.13-1.48; ≥2 abnormalities HR 2.10, 95% CI 1.73-2.53). Individual ECG abnormalities had an additive effect in predicting CVD outcome risk in our large-scale cohort study. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

CVD of SiC and AlN using cyclic organometallic precursors

NASA Technical Reports Server (NTRS)

Interrante, L. V.; Larkin, D. J.; Amato, C.

1992-01-01

The use of cyclic organometallic molecules as single-source MOCVD precursors is illustrated by means of examples taken from our recent work on AlN and SiC deposition, with particular focus on SiC. Molecules containing (AlN)3 and (SiC)2 rings as the 'core structure' were employed as the source materials for these studies. The organoaluminum amide, (Me2AlNH2)3, was used as the AlN source and has been studied in a molecular beam sampling apparatus in order to determine the gas phase species present in a hot-wall CVD reactor environment. In the case of SiC CVD, a series of disilacyclobutanes (Si(XX')CH2)2 (with X and X' = H, CH3, and CH2SiH2CH3), were examined in a cold-wall, hot-stage CVD reactor in order to compare their relative reactivities and prospective utility as single-source CVD precursors. The parent compound, disilacyclobutane, (SiH2CH2)2, was found to exhibit the lowest deposition temperature (ca. 670 C) and to yield the highest purity SiC films. This precursor gave a highly textured, polycrystalline film on the Si(100) substrates.

A novel Mo-W interlayer approach for CVD diamond deposition on steel

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kundrát, Vojtěch; Sullivan, John; Ye, Haitao, E-mail: h.ye@aston.ac.uk

Steel is the most widely used material in engineering for its cost/performance ratio and coatings are routinely applied on its surface to further improve its properties. Diamond coated steel parts are an option for many demanding industrial applications through prolonging the lifetime of steel parts, enhancement of tool performance as well as the reduction of wear rates. Direct deposition of diamond on steel using conventional chemical vapour deposition (CVD) processes is known to give poor results due to the preferential formation of amorphous carbon on iron, nickel and other elements as well as stresses induced from the significant difference inmore » the thermal expansion coefficients of those materials. This article reports a novel approach of deposition of nanocrystalline diamond coatings on high-speed steel (M42) substrates using a multi-structured molybdenum (Mo) – tungsten (W) interlayer to form steel/Mo/Mo-W/W/diamond sandwich structures which overcome the adhesion problem related to direct magnetron sputtering deposition of pure tungsten. Surface, interface and tribology properties were evaluated to understand the role of such an interlayer structure. The multi-structured Mo-W interlayer has been proven to improve the adhesion between diamond films and steel substrates by acting as an effective diffusion barrier during the CVD diamond deposition.« less

A novel Mo-W interlayer approach for CVD diamond deposition on steel

NASA Astrophysics Data System (ADS)

Kundrát, Vojtěch; Zhang, Xiaoling; Cooke, Kevin; Sun, Hailin; Sullivan, John; Ye, Haitao

2015-04-01

Steel is the most widely used material in engineering for its cost/performance ratio and coatings are routinely applied on its surface to further improve its properties. Diamond coated steel parts are an option for many demanding industrial applications through prolonging the lifetime of steel parts, enhancement of tool performance as well as the reduction of wear rates. Direct deposition of diamond on steel using conventional chemical vapour deposition (CVD) processes is known to give poor results due to the preferential formation of amorphous carbon on iron, nickel and other elements as well as stresses induced from the significant difference in the thermal expansion coefficients of those materials. This article reports a novel approach of deposition of nanocrystalline diamond coatings on high-speed steel (M42) substrates using a multi-structured molybdenum (Mo) - tungsten (W) interlayer to form steel/Mo/Mo-W/W/diamond sandwich structures which overcome the adhesion problem related to direct magnetron sputtering deposition of pure tungsten. Surface, interface and tribology properties were evaluated to understand the role of such an interlayer structure. The multi-structured Mo-W interlayer has been proven to improve the adhesion between diamond films and steel substrates by acting as an effective diffusion barrier during the CVD diamond deposition.

SPE-LEEM Studies on the Surface and Electronic Structure of 2-D Transition Metal Dichalcogenides (Part II)

NASA Astrophysics Data System (ADS)

Jin, Wencan; Yeh, Po-Chun; Zaki, Nader; Zhang, Datong; Sadowski, Jerzy; Al-Mahboob, Abdullah; van de Zande, Arend; Chenet, Daniel; Dadap, Jerry; Herman, Irving; Sutter, Peter; Hone, James; Osgood, Richard

2014-03-01

In this work, we studied the surface and electronic structure of monolayer and few-layer exfoliated MoS2 and WSe2, as well as chemical-vapor-deposition (CVD) grown MoS2, using Spectroscopic Photoemission and Low Energy Electron Microscope (SPE-LEEM). LEEM measurements reveal that, unlike exfoliated MoS2, CVD-grown MoS2 exhibits grain-boundary alterations due to surface strain. However, LEEM and micro-probe low energy electron diffraction show that the quality of CVD-grown MoS2 is comparable to that of exfoliated MoS2. Micrometer-scale angle-resolved photoemission spectroscopy (ARPES) measurement on exfoliated MoS2 and WSe2 single-crystals provides direct evidence for the shifting of the valence band maximum from Γ to K, when the layer number is thinned down to one, as predicted by density functional theory. Our measurements of the k-space resolved electronic structure allow for further comparison with other theoretical predictions and with transport measurements. This work is supported by DOE grant DE-FG 02-04-ER-46157, research carried out in part at the CFN and NSLS, Brookhaven National Laboratory.

C-Ni-Pd and CNT-Ni-Pd film's molecular and crystalline structure investigations by FTIR spectroscopy and XRD diffraction

NASA Astrophysics Data System (ADS)

Stepińska, Izabela; Czerwosz, ElŻbieta; Diduszko, Ryszard; Kozłowski, Mirosław; Wronka, Halina

2017-08-01

In this work molecular and crystalline structure of new type of nanocomposite films were investigated. These films compose of CNT decorated with palladium nanograins. They were prepared on a base of C-Ni films modified in CVD process. C-Ni nanocomposite films were obtained by PVD process and their modification by CVD leads to a growth of CNT film. CNTs-Ni or C-Ni films were treated with additional PVD process with palladium. Nickel and palladium acetate and fulleren C60 are precursors of films in PVD process. FTIR spectroscopy was used to studied the molecular structure of film in every stage of preparation . The crystalline structure of these films was studied by X-ray diffraction. SEM (scanning electron microscopy) was applied to investigate film's surface topography.

Facile preparation of superhydrophobic surfaces based on metal oxide nanoparticles

NASA Astrophysics Data System (ADS)

Bao, Xue-Mei; Cui, Jin-Feng; Sun, Han-Xue; Liang, Wei-Dong; Zhu, Zhao-Qi; An, Jin; Yang, Bao-Ping; La, Pei-Qing; Li, An

2014-06-01

A novel method for fabrication of superhydrophobic surfaces was developed by facile coating various metal oxide nanoparticles, including ZnO, Al2O3 and Fe3O4, on various substrates followed by treatment with polydimethylsiloxane (PDMS) via chemical vapor deposition (CVD) method. Using ZnO nanoparticles as a model, the changes in the surface chemical composition and crystalline structures of the metal oxide nanoparticles by PDMS treatment were investigated by X-ray photoelectron spectroscopy (XPS), X-ray powder diffraction (XRD) and Fourier transform infrared (FTIR) analysis. The results show that the combination of the improved surface roughness generated from of the nanoparticles aggregation with the low surface-energy of silicon-coating originated from the thermal pyrolysis of PDMS would be responsible for the surface superhydrophobicity. By a simple dip-coating method, we show that the metal oxide nanoparticles can be easily coated onto the surfaces of various textural and dimensional substrates, including glass slide, paper, fabric or sponge, for preparation of superhydrophobic surfaces for different purpose. The present strategy may provide an inexpensive and new route to surperhydrophobic surfaces, which would be of technological significance for various practical applications especially for separation of oils or organic contaminates from water.

Thermo-mechanical cyclic testing of carbon-carbon primary structure for an SSTO vehicle

NASA Astrophysics Data System (ADS)

Croop, Harold C.; Leger, Kenneth B.; Lowndes, Holland B.; Hahn, Steven E.; Barthel, Chris A.

1999-01-01

An advanced carbon-carbon structural component is being experimentally evaluated for use as primary load carrying structure for future single-stage-to-orbit (SSTO) vehicles. The component is a wing torque box section featuring an advanced, three-spar design. This design features 3D-woven, angle-interlock skins, 3D integrally woven spar webs and caps, oxidation inhibited matrix, chemical vapor deposited (CVD) oxidation protection coating, and ceramic matrix composite fasteners. The box spar caps are nested into the skins which, when processed together through the carbon-carbon processing cycle, resulted in monolithic box halves. The box half sections were then joined at the spar web intersections using ceramic matrix composite fasteners. This method of fabrication eliminated fasteners through both the upper and lower skins. Development of the carbon-carbon wing box structure was accomplished in a four phase design and fabrication effort, conducted by Boeing, Information, Space and Defense Systems, Seattle, WA, under contract to the Air Force Research Laboratory (AFRL). The box is now set up for testing and will soon begin cyclic loads testing in the AFRL Structural Test Facility at Wright-Patterson Air Force Base (WPAFB), OH. This paper discusses the latest test setup accomplishments and the results of the pre-cyclic loads testing performed to date.

Cold cathode vacuum discharge tube

DOEpatents

Boettcher, Gordon E.

1998-01-01

A cold cathode vacuum discharge tube, and method for making same, with an interior surface of the trigger probe coated with carbon deposited by carbon vapor deposition (CVD) or diamond-like carbon (DLC) deposition. Preferably a solid graphite insert is employed in the probe-cathode structure in place of an aluminum bushing employed in the prior art. The CVD or DLC probe face is laser scribed to allow resistance trimming to match available trigger voltage signals and to reduce electrical aging.

Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease.

PubMed

Johansson, Peter; Svensson, Erland; Alehagen, Urban; Dahlström, Ulf; Jaarsma, Tiny; Broström, Anders

2015-03-01

Inflammation can induce a cluster of symptoms, referred to as sickness behaviour (e.g., depressive symptoms, sleep disturbances, pain and fatigue). Cardiovascular disease (CVD) and sleep disordered breathing (SDB) are common in older adults. CVD is associated with an increased inflammatory activity and in SDB, hypoxia can also increase inflammation. The purpose of this study is to explore if SDB-related hypoxia is associated differently with inflammation and the presence of sickness behaviour in older adults with and without CVD. Three hundred and thirty-one older adults, whose mean age is 78 years, underwent one-night polygraphic recording to measure SDB and hypoxia. CVD was established by a clinical investigation. Questionnaires were used to measure sickness behaviour and depressive symptoms. High sensitivity C-reactive protein was used as a marker of inflammation. Structural Equation Modelling showed that SDB-related hypoxia was associated with inflammation (β > 0.40) which mediated indirect associations with sickness behaviour (β = 0.19) and depressive symptoms (β = 0.11), but only in those with CVD (n = 119). In this model, inflammation had a direct effect on sickness behaviour (β = 0.43) and an indirect effect on depressive symptoms (β = 0.24). Hypoxia had the strongest effect (i.e., β = 0.41; significant) on inflammation, whereas the AHI or ODI had weak and non-significant effects (β = 0.03 and β = 0.15). Older adults with CVD and SDB are at a particular risk of developing sickness behaviour and depressive symptoms. The effect of SDB was mainly caused by hypoxia, suggesting that hypoxia is an important marker of SDB severity in older adults with CVD.

Hypertension education and adherence in South Africa: a cost-effectiveness analysis of community health workers.

PubMed

Gaziano, Thomas A; Bertram, Melanie; Tollman, Stephen M; Hofman, Karen J

2014-03-10

To determine whether training community health workers (CHWs) about hypertension in order to improve adherence to medications is a cost-effective intervention among community members in South Africa. We used an established Markov model with age-varying probabilities of cardiovascular disease (CVD) events to assess the benefits and costs of using CHW home visits to increase hypertension adherence for individuals with hypertension and aged 25-74 in South Africa. Subjects considered for CHW intervention were those with a previous diagnosis of hypertension and on medications but who had not achieved control of their blood pressure. We report our results in incremental cost-effectiveness ratios (ICERs) in US dollars per disability-adjusted life-year (DALY) averted. The annual cost of the CHW intervention is about $8 per patient. This would lead to over a 2% reduction in CVD events over a life-time and decrease DALY burden. Due to reductions in non-fatal CVD events, lifetime costs are only $6.56 per patient. The CHW intervention leads to an incremental cost-effectiveness ratio of $320/DALY averted. At an annual cost of $6.50 or if the blood pressure reduction is 5 mmHg or greater per patient the intervention is cost-saving. Additional training for CHWs on hypertension management could be a cost-effective strategy for CVD in South Africa and a very good purchase according to World Health Organization (WHO) standards. The intervention could also lead to reduced visits at the health centres freeing up more time for new patients or reducing the burden of an overworked staff at many facilities.

Outcome of Intensive Care Unit-Dependent, Tracheotomized Patients with Cerebrovascular Diseases.

PubMed

Ponfick, Matthias; Wiederer, Ralf; Nowak, Dennis A

2015-07-01

Outcome studies in intensive care unit -dependent, tracheotomized, and mechanical ventilated patients with cerebrovascular disease (CVD) are scarce. In a retrospective approach, we analyzed the outcome of 143 patients with ischemic stroke (IS), primary intracerebral hemorrhage (PICH), and subarachnoid hemorrhage (SAH). To measure the potential benefit of in-patient rehabilitation, we used the Functional Independence Measure (FIM). In addition, weaning and rehabilitation duration, duration of mechanical ventilation (MV) in the acute care hospital (preweaning), and mortality rates were assessed. Approximately 50% of all patients were transferred home. These patients were fully independent or under nursing support. We found no differences regarding weaning and rehabilitation durations, or FIM scores in between each entity. Log-regression analyses showed that every day on MV generates a 3.2% reduction of the possibility to achieve a beneficial outcome (FIM ≥ 50 points [only moderate assistance necessary]), whereas every day in-patient rehabilitation without MV increases the chance for favorable outcome by 1.9%. Mortality rates were 5% for IS and 10% for PICH and SAH, respectively. This study shows that even severely affected, tracheotomized patients with CVD benefit from early in-patient rehabilitation, irrespective of the etiology of vascular brain injury. Mortality rates of early rehabilitation in CVD are low. Until no validated outcome predictors are available, all efforts should be undertaken to enable in-patient rehabilitation, even in severe cases of CVD to improve outcome and to prevent accommodation in long-time-care facilities. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

The use of CVD diamond burs for ultraconservative cavity preparations: a report of two cases.

PubMed

Carvalho, Carlos Augusto R; Fagundes, Ticiane C; Barata, Terezinha J E; Trava-Airoldi, Vladimir Jesus; Navarro, Maria Fidela L

2007-01-01

During the past decades, scientific developments in cutting instruments have changed the conventional techniques used to remove caries lesions. Ultrasound emerged as an alternative for caries removal since the 1950s. However, the conventional technology for diamond powder aggregation with nickel metallic binders could not withstand ultrasonic power. Around 5 years ago, an alternative approach using chemical vapor deposition (CVD) resulted in synthetic diamond technology. CVD diamond burs are obtained with high adherence of the diamond as a unique stone on the metallic surface with excellent abrading performance. This technology allows for diamond deposition with coalescent granulation in different formats of substrates. When connected to an ultrasonic handpiece, CVD diamond burs become an option for cavity preparation, maximizing preservation of tooth structure. Potential advantages such as reduced noise, minimal damage to the gingival tissue, extended bur durability, improved proximal cavity access, reduced risk of hitting the adjacent tooth resulting from the high inclination angles, and minimal patient's risk of metal contamination. These innovative instruments also potentially eliminate some problems regarding decreased cutting efficiency of conventional diamond burs. This clinical report presents the benefits of using CVD diamond burs coupled with an ultrasonic handpiece in the treatment of incipient caries. CVD diamond burs coupled with an ultrasonic device offer a promising alternative for removal of carious lesions when ultraconservative cavity preparations are required. Additionally, this system provides a less-painful technique for caries removal, with minimal noise.

Post-traumatic stress disorder symptom duration and remission in relation to cardiovascular disease risk among a large cohort of women.

PubMed

Gilsanz, P; Winning, A; Koenen, K C; Roberts, A L; Sumner, J A; Chen, Q; Glymour, M M; Rimm, E B; Kubzansky, L D

2017-06-01

Prior studies suggest that post-traumatic stress disorder (PTSD) is associated with elevated cardiovascular disease (CVD) risk, but effects of duration and remission of PTSD symptoms have rarely been evaluated. We examined the association of time-updated PTSD symptom severity, remission and duration with incident CVD risk (552 confirmed myocardial infarctions or strokes) over 20 years in 49 859 women in the Nurses' Health Study II. Among women who reported trauma on the Brief Trauma Questionnaire, PTSD symptoms, assessed by a screener, were classified by symptom severity and chronicity: (a) no symptoms, (b) 1-3 ongoing, (c) 4-5 ongoing, (d) 6-7 ongoing, (e) 1-3 remitted, (f) 4-7 remitted symptoms. Inverse probability weighting was used to estimate marginal structural logistic regression models, adjusting for time-varying and time-invariant confounders. Compared with women with no trauma exposure, women with trauma/no PTSD [odds ratio (OR) 1.30, 95% confidence interval (CI) 1.03-1.65] and women with trauma/6-7 symptoms (OR 1.69, 95% CI 1.08-2.63) had elevated risk of CVD; women with remitted symptoms did not have elevated CVD risk. Among women exposed to trauma, every 5 additional years of PTSD symptomology was associated with 9% higher CVD incidence compared with women with trauma/no PTSD. The findings suggest that alleviating PTSD symptoms shortly after onset may attenuate CVD risk.

Development and initial validation of the Cardiovascular Disease Acceptance and Action Questionnaire (CVD-AAQ) in an Italian sample of cardiac patients

PubMed Central

Spatola, Chiara A. M.; Cappella, Emanuele A. M.; Goodwin, Christina L.; Baruffi, Matteo; Malfatto, Gabriella; Facchini, Mario; Castelnuovo, Gianluca; Manzoni, Gian Mauro; Molinari, Enrico

2014-01-01

Psychological inflexibility refers to the attempt to decrease internal distress even when doing so is inconsistent with life values, and has been identified as a potential barrier to making and maintaining health behavior changes that are consistent with a heart-healthy lifestyle. Disease- and behavior-specific measures of psychological inflexibility have been developed and utilized in treatment research. However, no specific measure has been created for patients with heart disease. Thus, the CardioVascular Disease Acceptance and Action Questionnaire (CVD-AAQ) was developed. The present study is aimed to evaluate the psychometric properties of the CVD-AAQ and to explore its association with measures of psychological adjustment and cardiovascular risk factors in an Italian sample of 275 cardiac patients. Exploratory factor analysis showed a structural one-factor solution with satisfactory internal consistency and test–retest reliability. The relation with other measures was in the expected direction with stronger correlations for the theoretically consistent variables, supporting convergent and divergent validity. CVD-AAQ scores were associated with general psychological inflexibility, anxiety and depression and inversely correlated with psychological well-being. Moreover, the results showed that CVD-AAQ scores are associated with two relevant risk factors for cardiac patients, namely low adherence to medication and being overweight. In sum, results suggest that the CVD-AAQ is a reliable and valid measure of heart disease-specific psychological inflexibility with interesting clinical applications for secondary prevention care. PMID:25452737

Transition Metal Dichalcogenide Growth via Close Proximity Precursor Supply

NASA Astrophysics Data System (ADS)

O'Brien, Maria; McEvoy, Niall; Hallam, Toby; Kim, Hye-Young; Berner, Nina C.; Hanlon, Damien; Lee, Kangho; Coleman, Jonathan N.; Duesberg, Georg S.

2014-12-01

Reliable chemical vapour deposition (CVD) of transition metal dichalcogenides (TMDs) is currently a highly pressing research field, as numerous potential applications rely on the production of high quality films on a macroscopic scale. Here, we show the use of liquid phase exfoliated nanosheets and patterned sputter deposited layers as solid precursors for chemical vapour deposition. TMD monolayers were realized using a close proximity precursor supply in a CVD microreactor setup. A model describing the growth mechanism, which is capable of producing TMD monolayers on arbitrary substrates, is presented. Raman spectroscopy, photoluminescence, X-ray photoelectron spectroscopy, atomic force microscopy, transmission electron microscopy, scanning electron microscopy and electrical transport measurements reveal the high quality of the TMD samples produced. Furthermore, through patterning of the precursor supply, we achieve patterned growth of monolayer TMDs in defined locations, which could be adapted for the facile production of electronic device components.

Poco Graphite Mirror Metrology Report

NASA Technical Reports Server (NTRS)

Kester, Thomas J.

2005-01-01

Recently a lightweight mirror technology was tested at Marshall Space Flight Center's Space Optic Manufacturing Technology Center (MSFC, SOMTC). The mirror is a Poco Graphite CVD Si clad SiC substrate. It was tested for cryogenic (cryo) survivability to 20deg Kelvin in SOMTC's X-ray Calibration and Cryogenic Test Facility. The surface figure of the mirror was measured before and after cry0 cycling. The test technique and results are discussed.

Reducing salt intake for prevention of cardiovascular diseases in high-risk patients by advanced health education intervention (RESIP-CVD study), Northern Thailand: study protocol for a cluster randomized trial

PubMed Central

2012-01-01

Background Decreasing salt consumption can prevent cardiovascular diseases (CVD). Practically, it is difficult to promote people’s awareness of daily salt intake and to change their eating habits in terms of reducing salt intake for better cardiovascular health. Health education programs visualizing daily dietary salt content and intake may promote lifestyle changes in patients at high risk of cardiovascular diseases. Methods/Design This is a cluster randomized trial. A total of 800 high-CVD-risk patients attending diabetes and hypertension clinics at health centers in Muang District, Chiang Rai province, Thailand, will be studied with informed consent. A health center recruiting 100 participants is a cluster, the unit of randomization. Eight clusters will be randomized into intervention and control arms and followed up for 1 year. Within the intervention clusters the following will be undertaken: (1) salt content in the daily diet will be measured and shown to study participants; (2) 24-hour salt intake will be estimated in overnight-collected urine and the results shown to the participants; (3) a dietician will assist small group health education classes in cooking meals with less salt. The primary outcome is blood pressure change at the 1-year follow-up. Secondary outcomes at the 1-year follow-up are estimated 24-hoursalt intake, incidence of CVD events and CVD death. The intention-to-treat analysis will be followed. Blood pressure and estimated 24-hour salt intake will be compared between intervention and control groups at the cluster and individual level at the 1-year follow-up. Clinical CVD events and deaths will be analyzed by time-event analysis. Retinal blood vessel calibers of CVD-risk patients will be assessed cross-sectionally. Behavioral change to reduce salt intake and the influencing factors will be determined by structured equation model (SEM). Multilevel regression analyses will be applied. Finally, the cost effectiveness of the intervention will be analyzed. Discussion This study is unique as it will recruit the individuals most vulnerable to CVD morbidity and mortality by applying the general Framingham CVD risk scoring system. Dietary salt reduction will be applied as a prioritized, community level intervention for the prevention of CVD in a developing country. Trial registration ISRCTN39416277 PMID:22947342

Reducing salt intake for prevention of cardiovascular diseases in high-risk patients by advanced health education intervention (RESIP-CVD study), Northern Thailand: study protocol for a cluster randomized trial.

PubMed

Aung, Myo Nyein; Yuasa, Motoyuki; Moolphate, Saiyud; Nedsuwan, Supalert; Yokokawa, Hidehiro; Kitajima, Tsutomu; Minematsu, Kazuo; Tanimura, Susumu; Fukuda, Hiroshi; Hiratsuka, Yoshimune; Ono, Koichi; Kawai, Sachio; Marui, Eiji

2012-09-04

Decreasing salt consumption can prevent cardiovascular diseases (CVD). Practically, it is difficult to promote people's awareness of daily salt intake and to change their eating habits in terms of reducing salt intake for better cardiovascular health. Health education programs visualizing daily dietary salt content and intake may promote lifestyle changes in patients at high risk of cardiovascular diseases. This is a cluster randomized trial. A total of 800 high-CVD-risk patients attending diabetes and hypertension clinics at health centers in Muang District, Chiang Rai province, Thailand, will be studied with informed consent. A health center recruiting 100 participants is a cluster, the unit of randomization. Eight clusters will be randomized into intervention and control arms and followed up for 1 year. Within the intervention clusters the following will be undertaken: (1) salt content in the daily diet will be measured and shown to study participants; (2) 24-hour salt intake will be estimated in overnight-collected urine and the results shown to the participants; (3) a dietician will assist small group health education classes in cooking meals with less salt. The primary outcome is blood pressure change at the 1-year follow-up. Secondary outcomes at the 1-year follow-up are estimated 24-hoursalt intake, incidence of CVD events and CVD death. The intention-to-treat analysis will be followed.Blood pressure and estimated 24-hour salt intake will be compared between intervention and control groups at the cluster and individual level at the 1-year follow-up. Clinical CVD events and deaths will be analyzed by time-event analysis. Retinal blood vessel calibers of CVD-risk patients will be assessed cross-sectionally. Behavioral change to reduce salt intake and the influencing factors will be determined by structured equation model (SEM). Multilevel regression analyses will be applied. Finally, the cost effectiveness of the intervention will be analyzed. This study is unique as it will recruit the individuals most vulnerable to CVD morbidity and mortality by applying the general Framingham CVD risk scoring system. Dietary salt reduction will be applied as a prioritized, community level intervention for the prevention of CVD in a developing country. ISRCTN39416277.

Ethical considerations in clinical research on herbal medicine for prevention of cardiovascular disease in the ageing.

PubMed

Koonrungsesomboon, Nut; Karbwang, Juntra

2016-10-15

Cardiovascular disease (CVD) in the ageing is a major public health problem worldwide. The nature of most CVD is subclinical with pathological processes that can span over years. Use of preventive measures could be an appropriate approach to prevailing over CVD in the ageing, and herbal medicine is one of the promising preventive approaches and is currently of interest among medical societies. In the evidence-based era, herbal medicine is, however, often underestimated and approached with skepticism, mainly due to the paucity of scientific evidence. Properly designed clinical trials on herbal medicine for prevention of CVD in a geriatric population are thus of importance and of clinical value. To review ethical issues and discuss considerations when such research is proposed. Four ethical issues, including the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent, are structured and extensively discussed in this article. Ethical core considerations of prevention research of CVD on herbal medicine involve particular attention on the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent. These issues and considerations are keys, although they must be adapted to an individual research setting in which a clinical study is proposed. Copyright © 2015 Elsevier GmbH. All rights reserved.

Association between Epicondylitis and Cardiovascular Risk Factors in Pooled Occupational Cohorts.

PubMed

Hegmann, Kurt T; Thiese, Matthew S; Kapellusch, Jay; Merryweather, Andrew; Bao, Stephen; Silverstein, Barbara; Wood, Eric M; Kendall, Richard; Foster, James; Drury, David L; Garg, Arun

2017-05-30

The pathophysiology of lateral epicondylitis (LE) is unclear. Recent evidence suggests some common musculoskeletal disorders may have a basis in cardiovascular disease (CVD) risk factors. Thus, we examined CVD risks as potential LE risks. Workers (n = 1824) were enrolled in two large prospective studies and underwent structured interviews and physical examinations at baseline. Analysis of pooled baseline data assessed the relationships separately between a modified Framingham Heart Study CVD risk score and three prevalence outcomes of: 1) lateral elbow pain, 2) positive resisted wrist or middle finger extension, and 3) a combination of both symptoms and at least one resisted maneuver. Quantified job exposures, personal and psychosocial confounders were statistically controlled. Odds ratios (ORs) and 95% Confidence Intervals (CIs) were calculated. There was a strong relationship between CVD risk score and lateral elbow symptoms, resisted wrist or middle finger extension and LE after adjustment for confounders. The adjusted ORs for symptoms were as high as 3.81 (95% CI 2.11, 6.85), for positive examination with adjusted odds ratios as high as 2.85 (95% CI 1.59, 5.12) and for combined symptoms and physical examination 6.20 (95% CI 2.04, 18.82). Relationships trended higher with higher CVD risk scores. These data suggest a potentially modifiable disease mechanism for LE.

Creating a Transdisciplinary Research Center to Reduce Cardiovascular Health Disparities in Baltimore, Maryland: Lessons Learned

PubMed Central

Boulware, L. Ebony; Miller, Edgar R.; Golden, Sherita Hill; Carson, Kathryn A.; Noronha, Gary; Huizinga, Mary Margaret; Roter, Debra L.; Yeh, Hsin-Chieh; Bone, Lee R.; Levine, David M.; Hill-Briggs, Felicia; Charleston, Jeanne; Kim, Miyong; Wang, Nae-Yuh; Aboumatar, Hanan; Halbert, Jennifer P.; Ephraim, Patti L.; Brancati, Frederick L.

2013-01-01

Cardiovascular disease (CVD) disparities continue to have a negative impact on African Americans in the United States, largely because of uncontrolled hypertension. Despite the availability of evidence-based interventions, their use has not been translated into clinical and public health practice. The Johns Hopkins Center to Eliminate Cardiovascular Health Disparities is a new transdisciplinary research program with a stated goal to lower the impact of CVD disparities on vulnerable populations in Baltimore, Maryland. By targeting multiple levels of influence on the core problem of disparities in Baltimore, the center leverages academic, community, and national partnerships and a novel structure to support 3 research studies and to train the next generation of CVD researchers. We also share the early lessons learned in the center’s design. PMID:24028238

Cold cathode vacuum discharge tube

DOEpatents

Boettcher, G.E.

1998-03-10

A cold cathode vacuum discharge tube, and method for making same, are disclosed with an interior surface of the trigger probe coated with carbon deposited by carbon vapor deposition (CVD) or diamond-like carbon (DLC) deposition. Preferably a solid graphite insert is employed in the probe-cathode structure in place of an aluminum bushing employed in the prior art. The CVD or DLC probe face is laser scribed to allow resistance trimming to match available trigger voltage signals and to reduce electrical aging. 15 figs.

Cold cathode vacuum discharge tube

DOEpatents

Boettcher, G.E.

1998-04-14

A cold cathode vacuum discharge tube, and method for making same, with an interior surface of the trigger probe coated with carbon deposited by chemical vapor deposition (CVD) or diamond-like carbon (DLC) deposition are disclosed. Preferably a solid graphite insert is employed in the probe-cathode structure in place of an aluminum bushing employed in the prior art. The CVD or DLC probe face is laser scribed to allow resistance trimming to match available trigger voltage signals and to reduce electrical aging. 14 figs.

CVD of silicon carbide on structural fibers - Microstructure and composition

NASA Technical Reports Server (NTRS)

Veitch, Lisa C.; Terepka, Francis M.; Gokoglu, Suleyman A.

1992-01-01

Structural fibers are currently being considered as reinforcements for intermetallic and ceramic materials. Some of these fibers, however, are easily degraded in a high temperature oxidative environment. Therefore, coatings are needed to protect the fibers from environmental attack. Silicon carbide (SiC) was chemically vapor deposited (CVD) on Textron's SCS6 fibers. Fiber temperatures ranging from 1350 to 1500 C were studied. Silane (SiH4) and propane (C2H8) were used for the source gases and different concentrations of these source gases were studied. Deposition rates were determined for each group of fibers at different temperatures. Less variation in deposition rates were observed for the dilute source gas experiments than the concentrated source gas experiments. A careful analysis was performed on the stoichiometry of the CVD SiC coating using electron microprobe. Microstructures for the different conditions were compared. At 1350 C, the microstructures were similar; however, at higher temperatures, the microstructure for the more concentrated source gas group were porous and columnar in comparison to the cross sections taken from the same area for the dilute source gas group.

CVD of silicon carbide on structural fibers: Microstructure and composition

NASA Technical Reports Server (NTRS)

Veitch, Lisa C.; Terepka, Francis M.; Gokoglu, Suleyman A.

1992-01-01

Structural fibers are currently being considered as reinforcements for intermetallic and ceramic materials. Some of these fibers, however, are easily degraded in a high temperature oxidative environment. Therefore, coatings are needed to protect the fibers from environmental attack. Silicon carbide (SiC) was chemically vapor deposited (CVD) on Textron's SCS6 fibers. Fiber temperatures ranging from 1350 to 1500 C were studied. Silane (SiH4) and propane (C2H8) were used for the source gases and different concentrations of these source gases were studied. Deposition rates were determined for each group of fibers at different temperatures. Less variation in deposition rates were observed for the dilute source gas experiments than the concentrated source gas experiments. A careful analysis was performed on the stoichiometry of the CVD SiC coating using electron microprobe. Microstructures for the different conditions were compared. At 1350 C, the microstructures were similar; however, at higher temperatures, the microstructure for the more concentrated source gas group were porous and columnar in comparison to the cross sections taken from the same area for the dilute source gas group.

Fabrication of Nanocarbon Composites Using In Situ Chemical Vapor Deposition and Their Applications.

PubMed

He, Chunnian; Zhao, Naiqin; Shi, Chunsheng; Liu, Enzuo; Li, Jiajun

2015-09-23

Nanocarbon (carbon nanotubes (CNTs) and graphene (GN)) composites attract considerable research interest due to their fascinating applications in many fields. Here, recent developments in the field of in situ chemical vapor deposition (CVD) for the design and controlled preparation of advanced nanocarbon composites are highlighted, specifically, CNT-reinforced bulk structural composites, as well as CNT, GN, and CNT/GN functional composites, together with their practical and potential applications. In situ CVD is a very attractive approach for the fabrication of composites because of its engaging features, such as its simplicity, low-cost, versatility, and tunability. The morphologies, structures, dispersion, and interface of the resulting nanocarbon composites can be easily modulated by varying the experimental parameters (such as temperature, catalysts, carbon sources, templates or template catalysts, etc.), which enables a great potential for the in situ synthesis of high-quality nanocarbons with tailored size and dimension for constructing high-performance composites, which has not yet been achieved by conventional methods. In addition, new trends of the in situ CVD toward nanocarbon composites are discussed. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Characterization of TEM Moiré Patterns Originating from Two Monolayer Graphenes Grown on the Front and Back Sides of a Copper Substrate by CVD Method

NASA Astrophysics Data System (ADS)

Yamazaki, Kenji; Maehara, Yosuke; Gohara, Kazutoshi

2018-06-01

The number of layers affects the electronic properties of graphene owing to its unique band structure, called the Dirac corn. Raman spectroscopy is a key diagnostic tool for identifying the number of graphene layers and for determining their physical properties. Here, we observed moiré structures in transmission electron microscopy (TEM) observations; these are signature patterns in multilayer, although Raman spectra showed the typical intensity of the 2D/G peak in the monolayer. We also performed a multi-slice TEM image simulation to compare the 3D atomic structures of the two graphene membranes with experimental TEM images. We found that the experimental moiré image was constructed with a 9-12 Å interlayer distance between graphene membranes. This structure was constructed by transferring CVD-grown graphene films that formed on both sides of the Cu substrate at once.

Impact of Sex Hormone Metabolism on the Vascular Effects of Menopausal Hormone Therapy in Cardiovascular Disease

PubMed Central

Masood, Durr-e-Nayab; Roach, Emir C.; Beauregard, Katie G.; Khalil, Raouf A.

2010-01-01

Epidemiological studies have shown that cardiovascular disease (CVD) is less common in pre-menopausal women (Pre-MW) compared to men of the same age or post-menopausal women (Post-MW), suggesting cardiovascular benefits of estrogen. Estrogen receptors (ERs) have been identified in the vasculature, and experimental studies have demonstrated vasodilator effects of estrogen/ER on the endothelium, vascular smooth muscle (VSM) and extracellular matrix. Several natural and synthetic estrogenic preparations have been developed for relief of menopausal vasomotor symptoms. However, whether menopausal hormone therapy (MHT) is beneficial in postmenopausal CVD remains controversial. Despite reports of vascular benefits of MHT from observational and experimental studies, randomized clinical trials (RCTs), such as the Heart and Estrogen/progestin Replacement Study (HERS) and the Women’s Health Initiative (WHI), have suggested that, contrary to expectations, MHT may increase the risk of CVD. These discrepancies could be due to age-related changes in sex hormone synthesis and metabolism, which would influence the effective dose of MHT and the sex hormone environment in Post-MW. Age-related changes in the vascular ER subtype, structure, expression, distribution, and post-ER signaling pathways in the endothelium and VSM, along with factors related to the design of RCTs, preexisting CVD condition, and structural changes in the blood vessels architecture have also been suggested as possible causes of MHT failure in CVD. Careful examination of these factors should help in identifying the causes of the changes in the vascular effects of estrogen with age. The sex hormone metabolic pathways, the active versus inactive estrogen metabolites, and their effects on vascular function, the mitochondria, the inflammatory process and angiogenesis should be further examined. Also, the genomic and non-genomic effects of estrogenic compounds should be viewed as integrated rather than discrete responses. The complex interactions between these factors highlight the importance of careful design of MHT RCTs, and the need of a more customized approach for each individual patient in order to enhance the vascular benefits of MHT in postmenopausal CVD. PMID:21189141

Advanced zirconia-coated carbonyl-iron particles for acidic magnetorheological finishing of chemical-vapor-deposited ZnS and other IR materials

NASA Astrophysics Data System (ADS)

Salzman, S.; Giannechini, L. J.; Romanofsky, H. J.; Golini, N.; Taylor, B.; Jacobs, S. D.; Lambropoulos, J. C.

2015-10-01

We present a modified version of zirconia-coated carbonyl-iron (CI) particles that were invented at the University of Rochester in 2008. The amount of zirconia on the coating is increased to further protect the iron particles from corrosion when introduced to an acidic environment. Five low-pH, magnetorheological (MR) fluids were made with five acids: acetic, hydrochloric, nitric, phosphoric, and hydrofluoric. All fluids were based on the modified zirconia-coated CI particles. Off-line viscosity and pH stability were measured for all acidic MR fluids to determine the ideal fluid composition for acidic MR finishing of chemical-vapor-deposited (CVD) zinc sulfide (ZnS) and other infrared (IR) optical materials, such as hot-isostatic-pressed (HIP) ZnS, CVD zinc selenide (ZnSe), and magnesium fluoride (MgF2). Results show significant reduction in surface artifacts (millimeter-size, pebble-like structures on the finished surface) for several standard-grade CVD ZnS substrates and good surface roughness for the non-CVD MgF2 substrate when MR finished with our advanced acidic MR fluid.

Thermo-mechanical evaluation of carbon-carbon primary structure for SSTO vehicles

NASA Astrophysics Data System (ADS)

Croop, Harold C.; Lowndes, Holland B.; Hahn, Steven E.; Barthel, Chris A.

1998-01-01

An advanced development program to demonstrate carbon-carbon composite structure for use as primary load carrying structure has entered the experimental validation phase. The component being evaluated is a wing torque box section for a single-stage-to-orbit (SSTO) vehicle. The validation or demonstration component features an advanced carbon-carbon design incorporating 3D woven graphite preforms, integral spars, oxidation inhibited matrix, chemical vapor deposited (CVD) oxidation protection coating, and ceramic matrix composite fasteners. The validation component represents the culmination of a four phase design and fabrication development effort. Extensive developmental testing was performed to verify material properties and integrity of basic design features before committing to fabrication of the full scale box. The wing box component is now being set up for testing in the Air Force Research Laboratory Structural Test Facility at Wright-Patterson Air Force Base, Ohio. One of the important developmental tests performed in support of the design and planned testing of the full scale box was the fabrication and test of a skin/spar trial subcomponent. The trial subcomponent incorporated critical features of the full scale wing box design. This paper discusses the results of the trial subcomponent test which served as a pathfinder for the upcoming full scale box test.

Hypertensive Disorders in Pregnancy and the Risk of Subsequent Cardiovascular Disease.

PubMed

Grandi, Sonia M; Vallée-Pouliot, Karine; Reynier, Pauline; Eberg, Maria; Platt, Robert W; Arel, Roxane; Basso, Olga; Filion, Kristian B

2017-09-01

Hypertensive disorders in pregnancy (HDP) have been shown to predict later risk of cardiovascular disease (CVD). However, previous studies have not accounted for subsequent pregnancies and their complications, which are potential confounders and intermediates of this association. A cohort of 146 748 women with a first pregnancy was constructed using the Clinical Practice Research Datalink. HDP was defined using diagnostic codes, elevated blood pressure readings, or new use of an anti-hypertensive drug between 18 weeks' gestation and 6 weeks post-partum. The study outcomes were incident CVD and hypertension. Marginal structural Cox models (MSM) were used to account for time-varying confounders and intermediates. Time-fixed exposure defined at the first pregnancy was used in secondary analyses. A total of 997 women were diagnosed with incident CVD, and 6812 women were diagnosed with hypertension or received a new anti-hypertensive medication during the follow-up period. Compared with women without HDP, those with HDP had a substantially higher rate of CVD (hazard ratio (HR) 2.2, 95% confidence interval (CI) 1.7, 2.7). In women with HDP, the rate of hypertension was five times that of women without a HDP (HR 5.6, 95% CI 5.1, 6.3). With overlapping 95% CIs, the time-fixed analysis and the MSM produced consistent results for both outcomes. Women with HDP are at increased risk of developing subsequent CVD and hypertension. Similar estimates obtained with the MSM and the time-fixed analysis suggests that subsequent pregnancies do not confound a first episode of HDP and later CVD. © 2017 John Wiley & Sons Ltd.

Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions.

PubMed

Schultz, William M; Kelli, Heval M; Lisko, John C; Varghese, Tina; Shen, Jia; Sandesara, Pratik; Quyyumi, Arshed A; Taylor, Herman A; Gulati, Martha; Harold, John G; Mieres, Jennifer H; Ferdinand, Keith C; Mensah, George A; Sperling, Laurence S

2018-05-15

Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment. © 2018 American Heart Association, Inc.

'All singing from the same hymn sheet': healthcare professionals' perceptions of developing patient education material about the cardiovascular aspects of rheumatoid arthritis.

PubMed

John, Holly; Hale, Elizabeth D; Treharne, Gareth J; Carroll, Douglas; Kitas, George D

2009-12-01

Cardiovascular disease (CVD) is the leading cause of death in Britain, and its prevention is a priority. Rheumatoid arthritis (RA) patients have an increased risk of CVD, and management of modifiable classical risk factors requires a programme with patient education at its heart. Before a programme for RA patients is implemented, it is important to explore the perceptions of patients and relevant healthcare professionals and consider how these could influence the subsequent content, timing and delivery of such education. Here, we assess healthcare professionals' perceptions. Qualitative focus group methodology was adopted. Four group meetings of healthcare professionals were held using a semi-structured interview schedule. The focus group transcripts were analysed using interpretative phenomenological analysis. Three superordinate themes emerged: professional determinations about people with RA, including their perceptions about patients' priorities and motivations; communication about CVD risk, including what should be communicated, how, to whom and when; and responsibility for CVD management, referring to patients and the healthcare community. Although healthcare professionals agree that it is important to convey the increased CVD risk to patients with RA, there is concern they may be less proactive in promoting risk management strategies. There was uncertainty about the best time to discuss CVD with RA patients. Maintaining a close relationship between primary and secondary care was thought to be important, with all healthcare professionals 'singing from the same hymn sheet'. These findings can inform the development of novel education material to fulfil a currently unmet clinical need. Copyright (c) 2009 John Wiley & Sons, Ltd.

Pregnancy-induced hypertension is associated with an increase in the prevalence of cardiovascular disease risk factors in Japanese women.

PubMed

Watanabe, Kazushi; Kimura, Chiharu; Iwasaki, Ai; Mori, Toshitaka; Matsushita, Hiroshi; Shinohara, Koichi; Wakatsuki, Akihiko; Gosho, Masahiko; Miyano, Ichiro

2015-06-01

This study assessed whether pregnancy-induced hypertension (PIH) affects the prevalence of cardiovascular disease (CVD) risk factors in later life among Japanese women. Study participants were 1,185 women (mean [SD] age, 46.5 [5.6] y; range, 38-73 y) aged 40 years or older who underwent a health checkup at a periodic health examination facility between January 2012 and December 2013 and had experienced giving birth. Questionnaires were sent to potential participants, and they were encouraged to provide their Maternal and Child Health Handbook (handbook). We recruited 101 women with a history of PIH (PIH group) and 1,084 women with uncomplicated pregnancy at delivery (control group). Groupings were based on information from the handbook. We assessed the association between PIH and CVD in later life among Japanese women by focusing on hypertension, diabetes mellitus, and dyslipidemia as risk factors for CVD. Odds ratios (ORs) for the use of antihypertensive, diabetes mellitus, and dyslipidemic medications in the PIH group were determined. Women with PIH had increased risk of antihypertensive medication use compared with women without PIH (2.9% vs 13.9%; OR, 4.28; 95% CI, 2.14-8.57). Triglycerides were significantly higher and high-density lipoprotein cholesterol was significantly lower in the PIH group than in the control group. The OR for dyslipidemic medication use in the PIH group relative to the control group was 3.20 (95% CI, 1.42-7.22). Our findings suggest that a history of PIH may be associated with an increased risk of hypertension (a risk factor for CVD) in later life among Japanese women.

Optimal Magnetorheological Fluid for Finishing of Chemical-Vapor-Deposited Zinc Sulfide

NASA Astrophysics Data System (ADS)

Salzman, Sivan

Magnetorheological finishing (MRF) of polycrystalline, chemical-vapor- deposited zinc sulfide (ZnS) optics leaves visible surface artifacts known as "pebbles". These artifacts are a direct result of the material's inner structure that consists of cone-like features that grow larger (up to a few millimeters in size) as deposition takes place, and manifest on the top deposited surface as "pebbles". Polishing the pebble features from a CVD ZnS substrate to a flat, smooth surface to below 10 nm root-mean-square is challenging, especially for a non-destructive polishing process such as MRF. This work explores ways to improve the surface finish of CVD ZnS processed with MRF through modification of the magnetorheological (MR) fluid's properties. A materials science approach is presented to define the anisotropy of CVD ZnS through a combination of chemical and mechanical experiments and theoretical predictions. Magnetorheological finishing experiments with single crystal samples of ZnS, whose cuts and orientations represent most of the facets known to occur in the polycrystalline CVD ZnS, were performed to explore the influence of material anisotropy on the material removal rate during MRF. By adjusting the fluid's viscosity, abrasive type concentration, and pH to find the chemo-mechanical conditions that equalize removal rates among all single crystal facets during MRF, we established an optimized, novel MR formulation to polish CVD ZnS without degrading the surface finish of the optic.

Ballistic Transport Exceeding 28 μm in CVD Grown Graphene.

PubMed

Banszerus, Luca; Schmitz, Michael; Engels, Stephan; Goldsche, Matthias; Watanabe, Kenji; Taniguchi, Takashi; Beschoten, Bernd; Stampfer, Christoph

2016-02-10

We report on ballistic transport over more than 28 μm in graphene grown by chemical vapor deposition (CVD) that is fully encapsulated in hexagonal boron nitride. The structures are fabricated by an advanced dry van-der-Waals transfer method and exhibit carrier mobilities of up to three million cm(2)/(Vs). The ballistic nature of charge transport is probed by measuring the bend resistance in cross- and square-shaped devices. Temperature-dependent measurements furthermore prove that ballistic transport is maintained exceeding 1 μm up to 200 K.

Dietary modification, body mass index (BMI), blood pressure (BP) and cardiovascular risk in medical students of a government medical college of Karachi.

PubMed

Raza, Sajjad; Sheikh, Muhammad Adil; Hussain, Muhammad Fawwad Ahmed; Siddiqui, Saad Ebrahim; Muhammad, Rabia; Aziz, Sina; Qamar, Salima; Saleem, Mohammad Azfar; Waki, Nida; Faruqi, Hina; Zia, Aisha

2010-11-01

To determine the prevalence of major risk factors including dietary modification, Body Mass Index (BMI), Blood Pressure (BP) and physical activity in medical students of government teaching hospitals of Karachi. A cross sectional study was conducted on students of Dow Medical College, Karachi, Pakistan through a structured pre-tested questionnaire. Non-probability purposive sampling was used. Smoking, hypertension, family history of cardiovascular disease (CVD), overweight and low physical activity levels are risk factors the presence of which can lead to development of CVD. Prevalence of these risk factors was determined by asking appropriate questions and through measurement of BMI and blood pressure for overweight and hypertension respectively. Awareness of risk factors was determined through knowledge of the effect of various food substances on development of CVD and of adoption of dietary changes keeping in mind the risk of developing CVD. SPSS 16.0 was used for statistical analysis. A total of 132 medical students were included in the study of which 57 (43.2%) and 75 (56.8%) were male and female respectively with mean age of 20.85 +/- 1.21 years. About 15.9% of students had elevated blood pressure i.e. > or = 140/90 mmHg. Twenty eight percent of the total students were found to be underweight and 17.4% were overweight, 5% had some history of CVD, 56.8% had family history of CVD, 9.4% were smokers and 29.5% had high physical activity level. About 87.1% had modified their diet for preventing CVD. Most of the students had adequate knowledge about the cardiovascular risk factors Majority of students were not overweight. A high prevalence of cardiovascular risk factors; family history and elevated blood pressure was present. Awareness in terms of knowledge was satisfactory but implementation in terms of diet modification and adequate physical activity was lacking.

Synthesis of Three-dimensional Polymer Nanostructures via Chemical Vapor Deposition

NASA Astrophysics Data System (ADS)

Cheng, Kenneth

Chemical vapor deposition (CVD) is a widely practiced methodology for preparing thin film polymer coatings, and the coatings can be applied to a broad range of materials, including three-dimensional solid structures and low-vapor pressure liquids. Reactive poly(p-xylylene) (PPX) coatings prepared by CVD can be used as a powerful tool for surface functionalization and bio-conjugation. The first portion of this dissertation serves to extend the use of CVD-based reactive PPX coatings as a surface functionalization strategy for the conjugation of biomolecules. Micro-structured PPX coatings having multiple surface reactive groups were fabricated. Multiple orthogonal click reactions were then employed to selectively immobilize galactose and mannobiose to the micro-structured polymer coatings. The presence of different types of carbohydrate enables lectins binding for examining ligands/cell receptor interactions. This dissertation also demonstrates the use of CVD-based reactive PPX coatings as intermediate layers to immobilize adenoviral vectors onto tissue scaffolds. The ability to tether adenoviral vectors on tissue scaffolds localizes the transduction near the scaffold surface and reduces acute toxicity and hepatic pathology cause by direct administration of the viral vector, providing a safe and efficient gene therapy delivery strategy. In the second portion of this dissertation, we explore the CVD of PPX onto surfaces coated with a thin layer of liquid crystal (LC). Instead of forming a conformal PPX coating encapsulating the LC layer, PPX assembled into an array of high-aspect ratio nanofibers inside the LC layer. The LC layer was demonstrated to act as a template where the anisotropic internal ordering of the LC facilitated the formation of nanofibers. The diameter of the nanofibers was in the range of 100 nm and could be tuned by type of LC template used, and the length of the nanofibers could be precisely controlled by varying the thickness of the LC film. The overall shape of the nanofibers could be controlled by the internal ordering of the LC template, as exemplified by the assembly of helical nanofibers using cholesteric LC as the template. PPX nanofibers could be applied to a broad range of materials, such as curved surface, metal meshes and microparticles. We successfully created nanofibers with different surface functionalities and utilized them to capture molecules of interest. We also demonstrated the synthesis of twisted nanofibers using chiral-substituted precursors. The direction and the degree of twisting of nanofibers could be controlled by the handedness and the enantiomeric excess of the chiral precursor. Finally, we showed that the LC-templated CVD method could be extended to fabricating nanofibers made of other CVD-based polymer systems, such as poly(lutidine) and poly(p-phenylene vinylene). Our work opens a new platform for designing functional polymer nanostructures with programmable geometry, alignment and chemistry. The polymer nanostructures can be attractive for applications ranging from sensors, affinity filtration, and catalytic supports.

IndEcho study: cohort study investigating birth size, childhood growth and young adult cardiovascular risk factors as predictors of midlife myocardial structure and function in South Asians

PubMed Central

Vasan, Senthil K; Roy, Ambuj; Samuel, Viji Thomson; Antonisamy, Belavendra; Bhargava, Santosh K; Alex, Anoop George; Singh, Bhaskar; Osmond, Clive; Geethanjali, Finney S; Karpe, Fredrik; Sachdev, Harshpal; Agrawal, Kanhaiya; Ramakrishnan, Lakshmy; Tandon, Nikhil; Thomas, Nihal; Premkumar, Prasanna S; Asaithambi, Prrathepa; Princy, Sneha F X; Sinha, Sikha; Paul, Thomas Vizhalil; Prabhakaran, Dorairaj; Fall, Caroline H D

2018-01-01

Introduction South Asians have high rates of cardiovascular disease (CVD) and its risk factors (hypertension, diabetes, dyslipidaemia and central obesity). Left ventricular (LV) hypertrophy and dysfunction are features of these disorders and important predictors of CVD mortality. Lower birth and infant weight and greater childhood weight gain are associated with increased adult CVD mortality, but there are few data on their relationship to LV function. The IndEcho study will examine associations of birth size, growth during infancy, childhood and adolescence and CVD risk factors in young adulthood with midlife cardiac structure and function in South Asian Indians. Methods and analysis We propose to study approximately 3000 men and women aged 43–50 years from two birth cohorts established in 1969–1973: the New Delhi Birth Cohort (n=1508) and Vellore Birth Cohort (n=2156). They had serial measurements of weight and height from birth to early adulthood. CVD risk markers (body composition, blood pressure, glucose tolerance and lipids) and lifestyle characteristics (tobacco and alcohol consumption, physical activity, socioeconomic status) were assessed at age ~30 years. Clinical measurements in IndEcho will include anthropometry, blood pressure, biochemistry (glucose, fasting insulin and lipids, urinary albumin/creatinine ratio) and body composition by dual energy X-ray absorptiometry and bioelectrical impedance. Outcomes are LV mass and indices of LV systolic and diastolic function assessed by two-dimensional and Doppler echocardiography, carotid intimal-media thickness and ECG indicators of ischaemia. Regression and conditional growth models, adjusted for potential confounders, will be used to study associations of childhood and young adult exposures with these cardiovascular outcomes. Ethics and dissemination The study has been approved by the Health Ministry Steering Committee, Government of India and institutional ethics committees of participating centres in India and the University of Southampton, UK. Results will be disseminated through scientific meetings and peer-reviewed journals. Trial registration number ISRCTN13432279; Pre-results. PMID:29643156

Evaluation of community health screening participants' knowledge of cardiovascular risk factors.

PubMed

Mooney, Leslie A; Franks, Amy M

2009-01-01

To assess knowledge of cardiovascular disease (CVD) risk factors among a group of health screening participants and to compare knowledge between participants with high and low CVD risk. Cross-sectional pilot study. Jonesboro, AR, during June 2007. 121 adult volunteers participating in a community health screening. 34-item self-administered written questionnaire. Ability to identify CVD risk factors and healthy values for CVD risk factors and the differences in these abilities between participants with high and low CVD risk. Participants demonstrated good knowledge of traditional CVD risk factors such as high blood pressure, high cholesterol, lack of exercise, and overweight or obese status. Knowledge of other CVD risk factors and healthy values for major CVD risk factors was limited. Participants with high CVD risk were significantly more likely to correctly identify high triglycerides as a CVD risk factor and to identify healthy values for fasting blood glucose and total cholesterol compared with participants with low CVD risk. Overall, participants lacked knowledge of the risk factor status and healthy values for many CVD risk factors. Participants with high CVD risk may have better knowledge of some CVD risk factors than participants with low CVD risk. These findings highlight the need for more education to improve knowledge in both risk groups.

High performance a-Si solar cells and new fabrication methods for a-Si solar cells

NASA Astrophysics Data System (ADS)

Nakano, S.; Kuwano, Y.; Ohnishi, M.

1986-12-01

The super chamber, a separated UHV reaction-chamber system has been developed. A conversion efficiency of 11.7% was obtained for an a-Si solar cell using a high-quality i-layer deposited by the super chamber, and a p-layer fabricated by a photo-CVD method. As a new material, amorphous superlattice-structure films were fabricated by the photo-CVD method for the first time. Superlattice structure p-layer a-Si solar cells were fabricated, and a conversion efficiency of 10.5% was obtained. For the fabrication of integrated type a-Si solar cell modules, a laser pattering method was investigated. A thermal analysis of the multilayer structure was done. It was confirmed that selective scribing for a-Si, TCO and metal film is possible by controlling the laser power density. Recently developed a-Si solar power generation systems and a-Si solar cell roofing tiles are also described.

Searching for polycystic ovary syndrome in postmenopausal women: evidence of a dose-effect association with prevalent cardiovascular disease.

PubMed

Krentz, Andrew J; von Mühlen, Denise; Barrett-Connor, Elizabeth

2007-01-01

To test the hypothesis that polycystic ovary syndrome (PCOS) is associated with an increased risk of atherosclerotic cardiovascular disease (CVD) in older postmenopausal women. Cross-sectional study of community-dwelling non-estrogen-using postmenopausal-white women (N=713; mean+/-SD age, 73.8+/-7.9 years; mean body mass index, 24.0+/-3.5 kg/m) participating in the Rancho Bernardo Study. A putative PCOS phenotype was defined as the presence of three or more of the following features: (1) recalled history of irregular menses, (2) symptomatic premenopausal hyperandrogenism or biochemical evidence of current biochemical hyperandrogenism, (3) history of infertility or miscarriage, (4) central obesity, or (5) insulin resistance. Atherosclerotic CVD was determined from clinical history, electrocardiography, and structured interviews using validated techniques. The analysis was stratified by diabetes status, ascertained from medical history or 75-g oral glucose tolerance tests. The PCOS phenotype was present in 9.3% of the entire cohort and 5.8% of nondiabetic women. The prevalence of CVD was similar between women with the phenotype and unaffected women (27.3% vs 24.4%). Among women with intact ovaries and no diabetes, there was a stepwise graded association between an increasing number of features of the PCOS phenotype (ie, none to three or more) and prevalent CVD (P=0.02). A similar association was also observed for coronary heart disease alone (P=0.03). Among nondiabetic postmenopausal women with intact ovaries, prevalent atherosclerotic CVD is associated with features of a putative PCOS phenotype. This finding supports the thesis that PCOS increases the risk of atherosclerotic CVD after menopause.

Searching for Polycystic Ovary Syndrome in Postmenopausal Women: Evidence for a Dose-Effects Association with Prevalent Cardiovascular Disease

PubMed Central

Krentz, Andrew J.; von Mühlen, Denise; Barrett-Connor, Elizabeth

2007-01-01

Objective To test the hypothesis that polycystic ovary syndrome (PCOS) is associated with an increased risk of atherosclerotic cardiovascular disease (CVD) in older postmenopausal women. Design Cross-sectional study of community-dwelling non-estrogen-using postmenopausal Caucasian women (n=713) mean (± SD) age 73.8 ± 7.9 years, mean body mass index 24.0 ± 3.5 kg/m2 participating in the Rancho Bernardo Study. A putative PCOS phenotype was defined as the presence of ≥3 features: (1) recalled history of irregular menses, (2) symptomatic premenopausal hyperandrogenism or biochemical evidence of current biochemical hyperandrogenism, (3) history of infertility or miscarriage, (4) central obesity, or (5) biochemical insulin resistance. Atherosclerotic CVD was determined from clinical history, electrocardiography, and structured interviews using validated techniques. The analysis was stratified by diabetes status, ascertained from medical history or 75 g oral glucose tolerance tests. Results The PCOS phenotype was present in 9.3% of the entire cohort and 5.8% of non-diabetic women. The prevalence of CVD was similar between women with the phenotype compared to non-affected women (27.3%, vs. 24.4%). Among women with intact ovaries and no diabetes there was a stepwise graded association between an increasing number of features of the PCOS phenotype (i.e., 0 – ≥3) and prevalent CVD (p=0.02) and coronary heart disease alone (p=0.03). Conclusions – Among non-diabetic postmenopausal women with intact ovaries, prevalent atherosclerotic CVD is associated with features of a putative PCOS phenotype. This finding supports the thesis that PCOS increases the risk of atherosclerotic CVD years after menopause. PMID:17245231

The Aging Cardiovascular System: Understanding It at the Cellular and Clinical Levels.

PubMed

Paneni, Francesco; Diaz Cañestro, Candela; Libby, Peter; Lüscher, Thomas F; Camici, Giovanni G

2017-04-18

Cardiovascular disease (CVD) presents a great burden for elderly patients, their caregivers, and health systems. Structural and functional alterations of vessels accumulate throughout life, culminating in increased risk of developing CVD. The growing elderly population worldwide highlights the need to understand how aging promotes CVD in order to develop new strategies to confront this challenge. This review provides examples of some major unresolved clinical problems encountered in daily cardiovascular practice as we care for elderly patients. Next, the authors summarize the current understanding of the mechanisms implicated in cardiovascular aging, and the potential for targeting novel pathways implicated in endothelial dysfunction, mitochondrial oxidative stress, chromatin remodeling, and genomic instability. Lastly, the authors consider critical aspects of vascular repair, including autologous transplantation of bone marrow-derived stem cells in elderly patients. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Vertical graphene nanosheets synthesized by thermal chemical vapor deposition and the field emission properties

NASA Astrophysics Data System (ADS)

Guo, Xin; Qin, Shengchun; Bai, Shuai; Yue, Hongwei; Li, Yali; Chen, Qiang; Li, Junshuai; He, Deyan

2016-09-01

In this paper, we explored synthesis of vertical graphene nanosheets (VGNs) by thermal chemical vapor deposition (CVD). Through optimizing the experimental condition, growth of well aligned VGNs with uniform morphologies on nickel-coated stainless steel (SS) was realized for the first time by thermal CVD. In the meantime, influence of growth parameters on the VGN morphology was understood based on the balancing between the concentration and kinetic energy of carbon-containing radicals. Structural characterizations demonstrate that the achieved VGNs are normally composed of several graphene layers and less corrugated compared to the ones synthesized by other approaches, e.g. plasma enhanced (PE) CVD. The field emission measurement indicates that the VGNs exhibit relatively stable field emission and a field enhancement factor of about 1470, which is comparable to the values of VGNs prepared by PECVD can be achieved.

CVD-Enabled Graphene Manufacture and Technology

PubMed Central

2015-01-01

Integrated manufacturing is arguably the most challenging task in the development of technology based on graphene and other 2D materials, particularly with regard to the industrial demand for “electronic-grade” large-area films. In order to control the structure and properties of these materials at the monolayer level, their nucleation, growth and interfacing needs to be understood to a level of unprecedented detail compared to existing thin film or bulk materials. Chemical vapor deposition (CVD) has emerged as the most versatile and promising technique to develop graphene and 2D material films into industrial device materials and this Perspective outlines recent progress, trends, and emerging CVD processing pathways. A key focus is the emerging understanding of the underlying growth mechanisms, in particular on the role of the required catalytic growth substrate, which brings together the latest progress in the fields of heterogeneous catalysis and classic crystal/thin-film growth. PMID:26240694

Graphene growth with ‘no’ feedstock

NASA Astrophysics Data System (ADS)

Qing, Fangzhu; Jia, Ruitao; Li, Bao-Wen; Liu, Chunlin; Li, Congzhou; Peng, Bo; Deng, Longjiang; Zhang, Wanli; Li, Yanrong; Ruoff, Rodney S.; Li, Xuesong

2017-06-01

Synthesis of graphene by chemical vapor deposition (CVD) from hydrocarbons on Cu foil substrates can yield high quality and large area graphene films. In a typical CVD process, a hydrocarbon in the gas phase is introduced for graphene growth and hydrogen is usually required to achieve high quality graphene. We have found that in a low pressure CVD system equipped with an oil mechanical vacuum pump located downstream, graphene can be grown without deliberate introduction of a carbon feedstock but with only trace amounts of C present in the system, the origin of which we attribute to the vapor of the pump oil. This finding may help to rationalize the differences in graphene growth reported by different research groups. It should also help to gain an in-depth understanding of graphene growth mechanisms with the aim to improve the reproducibility and structure control in graphene synthesis, e.g. the formation of large area single crystal graphene and uniform bilayer graphene.

Advances in the Development of a WCl6 CVD System for Coating UO2 Powders with Tungsten

NASA Technical Reports Server (NTRS)

Mireles, Omar R.; Tieman, Alyssa; Broadway, Jeramie; Hickman, Robert

2013-01-01

W-UO2 CERMET fuels are under development to enable Nuclear Thermal Propulsion (NTP) for deep space exploration. Research efforts with an emphasis on fuel fabrication, testing, and identification of potential risks is underway. One primary risk is fuel loss due to CTE mismatch between W and UO2 and the grain boundary structure of W particles resulting in higher thermal stresses. Mechanical failure can result in significant reduction of the UO2 by hot hydrogen. Fuel loss can be mitigated if the UO2 particles are coated with a layer of high density tungsten before the consolidation process. This paper discusses the work to date, results, and advances of a fluidized bed chemical vapor deposition (CVD) system that utilizes the H2-WCl6 reduction process. Keywords: Space, Nuclear, Thermal, Propulsion, Fuel, CERMET, CVD, Tungsten, Uranium

The optical properties of transferred graphene and the dielectrics grown on it obtained by ellipsometry

NASA Astrophysics Data System (ADS)

Kasikov, Aarne; Kahro, Tauno; Matisen, Leonard; Kodu, Margus; Tarre, Aivar; Seemen, Helina; Alles, Harry

2018-04-01

Graphene layers grown by chemical vapour deposition (CVD) method and transferred from Cu-foils to the oxidized Si-substrates were investigated by spectroscopic ellipsometry (SE), Raman and X-Ray Photoelectron Spectroscopy (XPS) methods. The optical properties of transferred CVD graphene layers do not always correspond to the ones of the exfoliated graphene due to the contamination from the chemicals used in the transfer process. However, the real thickness and the mean properties of the transferred CVD graphene layers can be found using ellipsometry if a real thickness of the SiO2 layer is taken into account. The pulsed laser deposition (PLD) and atomic layer deposition (ALD) methods were used to grow dielectric layers on the transferred graphene and the obtained structures were characterized using optical methods. The approach demonstrated in this work could be useful for the characterization of various materials grown on graphene.

Parental Age of Onset of Cardiovascular Disease as a Predictor for Offspring Age of Onset of Cardiovascular Disease.

PubMed

Allport, Shannon Anjelica; Kikah, Ngum; Abu Saif, Nessim; Ekokobe, Fonkem; Atem, Folefac D

2016-01-01

The risk for cardiovascular disease (CVD) is higher for individuals with a first-degree relative who developed premature CVD (with a threshold at age 55 years for a male or 65 years for a female). However, little is known about the effect that each unit increase or decrease of maternal or paternal age of onset of CVD has on offspring age of onset of CVD. We hypothesized that there is an association between maternal and paternal age of onset of CVD and offspring age of onset of CVD. We used the Framingham Heart Study database and performed conditional imputation for CVD-censored parental age (i.e. parents that didn't experience onset of CVD) and Cox proportional regression analysis, with offspring's age of onset of CVD as the dependent variable and parental age of onset of CVD as the primary predictor. Modifiable risk factors in offspring, such as cigarette smoking, body mass index (BMI), diabetes mellitus, systolic blood pressure (SBP), high-density lipoprotein (HDL) level, and low-density lipoprotein (LDL) level, were controlled for. Separate analyses were performed for the association between maternal age of onset of CVD and offspring age of onset of CVD and the association between paternal age of onset of CVD and offspring age of onset of CVD. Parental age of onset of CVD was predictive of offspring age of onset of CVD for maternal age of onset of CVD (P < .0001; N = 1401) and for paternal age of onset of CVD (P = 0.0134; N = 1221). A negative estimate of the coefficient of interest signifies that late onset of cardiovascular events in parents is protective of onset of CVD in offspring. Cigarette smoking and HDL level were important associated confounders. Offspring age of onset of cardiovascular disease is significantly associated with both maternal and paternal age of onset CVD. The incorporation of the parameters, maternal or paternal age of onset of CVD, into risk estimate calculators may improve accuracy of identification of high-risk patients in clinical settings.

Analysis of synthetic diamond single crystals by X-ray topography and double-crystal diffractometry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Prokhorov, I. A., E-mail: igor.prokhorov@mail.ru; Ralchenko, V. G.; Bolshakov, A. P.

2013-12-15

Structural features of diamond single crystals synthesized under high pressure and homoepitaxial films grown by chemical vapor deposition (CVD) have been analyzed by double-crystal X-ray diffractometry and topography. The conditions of a diffraction analysis of diamond crystals using Ge monochromators have been optimized. The main structural defects (dislocations, stacking faults, growth striations, second-phase inclusions, etc.) formed during crystal growth have been revealed. The nitrogen concentration in high-pressure/high-temperature (HPHT) diamond substrates is estimated based on X-ray diffraction data. The formation of dislocation bundles at the film-substrate interface in the epitaxial structures has been revealed by plane-wave topography; these dislocations are likelymore » due to the relaxation of elastic macroscopic stresses caused by the lattice mismatch between the substrate and film. The critical thicknesses of plastic relaxation onset in CVD diamond films are calculated. The experimental techniques for studying the real diamond structure in optimizing crystal-growth technology are proven to be highly efficient.« less

E-Bra system for women ECG measurement with GPRS communication, Nanosensor, and motion artifact remove algorithm

NASA Astrophysics Data System (ADS)

Kwon, Hyeokjun; Oh, Sechang; Kumar, Prashanth S.; Varadan, Vijay K.

2012-10-01

CardioVascular Disease(CVD)s lead the sudden cardiac death due to irregular phenomenon of the cardiac signal by the abnormal case of blood vessel and cardiac structure. For last two decades, cardiac disease research for man is under active discussion. As a result, the death rate by cardiac disease in men has been falling gradually compared with relatively increasing the women death rate due to CVD[2]. The main reason of this phenomenon causes the lack a sense of the seriousness to female CVD and different symptom of female CVD compared with the symptoms of male CVD. Usually, because the women CVD accompanies with ordinary symptoms unrecognizing the heart abnormality signal such as unusual fatigue, sleep disturbances, shortness of breath, anxiety, chest discomfort, and indigestion dyspepsia, most women CVD patients do not realize that these symptoms are related to the CVD symptoms. Therefore, periodic ECG signal observation is required for women cardiac disease patients. ElectroCardioGram(ECG) detection, treadmill test/exercise ECG, nuclear scan, coronary angiography, and intracoronary ultrasound are used to diagnose abnormality of heart. Among the medical checkup methods for CVDs checkup, it is very effective method for the diagnosis of cardiac disease and the early detection of heart abnormality to monitor ECG periodically. This paper suggests the effective ECG monitoring system for woman by attaching the system on woman's brassiere by using augmented chest lead attachment method. The suggested system in this paper consists of ECG signal transmission system and a server program to display and analyze the transmitted ECG. The ECG signal transmission system consists of three parts such as ECG physical signal detection part with two electrodes made by gold nanowire structure, data acquisition with AD converter, and data transmission part with GPRS(General Packet Radio Service) communication. Usually, to detect human bio signal, Ag/AgCl or gold cup electrodes are used with conductive gel. However, the gel can be dried when taking long time monitoring. The gold nanowire structure electrodes without consideration of uncomfortable usage of gel are attached on beneath the chest position of a brassiere, and the electrodes convert the physical ECG signal to voltage potential signal. The voltage potential ECG signal is converted to digital signal by AD converter included in microprocessor. The converted ECG signal by AD converter is saved on every 1 sec period in the internal RAM in microprocessor. For transmission of the saved data in the internal RAM to a server computer locating at remote area, the system uses the GPRS communication technology, which can develop the wide area network(WAP) without any gateway and repeater. In addition, the transmission system is operated on client mode of GPRS communication. The remote server is installed a program including the functions of displaying and analyzing the transmitted ECG. To display the ECG data, the program is operated with TCP/IP server mode and static IP address, and to analyze the ECG data, the paper suggests motion artifact remove algorithm including adaptive filter with LMS(least mean square), baseline detection algorithm using predictability estimation theory, a filter with moving weighted factor, low pass filter, peak to peak detection, and interpolation.

CVD Polymers for Devices and Device Fabrication.

PubMed

Wang, Minghui; Wang, Xiaoxue; Moni, Priya; Liu, Andong; Kim, Do Han; Jo, Won Jun; Sojoudi, Hossein; Gleason, Karen K

2017-03-01

Chemical vapor deposition (CVD) polymerization directly synthesizes organic thin films on a substrate from vapor phase reactants. Dielectric, semiconducting, electrically conducting, and ionically conducting CVD polymers have all been readily integrated into devices. The absence of solvent in the CVD process enables the growth of high-purity layers and avoids the potential of dewetting phenomena, which lead to pinhole defects. By limiting contaminants and defects, ultrathin (<10 nm) CVD polymeric device layers have been fabricated in multiple laboratories. The CVD method is particularly suitable for synthesizing insoluble conductive polymers, layers with high densities of organic functional groups, and robust crosslinked networks. Additionally, CVD polymers are prized for the ability to conformally cover rough surfaces, like those of paper and textile substrates, as well as the complex geometries of micro- and nanostructured devices. By employing low processing temperatures, CVD polymerization avoids damaging substrates and underlying device layers. This report discusses the mechanisms of the major CVD polymerization techniques and the recent progress of their applications in devices and device fabrication, with emphasis on initiated CVD (iCVD) and oxidative CVD (oCVD) polymerization. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Cardiovascular Disease Prevalence and Risk Factors of Persons with Mental Retardation

ERIC Educational Resources Information Center

Draheim, Christopher C.

2006-01-01

This paper reviews the recent literature on cardiovascular disease (CVD) prevalence, CVD-related mortality, physiological CVD risk factors, and behavioral CVD risk factors in adults with mental retardation (MR). The literature on the potential influences of modifiable behavioral CVD risk factors and the physiological CVD risk factors are also…

Family history of cardiovascular disease (CVD), perceived CVD risk, and health-related behavior: A review of the literature

PubMed Central

Imes, Christopher C.; Lewis, Frances Marcus

2012-01-01

Background Over 82 million Americans have one or more forms of cardiovascular disease (CVD), accounting for 32.8% of all deaths in the United States. Although the evidence for the familial aggregation of CVD is strong, the relationship between family history (FH) of CVD, perceived risk for CVD and their relationship to health-related behavior is poorly understood. Objective The objective of this article is to review and summarize the published research on the relationship between a FH of CVD, an individual’s perceived risk, and health-related behavior in order to make recommendations for clinical practice and future research. Methods A literature search was conducted using PubMed, CINAHL Plus, and PsycINFO to identify articles that examined the relationship between a FH of CVD, perceived CVD risk, and health-promoting behaviors. A total of 263 unique articles were reviewed. Two hundred thirty-eight were excluded, resulting in a total of 25 articles included in the paper. Results There was a positive relationship between a reported FH of CVD and perceived risk. However, the relationship between a FH of CVD and health-related behavior change and perceived risk and behavior change was inconsistent. Conclusions A person’s awareness of their FH of CVD or their own risk for CVD is not a sufficient predictor of changes in their health-related behavior. Future studies are needed to better explain the processes by which perceived CVD risk or FH of CVD can be used to affect health-related behavior changes. It appears that both FH and perceived personal risk for CVD are necessary but not sufficient conditions to change health-related behavior in high-risk populations. Future studies should also test interventions that help individuals with a FH of CVD attribute increased personal risk to themselves for developing CVD, while providing lifestyle management options to minimize their risk. PMID:23321782

High efficiency epitaxial GaAs/GaAs and GaAs/Ge solar cell technology using OM/CVD

NASA Technical Reports Server (NTRS)

Wang, K. L.; Yeh, Y. C. M.; Stirn, R. J.; Swerdling, S.

1980-01-01

A technology for fabricating high efficiency, thin film GaAs solar cells on substrates appropriate for space and/or terrestrial applications was developed. The approach adopted utilizes organometallic chemical vapor deposition (OM-CVD) to form a GaAs layer epitaxially on a suitably prepared Ge epi-interlayer deposited on a substrate, especially a light weight silicon substrate which can lead to a 300 watt per kilogram array technology for space. The proposed cell structure is described. The GaAs epilayer growth on single crystal GaAs and Ge wafer substrates were investigated.

Structurally controlled deposition of silicon onto nanowires

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Weijie; Liu, Zuqin; Han, Song

Provided herein are nanostructures for lithium ion battery electrodes and methods of fabrication. In some embodiments, a nanostructure template coated with a silicon coating is provided. The silicon coating may include a non-conformal, more porous layer and a conformal, denser layer on the non-conformal, more porous layer. In some embodiments, two different deposition processes, e.g., a PECVD layer to deposit the non-conformal layer and a thermal CVD process to deposit the conformal layer, are used. Anodes including the nanostructures have longer cycle lifetimes than anodes made using either a PECVD or thermal CVD method alone.

Geographic Variation in Morbidity and Mortality of Cerebrovascular Diseases in Korea during 2011-2015.

PubMed

Lee, Juyeon; Bahk, Jinwook; Kim, Ikhan; Kim, Yeon-Yong; Yun, Sung-Cheol; Kang, Hee-Yeon; Lee, Jeehye; Park, Jong Heon; Shin, Soon-Ae; Khang, Young-Ho

2018-03-01

Little is known about within-country variation in morbidity and mortality of cerebrovascular diseases (CVDs). Geographic differences in CVD morbidity and mortality have yet to be properly examined. This study examined geographic variation in morbidity and mortality of CVD, neighborhood factors for CVD morbidity and mortality, and the association between CVD morbidity and mortality across the 245 local districts in Korea during 2011-2015. District-level health care utilization and mortality data were obtained to estimate age-standardized CVD morbidity and mortality. The bivariate Pearson correlation was used to examine the linear relationship between district-level CVD morbidity and mortality Z-scores. Simple linear regression and multivariate analyses were conducted to investigate the associations of area characteristics with CVD morbidity, mortality, and discrepancies between morbidity and mortality. Substantial variation was found in CVD morbidity and mortality across the country, with 1074.9 excess CVD inpatients and 73.8 excess CVD deaths per 100,000 between the districts with the lowest and highest CVD morbidity and mortality, respectively. Higher rates of CVD admissions and deaths were clustered in the noncapital regions. A moderate geographic correlation between CVD morbidity and mortality was found (Pearson correlation coefficient = .62 for both genders). Neighborhood level indicators for socioeconomic disadvantages, undersupply of health care resources, and unhealthy behaviors were positively associated with CVD morbidity and mortality and the relative standing of CVD mortality vis-à-vis morbidity. Policy actions targeting life-course socioeconomic conditions, equitable distribution of health care resources, and behavioral risk factors may help reduce geographic differences in CVD morbidity and mortality in Korea. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Vivir Con Un Corazón Saludable: a Community-Based Educational Program Aimed at Increasing Cardiovascular Health Knowledge in High-Risk Hispanic Women.

PubMed

Romero, Daniela C; Sauris, Aileen; Rodriguez, Fátima; Delgado, Daniela; Reddy, Ankita; Foody, JoAnne M

2016-03-01

Hispanic women suffer from high rates of cardiometabolic risk factors and an increasingly disproportionate burden of cardiovascular disease (CVD). Particularly, Hispanic women with limited English proficiency suffer from low levels of CVD knowledge associated with adverse CVD health outcomes. Thirty-two predominantly Spanish-speaking Hispanic women completed, Vivir Con un Corazón Saludable (VCUCS), a culturally tailored Spanish language-based 6-week intensive community program targeting CVD health knowledge through weekly interactive health sessions. A 30-question CVD knowledge questionnaire was used to assess mean changes in CVD knowledge at baseline and postintervention across five major knowledge domains including CVD epidemiology, dietary knowledge, medical information, risk factors, and heart attack symptoms. Completion of the program was associated with a statistically significant (p < 0.001) increase in total mean CVD knowledge scores from 39 % (mean 11.7/30.0) to 66 % (mean 19.8/30.0) postintervention consistent with a 68 % increase in overall mean CVD scores. There was a statistically significant (p < 0.001) increase in mean knowledge scores across all five CVD domains. A culturally tailored Spanish language-based health program is effective in increasing CVD awareness among high CVD risk Hispanic women with low English proficiency and low baseline CVD knowledge.

Work stress and cardiovascular disease: a life course perspective.

PubMed

Li, Jian; Loerbroks, Adrian; Bosma, Hans; Angerer, Peter

2016-05-25

Individuals in employment experience stress at work, and numerous epidemiological studies have documented its negative health effects, particularly on cardiovascular disease (CVD). Although evidence on the various interrelationships between work stress and CVD has been accumulated, those observations have not yet been conceptualized in terms of a life course perspective. Using the chain of risk model, we would like to propose a theoretical model incorporating six steps: (1) work stress increases the risk of incident CVD in healthy workers. (2) Among those whose work ability is not fully and permanently damaged, work stress acts as a determinant of the process of return to work after CVD onset. (3) CVD patients experience higher work stress after return to work. (4) Work stress increases the risk of recurrent CVD in workers with prior CVD. (5) CVD patients who fully lose their work ability transit to disability retirement. (6) Disability retirees due to CVD have an elevated risk of CVD mortality. The life course perspective might facilitate an in-depth understanding of the diverse interrelationships between work stress and CVD, thereby leading to work stress management interventions at each period of the lifespan and three-level prevention of CVD.

Cardiovascular disease risk factors and the perception of general health among male law enforcement officers: encouraging behavioral change.

PubMed

Ramey, Sandra L

2003-05-01

The relationship among cardiovascular disease (CVD) morbidity, risk factors (including stress), and the perception of health among male law enforcement officers (LEOs) compared to men in the general population were examined in this study. Self reported prevalence of CVD and CVD risk factors among currently employed male LEOs from nine states (n = 2,818) were compared to those of other men in the same states (n = 9,650 for CVD risk factors, n = 3,147 for CVD prevalence). Perceived stress in LEOs was assessed to determine if it affected the relationship between CVD prevalence and CVD risk factors. Cross tabulated simple percentages showed CVD was less prevalent in the LEO group than among the general population. The best predictor variables for CVD were perceived stress, time in the profession, and hypertension. The LEO group had greater prevalence of hypercholesterolemia, overweight, and tobacco use than the general population. However, a greater percentage of LEOs perceived their health as "good to excellent" compared to men in the general population. Using multivariate analysis of variance (MANOVA) it was determined that perceived stress was associated with CVD in the LEO group and three CVD risk factors (i.e., cholesterol, hypertension, physical activity) were significantly affected by perceived stress. Among susceptible officers, stress may contribute to CVD development as well as potentiate several CVD risk factors. However, an apparent lack of association exists between perception of general health and CVD risk in LEOs.

Risks of restrictive red blood cell transfusion strategies in patients with cardiovascular disease (CVD): a meta-analysis.

PubMed

Cortés-Puch, I; Wiley, B M; Sun, J; Klein, H G; Welsh, J; Danner, R L; Eichacker, P Q; Natanson, C

2018-04-19

To evaluate the risks of restrictive red blood cell transfusion strategies (haemoglobin 7-8 g dL -1 ) in patients with and without known cardiovascular disease (CVD). Recent guidelines recommend restrictive strategies for CVD patients hospitalised for non-CVD indications, patients without known CVD and patients hospitalised for CVD corrective procedures. Database searches were conducted through December 2017 for randomised clinical trials that enrolled patients with and without known CVD, hospitalised either for CVD-corrective procedures or non-cardiac indications, comparing effects of liberal with restrictive strategies on major adverse coronary events (MACE) and death. In CVD patients not undergoing cardiac interventions, a liberal strategy decreased (P = 0·01) the relative risk (95% CI) (RR) of MACE [0·50 (0·29-0·86)] (I 2  = 0%). Among patients without known CVD, the incidence of MACE was lower (1·7 vs 3·9%), and the effect of a liberal strategy on MACE [0·79, (0·39-1·58)] was smaller and non-significant but not different from CVD patients (P = 0·30). Combining all CVD and non-CVD patients, a liberal strategy decreased MACE [0·59, (0·39-0·91); P = 0·02]. Conversely, among studies reporting mortality, a liberal strategy decreased mortality in CVD patients (11·7% vs·13·3%) but increased mortality (19·2% vs 18·0%) in patients without known CVD [interaction P = 0·05; ratio of RR 0·73, (0·53-1·00)]. A liberal strategy also did not benefit patients undergoing cardiac surgery; data were insufficient for percutaneous cardiac procedures. In patients hospitalised for non-cardiac indications, liberal transfusion strategies are associated with a decreased risk of MACE in both those with and without known CVD. However, this only provides a survival benefit to CVD patients not admitted for CVD-corrective procedures. © 2018 British Blood Transfusion Society.

Chronic Kidney Disease as a Predictor of Cardiovascular Disease (From the Framingham Heart Study)

PubMed Central

Parikh, Nisha I.; Hwang, Shih-Jen; Larson, Martin G.; Levy, Daniel; Fox, Caroline S.

2008-01-01

Chronic kidney disease (CKD) is a risk factor for cardiovascular disease (CVD), although shared risk factors may mediate much of the association. We related CKD and CVD in the setting of specific CVD risk factors and determined whether more advanced CKD was a CVD risk equivalent. The Framingham Heart Study original cohort (n=2471, mean age 68 years, 58.9% women) was studied. Glomerular filtration rate (eGFR) was estimated using the simplified Modification of Diet in Renal Disease Study equation. CKD was defined as eGFR < 59 mL/min per 1.73 m2 (women) and < 64 (men) and Stage 3b CKD defined as eGFR 30-44 (women) and 30-50 (men). Cox Proportional Hazard models adjusting for CVD risk factors were used to relate CKD to CVD. We tested for effect modification by CVD risk factors. Overall, 23.2% of the study sample had CKD (n=574; mean eGFR 50 mL/min per 1.73 m2) and 5.3% had Stage 3b CKD (n=131; mean eGFR 42 mL/min per 1.73 m2). In multivariable models (mean follow-up time 16 years), Stage 3 CKD was marginally associated with CVD (HR=1.17, 95% CI 0.99-1.38, p=0.06), whereas Stage 3b CKD was associated with CVD [HR=1.41, 95% CI 1.05-1.91, p=0.02]. Upon testing CVD risk equivalency, the risk of CVD for Stage 3b CKD among participants with prior CVD was significantly lower as compared to participants with prior CVD and no Stage 3b CKD (age- and sex-adjusted HR for CVD = 0.66 [95% CI 0.47 to 0.91], p=0.01). Low HDL modified the association between CKD and CVD (p-value=0.004 for interaction). Stage 3b CKD is associated with CVD but is not a CVD risk equivalent. In conclusion, CVD risk in the setting of CKD is higher in the setting of low HDL cholesterol. PMID:18572034

Probing Growth-Induced Anisotropic Thermal Transport in High-Quality CVD Diamond Membranes by Multifrequency and Multiple-Spot-Size Time-Domain Thermoreflectance.

PubMed

Cheng, Zhe; Bougher, Thomas; Bai, Tingyu; Wang, Steven Y; Li, Chao; Yates, Luke; Foley, Brian M; Goorsky, Mark; Cola, Baratunde A; Faili, Firooz; Graham, Samuel

2018-02-07

The maximum output power of GaN-based high-electron mobility transistors is limited by high channel temperature induced by localized self-heating, which degrades device performance and reliability. Chemical vapor deposition (CVD) diamond is an attractive candidate to aid in the extraction of this heat and in minimizing the peak operating temperatures of high-power electronics. Owing to its inhomogeneous structure, the thermal conductivity of CVD diamond varies along the growth direction and can differ between the in-plane and out-of-plane directions, resulting in a complex three-dimensional (3D) distribution. Depending on the thickness of the diamond and size of the electronic device, this 3D distribution may impact the effectiveness of CVD diamond in device thermal management. In this work, time-domain thermoreflectance is used to measure the anisotropic thermal conductivity of an 11.8 μm-thick high-quality CVD diamond membrane from its nucleation side. Starting with a spot-size diameter larger than the thickness of the membrane, measurements are made at various modulation frequencies from 1.2 to 11.6 MHz to tune the heat penetration depth and sample the variation in thermal conductivity. We then analyze the data by creating a model with the membrane divided into ten sublayers and assume isotropic thermal conductivity in each sublayer. From this, we observe a two-dimensional gradient of the depth-dependent thermal conductivity for this membrane. The local thermal conductivity goes beyond 1000 W/(m K) when the distance from the nucleation interface only reaches 3 μm. Additionally, by measuring the same region with a smaller spot size at multiple frequencies, the in-plane and cross-plane thermal conductivities are extracted. Through this use of multiple spot sizes and modulation frequencies, the 3D anisotropic thermal conductivity of CVD diamond membrane is experimentally obtained by fitting the experimental data to a thermal model. This work provides an improved understanding of thermal conductivity inhomogeneity in high-quality CVD polycrystalline diamond that is important for applications in the thermal management of high-power electronics.

Drugs for cardiovascular disease in India: perspectives of pharmaceutical executives and government officials on access and development-a qualitative analysis.

PubMed

Newman, Charles; Ajay, Vamadevan S; Srinivas, Ravi; Bhalla, Sandeep; Prabhakaran, Dorairaj; Banerjee, Amitava

2016-01-01

India shoulders the greatest global burden of cardiovascular diseases (CVDs), which are the leading cause of mortality worldwide. Drugs are the bedrock of treatment and prevention of CVD. India's pharmaceutical industry is the third largest, by volume, globally, but access to CVD drugs in India is poor. There is a lack of qualitative data from government and pharmaceutical sectors regarding CVD drug development and access in India. By purposive sampling, we recruited either Indian government officials, or pharmaceutical company executives. We conducted a stakeholder analysis via semi-structured, face-to-face interviews in India. Topic guides allow for the exploration of key issues across multiple interviews, along with affording the interviewer the flexibility to examine matters arising from the discussions themselves. After transcription, interviews underwent inductive thematic analysis. Ten participants were interviewed (Government Officials: n = 5, and Pharmaceutical Executives: n = 5). Two themes emerged: i) 'Policy-derived Factors'; ii) 'Patient- derived Factors' with three findings. First, both government and pharmaceutical participants felt that the focus of Indian pharma is shifting to more complex, high-quality generics and to new drug development, but production of generic drugs rather than new molecular entities will remain a major activity. Second, current trial regulations in India may restrict India's potential role in the future development of CVD drugs. Third, it is likely that the Indian government will tighten its intellectual property regime in future, with potentially far-reaching implications on CVD drug development and access. Our stakeholder analysis provides some support for present patent regulations, whilst suggesting areas for further research in order to inform future policy decisions regarding CVD drug development and availability. Whilst interviewees suggested government policy plays an important role in shaping the industry, a significant force for change was ascribed to patient-derived factors. This suggests a potential role for Indian initiatives that market the unique advantages of its patient population for drug research in influencing national and multinational pharmaceutical companies to undertake CVD drug development in India, rather than simply IP policy-directed factors.

Development of CVD mullite coatings for Si-based ceramics

NASA Astrophysics Data System (ADS)

Auger, Michael Lawrence

1999-09-01

To raise fuel efficiencies, the next generation of engines and fuel systems must be lighter and operate at higher temperatures. Ceramic-based materials, which are considerably lighter than metals and can withstand working temperatures of up to 1400sp°C, have been targeted to replace traditional metal-based components. The materials used in combustion environments must also be capable of withstanding erosion and corrosion caused by combustion gases, particulates, and deposit-forming corrodants. With these demanding criteria, silicon-based ceramics are the leading candidate materials for high temperature engine and heat exchanger structural components. However, these materials are limited in gaseous environments and in the presence of molten salts since they form liquid silicates on exposed surfaces at temperatures as low as 800sp°C. Protective coatings that can withstand higher operating temperatures and corrosive atmospheres must be developed for silicon-based ceramics. Mullite (3Alsb2Osb3{*}2SiOsb2) was targeted as a potential coating material due to its unique ability to resist corrosion, retain its strength, resist creep, and avoid thermal shock failure at elevated temperatures. Several attempts to deposit mullite coatings by various processing methods have met with limited success and usually resulted in coatings that have had pores, cracks, poor adherence, and required thermal post-treatments. To overcome these deficiencies, the direct formation of chemically vapor deposited (CVD) mullite coatings has been developed. CVD is a high temperature atomistic deposition technique that results in dense, adherent crystalline coatings. The object of this dissertation was to further the understanding of the CVD mullite deposition process and resultant coating. The kinetics of CVD mullite deposition were investigated as a function of the following process parameters: temperature, pressure, and the deposition reactor system. An empirical kinetic model was developed indicating that an intermediate gaseous reaction is significant to the growth rate of mullite. CVD mullite coatings were deposited on SiC and Sisb3Nsb4 substrates and subjected to both simulated coal gasification and simulated jet fuel combustion conditions. Corrosion resistance of CVD mullite coated ceramics was superior to traditional refractory materials including alumina, solid mullite, Sisb3Nsb4, and silicon carbide.

Factors associated with blue-collar workers' risk perception of cardiovascular disease.

PubMed

Hwang, Won Ju; Hong, Oisaeng; Kim, Mi Ja

2012-12-01

The purpose of this study was to investigate the contribution of actual cardiovascular disease (CVD) risk, as well as, individual, psychosocial, and work-related factors as predictors of CVD risk perception among Korean blue-collar workers. The participants were 238 Korean blue-collar workers who worked in small companies. Data were collected through a survey; anthropometric and blood pressure measures; and blood sampling for lipid levels. Blue-collar workers had high actual CVD risk and low CVD risk perception. The significant predictors of risk perception included perceived health status, alcohol consumption, knowledge of CVD risk, actual CVD risk, decision latitude, and shift work. The model explained 26% of the variance in CVD risk perception. The result suggests when occupational health nurses are giving routine health examination in small companies, they can enhance CVD risk perception in blue-collar workers by providing essential information about CVD risk factors and personal counseling on the individual worker's CVD risk status.

An overview on tritium permeation barrier development for WCLL blanket concept

NASA Astrophysics Data System (ADS)

Aiello, A.; Ciampichetti, A.; Benamati, G.

2004-08-01

The reduction of tritium permeation through blanket structural materials and cooling tubes has to be carefully evaluated to minimise radiological hazards. A strong effort has been made in the past to select the best technological solution for the realisation of tritium permeation barriers (TPB) on complex structures not directly accessible after the completion of the manufacturing process. The best solution was identified in aluminium rich coatings, which form Al 2O 3 at their surface. Two technologies were selected as reference for the realisation of coating in the WCLL blanket concept: the chemical vapour deposition (CVD) process developed on laboratory scale by CEA, and the hot dipping (HD) process developed by FZK. The results obtained during three years of tests on CVD and HD coated specimens in gas and liquid metal phase are summarised and discussed.

CVD growth of large-area and high-quality HfS2 nanoforest on diverse substrates

NASA Astrophysics Data System (ADS)

Zheng, Binjie; Wang, Zegao; Qi, Fei; Wang, Xinqiang; Yu, Bo; Zhang, Wanli; Chen, Yuanfu

2018-03-01

Two-dimensional layered transition metal dichalcogenides (TMDs) have attracted burgeoning attention due to their various properties and wide potential applications. As a new TMD, hafnium disulfide (HfS2) is theoretically predicted to have better electrical performance than widely studied MoS2. The experimental researches also confirmed the extraordinary feature in electronics and optoelectronics. However, the maximal device performance may not be achieved due to its own limitation of planar structure and challenge of transfer without contamination. Here, through the chemical vapor deposition (CVD) technique, inch-size HfS2 nanoforest has been directly grown on diverse objective substrates covering insulating, semiconducting and conducting substrates. This direct CVD growth without conventional transfer process avoids contamination and degradation in quality, suggesting its promising and wide applications in high-quality and multifarious devices. It is noted that all the HfS2 nanoforests grown on diverse substrates are constructed with vertically aligned few-layered HfS2 nanosheets with high crystalline quality and edge orientation. Moreover, due to its unique structure, the HfS2 nanoforest owns abundant exposed edge sites and large active surface area, which is essential to apply in high-performance catalyst, sensor, and energy storage or field emitter.

Thermal barrier coatings on gas turbine blades: Chemical vapor deposition (Review)

NASA Astrophysics Data System (ADS)

Igumenov, I. K.; Aksenov, A. N.

2017-12-01

Schemes are presented for experimental setups (reactors) developed at leading scientific centers connected with the development of technologies for the deposition of coatings using the CVD method: at the Technical University of Braunschweig (Germany), the French Aerospace Research Center, the Materials Research Institute (Tohoku University, Japan) and the National Laboratory Oak Ridge (USA). Conditions and modes for obtaining the coatings with high operational parameters are considered. It is established that the formed thermal barrier coatings do not fundamentally differ in their properties (columnar microstructure, thermocyclic resistance, thermal conductivity coefficient) from standard electron-beam condensates, but the highest growth rates and the perfection of the crystal structure are achieved in the case of plasma-chemical processes and in reactors with additional laser or induction heating of a workpiece. It is shown that CVD reactors can serve as a basis for the development of rational and more advanced technologies for coating gas turbine blades that are not inferior to standard electron-beam plants in terms of the quality of produced coatings and have a much simpler and cheaper structure. The possibility of developing a new technology based on CVD processes for the formation of thermal barrier coatings with high operational parameters is discussed, including a set of requirements for industrial reactors, high-performance sources of vapor precursors, and promising new materials.

Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?

PubMed

Ludt, Sabine; Campbell, Stephen M; Petek, Davorina; Rochon, Justine; Szecsenyi, Joachim; van Lieshout, Jan; Wensing, Michel; Ose, Dominik

2013-03-09

Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care. An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM. The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score 'Preventive Services' (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001). There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology.

Sleep as a Potential Fundamental Contributor to Cardiovascular Health Disparities

PubMed Central

Jackson, Chandra L.; Redline, Susan; Emmons, Karen M.

2016-01-01

Optimal sleep is integral to health but is commonly not obtained. Despite its wide ranging public health impact, sleep health is under-appreciated by the general public and is only rarely considered by policy makers, employers, schools, and others whose policies and structures can adversely affect sleep. Inadequate sleep duration and quality are prevalent in minority and low-income populations and may play a fundamental role in racial and socioeconomic status (SES) inequities for a wide range of health conditions including cardiovascular disease (CVD).The goal of this review is to examine the relationship between sleep and CVD health disparities. To this end, we describe the overall public health importance of sleep and the role of sleep duration as well as the two most common disorders (sleep apnea and insomnia) as risk factors for a number of chronic diseases. We then focus on the potential link between sleep and CVD disparities. A multilevel model developed for the analysis of population health and health disparities as a part of the National Cancer Institute’s Centers on Population Health and Health Disparities served as our conceptual framework. It is based on the notion that individual behaviors, like sleep, are influenced by complex and dynamic interrelations among the individual and his or her physical and social environments across the lifespan. Using this model, we describe modifiable factors that contribute to insufficient sleep and circadian misalignment, propose potential interventions in various sectors (e.g. neighborhoods, schools, workplaces) that address social structures that contribute to disparities, and conclude by recommending critical areas for future sleep research. We ultimately suggest that integrating sleep into public health research will identify novel approaches for closing the gap in health disparities, such as CVD. PMID:25785893

Nano- and microcrystalline diamond deposition on pretreated WC-Co substrates: structural properties and adhesion

NASA Astrophysics Data System (ADS)

Fraga, M. A.; Contin, A.; Rodríguez, L. A. A.; Vieira, J.; Campos, R. A.; Corat, E. J.; Trava Airoldi, V. J.

2016-02-01

Many developments have been made to improve the quality and adherence of CVD diamond films onto WC-Co hard metal tools by the removing the cobalt from the substrate surface through substrate pretreatments. Here we compare the efficiency of three chemical pretreatments of WC-Co substrates for this purpose. First, the work was focused on a detailed study of the composition and structure of as-polished and pretreated substrate surfaces to characterize the effects of the substrate preparation. Considering this objective, a set of WC-9% Co substrates, before and after pretreatment, was analyzed by FEG-SEM, EDS and x-ray diffraction (XRD). The second stage of the work was devoted to the evaluation of the influence of seeding process, using 4 nm diamond nanoparticles, on the morphology and roughness of the pretreated substrates. The last and most important stage was to deposit diamond coatings with different crystallite sizes (nano and micro) by hot-filament CVD to understand fully the mechanism of growth and adhesion of CVD diamond films on pretreated WC-Co substrates. The transition from nano to microcrystalline diamond was achieved by controlling the CH4/H2 gas ratio. The nano and microcrystalline samples were grown under same time at different substrate temperatures 600 °C and 800 °C, respectively. The different substrate temperatures allowed the analysis of the cobalt diffusion from the bulk to the substrate surface during CVD film growth. Furthermore, it was possible to evaluate how the coating adhesion is affected by the diffusion. The diamond coatings were characterized by Raman spectroscopy, XRD, EDS, FEG-SEM, atomic force microscope and 1500 N Rockwell indentation to evaluate the adhesion.

Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?

PubMed Central

2013-01-01

Background Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care. Methods An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM. Results The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score ‘Preventive Services’ (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001). Conclusions There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology. PMID:23510482

Ultrasensitive label-free detection of DNA hybridization by sapphire-based graphene field-effect transistor biosensor

NASA Astrophysics Data System (ADS)

Xu, Shicai; Jiang, Shouzhen; Zhang, Chao; Yue, Weiwei; Zou, Yan; Wang, Guiying; Liu, Huilan; Zhang, Xiumei; Li, Mingzhen; Zhu, Zhanshou; Wang, Jihua

2018-01-01

Graphene has attracted much attention in biosensing applications for its unique properties. Because of one-atom layer structure, every atom of graphene is exposed to the environment, making the electronic properties of graphene are very sensitive to charged analytes. Therefore, graphene is an ideal material for transistors in high-performance sensors. Chemical vapor deposition (CVD) method has been demonstrated the most successful method for fabricating large area graphene. However, the conventional CVD methods can only grow graphene on metallic substrate and the graphene has to be transferred to the insulating substrate for further device fabrication. The transfer process creates wrinkles, cracks, or tears on the graphene, which severely degrade electrical properties of graphene. These factors severely degrade the sensing performance of graphene. Here, we directly fabricated graphene on sapphire substrate by high temperature CVD without the use of metal catalysts. The sapphire-based graphene was patterned and make into a DNA biosensor in the configuration of field-effect transistor. The sensors show high performance and achieve the DNA detection sensitivity as low as 100 fM (10-13 M), which is at least 10 times lower than prior transferred CVD G-FET DNA sensors. The use of the sapphire-based G-FETs suggests a promising future for biosensing applications.

Role of mitochondrial dysfunction and altered autophagy in cardiovascular aging and disease: from mechanisms to therapeutics

PubMed Central

Marzetti, Emanuele; Csiszar, Anna; Dutta, Debapriya; Balagopal, Gauthami; Calvani, Riccardo

2013-01-01

Advanced age is associated with a disproportionate prevalence of cardiovascular disease (CVD). Intrinsic alterations in the heart and the vasculature occurring over the life course render the cardiovascular system more vulnerable to various stressors in late life, ultimately favoring the development of CVD. Several lines of evidence indicate mitochondrial dysfunction as a major contributor to cardiovascular senescence. Besides being less bioenergetically efficient, damaged mitochondria also produce increased amounts of reactive oxygen species, with detrimental structural and functional consequences for the cardiovascular system. The age-related accumulation of dysfunctional mitochondrial likely results from the combination of impaired clearance of damaged organelles by autophagy and inadequate replenishment of the cellular mitochondrial pool by mitochondriogenesis. In this review, we summarize the current knowledge about relevant mechanisms and consequences of age-related mitochondrial decay and alterations in mitochondrial quality control in the cardiovascular system. The involvement of mitochondrial dysfunction in the pathogenesis of cardiovascular conditions especially prevalent in late life and the emerging connections with neurodegeneration are also illustrated. Special emphasis is placed on recent discoveries on the role played by alterations in mitochondrial dynamics (fusion and fission), mitophagy, and their interconnections in the context of age-related CVD and endothelial dysfunction. Finally, we discuss pharmacological interventions targeting mitochondrial dysfunction to delay cardiovascular aging and manage CVD. PMID:23748424

Frictional behavior of atomically thin sheets: hexagonal-shaped graphene islands grown on copper by chemical vapor deposition.

PubMed

Egberts, Philip; Han, Gang Hee; Liu, Xin Z; Johnson, A T Charlie; Carpick, Robert W

2014-05-27

Single asperity friction experiments using atomic force microscopy (AFM) have been conducted on chemical vapor deposited (CVD) graphene grown on polycrystalline copper foils. Graphene substantially lowers the friction force experienced by the sliding asperity of a silicon AFM tip compared to the surrounding oxidized copper surface by a factor ranging from 1.5 to 7 over loads from the adhesive minimum up to 80 nN. No damage to the graphene was observed over this range, showing that friction force microscopy serves as a facile, high contrast probe for identifying the presence of graphene on Cu. Consistent with studies of epitaxially grown, thermally grown, and mechanically exfoliated graphene films, the friction force measured between the tip and these CVD-prepared films depends on the number of layers of graphene present on the surface and reduces friction in comparison to the substrate. Friction results on graphene indicate that the layer-dependent friction properties result from puckering of the graphene sheet around the sliding tip. Substantial hysteresis in the normal force dependence of friction is observed with repeated scanning without breaking contact with a graphene-covered region. Because of the hysteresis, friction measured on graphene changes with time and maximum applied force, unless the tip slides over the edge of the graphene island or contact with the surface is broken. These results also indicate that relatively weak binding forces exist between the copper foil and these CVD-grown graphene sheets.

Preliminary Results of Field Emission Cathode Tests

NASA Technical Reports Server (NTRS)

Sovey, James S.; Kovaleski, Scott D.

2001-01-01

Preliminary screening tests of field emission cathodes such as chemical vapor deposited (CVD) diamond, textured pyrolytic graphite, and textured copper were conducted at background pressures typical of electric thruster test facilities to assess cathode performance and stability. Very low power electric thrusters which provide tens to hundreds micronewtons of thrust may need field emission neutralizers that have a capability of tens to hundreds of microamperes. From current voltage characteristics, it was found that the CVD diamond and textured metals cathodes clearly satisfied the Fowler-Nordheim emission relation. The CVD diamond and a textured copper cathode had average current densities of 270 and 380 mA/sq cm, respectively, at the beginning-of-life. After a few hours of operation the cathode emission currents degraded by 40 to 75% at background pressures in the 10(exp -5) Pa to 10(exp -4) Pa range. The textured pyrolytic graphite had a modest current density at beginning-of-life of 84 mA/sq cm, but this cathode was the most stable of all. Extended testing of the most promising cathodes is warranted to determine if current degradation is a burn-in effect or whether it is a long-term degradation process. Preliminary experiments with ferroelectric emission cathodes, which are ceramics with spontaneous electric polarization, were conducted. Peak current densities of 30 to 120 mA/sq cm were obtained for pulse durations of about 500 ns in the 10(exp -4) Pa pressure range.

Community cardiovascular disease risk from cross-sectional general practice clinical data: a spatial analysis.

PubMed

Bagheri, Nasser; Gilmour, Bridget; McRae, Ian; Konings, Paul; Dawda, Paresh; Del Fante, Peter; van Weel, Chris

2015-02-26

Cardiovascular disease (CVD) continues to be a leading cause of illness and death among adults worldwide. The objective of this study was to calculate a CVD risk score from general practice (GP) clinical records and assess spatial variations of CVD risk in communities. We used GP clinical data for 4,740 men and women aged 30 to 74 years with no history of CVD. A 10-year absolute CVD risk score was calculated based on the Framingham risk equation. The individual risk scores were aggregated within each Statistical Area Level One (SA1) to predict the level of CVD risk in that area. Finally, the pattern of CVD risk was visualized to highlight communities with high and low risk of CVD. The overall 10-year risk of CVD in our sample population was 14.6% (95% confidence interval [CI], 14.3%-14.9%). Of the 4,740 patients in our study, 26.7% were at high risk, 29.8% were at moderate risk, and 43.5% were at low risk for CVD over 10 years. The proportion of patients at high risk for CVD was significantly higher in the communities of low socioeconomic status. This study illustrates methods to further explore prevalence, location, and correlates of CVD to identify communities of high levels of unmet need for cardiovascular care and to enable geographic targeting of effective interventions for enhancing early and timely detection and management of CVD in those communities.

Chronic Inflammatory Diseases and Atherosclerotic Cardiovascular Disease: Innocent Bystanders or Partners in Crime?

PubMed

Hansen, Peter Riis

2018-01-01

Inflammation plays a significant role in atherosclerosis and cardiovascular disease (CVD). Patients with chronic inflammatory diseases are at increased risk of CVD, but it is debated whether this association is causal or dependent on shared risk factors, other exposures, genes, and/or inflammatory pathways. The current review summarizes epidemiological, clinical, and experimental data supporting the role of shared inflammatory mechanisms between atherosclerotic CVD and rheumatoid arthritis, psoriasis, inflammatory bowel disease, and periodontitis, respectively, and provides insights to future prospects in this area of research. Awareness of the role of inflammation in CVD in patients with chronic inflammatory diseases and the potential for anti-inflammatory therapy, e.g., with tumor necrosis factor-α inhibitors, to also reduce atherosclerotic CVD has evolved into guideline- based recommendations. These include regular CVD risk assessment, aggressive treatment of traditional CVD risk factors, and recognition of reduced CVD as an added benefit of strict inflammatory disease control. At present, chronic inflammatory diseases would appear to qualify as partners in crime and not merely innocent bystanders to CVD. However, definite incremental contributions of inflammation versus effects of the complex interplay with other CVD risk factors may never be fully elucidated and for the foreseeable future, inflammation is posed to maintain its current position as both a marker and a maker of CVD, with clinical utility both for identification of patient at risk of CVD and as target for therapy to reduce CVD. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Cardiovascular risk estimation by professionally active cardiovascular nurses: results from the Basel 2005 Nurses Cohort.

PubMed

Scholte op Reimer, Wilma J M; Moons, Philip; De Geest, Sabina; Fridlund, Bengt; Heikkilä, Johanna; Jaarsma, Tiny; Lenzen, Mattie; Martensson, Jan; Norekvål, Tone M; Smith, Karen; Stewart, Simon; Strömberg, Anna; Thompson, David R

2006-12-01

Nurses play a key role in the prevention of cardiovascular disease (CVD) and one would, therefore, expect them to have a heightened awareness of the need for systematic screening and their own CVD risk profile. The aim of this study was to examine personal awareness of CVD risk among a cohort of cardiovascular nurses attending a European conference. Of the 340 delegates attending the 5th annual Spring Meeting on Cardiovascular Nursing (Basel, Switzerland, 2005), 287 (83%) completed a self-report questionnaire to assess their own risk factors for CVD. Delegates were also asked to give an estimation of their absolute total risk of experiencing a fatal CVD event in the next 10 years. Level of agreement between self-reported CVD risk estimation and their actual risk according to the SCORE risk assessment system was compared by calculating weighted Kappa (kappa(w)). Overall, 109 responders (38%) self-reported having either pre-existing CVD (only 2%), one or more markedly raised CVD risk factors, a high total risk of fatal CVD (> or =5% in 10 years) or a strong family history of CVD. About half of this cohort (53%) did not know their own total cholesterol level. Less than half (45%) reported having a 10-year risk of fatal CVD of <1%, while 13% reported having a risk > or =5%. Based on the SCORE risk function, the estimated 10-year risk of a fatal CVD event was <1% for 96% of responders: only 2% had a > or =5% risk of such an event. Overall, less than half (46%) of this cohort's self-reported CVD risk corresponded with that calculated using the SCORE risk function (kappa(w)=0.27). Most cardiovascular nurses attending a European conference in 2005 poorly understood their own CVD risk profile, and the agreement between their self-reported 10-year risk of a fatal CVD and their CVD risk using SCORE was only fair. Given the specialist nature of this conference, our findings clearly demonstrate a need to improve overall nursing awareness of the role and importance of systematic CVD risk assessment.

Development and optimization of carvedilol orodispersible tablets: enhancement of pharmacokinetic parameters in rabbits

PubMed Central

Aljimaee, Yazeed HM; El-Helw, Abdel-Rahim M; Ahmed, Osama AA; El-Say, Khalid M

2015-01-01

Background Carvedilol (CVD) is used for the treatment of essential hypertension, heart failure, and systolic dysfunction after myocardial infarction. Due to its lower aqueous solubility and extensive first-pass metabolism, the absolute bioavailability of CVD does not exceed 30%. To overcome these drawbacks, the objective of this work was to improve the solubility and onset of action of CVD through complexation with hydroxypropyl-β-cyclodextrin and formulation of the prepared complex as orodispersible tablets (ODTs). Methods Compatibility among CVD and all tablet excipients using differential scanning calorimetry and Fourier transform infrared spectroscopy, complexation of CVD with different polymers, and determination of the solubility of CVD in the prepared complexes were first determined. A Box-Behnken design (BBD) was used to study the effect of tablet formulation variables on the characteristics of the prepared tablets and to optimize preparation conditions. According to BBD design, 15 formulations of CVD-ODTs were prepared by direct compression and then evaluated for their quality attributes. The relative pharmacokinetic parameters of the optimized CVD-ODTs were compared with those of the marketed CVD tablet. A single dose, equivalent to 2.5 mg/kg CVD, was administered orally to New Zealand white rabbits using a double-blind, randomized, crossover design. Results The solubility of CVD was improved from 7.32 to 22.92 mg/mL after complexation with hydroxypropyl-β-cyclodextrin at a molar ratio of 1:2 (CVD to cyclodextrin). The formulated CVD-ODTs showed satisfactory results concerning tablet hardness (5.35 kg/cm2), disintegration time (18 seconds), and maximum amount of CVD released (99.72%). The pharmacokinetic data for the optimized CVD-ODT showed a significant (P<0.05) increase in maximum plasma concentration from 363.667 to 496.4 ng/mL, and a shortening of the time taken to reach maximum plasma concentration to 2 hours in comparison with the marketed tablet. Conclusion The optimized CVD-ODTs showed improved oral absorption of CVD and a subsequent acceleration of clinical effect, which is favored for hypertensive and cardiac patients. PMID:25834396

A general strategy toward graphitized carbon coating on iron oxides as advanced anodes for lithium-ion batteries.

PubMed

Ding, Chunyan; Zhou, Weiwei; Wang, Bin; Li, Xin; Wang, Dong; Zhang, Yong; Wen, Guangwu

2017-08-25

Integration of carbon materials with benign iron oxides is blazing a trail in constructing high-performance anodes for lithium-ion batteries (LIBs). In this paper, a unique general, simple, and controllable strategy is developed toward in situ uniform coating of iron oxide nanostructures with graphitized carbon (GrC) layers. The basic synthetic procedure only involves a simple dip-coating process for the loading of Ni-containing seeds and a subsequent Ni-catalyzed chemical vapor deposition (CVD) process for the growth of GrC layers. More importantly, the CVD treatment is conducted at a quite low temperature (450 °C) and with extremely facile liquid carbon sources consisting of ethylene glycol (EG) and ethanol (EA). The GrC content of the resulting hybrids can be controllably regulated by altering the amount of carbon sources. The electrochemical results reveal remarkable performance enhancements of iron oxide@GrC hybrids compared with pristine iron oxides in terms of high specific capacity, excellent rate and cycling performance. This can be attributed to the network-like GrC coating, which can improve not only the electronic conductivity but also the structural integrity of iron oxides. Moreover, the lithium storage performance of samples with different GrC contents is measured, manifesting that optimized electrochemical property can be achieved with appropriate carbon content. Additionally, the superiority of GrC coating is demonstrated by the advanced performance of iron oxide@GrC compared with its corresponding counterpart, i.e., iron oxides with amorphous carbon (AmC) coating. All these results indicate the as-proposed protocol of GrC coating may pave the way for iron oxides to be promising anodes for LIBs.

Structure and wettability property of the growth and nucleation surfaces of thermally treated freestanding CVD diamond films

NASA Astrophysics Data System (ADS)

Pei, Xiaoqiang; Cheng, Shaoheng; Ma, Yibo; Wu, Danfeng; Liu, Junsong; Wang, Qiliang; Yang, Yizhou; Li, Hongdong

2015-08-01

This paper reports the surface features and wettability properties of the (1 0 0)-textured freestanding chemical vapor deposited (CVD) diamond films after thermal exposure in air at high temperature. Thermal oxidation at proper conditions eliminates selectively nanodiamonds and non-diamond carbons in the films. The growth side of the films contains (1 0 0)-oriented micrometer-sized columns, while its nucleation side is formed of nano-sized tips. The examined wettability properties of the as-treated diamond films reveal a hydrophilicity and superhydrophilicity on the growth surface and nucleation surface, respectively, which is determined by oxygen termination and geometry structure of the surface. When the surface termination is hydrogenated, the wettability of nucleation side converted from superhydrophilicity to high hydrophobicity, while the hydrophilicity of the growth side does not change significantly. The findings open a possibility for realizing freestanding diamond films having not only novel surface structures but also multifunction applications, especially proposed on the selected growth side or nucleation side in one product.

Facile synthesis of graphene on dielectric surfaces using a two-temperature reactor CVD system

NASA Astrophysics Data System (ADS)

Zhang, C.; Man, B. Y.; Yang, C.; Jiang, S. Z.; Liu, M.; Chen, C. S.; Xu, S. C.; Sun, Z. C.; Gao, X. G.; Chen, X. J.

2013-10-01

Direct deposition of graphene on a dielectric substrate is demonstrated using a chemical vapor deposition system with a two-temperature reactor. The two-temperature reactor is utilized to offer sufficient, well-proportioned floating Cu atoms and to provide a temperature gradient for facile synthesis of graphene on dielectric surfaces. The evaporated Cu atoms catalyze the reaction in the presented method. C atoms and Cu atoms respectively act as the nuclei for forming graphene film in the low-temperature zone and the zones close to the high-temperature zones. A uniform and high-quality graphene film is formed in an atmosphere of sufficient and well-proportioned floating Cu atoms. Raman spectroscopy, scanning electron microscopy and atomic force microscopy confirm the presence of uniform and high-quality graphene.

Influence of low energy argon plasma treatment on the moisture barrier performance of hot wire-CVD grown SiNx multilayers

NASA Astrophysics Data System (ADS)

Majee, Subimal; Fátima Cerqueira, Maria; Tondelier, Denis; Geffroy, Bernard; Bonnassieux, Yvan; Alpuim, Pedro; Bourée, Jean Eric

2014-01-01

The reliability and stability are key issues for the commercial utilization of organic photovoltaic devices based on flexible polymer substrates. To increase the shelf-lifetime of these devices, transparent moisture barriers of silicon nitride (SiNx) films are deposited at low temperature by hot wire CVD (HW-CVD) process. Instead of the conventional route based on organic/inorganic hybrid structures, this work defines a new route consisting in depositing multilayer stacks of SiNx thin films, each single layer being treated by argon plasma. The plasma treatment allows creating smoother surface and surface atom rearrangement. We define a critical thickness of the single layer film and focus our attention on the effect of increasing the number of SiNx single-layers on the barrier properties. A water vapor transmission rate (WVTR) of 2 × 10-4 g/(m2·day) is reported for SiNx multilayer stack and a physical interpretation of the plasma treatment effect is given.

Aerobic exercise and other healthy lifestyle factors that influence vascular aging.

PubMed

Santos-Parker, Jessica R; LaRocca, Thomas J; Seals, Douglas R

2014-12-01

Cardiovascular diseases (CVDs) remain the leading cause of death in the United States and other modern societies. Advancing age is the major risk factor for CVD, primarily due to stiffening of the large elastic arteries and the development of vascular endothelial dysfunction. In contrast, regular aerobic exercise protects against the development of large elastic artery stiffness and vascular endothelial dysfunction with advancing age. Moreover, aerobic exercise interventions reduce arterial stiffness and restore vascular endothelial function in previously sedentary middle-aged/older adults. Aerobic exercise exerts its beneficial effects on arterial function by modulating structural proteins, reducing oxidative stress and inflammation, and restoring nitric oxide bioavailability. Aerobic exercise may also promote "resistance" against factors that reduce vascular function and increase CVD risk with age. Preventing excessive increases in abdominal adiposity, following healthy dietary practices, maintaining a low CVD risk factor profile, and, possibly, selective use of pharmaceuticals and nutraceuticals also play a major role in preserving vascular function with aging. Copyright © 2014 The American Physiological Society.

Combinatorial Optimization of Heterogeneous Catalysts Used in the Growth of Carbon Nanotubes

NASA Technical Reports Server (NTRS)

Cassell, Alan M.; Verma, Sunita; Delzeit, Lance; Meyyappan, M.; Han, Jie

2000-01-01

Libraries of liquid-phase catalyst precursor solutions were printed onto iridium-coated silicon substrates and evaluated for their effectiveness in catalyzing the growth of multi-walled carbon nanotubes (MWNTs) by chemical vapor deposition (CVD). The catalyst precursor solutions were composed of inorganic salts and a removable tri-block copolymer (EO)20(PO)70(EO)20 (EO = ethylene oxide, PO = propylene oxide) structure-directing agent (SDA), dissolved in ethanol/methanol mixtures. Sample libraries were quickly assayed using scanning electron microscopy after CVD growth to identify active catalysts and CVD conditions. Composition libraries and focus libraries were then constructed around the active spots identified in the discovery libraries to understand how catalyst precursor composition affects the yield, density, and quality of the nanotubes. Successful implementation of combinatorial optimization methods in the development of highly active, carbon nanotube catalysts is demonstrated, as well as the identification of catalyst formulations that lead to varying densities and shapes of aligned nanotube towers.

Large-scale synthesis of NbS2 nanosheets with controlled orientation on graphene by ambient pressure CVD.

PubMed

Ge, Wanyin; Kawahara, Kenji; Tsuji, Masaharu; Ago, Hiroki

2013-07-07

We report ambient pressure chemical vapor deposition (CVD) growth of single-crystalline NbS2 nanosheets with controlled orientation. On Si and SiO2 substrates, NbS2 nanosheets grow almost perpendicular to the substrate surface. However, when we apply transferred CVD graphene on SiO2 as a substrate, NbS2 sheets grow laterally lying on the graphene. The NbS2 sheets show the triangular and hexagonal shapes with a thickness of about 20-200 nm and several micrometres in the lateral dimension. Analyses based on X-ray diffraction and Raman spectroscopy indicate that the NbS2 nanosheets are single crystalline 3R-type with a rhombohedral structure of R3m space group. Our findings on the formation of highly aligned NbS2 nanosheets on graphene give new insight into the formation mechanism of NbS2 and would contribute to the templated growth of various layered materials.

Aerobic exercise and other healthy lifestyle factors that influence vascular aging

PubMed Central

Santos-Parker, Jessica R.; LaRocca, Thomas J.

2014-01-01

Cardiovascular diseases (CVDs) remain the leading cause of death in the United States and other modern societies. Advancing age is the major risk factor for CVD, primarily due to stiffening of the large elastic arteries and the development of vascular endothelial dysfunction. In contrast, regular aerobic exercise protects against the development of large elastic artery stiffness and vascular endothelial dysfunction with advancing age. Moreover, aerobic exercise interventions reduce arterial stiffness and restore vascular endothelial function in previously sedentary middle-aged/older adults. Aerobic exercise exerts its beneficial effects on arterial function by modulating structural proteins, reducing oxidative stress and inflammation, and restoring nitric oxide bioavailability. Aerobic exercise may also promote “resistance” against factors that reduce vascular function and increase CVD risk with age. Preventing excessive increases in abdominal adiposity, following healthy dietary practices, maintaining a low CVD risk factor profile, and, possibly, selective use of pharmaceuticals and nutraceuticals also play a major role in preserving vascular function with aging. PMID:25434012

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dong, Rui; Moore, Logan; Ocola, Leonidas E.

The mask-free patterning technique is employed to fabricate arrays of MoS2 and WS2 structures on silicon and graphene substrates with quality interfaces. By depositing precursor inks with the AFM cantilevers and subsequent heat treatment in the CVD furnace, it is demonstrated that MoS2 and WS2 structures can be formed on graphene surfaces at predefined device architectures.

500-m and 1000-m moderate walks equally assess cardiorespiratory fitness in male outpatients with cardiovascular diseases.

PubMed

Mazzoni, Gianni; Chiaranda, Giorgio; Myers, Jonathan; Sassone, Biagio; Pasanisi, Giovanni; Mandini, Simona; Volpato, Stefano; Conconi, Francesco; Grazzi, Giovanni

2017-09-29

The walking speed maintained during a moderate 1-km treadmill walk (1k-TWT) has been demonstrated to be a valid tool for estimating peak oxygen uptake (VO2peak), and to be inversely related to long-term survival and hospitalization in outpatients with cardiovascular disease (CVD). We aimed to examine whether 500-m and 1-k moderate treadmill-walking tests equally estimate VO2peak in male outpatients with CVD. 142 clinically stable male outpatients with CVD, aged 34-92 years, referred to an exercise-based secondary prevention program, performed a moderate and perceptually-regulated (11-13/20 on the Borg scale) 1k- TWT. Age, height, weight, time to walk 500-m and the entire 1000-m, and the corresponding heart rates were entered into validated equations to estimate VO2peak. VO2peak estimated from the 500-m test was not different from that estimated from the 1k test (25.2±5.1 vs 25.1±5.2 mL/kg/min). The correlation coefficient between the two was 0.98. The slope and the intercept of the relationship between the 500-m and 1k tests were not different from the line of identity. Bland-Altman analysis demonstrated that 96% of the data points were within two standard deviations (from -1.9 to 1.7 mL/kg/min). The 500-m treadmill-walking test is a reliable method for estimating VO2peak in stable male outpatients with CVD. A shorter version of the test, 500-m, provides similar information as that from the original 1k test, but is more time efficient. These findings have practical implications in the context of transitioning patients from clinically based and supervised programs to fitness facilities or self-guided exercise programs.

Cardiovascular disease incidence in adolescent and young adult cancer survivors: a retrospective cohort study.

PubMed

Keegan, Theresa H M; Kushi, Lawrence H; Li, Qian; Brunson, Ann; Chawla, X; Chew, Helen K; Malogolowkin, Marcio; Wun, Ted

2018-06-01

Few population-based studies have focused on cardiovascular disease (CVD) risk in adolescent and young adult (AYA; 15-39 years) cancer survivors and none have considered whether CVD risk differs by sociodemographic factors. Analyses focused on 79,176 AYA patients diagnosed with 14 first primary cancers in 1996-2012 and surviving > 2 years after diagnosis with follow-up through 2014. Data were obtained from the California Cancer Registry and State hospital discharge data. CVD included coronary artery disease, heart failure, and stroke. The cumulative incidence of developing CVD accounted for the competing risk of death. Multivariable Cox proportional hazards regression evaluated factors associated with CVD and the impact of CVD on mortality. Overall, 2249 (2.8%) patients developed CVD. Survivors of central nervous system cancer (7.3%), acute lymphoid leukemia (6.9%), acute myeloid leukemia (6.8%), and non-Hodgkin lymphoma (4.1%) had the highest 10-year CVD incidence. In multivariable models, African-Americans (hazard ratio (HR) = 1.55, 95% confidence interval (CI) = 1.33-1.81; versus non-Hispanic Whites), those with public/no health insurance (HR = 1.78, 95% CI = 1.61-1.96; versus private) and those who resided in lower socioeconomic status neighborhoods had a higher CVD risk. These sociodemographic differences in CVD incidence were apparent across most cancer sites. The risk of death was increased by eightfold or higher among AYAs who developed CVD. While cancer therapies are known to increase the risk of CVD, this study additionally shows that CVD risk varies by sociodemographic factors. The identification and mitigation of CVD risk factors in these subgroups may improve long-term patient outcomes.

An evaluation of longitudinal changes in serum uric acid levels and associated risk of cardio-metabolic events and renal function decline in gout.

PubMed

Desai, Rishi J; Franklin, Jessica M; Spoendlin-Allen, Julia; Solomon, Daniel H; Danaei, Goodarz; Kim, Seoyoung C

2018-01-01

Gout patients have a high burden of co-morbid conditions including diabetes mellitus (DM), chronic kidney disease (CKD), and cardiovascular disease (CVD). We sought to evaluate the association between changes in serum uric acid (SUA) levels over time and the risk of incident DM, CVD, and renal function decline in gout patients. An observational cohort study was conducted among enrollees of private health insurance programs in the US between 2004 and 2015. Gout patients were included on the index date of a SUA measurement ≥6.8 mg/dl. The exposure of interest was cumulative change in SUA levels from baseline. Hazard ratios (HR) and 95% confidence intervals (CI) for incident DM, incident CVD, and renal function decline (≥30% reduction in glomerular filtration rate) were derived using marginal structural models with stabilized inverse probability weights accounting for baseline confounders (age, gender, co-morbidities, co-medications) and time-varying confounders (serum creatinine, blood urea nitrogen, glycated hemoglobin). Among 26,341 patients with gout, the average age was 62, 75% were men, and the median baseline SUA was 8.6 mg/dl (interquartile range 7.7 to 9.5). The incidence rates/100 person-years (95% CI) were 1.63 (1.51-1.75) for DM, 0.77 (0.70-0.84) for CVD, and 4.32 (4.14-4.49) for renal function decline. The adjusted HR (95% CI) per 3 mg/dl reduction in SUA, corresponding on average to achieving the target level of <6 mg/dl in this population, was 1.04 (0.92-1.17) for DM, 1.07 (0.89-1.29) for CVD, and 0.85 (0.78-0.92) for renal function decline. Reduction in SUA in patients with gout may be associated with a reduced risk of renal function decline, but not with DM or CVD.

Taste phenotype associates with cardiovascular disease risk factors via diet quality in multivariate modeling.

PubMed

Sharafi, Mastaneh; Rawal, Shristi; Fernandez, Maria Luz; Huedo-Medina, Tania B; Duffy, Valerie B

2018-05-08

Sensations from foods and beverages drive dietary choices, which in turn, affect risk of diet-related diseases. Perception of these sensation varies with environmental and genetic influences. This observational study aimed to examine associations between chemosensory phenotype, diet and cardiovascular disease (CVD) risk. Reportedly healthy women (n = 110, average age 45 ± 9 years) participated in laboratory-based measures of chemosensory phenotype (taste and smell function, propylthiouracil (PROP) bitterness) and CVD risk factors (waist circumference, blood pressure, serum lipids). Diet variables included preference and intake of sweet/high-fat foods, dietary restraint, and diet quality based on reported preference (Healthy Eating Preference Index-HEPI) and intake (Healthy Eating Index-HEI). We found that females who reported high preference yet low consumption of sweet/high-fat foods had the highest dietary restraint and depressed quinine taste function. PROP nontasters were more likely to report lower diet quality; PROP supertasters more likely to consume but not like a healthy diet. Multivariate structural models were fitted to identify predictors of CVD risk factors. Reliable latent taste (quinine taste function, PROP tasting) and smell (odor intensity) variables were identified, with taste explaining more variance in the CVD risk factors. Lower bitter taste perception was associated with elevated risk. In multivariate models, the HEPI completely mediated the taste-adiposity and taste-HDL associations and partially mediated the taste-triglyceride or taste-systolic blood pressure associations. The taste-LDL pathway was significant and direct. The HEI could not replace HEPI in adequate models. However, using a latent diet quality variable with HEPI and HEI, increased the strength of association between diet quality and adiposity or CVD risk factors. In conclusion, bitter taste phenotype was associated with CVD risk factors via diet quality, particularly when assessed by level of food liking/disliking. Copyright © 2018 Elsevier Inc. All rights reserved.

Dietary Choline and Betaine and Risk of CVD: A Systematic Review and Meta-Analysis of Prospective Studies

PubMed Central

Meyer, Katie A.; Shea, Jonathan W.

2017-01-01

Studies implicate choline and betaine metabolite trimethylamine N-oxide (TMAO) in cardiovascular disease (CVD). We conducted a systematic review and random-effects meta-analysis to quantify a summary estimated effect of dietary choline and betaine on hard CVD outcomes (incidence and mortality). Eligible studies were prospective studies in adults with comprehensive diet assessment and follow-up for hard CVD endpoints. We identified six studies that met our criteria, comprising 18,076 incident CVD events, 5343 CVD deaths, and 184,010 total participants. In random effects meta-analysis, incident CVD was not associated with choline (relative risk (RR): 1.00; 95% CI: 0.98, 1.02) or betaine (RR: 0.99; 95% CI: 0.98, 1.01) intake. Results did not vary by study outcome (incident coronary heart disease, stroke, total CVD) and there was no evidence for heterogeneity among studies. Only two studies provided data on phosphatidylcholine and CVD mortality. Random effects meta-analysis did not support an association between choline and CVD mortality (RR: 1.09, 95% CI: 0.89, 1.35), but one study supported a positive association and there was significant heterogeneity (I2 = 84%, p-value < 0.001). Our findings do not support an association between dietary choline/betaine with incident CVD, but call for further research into choline and CVD mortality. PMID:28686188

Dietary Choline and Betaine and Risk of CVD: A Systematic Review and Meta-Analysis of Prospective Studies.

PubMed

Meyer, Katie A; Shea, Jonathan W

2017-07-07

Studies implicate choline and betaine metabolite trimethylamine N-oxide (TMAO) in cardiovascular disease (CVD). We conducted a systematic review and random-effects meta-analysis to quantify a summary estimated effect of dietary choline and betaine on hard CVD outcomes (incidence and mortality). Eligible studies were prospective studies in adults with comprehensive diet assessment and follow-up for hard CVD endpoints. We identified six studies that met our criteria, comprising 18,076 incident CVD events, 5343 CVD deaths, and 184,010 total participants. In random effects meta-analysis, incident CVD was not associated with choline (relative risk (RR): 1.00; 95% CI: 0.98, 1.02) or betaine (RR: 0.99; 95% CI: 0.98, 1.01) intake. Results did not vary by study outcome (incident coronary heart disease, stroke, total CVD) and there was no evidence for heterogeneity among studies. Only two studies provided data on phosphatidylcholine and CVD mortality. Random effects meta-analysis did not support an association between choline and CVD mortality (RR: 1.09, 95% CI: 0.89, 1.35), but one study supported a positive association and there was significant heterogeneity ( I ² = 84%, p -value < 0.001). Our findings do not support an association between dietary choline/betaine with incident CVD, but call for further research into choline and CVD mortality.

Racial and Ethnic Disparities in Cardiovascular Disease: An Assessment of Obstetrician-Gynecologists' Knowledge, Attitudes, and Practice Patterns.

PubMed

Jones, Katherine M; Carter, Michele M; Schulkin, Jay

2015-06-01

African American and Hispanic women are disproportionately affected by cardiovascular disease (CVD) and its many risk factors. Obstetrician-gynecologists (OB/GYNs) play an integral role in well-woman care and have a unique opportunity to provide CVD counseling and screening to these at-risk and underserved groups. To assess whether OB/GYN race/ethnicity and OB/GYN practices with increasing minority patient populations predicted differences in OB/GYNs' knowledge, attitudes, and practice patterns relevant to racial/ethnic disparities in CVD. This study also sought to determine provider and patient-related barriers to CVD care. A questionnaire on CVD was mailed to 273 members of The American College of Obstetricians and Gynecologists in March-July 2013. African American and Hispanic OB/GYNs and OB/GYN practices with increasing minority patient populations were more knowledgeable of CVD disparities. These OB/GYNs reported greater concern for minority women's CVD risk relative to White OB/GYNs. Overall, OB/GYNs appear less knowledgeable and concerned with Hispanics' increased CVD risk relative to African Americans'. The most commonly reported provider and patient-related barriers to CVD care were time constraints, patient nonadherence to treatment recommendations, and inadequate training. It is likely that minority OB/GYNs and those with practices with increasing minority patient populations have greater exposure to women at risk for CVD. Dissemination of educational information regarding Hispanic women's CVD risk profile may improve OB/GYN knowledge, counseling, and screening. Increased training in CVD and multicultural competency during medical school and residency should help OB/GYNs overcome what they report as primary barriers to CVD care.

Exercise and eating habits among urban adolescents: a cross-sectional study in Kolkata, India.

PubMed

Kumar, Soumitra; Ray, Saumitra; Roy, Debabrata; Ganguly, Kajal; Dutta, Sibananda; Mahapatra, Tanmay; Mahapatra, Sanchita; Gupta, Kinnori; Chakraborty, Kaushik; Das, Mrinal Kanti; Guha, Santanu; Deb, Pradip K; Banerjee, Amal K

2017-05-18

Unhealthy eating and lack of exercise during adolescence culminated into earlier onset and increasing burden of atherosclerotic cardiovascular diseases (CVDs) worldwide. Among urban Indian adolescents, prevalence of these risk factors of CVD seemed to be high, but data regarding their pattern and predictors was limited. To address this dearth of information, a survey was conducted among urban adolescent school-students in Kolkata, a highly populated metro city in eastern India. During January-June, 2014, 1755 students of 9th-grade were recruited through cluster (schools) random sampling. Informed consents from parents and assents from adolescents were collected. Information on socio-demographics, CVD-related knowledge and perception along with eating and exercise patterns were collected with an internally validated structured questionnaire. Descriptive and regression analyses were performed in SAS-9.3.2. Among 1652 participants (response rate = 94.1%), about 44% had poor overall knowledge about CVD, 24% perceived themselves as overweight and 60% considered their general health as good. Only 18% perceived their future CVD-risk and 29% were engaged in regular moderate-to-vigorous exercise. While 55% skipped meals regularly, 90% frequently consumed street-foods and 54% demonstrated overall poor eating habits. Males were more likely to engage in moderate-to-vigorous exercise [adjusted odds ratio (AOR) = 3.40(95% confidence interval = 2.55-4.54)] while students of higher SES were less likely [AOR = 0.59(0.37-0.94)]. Males and those having good CVD-related knowledge were more likely to exercise at least 1 h/day [AOR = 7.77(4.61-13.07) and 2.90(1.46-5.78) respectively]. Those who perceived their future CVD-risk, skipped meals more [2.04(1.28-3.25)] while Males skipped them less [AOR = 0.62(0.42-0.93)]. Subjects from middle class ate street-foods less frequently [AOR = 0.45(0.24-0.85)]. Relatively older students and those belonging to higher SES were less likely to demonstrate good eating habits [AOR = 0.70(0.56-0.89) and 0.23(0.11-0.47) respectively]. A large knowledge-practice gap was evident as students with good CVD-related knowledge were less likely to have good eating habits [AOR = 0.55(0.32-0.94)]. CVD-related knowledge as well as eating and exercise habits were quite poor among adolescent school-students of Kolkata. Additionally, there was a large knowledge-practice gap. Multi-component educational interventions targeting behavioral betterment seemed necessary for these adolescents to improve their CVD-related knowledge, along with appropriate translation of knowledge into exercise and eating practices to minimize future risk of CVDs.

Study of the Physics of Insulating Films as Related to the Reliability of Metal-Oxide Semiconductor Devices

DTIC Science & Technology

1980-05-01

York 10598 Technical assistance of F.L. Pesavento and J.A. Calse Typed by Steila B. Havreluk (3277) Abstract: Chemically vapor deposited (CVD) Si rich...wish to acknowledge the critical reading of this manuscript by D.R. Young and M.I. Nathan; the technical assistance of F.L. Pesavento and L.A. Calise...rendered by J.A. Calise and F.L. Pesavento . Samples have been prepared by the I.B.M. Yorktown Si Process Facility and the work has been supported in part

Results of Uranium Dioxide-Tungsten Irradiation Test and Post-Test Examination

NASA Technical Reports Server (NTRS)

Collins, J. F.; Debogdan, C. E.; Diianni, D. C.

1973-01-01

A uranium dioxide (UO2) fueled capsule was fabricated and irradiated in the NASA Plum Brook Reactor Facility. The capsule consisted of two bulk UO2 specimens clad with chemically vapor deposited tungsten (CVD W) 0.762 and 0.1016 cm (0.030-and 0.040-in.) thick, respectively. The second specimen with 0.1016-cm (0.040-in.) thick cladding was irradiated at temperature for 2607 hours, corresponding to an average burnup of 1.516 x 10 to the 20th power fissions/cu cm. Postirradiation examination showed distortion in the bottom end cap, failure of the weld joint, and fracture of the central vent tube. Diametral growth was 1.3 percent. No evidence of gross interaction between CVD tungsten or arc-cast tungsten cladding and the UO2 fuel was observed. Some of the fission gases passed from the fuel cavity to the gas surrounding the fuel specimen via the vent tube and possibly the end-cap weld failure. Whether the UO2 loss rates through the vent tube were within acceptable limits could not be determined in view of the end-cap weld failure.

The 13C(n,α0)10Be cross section at 14.3 MeV and 17 MeV neutron energy

NASA Astrophysics Data System (ADS)

Kavrigin, P.; Belloni, F.; Frais-Koelbl, H.; Griesmayer, E.; Plompen, A. J. M.; Schillebeeckx, P.; Weiss, C.

2017-09-01

At nuclear fusion reactors, CVD diamond detectors are considered an advantageous solution for neutron flux monitoring. For such applications the knowledge of the cross section of neutron-induced nuclear reactions on natural carbon are of high importance. Especially the (n,α0) reactions, yielding the highest energy reaction products, are of relevance as they can be clearly distinguished in the spectrum. The 13C(n,α0)10Be cross section was measured relative to 12C(n,α0)9Be at the Van de Graaff facility of EC-JRC Geel, Belgium, at 14.3 MeV and 17.0 MeV neutron energies. The measurement was performed with an sCVD (single-crystal Chemical Vapor Deposition) diamond detector, where the detector material acted simultaneously as sample and as sensor. A novel data analysis technique, based on pulse-shape discrimination, allowed an efficient reduction of background events. The results of the measurement are presented and compared to previously published values for this cross-section.

ATLAS DBM Module Qualification

DOE Office of Scientific and Technical Information (OSTI.GOV)

Soha, Aria; Gorisek, Andrej; Zavrtanik, Marko

2014-06-18

This is a technical scope of work (TSW) between the Fermi National Accelerator Laboratory (Fermilab) and the experimenters of Jozef Stefan Institute, CERN, and University of Toronto who have committed to participate in beam tests to be carried out during the 2014 Fermilab Test Beam Facility program. Chemical Vapour Deposition (CVD) diamond has a number of properties that make it attractive for high energy physics detector applications. Its large band-gap (5.5 eV) and large displacement energy (42 eV/atom) make it a material that is inherently radiation tolerant with very low leakage currents and high thermal conductivity. CVD diamond is beingmore » investigated by the RD42 Collaboration for use very close to LHC interaction regions, where the most extreme radiation conditions are found. This document builds on that work and proposes a highly spatially segmented diamond-based luminosity monitor to complement the time-segmented ATLAS Beam Conditions Monitor (BCM) so that, when Minimum Bias Trigger Scintillators (MTBS) and LUCID (LUminosity measurement using a Cherenkov Integrating Detector) have difficulty functioning, the ATLAS luminosity measurement is not compromised.« less

Suicide in males and females with cardiovascular disease and comorbid depression.

PubMed

Hawkins, Michael; Schaffer, Ayal; Reis, Catherine; Sinyor, Mark; Herrmann, Nathan; Lanctôt, Krista L

2016-06-01

Myocardial infarction (MI) has been associated with an increased risk of suicide, further increased among individuals with a comorbid psychiatric illness. A paucity of studies have examined details of suicide among individuals with cardiovascular disease (CVD) and comorbid depression. We aimed to compare demographic, clinical and suicide-specific characteristics between suicide victims with CVD with depression (CVD+D) and without comorbid depression (CVD-D). Coroner data on suicide decedents with CVD (n=413) occurring in Toronto, Canada from 1998 to 2012 were collected. Characteristics were compared between the CVD+D and CVD-D groups. Regression analysis examined for gender differences in these groups. CVD+D subjects compared to CVD-D were more likely to have had a past suicide attempt (p=0.008), and to have experienced a bereavement (p=0.008) or financial stressor (p=0.005) in the past year. Each of these variables remained significantly associated with the presence of depression after the regression analysis. Within the CVD+D group, females were more likely to die from suicide by self-poisoning (p<0.0001) and males by shooting (p=0.001). Psychological autopsies were not available. The definition of CVD was broad and the accuracy of its diagnosis could not be confirmed. Individuals with CVD+D who died from suicide had significant differences in clinical characteristics and specific stressors compared to those without depression. These data may help to better characterize suicide risk and prevention in this vulnerable population. Copyright © 2016 Elsevier B.V. All rights reserved.

Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP).

PubMed

Jones, Charlotte A; Nanji, Alykhan; Mawani, Shefina; Davachi, Shahnaz; Ross, Leanne; Vollman, Ardene; Aggarwal, Sandeep; King-Shier, Kathryn; Campbell, Norman

2013-02-21

South Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population. South Asians (≥ 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or ≥ 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar's test (proportions) and paired t-tests (continuous measures). Baseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering multilingual programs/translation assistance, reducing screening wait times and increasing numbers of project staff. SA-CHAMP demonstrated the feasibility and value of implementing a lay volunteer-led, culturally adapted, sustainable community-based CVD risk factor screening program in South Asian places of worship in Calgary, Alberta, Canada. Subsequent screening and CDM programs were refined based on the learnings from this study. Further research is needed to determine physician and patient factors associated with uptake of and adherence to risk reduction strategies.

Influence of BN fiber coatings on the interfacial structure of sapphire fiber reinforced NiAl composites

NASA Astrophysics Data System (ADS)

Reichert, K.; Wen, K.; Cremer, R.; Hu, W.; Neuschütz, D.; Gottstein, G.

2001-07-01

A new concept for a tailored fiber-matrix interface for sapphire fiber reinforced NiAl matrix composites is proposed, consisting of an initial hexagonal boron nitride (hBN) fiber coating. For this, single crystal Al 2O 3 fibers were coated with hBN by chemical vapor deposition (CVD). Following a comprehensive characterization of the CVD coating as to composition and structure by means of X-ray photoelectron spectroscopy (XPS) and grazing incidence X-ray diffraction (GIXRD), the fiber reinforced NiAl matrix composites were fabricated by diffusion bonding at 1400°C. The interfaces NiAl/BN and BN/Al 2O 3 were analyzed by scanning electron microscopy (SEM), analytical transmission electron microscopy (TEM), and selected area diffraction (SAD). An interfacial reaction between NiAl and hBN to form AlN was revealed using these analytical techniques.

Raman spectra boron doped amorphous carbon thin film deposited by bias assisted-CVD

NASA Astrophysics Data System (ADS)

Ishak, A.; Fadzilah, A. N.; Dayana, K.; Saurdi, I.; Malek, M. F.; Nurbaya, Z.; Shafura, A. K.; Rusop, M.

2018-05-01

Boron doped amorphous carbon thin film carbon was deposited at 200°C-350°C by bias assisted-CVD using palm oil as a precursor material. The structural boron doped amorphous carbon films were discussed by Raman analysis through the evolution of D and G bands. The spectral evolution observed showed the increase of upward shift of D and G peaks as substrate deposition temperatures increased. These structural changes were further correlated with optical gap and the results obtained are discussed and compared. The estimated optical band gap is found to be 1.9 to 2.05 eV and conductivity is to be in the range of 10-5 Scm-1 to 10-4 Scm-1. The decrease of optical band gap is associated to conductivity increased which change the characteristic parameters of Raman spectra including the position of G peak, full width at half maximum of G peak, and ID/IG.

Epidemiology of ischemic heart disease in HIV.

PubMed

Triant, Virginia A; Grinspoon, Steven K

2017-11-01

The purpose of this review is to summarize and synthesize recent data on the risk of ischemic heart disease (IHD) in HIV-infected individuals. Recent studies in the field demonstrate an increasing impact of cardiovascular disease (CVD) on morbidity and mortality in HIV relative to AIDS-related diagnoses. Studies continue to support an approximately 1.5 to two-fold increased risk of IHD conferred by HIV, with specific risk varying by sex and virologic/immunologic status. Risk factors include both traditional CVD risk factors and novel, HIV-specific factors including inflammation and immune activation. Specific antiretroviral therapy (ART) drugs may increase CVD risk, yet the net effect of ART with viral suppression is beneficial with regard to CVD risk. Management of cardiovascular risk and prevention of CVD is complex, because current general population strategies target traditional CVD risk factors only. Extensive investigation is being directed at developing tailored CVD risk prediction algorithms and interventions to reduce CVD risk in HIV. Increased IHD risk is a significant clinical and public health challenge in HIV. The development and application of HIV-specific interventions to manage CVD risk factors and reduce CVD risk will improve the long-term health of this ageing population.

All-Cause and CVD Mortality in Native Hawaiians

PubMed Central

Aluli, N. Emmett; Reyes, Phillip W.; Brady, S. Kalani; Tsark, JoAnn U.; Jones, Kristina L.; Mau, Marjorie; Howard, Wm. J.; Howard, Barbara V.

2010-01-01

Aims Cardiovascular disease (CVD) is the leading cause of death among Native Hawaiians. In this article, all-cause and cardiovascular mortality rates among Native Hawaiians are examined, along with associated CVD risk factors. Methods A total of 855 Native Hawaiians (343 men and 512 women, ages 19–88) were examined as participants of the Cardiovascular Risk Clinics program (1992–1998) and underwent surveillance through September 2007. Cause of each death was determined by review of medical records, death certificates, newspapers, and through queries to community members. Results CVD accounted for 55% of deaths. Coronary heart disease (CHD) accounted for the majority of CVD deaths. CVD increased with age and was higher in those with diabetes, hypertension, or high low-density lipoprotein cholesterol (LDL-C). CVD rates were higher in men than in women and 4-fold higher in those with diabetes. In addition to age, diabetes, hypertension, and elevated LDL-C were major risk factors. Conclusions Diabetes is a major determinant of CVD in this population and most of the CVD is occurring in those with diabetes. Strategies to prevent diabetes and manage blood pressure and lipids should reduce CVD rates in Native Hawaiians. PMID:20392507

Prediction of cardiovascular risk in rheumatoid arthritis: performance of original and adapted SCORE algorithms.

PubMed

Arts, E E A; Popa, C D; Den Broeder, A A; Donders, R; Sandoo, A; Toms, T; Rollefstad, S; Ikdahl, E; Semb, A G; Kitas, G D; Van Riel, P L C M; Fransen, J

2016-04-01

Predictive performance of cardiovascular disease (CVD) risk calculators appears suboptimal in rheumatoid arthritis (RA). A disease-specific CVD risk algorithm may improve CVD risk prediction in RA. The objectives of this study are to adapt the Systematic COronary Risk Evaluation (SCORE) algorithm with determinants of CVD risk in RA and to assess the accuracy of CVD risk prediction calculated with the adapted SCORE algorithm. Data from the Nijmegen early RA inception cohort were used. The primary outcome was first CVD events. The SCORE algorithm was recalibrated by reweighing included traditional CVD risk factors and adapted by adding other potential predictors of CVD. Predictive performance of the recalibrated and adapted SCORE algorithms was assessed and the adapted SCORE was externally validated. Of the 1016 included patients with RA, 103 patients experienced a CVD event. Discriminatory ability was comparable across the original, recalibrated and adapted SCORE algorithms. The Hosmer-Lemeshow test results indicated that all three algorithms provided poor model fit (p<0.05) for the Nijmegen and external validation cohort. The adapted SCORE algorithm mainly improves CVD risk estimation in non-event cases and does not show a clear advantage in reclassifying patients with RA who develop CVD (event cases) into more appropriate risk groups. This study demonstrates for the first time that adaptations of the SCORE algorithm do not provide sufficient improvement in risk prediction of future CVD in RA to serve as an appropriate alternative to the original SCORE. Risk assessment using the original SCORE algorithm may underestimate CVD risk in patients with RA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Carotid Plaque Score and Risk of Cardiovascular Mortality in the Oldest Old: Results from the TOOTH Study.

PubMed

Hirata, Takumi; Arai, Yasumichi; Takayama, Michiyo; Abe, Yukiko; Ohkuma, Kiyoshi; Takebayashi, Toru

2018-01-01

Accumulating evidence suggests that predictability of traditional cardiovascular risk factors declines with advancing age. We investigated whether carotid plaque scores (CPSs) were associated with cardiovascular disease (CVD) death in the oldest old, and whether asymmetrical dimethylarginine (ADMA), a marker of endothelial dysfunction, moderated the association between the CPS and CVD death. We conducted a prospective cohort study of Japanese subjects aged ≥85 years without CVD at baseline. We followed this cohort for 6 years to investigate the association of CPS with CVD death via multivariable Cox proportional hazard analysis. We divided participants into three groups according to CPS (no, 0 points; low, 1.2-4.9 points; high, ≥5.0 points). The predictive value of CPS for estimating CVD death risk over CVD risk factors, including ADMA, was examined using C-statistics. We analyzed 347 participants (151 men, 196 women; mean age, 87.6 years), of which 135 (38.9%) had no carotid plaque at baseline, and 48 (13.8%) had high CPS. Of the total, 29 (8.4%) participants experienced CVD-related death during the study period. Multivariable analysis revealed a significant association of high CPS with CVD-related mortality relative to no CPS (hazard ratio, 3.90; 95% confidence interval: 1.47-10.39). ADMA was not associated with CVD death, but the significant association between CPS and CVD death was observed only in lower ADMA level. The addition of CPS to other risk factors improved the predictability of CVD death (p=0.032). High CPS correlated significantly with a higher CVD death risk in the oldest old with low cardiovascular risk. Ultrasound carotid plaque evaluation might facilitate risk evaluations of CVD death in the very old.

Impact of anti-rheumatic treatment on cardiovascular risk in Asian patients with rheumatoid arthritis.

PubMed

Cho, Soo-Kyung; Kim, Dam; Won, Soyoung; Lee, Jiyoung; Park, ByeongJu; Jang, Eun Jin; Bae, Sang-Cheol; Sung, Yoon-Kyoung

2018-02-01

To estimate the incidence of cardiovascular disease (CVD) in Asian patients with rheumatoid arthritis (RA) and to evaluate the impact of anti-rheumatic treatment on the development of CVD. A retrospective cohort of Asian patients with RA was established to identify the incidence rate (IR) of CVD in RA patients. The cohort was generated using the Korean National Healthcare claims database, which contained claims from Jan 2009 to Dec 2013. A total of 137,512 RA patients were identified; individuals with a history of CVD for 6 months or more before the index date were excluded. Nested case-control samples were drawn from the full study population with a case:control ratio of 1:4 (n = 7102 cases; n = 27,018 controls without CVD). A conditional multivariate regression model was used to evaluate the impact of anti-rheumatic treatment on the development of CVD in RA patients after matching for age, sex, RA index date, comorbidities, and drug use (e.g., antiplatelet agents and cholesterol-lowering agents). The IR for development of overall CVD in RA patients was 182.1 (95% CI: 178.4-185.9) per 10,000 person-years. In models adjusted for other CVD risk factors, disease-modifying anti-rheumatic drugs (DMARDs) (OR = 0.79) were protective against CVD, and biologic DMARDs were not significantly associated with CVD risk (OR = 0.85). Corticosteroids (OR = 1.26) and NSAIDs (nonselective NSAIDs: OR = 1.32, Cox-2 inhibitors: OR = 1.31) were risk factors for CVD in RA patients. The use of DMARDs is protective against CVD, while corticosteroids and NSAIDs increased the risk of CVD in RA patients. Copyright © 2018 Elsevier Inc. All rights reserved.

Standard cardiovascular disease risk algorithms underestimate the risk of cardiovascular disease in schizophrenia: evidence from a national primary care database.

PubMed

McLean, Gary; Martin, Julie Langan; Martin, Daniel J; Guthrie, Bruce; Mercer, Stewart W; Smith, Daniel J

2014-10-01

Schizophrenia is associated with increased cardiovascular mortality. Although cardiovascular disease (CVD) risk prediction algorithms are widely in the general population, their utility for patients with schizophrenia is unknown. A primary care dataset was used to compare CVD risk scores (Joint British Societies (JBS) score), cardiovascular risk factors, rates of pre-existing CVD and age of first diagnosis of CVD for schizophrenia (n=1997) relative to population controls (n=215,165). Pre-existing rates of CVD and the recording of risk factors for those without CVD were higher in the schizophrenia cohort in the younger age groups, for both genders. Those with schizophrenia were more likely to have a first diagnosis of CVD at a younger age, with nearly half of men with schizophrenia plus CVD diagnosed under the age of 55 (schizophrenia men 46.1% vs. control men 34.8%, p<0.001; schizophrenia women 28.9% vs. control women 23.8%, p<0.001). However, despite high rates of CVD risk factors within the schizophrenia group, only a very small percentage (3.2% of men and 7.5% of women) of those with schizophrenia under age 55 were correctly identified as high risk for CVD according to the JBS risk algorithm. The JBS2 risk score identified only a small proportion of individuals with schizophrenia under the age of 55 as being at high risk of CVD, despite high rates of risk factors and high rates of first diagnosis of CVD within this age group. The validity of CVD risk prediction algorithms for schizophrenia needs further research. Copyright © 2014 Elsevier B.V. All rights reserved.

Circulating Branched-Chain Amino Acids and Incident Cardiovascular Disease in a Prospective Cohort of US Women.

PubMed

Tobias, Deirdre K; Lawler, Patrick R; Harada, Paulo H; Demler, Olga V; Ridker, Paul M; Manson, JoAnn E; Cheng, Susan; Mora, Samia

2018-04-01

Circulating branched-chain amino acids (BCAAs; isoleucine, leucine, and valine) are strong predictors of type 2 diabetes mellitus (T2D), but their association with cardiovascular disease (CVD) is uncertain. We hypothesized that plasma BCAAs are positively associated with CVD risk and evaluated whether this was dependent on an intermediate diagnosis of T2D. Participants in the Women's Health Study prospective cohort were eligible if free of CVD at baseline blood collection (n=27 041). Plasma metabolites were measured via nuclear magnetic resonance spectroscopy. Multivariable Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for BCAAs with incident CVD (myocardial infarction, stroke, and coronary revascularization). We confirmed 2207 CVD events over a mean 18.6 years of follow-up. Adjusting for age, body mass index, and other established CVD risk factors, total BCAAs were positively associated with CVD (per SD: HR, 1.13; 95% CI, 1.08-1.18), comparable to LDL-C (low-density lipoprotein cholesterol) with CVD (per SD: HR, 1.12; 95% CI, 1.07-1.17). BCAAs were associated with coronary events (myocardial infarction: HR, 1.16; 95% CI, 1.06-1.26; revascularization: HR, 1.17; 95% CI, 1.11-1.25), and borderline significant association with stroke (HR, 1.07; 95% CI, 0.99-1.15). The BCAA-CVD association was greater ( P interaction=0.036) among women who developed T2D before CVD (HR, 1.20; 95% CI, 1.08-1.32) versus women without T2D (HR, 1.08; 95% CI, 1.03-1.14). Adjusting for LDL-C, an established CVD risk factor, did not attenuate these findings; however, adjusting for HbA1c and insulin resistance eliminated the associations of BCAAs with CVD. Circulating plasma BCAAs were positively associated with incident CVD in women. Impaired BCAA metabolism may capture the long-term risk of the common cause underlying T2D and CVD. © 2018 American Heart Association, Inc.

Role of pharmacist in cardiovascular disease-related health promotion and in hypertension and dyslipidemia management: a cross-sectional study in the State of Qatar.

PubMed

El Hajj, Maguy Saffouh; Mahfoud, Ziyad R; Al Suwaidi, Jassim; Alkhiyami, Dania; Alasmar, Aya Riyad

2016-06-01

In Qatar, cardiovascular diseases (CVD) have recently become the leading cause of morbidity and mortality. Prevention, detection and management of CVD risk factors reduce CVD chance. The study objectives were to assess Qatar pharmacists' involvement in CVD health promotion, to identify the activities that they currently provide to patients with CVD risk factors, to describe their attitudes towards their involvement in CVD prevention and to assess their perceived barriers for provision of CVD prevention services We conducted a cross-sectional survey of community and ambulatory pharmacists in Qatar. Pharmacist characteristics, involvement in CVD-related activities along with their attitudes and perceived barriers were analysed using frequency distributions. Bivariate linear regression models were used to test for associations between CVD health promotion activity score and each variable. Variables with a P-value of 0.20 or less were included in the multivariate model. A total of 141 pharmacists completed the survey (response rate 60%). More than 70% responded with rarely or never to 6 out of the 10 CVD health promotion activities. Eighty-four per cent and 68% always or often describe to patients the appropriate time to take antihypertensive medications and the common medication adverse effects, respectively. Yet, 50% rarely or never review the medication refill history or provide adherence interventions. Lack of CVD educational materials was the top perceived barrier (55%) in addition to lack of having private counselling area (44.6%), and lack of time (38.3%). Females and community pharmacists were more involved in CVD health promotion (P = 0.046 and P = 0.017, respectively) than their counterparts. Health promotion practice increased with increasing attitudes score and decreased with increased barriers score (P = 0.012 and P = 0.001). The scope of pharmacy practice in CVD prevention is limited in Qatar. Efforts need to be exerted to increase pharmacists' involvement in CVD prevention. © 2015 John Wiley & Sons, Ltd.

Dietary antioxidant capacity of the patients with cardiovascular disease in a cross-sectional study.

PubMed

Zujko, Małgorzata E; Witkowska, Anna M; Waśkiewicz, Anna; Piotrowski, Walerian; Terlikowska, Katarzyna M

2015-03-15

The purpose of this study was to establish sources and patterns of antioxidant, polyphenol and flavonoid intakes in men and women with cardiovascular disease (CVD). The subjects with CVD and healthy controls (HC) were participants of the Polish National Multicenter Health Survey (WOBASZ). Food intakes were measured with the 1-day 24-hour recall method. A self-developed database was used to calculate dietary total antioxidant capacity (DTAC), dietary total polyphenol content (DTPC) and dietary total flavonoid content (DTFC). DTAC did not differ between the men with CVD and HC men (6442 vs. 6066 μmol trolox equivalents - TE), but in the women with CVD it was significantly higher than in the HC women (6182 vs. 5500 μmol TE). The main sources of antioxidants in the males with CVD were: tea, coffee, apples, and nuts and seeds, and tea, coffee and apples in HC. In the females they were: tea, coffee, apples and strawberries, both in the women with CVD and HC. DTPC in the men with CVD did not differ from HC (1198 vs. 1114 mg gallic acid equivalents, GAE). In the females, DTPC was significantly higher in the subjects with CVD as compared to HC (1075 vs. 981 mg GAE). Predominant sources of polyphenols were: tea, coffee, cabbage, potatoes, apples and white bread in the men with CVD, and tea, coffee, potatoes, white bread and apples in HC, while in the women (both with CVD and HC): tea, coffee, apples, potatoes and cabbage. No differences in DTFC have been found between the males with CVD and HC (212 vs. 202 mg quercetine equivalents, QE). In the women with CVD, DTFC was significantly higher than in HC (200 vs. 177 mg QE). Main sources of flavonoids in all participants (men and women, CVD and HC) were tea, apples, cabbage and coffee. Polish men and women faced with CVD beneficially modify their dietary practices by enhancing intakes of foods that are sources of antioxidants, polyphenols and flavonoids. Different sources and patterns of antioxidant, polyphenol and flavonoid intakes, however, between male and female patients with CVD were observed.

Screening for Cardiovascular Disease Risk With Electrocardiography: US Preventive Services Task Force Recommendation Statement.

PubMed

Curry, Susan J; Krist, Alex H; Owens, Douglas K; Barry, Michael J; Caughey, Aaron B; Davidson, Karina W; Doubeni, Chyke A; Epling, John W; Kemper, Alex R; Kubik, Martha; Landefeld, C Seth; Mangione, Carol M; Silverstein, Michael; Simon, Melissa A; Tseng, Chien-Wen; Wong, John B

2018-06-12

Cardiovascular disease (CVD), which encompasses atherosclerotic conditions such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease, is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by CVD risk assessment with tools such as the Framingham Risk Score or the Pooled Cohort Equations, which stratify individual risk to inform treatment decisions. To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on screening for coronary heart disease with electrocardiography (ECG). The USPSTF reviewed the evidence on whether screening with resting or exercise ECG improves health outcomes compared with the use of traditional CVD risk assessment alone in asymptomatic adults. For asymptomatic adults at low risk of CVD events (individuals with a 10-year CVD event risk less than 10%), it is very unlikely that the information from resting or exercise ECG (beyond that obtained with conventional CVD risk factors) will result in a change in the patient's risk category as assessed by the Framingham Risk Score or Pooled Cohort Equations that would lead to a change in treatment and ultimately improve health outcomes. Possible harms are associated with screening with resting or exercise ECG, specifically the potential adverse effects of subsequent invasive testing. For asymptomatic adults at intermediate or high risk of CVD events, there is insufficient evidence to determine the extent to which information from resting or exercise ECG adds to current CVD risk assessment models and whether information from the ECG results in a change in risk management and ultimately reduces CVD events. As with low-risk adults, possible harms are associated with screening with resting or exercise ECG in asymptomatic adults at intermediate or high risk of CVD events. The USPSTF recommends against screening with resting or exercise ECG to prevent CVD events in asymptomatic adults at low risk of CVD events. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG to prevent CVD events in asymptomatic adults at intermediate or high risk of CVD events. (I statement).

Genetic ancestry is associated with subclinical cardiovascular disease in African Americans and Hispanics from the Multi-Ethnic Study of Atherosclerosis (MESA)

PubMed Central

Wassel, Christina L.; Pankow, James S.; Peralta, Carmen A.; Choudhry, Shweta; Seldin, Michael F.; Arnett, Donna K.

2009-01-01

Background Differences in cardiovascular disease (CVD) burden exist among racial/ethnic groups in the United States, with African Americans having the highest prevalence. Subclinical CVD measures have also been shown to differ by race/ethnicity. In the United States, there has been significant intermixing among racial/ethnic groups creating admixed populations. Very little research exists on the relationship of genetic ancestry and subclinical CVD measures. Methods and Results These associations were investigated in 712 African-American and 705 Hispanic participants from the MESA candidate gene sub-study. Individual ancestry was estimated from 199 genetic markers using STRUCTURE. Associations of ancestry and coronary artery calcium (CAC) and common and internal carotid intima media thickness (cIMT) were evaluated using log-binomial and linear regression models. Splines indicated linear associations of ancestry with subclinical CVD measures in African-Americans, but presence of threshold effects in Hispanics. Among African Americans, each standard deviation (SD) increase in European ancestry was associated with an 8% (95% CI (1.02, 1.15), p=0.01) greater CAC prevalence. Each SD increase in European ancestry was also associated with a 2% (95% CI (−3.4%, −0.5%), p=0.008) lower common cIMT in African Americans. Among Hispanics, the highest tertile of European ancestry was associated with a 34% greater CAC prevalence, p=0.02 as compared to lowest tertile. Conclusions The linear association of ancestry and subclinical CVD suggests that genetic effects may be important in determining CAC and cIMT among African-Americans. Our results also suggest that CAC and common cIMT may be important phenotypes for further study with admixture mapping. PMID:20031644

Quality and Cultural Sensitivity of Linguistically Appropriate Cardiovascular Disease Information for Chinese Immigrants: A Review of Online Resources From Heart Foundations.

PubMed

Li, Jialin; Lowres, Nicole; Jin, Kai; Zhang, Ling; Neubeck, Lis; Gallagher, Robyn

Chinese immigrants are at an increased risk for cardiovascular diseases (CVDs) compared with Chinese nationals partly because of lifestyle changes and knowledge deficits. Translated patient resources are available on the Internet and are often provided by health professionals; however, the quality and cultural sensitivity of these resources have not been reported. The aim of this study was to assess the availability, quality, and cultural sensitivity of Chinese-language information available from national "Heart Foundations" (cardiac research bodies, nongovernmental organisations) of the 5 most popular destinations of Chinese immigration. This study is a descriptive research in which national "Heart Foundation" websites were systematically searched for Chinese-language CVD patient education resources. Quality (content, identification, structure) was assessed using the Ensuring Quality Information for Patients instrument. Cultural sensitivity was evaluated using the Cultural Sensitivity Assessment Tool. From 107 identified resources, 33 were CVD specific: coronary heart disease (n = 20), arrhythmias (n = 7), and heart failure (n = 6). Quality of resources was adequate (mean Ensuring Quality Information for Patients score, 69%), but scores varied significantly (min, 60%; max, 85%). Although all resources were classified as culturally sensitive (Cultural Sensitivity Assessment Tool score ≥ 2.5), 2 resources scored low (≤2.5) for visual impact, and across all resources, written and visual domains were assessed as least culturally sensitive. Most resources lacked culturally specific references. Chinese-language CVD resources were inconsistent in the supply of key information. Quality and level of cultural sensitivity were adequate, but most resources lacked culturally specific references. Comprehensive, high-quality CVD resources powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation tailored for Chinese immigrants are urgently needed for healthcare providers to support CVD education and care of patients belonging to this population.

Onset of Impaired Sleep and Cardiovascular Disease Risk Factors: A Longitudinal Study

PubMed Central

Clark, Alice Jessie; Salo, Paula; Lange, Theis; Jennum, Poul; Virtanen, Marianna; Pentti, Jaana; Kivimäki, Mika; Rod, Naja Hulvej; Vahtera, Jussi

2016-01-01

Study Objectives: Impaired sleep has been linked to increased risk of cardiovascular disease (CVD), but the underlying mechanisms are still unsettled. We sought to determine how onset of impaired sleep affects the risk of established physiological CVD risk factors (i.e., hypertension, diabetes, and dyslipidemia). Methods: In a longitudinal cohort study with 3 survey waves (2000, 2004, 2008) from the Finnish Public Sector study we used repeated information on sleep duration and disturbances to determine onset of impaired sleep. Information on development of CVD risk factors, as indicated by initiation of medication for hypertension, diabetes, and dyslipidemia was derived from electronic medical records within 8 years of follow-up. Data on 45,647 participants was structured as two data-cycles to examine the effect of change in sleep (between two waves) on incident CVD events. We applied strict inclusion and exclusion criteria to determine temporality between changes in sleep and the outcomes. Results: While we did not find consistent effects of onset of short or long sleep, we found onset of disturbed sleep to predict subsequent risk of hypertension (hazard ratio = 1.22, 95% CI: 1.04–1.44) and dyslipidemia (HR = 1.17, 95% CI: 1.07–1.29) in fully adjusted analyses. Conclusions: Results suggest that onset of sleep disturbances rather than short or long sleep mark an increase in physiological risk factors, which may partly explain the higher risk of CVD observed among impaired sleepers. Commentary: A commentary on this paper appears in this issue on page 1629. Citation: Clark AJ, Salo P, Lange T, Jennum P, Virtanen M, Pentti J, Kivimäki M, Rod NH, Vahtera J. Onset of impaired sleep and cardiovascular disease risk factors: a longitudinal study. SLEEP 2016;39(9):1709–1718. PMID:27397560

Correlates for cardiovascular diseases among diabetic/hypertensive patients attending outreach clinics in two Nairobi slums, Kenya

PubMed Central

Mugure, Gladys; Karama, Mohamed; Kyobutungi, Catherine; Karanja, Simon

2014-01-01

Introduction Cardiovascular diseases (CVD) are the leading cause of death in the world. Over 80% of CVD related deaths occur in low- and middle-income countries (LMICs). Diabetes and hypertension, whose prevalence in Kenya is on the rise, are major risk factors for CVD. Despite this, studies indicate that awareness on the management of risk factors for CVD among diabetic/hypertensive patients in African populations is generally low. The aim of the study was to determine the risk factors for CVD among diabetic and/or hypertensive patients attending diabetes and hypertension management clinics in Korogocho and Viwandani slums of Nairobi. Methods Data were collected using questionnaires administered to 206 diabetic/hypertensive patients attending the clinics between July 2010 and February 2011. A review of these patients’ medical records was done to determine the history of CVD outcomes such as hypertensive heart diseases, stroke and peripheral arterial diseases. Results Majority (66.5%) of the study participants were females mainly in the 51-65 age category. The study findings revealed that 73 (33.4%) respondents had CVD outcomes. In addition, 41.8% of the respondents were not aware of the causes of diabetes/hypertension. Age category 51-65 years had the highest (43.8%) number of respondents with CVD. Sex of the respondents and awareness of the link between hypertension and CVD were significantly associated with CVD outcomes (p<0.05) among the respondents. Conclusion Measures to improve awareness levels among patients at high risk of CVD outcomes are needed to complement other measures to reduce CVD risk among such patients. PMID:25852804

Fibrinogen concentration and its role in CVD risk in black South Africans--effect of urbanisation.

PubMed

Pieters, Marlien; de Maat, Moniek P M; Jerling, Johann C; Hoekstra, Tiny; Kruger, Annamarie

2011-09-01

The aim of this study was to investigate correlates of fibrinogen concentration in black South Africans, as well as its association with cardiovascular disease (CVD) risk and whether urbanisation influences this association. A total of 1,006 rural and 1,004 urban black South Africans from the PURE study were cross-sectionally analysed. The association of fibrinogen with CVD risk was determined by investigating the association of fibrinogen with other CVD risk markers as well as with predicted CVD risk using the Reynolds Risk score. The rural group had a significantly higher fibrinogen concentration than the urban group, despite higher levels of risk factors and increased predicted CVD risk in the urban group. Increased levels of CVD risk factors were, however, still associated with increased fibrinogen concentration. Fibrinogen correlated significantly, but weakly, with overall predicted CVD risk. This correlation was stronger in the urban than in the rural group. Multiple regression analysis showed that a smaller percentage of the variance in fibrinogen is explained by the traditional CVD risk factors in the rural than in the urban group. In conclusion, fibrinogen is weakly associated with CVD risk (predicted overall risk as well with individual risk factors) in black South Africans, and is related to the degree of urbanisation. Increased fibrinogen concentration, in black South Africans, especially in rural areas, is largely unexplained, and likely not strongly correlated with traditional CVD-related lifestyle and pathophysiological processes. This does, however, not exclude the possibility that once increased, the fibrinogen concentration contributes to future development of CVD.

Chemical Vapor-Deposited Hexagonal Boron Nitride as a Scalable Template for High-Performance Organic Field-Effect Transistors

DOE PAGES

Lee, Tae Hoon; Kim, Kwanpyo; Kim, Gwangwoo; ...

2017-02-27

Organic field-effect transistors have attracted much attention because of their potential use in low-cost, large-area, flexible electronics. High-performance organic transistors require a low density of grain boundaries in their organic films and a decrease in the charge trap density at the semiconductor–dielectric interface for efficient charge transport. In this respect, the role of the dielectric material is crucial because it primarily determines the growth of the film and the interfacial trap density. Here, we demonstrate the use of chemical vapor-deposited hexagonal boron nitride (CVD h-BN) as a scalable growth template/dielectric for high-performance organic field-effect transistors. The field-effect transistors based onmore » C60 films grown on single-layer CVD h-BN exhibit an average mobility of 1.7 cm 2 V –1 s –1 and a maximal mobility of 2.9 cm 2 V –1 s –1 with on/off ratios of 10 7. The structural and morphology analysis shows that the epitaxial, two-dimensional growth of C 60 on CVD h-BN is mainly responsible for the superior charge transport behavior. In conclusion, we believe that CVD h-BN can serve as a growth template for various organic semiconductors, allowing the development of large-area, high-performance flexible electronics.« less

Chemical Vapor-Deposited Hexagonal Boron Nitride as a Scalable Template for High-Performance Organic Field-Effect Transistors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Tae Hoon; Kim, Kwanpyo; Kim, Gwangwoo

Organic field-effect transistors have attracted much attention because of their potential use in low-cost, large-area, flexible electronics. High-performance organic transistors require a low density of grain boundaries in their organic films and a decrease in the charge trap density at the semiconductor–dielectric interface for efficient charge transport. In this respect, the role of the dielectric material is crucial because it primarily determines the growth of the film and the interfacial trap density. Here, we demonstrate the use of chemical vapor-deposited hexagonal boron nitride (CVD h-BN) as a scalable growth template/dielectric for high-performance organic field-effect transistors. The field-effect transistors based onmore » C60 films grown on single-layer CVD h-BN exhibit an average mobility of 1.7 cm 2 V –1 s –1 and a maximal mobility of 2.9 cm 2 V –1 s –1 with on/off ratios of 10 7. The structural and morphology analysis shows that the epitaxial, two-dimensional growth of C 60 on CVD h-BN is mainly responsible for the superior charge transport behavior. In conclusion, we believe that CVD h-BN can serve as a growth template for various organic semiconductors, allowing the development of large-area, high-performance flexible electronics.« less

Plasma boriding of a cobalt-chromium alloy as an interlayer for nanostructured diamond growth

NASA Astrophysics Data System (ADS)

Johnston, Jamin M.; Jubinsky, Matthew; Catledge, Shane A.

2015-02-01

Chemical vapor deposited (CVD) diamond coatings can potentially improve the wear resistance of cobalt-chromium medical implant surfaces, but the high cobalt content in these alloys acts as a catalyst to form graphitic carbon. Boriding by high temperature liquid baths and powder packing has been shown to improve CVD diamond compatibility with cobalt alloys. We use the microwave plasma-enhanced (PE) CVD process to deposit interlayers composed primarily of the borides of cobalt and chromium. The use of diborane (B2H6) in the plasma feedgas allows for the formation of a robust boride interlayer for suppressing graphitic carbon during subsequent CVD of nano-structured diamond (NSD). This metal-boride interlayer is shown to be an effective diffusion barrier against elemental cobalt for improving nucleation and adhesion of NSD coatings on a CoCrMo alloy. Migration of elemental cobalt to the surface of the interlayer is significantly reduced and undetectable on the surface of the subsequently-grown NSD coating. The effects of PECVD boriding are compared for a range of substrate temperatures and deposition times and are evaluated using glancing-angle X-ray diffraction (XRD), cross-sectional scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), and micro-Raman spectroscopy. Boriding of CoCrMo results in adhered nanostructured diamond coatings with low surface roughness.

Structural and functional correlates in color vision deficiency

PubMed Central

Gupta, A; Laxmi, G; Nittala, M G; Raman, R

2011-01-01

Purpose The aim of this study is to assess the photoreceptor integrity, using spectral domain optical coherence tomography (SD-OCT), and to measure the retinal sensitivity of patients with congenital red–green color vision deficiency (CVD). Methods In all, 14 eyes from 7 patients with congenital red–green CVD (diagnosed by Farnsworth Munsell 100 hue test), and 14 eyes from 7 control subjects were examined by SD-OCT and microperimetry. Radial scans (7-mm) were taken of the macula. The center of the fovea was defined. The thickness of different retinal layers, at the foveal center, and at multiple defined points along all six radial scans, was measured. The median readings were compared between the two groups using Mann–Whitney U-test. Results SD-OCT demonstrated normal total retinal thickness, normal thickness of the photoreceptor layer, normal thickness of the outer nuclear layer, normal vertical thickness of the outer segments (OSs), and normal vertical thickness of the inner segments. OS horizontal diameter was less in left eye in cases with CVD when compared with controls. The mean retinal and foveal sensitivity was similar between cases and controls. Conclusions In subjects with congenital red–green CVD, there are no discernible anatomical abnormalities seen on SD-OCT in various retinal layers, except for a narrower foveal pit. However, further studies with larger sample size are required. PMID:21494280

Noncatalytic thermocouple coatings produced with chemical vapor deposition for flame temperature measurements.

PubMed

Bahlawane, N; Struckmeier, U; Kasper, T S; Osswald, P

2007-01-01

Chemical vapor deposition (CVD) and metal-organic chemical vapor deposition (MOCVD) have been employed to develop alumina thin films in order to protect thermocouples from catalytic overheating in flames and to minimize the intrusion presented to the combustion process. Alumina films obtained with a CVD process using AlCl(3) as the precursor are dense, not contaminated, and crystallize in the corundum structure, while MOCVD using Al(acetyl acetone)(3) allows the growth of corundum alumina with improved growth rates. These films, however, present a porous columnar structure and show some carbon contamination. Therefore, coated thermocouples using AlCl(3)-CVD were judged more suitable for flame temperature measurements and were tested in different fuels over a typical range of stoichiometries. Coated thermocouples exhibit satisfactory measurement reproducibility, no temporal drifts, and do not suffer from catalytic effects. Furthermore, their increased radiative heat loss (observed by infrared spectroscopy) allows temperature measurements over a wider range when compared to uncoated thermocouples. A flame with a well-known temperature profile established with laser-based techniques was used to determine the radiative heat loss correction to account for the difference between the apparent temperature measured by the coated thermocouple and the true flame temperature. The validity of the correction term was confirmed with temperature profile measurements for several flames previously studied in different laboratories with laser-based techniques.

Controlled growth of CNT in mesoporous AAO through optimized conditions for membrane preparation and CVD operation

NASA Astrophysics Data System (ADS)

Ciambelli, P.; Arurault, L.; Sarno, M.; Fontorbes, S.; Leone, C.; Datas, L.; Sannino, D.; Lenormand, P.; Le Blond Du Plouy, S.

2011-07-01

Anodic aluminium oxide (RAAO) membranes with a mesoporous structure were prepared under strictly controlling experimental process conditions, and physically and chemically characterized by a wide range of experimental techniques. Commercial anodic aluminium oxide (CAAO) membranes were also investigated for comparison. We demonstrated that RAAO membranes have lower content of both water and phosphorus and showed better porosity shape than CAAO. The RAAO membranes were used for template growth of carbon nanotubes (CNT) inside its pores by ethylene chemical vapour deposition (CVD) in the absence of a catalyst. A composite material, containing one nanotube for each channel, having the same length as the membrane thickness and an external diameter close to the diameter of the membrane holes, was obtained. Yield, selectivity and quality of CNTs in terms of diameter, length and arrangement (i.e. number of tubes for each channel) were optimized by investigating the effect of changing the experimental conditions for the CVD process. We showed that upon thermal treatment RAAO membranes were made up of crystallized allotropic alumina phases, which govern the subsequent CNT growth, because of their catalytic activity, likely due to their Lewis acidity. The strict control of experimental conditions for membrane preparation and CNT growth allowed us to enhance the carbon structural order, which is a critical requisite for CNT application as a substitute for copper in novel nano-interconnects.

Controlled growth of CNT in mesoporous AAO through optimized conditions for membrane preparation and CVD operation.

PubMed

Ciambelli, P; Arurault, L; Sarno, M; Fontorbes, S; Leone, C; Datas, L; Sannino, D; Lenormand, P; Du Plouy, S Le Blond

2011-07-01

Anodic aluminium oxide (RAAO) membranes with a mesoporous structure were prepared under strictly controlling experimental process conditions, and physically and chemically characterized by a wide range of experimental techniques. Commercial anodic aluminium oxide (CAAO) membranes were also investigated for comparison. We demonstrated that RAAO membranes have lower content of both water and phosphorus and showed better porosity shape than CAAO. The RAAO membranes were used for template growth of carbon nanotubes (CNT) inside its pores by ethylene chemical vapour deposition (CVD) in the absence of a catalyst. A composite material, containing one nanotube for each channel, having the same length as the membrane thickness and an external diameter close to the diameter of the membrane holes, was obtained. Yield, selectivity and quality of CNTs in terms of diameter, length and arrangement (i.e. number of tubes for each channel) were optimized by investigating the effect of changing the experimental conditions for the CVD process. We showed that upon thermal treatment RAAO membranes were made up of crystallized allotropic alumina phases, which govern the subsequent CNT growth, because of their catalytic activity, likely due to their Lewis acidity. The strict control of experimental conditions for membrane preparation and CNT growth allowed us to enhance the carbon structural order, which is a critical requisite for CNT application as a substitute for copper in novel nano-interconnects.

Anxiety sensitivity in smokers with indicators of cardiovascular disease.

PubMed

Farris, Samantha G; Abrantes, Ana M

2017-09-01

There is growing recognition of the importance of understanding the nature of the associations between anxiety and cardiovascular disease (CVD), although limited research has examined mechanisms that may explain the anxiety-CVD link. Anxiety sensitivity (fear of anxiety-relevant somatic sensations) is a cognitive-affective risk factor implicated in the development of anxiety psychopathology and various behavioral risk factors for CVD, although has not been examined among individuals with CVD. Adult daily smokers (n = 619; 50.9% female; M age  = 44.0, SD = 13.67) completed an online survey that included the Anxiety Sensitivity Index-3 (ASI-3) and the Patient Health Questionnaire (PHQ). The presence of CVD was assessed via the presence of ≥1 of the following: heart attack, heart murmur, positive stress test, heart valve abnormality, angina, and heart failure. Smokers with CVD indicators (n = 66, 10.7%) had significantly higher scores on the ASI-3 (M = 33.5, SD = 22.15), relative to smokers without CVD (M = 22.0, SD = 17.92; Cohen's d = .57). Those with CVD were significantly more likely to have moderate or high anxiety sensitivity (66.7%) relative to those without CVD (49.4%). Physical and social concerns about the meaning of somatic sensations were common among smokers with CVD.

Friction and Wear of Ion-Beam-Deposited Diamondlike Carbon on Chemical-Vapor-Deposited, Fine-Grain Diamond

NASA Technical Reports Server (NTRS)

Miyoshi, Kazuhisa; Wu, Richard L. C.; Lanter, William C.

1996-01-01

Friction and wear behavior of ion-beam-deposited diamondlike carbon (DLC) films coated on chemical-vapor-deposited (CVD), fine-grain diamond coatings were examined in ultrahigh vacuum, dry nitrogen, and humid air environments. The DLC films were produced by the direct impact of an ion beam (composed of a 3:17 mixture of Ar and CH4) at ion energies of 1500 and 700 eV and an RF power of 99 W. Sliding friction experiments were conducted with hemispherical CVD diamond pins sliding on four different carbon-base coating systems: DLC films on CVD diamond; DLC films on silicon; as-deposited, fine-grain CVD diamond; and carbon-ion-implanted, fine-grain CVD diamond on silicon. Results indicate that in ultrahigh vacuum the ion-beam-deposited DLC films on fine-grain CVD diamond (similar to the ion-implanted CVD diamond) greatly decrease both the friction and wear of fine-grain CVD diamond films and provide solid lubrication. In dry nitrogen and in humid air, ion-beam-deposited DLC films on fine-grain CVD diamond films also had a low steady-state coefficient of friction and a low wear rate. These tribological performance benefits, coupled with a wider range of coating thicknesses, led to longer endurance life and improved wear resistance for the DLC deposited on fine-grain CVD diamond in comparison to the ion-implanted diamond films. Thus, DLC deposited on fine-grain CVD diamond films can be an effective wear-resistant, lubricating coating regardless of environment.

Crystal-proven Gout and Characteristic Gout Severity Factors are Associated with Cardiovascular Disease.

PubMed

Disveld, Iris J M; Fransen, Jaap; Rongen, Gerard A; Kienhorst, Laura B E; Zoakman, Sahel; Janssens, Hein J E M; Janssen, Matthijs

2018-04-15

Our aim was to examine the prevalence of cardiovascular disease (CVD) in patients with crystal-proven gout compared to arthritis controls. Further, we analyzed the association between characteristic gout severity factors and CVD to provide further support for a pathogenetic relationship between gout and CVD. Patients with arthritis referred for diagnosis were consecutively included in the Gout Arnhem-Liemers cohort. Joint fluid analysis was performed in all referred patients; controls were negative for crystals. Patients' characteristics and different manifestations of CVD and gout severity factors (disease duration, attack frequency, tophi, affected joints, high serum urate acid level, joint damage) were collected. Gout patients were compared with controls for the prevalence of CVD. In addition, the association between characteristic gout severity factors and presence of CVD was analyzed. Data from 700 gout patients and 276 controls were collected. CVD was present in 47% (95% CI 44%-51%) and 24% (95% CI 19%-29%) of gout patients and controls, respectively. Corrected for confounders, gout was still strongly associated with an increased prevalence of CVD compared to controls (OR 3.39, 95% CI 2.37-4.84). In patients with gout, disease duration ≥ 2 years, oligo- or polyarthritis, serum urate acid > 0.55 mmol/l at presentation, and joint damage were independently (p < 0.05) associated with prevalent CVD. Crystal-proven gout was strongly associated with an increased prevalence of CVD. In patients with gout, characteristic gout severity factors were associated with CVD.

Density of calcium in the ascending thoracic aorta and risk of incident cardiovascular disease events.

PubMed

Thomas, Isac C; McClelland, Robyn L; Michos, Erin D; Allison, Matthew A; Forbang, Nketi I; Longstreth, W T; Post, Wendy S; Wong, Nathan D; Budoff, Matthew J; Criqui, Michael H

2017-10-01

The volume and density of coronary artery calcium (CAC) both independently predict cardiovascular disease (CVD) beyond standard risk factors, with CAC density inversely associated with incident CVD after accounting for CAC volume. We tested the hypothesis that ascending thoracic aorta calcium (ATAC) volume and density predict incident CVD events independently of CAC. The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study of participants without clinical CVD at baseline. ATAC and CAC were measured from baseline cardiac computed tomography (CT). Cox regression models were used to estimate the associations of ATAC volume and density with incident coronary heart disease (CHD) events and CVD events, after adjustment for standard CVD risk factors and CAC volume and density. Among 6811 participants, 234 (3.4%) had prevalent ATAC and 3395 (49.8%) had prevalent CAC. Over 10.3 years, 355 CHD and 562 CVD events occurred. One-standard deviation higher ATAC density was associated with a lower risk of CHD (HR 0.48 [95% CI 0.29-0.79], p<0.01) and CVD (HR 0.56 [0.37-0.84], p<0.01) after full adjustment. ATAC volume was not associated with outcomes after full adjustment. ATAC was uncommon in a cohort free of clinical CVD at baseline. However, ATAC density was inversely associated with incident CHD and CVD after adjustment for CVD risk factors and CAC volume and density. Copyright © 2017 Elsevier B.V. All rights reserved.

Mortality from cardiovascular diseases in Bavi District, Vietnam.

PubMed

Minh, Hoang Van; Byass, Peter; Wall, Stig

2003-01-01

Like other developing countries, Vietnam is undergoing epidemiological transition, which is characterized by many changes in terms of morbidity and mortality patterns. The fact that cardiovascular diseases (CVD) are leading causes of death in hospitals in the whole country was ascertained from annual statistics. However, the magnitude of the burden of mortality from CVD at the community level remained unknown. The aims of the study were to outline CVD mortality during health transition in a rural community in the north of Vietnam and to examine associations between CVD mortality and the socioeconomic status of the population. Within an established demographic surveillance system (DSS), verbal autopsy (VA) was used to identify the burden of mortality from CVD. Cohort analysis was used in this study to measure associations between CVD mortality and socioeconomic determinants. CVD emerged as a leading cause of death in the study area, accounting for more than infectious and parasitic diseases combined. CVD killed many people among the most economically productive age group, both men and women, in all socioeconomic groups. Occupational status was shown to be significantly associated with CVD mortality. Already at this point in the epidemiological transition, there is evidence of a substantial burden of CVD in rural Vietnam. Although this study was not able to show trends, the current situation is a cause for concern in health policy and planning. Verbal autopsy methods and CVD risk factor evaluations will form important parts of future research agendas.

Strain Gauges Based on CVD Graphene Layers and Exfoliated Graphene Nanoplatelets with Enhanced Reproducibility and Scalability for Large Quantities

PubMed Central

Yokaribas, Volkan; Schneider, Daniel S.; Friebertshäuser, Philipp; Lemme, Max C.; Fritzen, Claus-Peter

2017-01-01

The two-dimensional material graphene promises a broad variety of sensing activities. Based on its low weight and high versatility, the sensor density can significantly be increased on a structure, which can improve reliability and reduce fluctuation in damage detection strategies such as structural health monitoring (SHM). Moreover; it initializes the basis of structure–sensor fusion towards self-sensing structures. Strain gauges are extensively used sensors in scientific and industrial applications. In this work, sensing in small strain fields (from −0.1% up to 0.1%) with regard to structural dynamics of a mechanical structure is presented with sensitivities comparable to bulk materials by measuring the inherent piezoresistive effect of graphene grown by chemical vapor deposition (CVD) with a very high aspect ratio of approximately 4.86 × 108. It is demonstrated that the increasing number of graphene layers with CVD graphene plays a key role in reproducible strain gauge application since defects of individual layers may become less important in the current path. This may lead to a more stable response and, thus, resulting in a lower scattering.. Further results demonstrate the piezoresistive effect in a network consisting of liquid exfoliated graphene nanoplatelets (GNP), which result in even higher strain sensitivity and reproducibility. A model-assisted approach provides the main parameters to find an optimum of sensitivity and reproducibility of GNP films. The fabricated GNP strain gauges show a minimal deviation in PRE effect with a GF of approximately 5.6 and predict a linear electromechanical behaviour up to 1% strain. Spray deposition is used to develop a low-cost and scalable manufacturing process for GNP strain gauges. In this context, the challenge of reproducible and reliable manufacturing and operating must be overcome. The developed sensors exhibit strain gauges by considering the significant importance of reproducible sensor performances and open the path for graphene strain gauges for potential usages in science and industry. PMID:29258260

Effects of etchants in the transfer of chemical vapor deposited graphene

NASA Astrophysics Data System (ADS)

Wang, M.; Yang, E. H.; Vajtai, R.; Kono, J.; Ajayan, P. M.

2018-05-01

The quality of graphene can be strongly modified during the transfer process following chemical vapor deposition (CVD) growth. Here, we transferred CVD-grown graphene from a copper foil to a SiO2/Si substrate using wet etching with four different etchants: HNO3, FeCl3, (NH4)2S2O8, and a commercial copper etchant. We then compared the quality of graphene after the transfer process in terms of surface modifications, pollutions (residues and contaminations), and electrical properties (mobility and density). Our tests and analyses showed that the commercial copper etchant provides the best structural integrity, the least amount of residues, and the smallest doping carrier concentration.

Saturated Fatty Acids and Cardiovascular Disease: Replacements for Saturated Fat to Reduce Cardiovascular Risk

PubMed Central

Briggs, Michelle A.; Petersen, Kristina S.; Kris-Etherton, Penny M.

2017-01-01

Dietary recommendations to decrease the risk of cardiovascular disease (CVD) have focused on reducing intake of saturated fatty acids (SFA) for more than 50 years. While the 2015–2020 Dietary Guidelines for Americans advise substituting both monounsaturated and polyunsaturated fatty acids for SFA, evidence supports other nutrient substitutions that will also reduce CVD risk. For example, replacing SFA with whole grains, but not refined carbohydrates, reduces CVD risk. Replacing SFA with protein, especially plant protein, may also reduce CVD risk. While dairy fat (milk, cheese) is associated with a slightly lower CVD risk compared to meat, dairy fat results in a significantly greater CVD risk relative to unsaturated fatty acids. As research continues, we will refine our understanding of dietary patterns associated with lower CVD risk. PMID:28635680

Cardiovascular Disease is Associated with COPD Severity and Reduced Functional Status and Quality of Life

PubMed Central

Black-Shinn, Jennifer L.; Kinney, Gregory L.; Wise, Anastasia L.; Regan, Elizabeth A.; Make, Barry; Krantz, Mori J.; Barr, R. Graham; Murphy, James R.; Lynch, David; Silverman, Edwin K.; Crapo, James D.; Hokanson, John E.

2015-01-01

Introduction Smoking is a major risk factor for both cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD). More individuals with COPD die from CVD than respiratory causes and the risk of developing CVD appears to be independent of smoking burden. Although CVD is a common comorbid condition within COPD, the nature of its relationships to COPD affection status and severity, and functional status is not well understood. Methods The first 2,500 members of the COPDGene cohort were evaluated. Subjects were current and former smokers with a minimum 10 pack year history of cigarette smoking. COPD was defined by spirometry as an FEV1/FVC < lower limit of normal (LLN) with further identification of severity by FEV1 percent of predicted (GOLD stages 2, 3, and 4) for the main analysis. The presence of physician-diagnosed self-reported CVD was determined from a medical history questionnaire administered by a trained staff member. Results A total of 384 (15%) had pre-existing CVD. Self-reported CVD was independently related to COPD (Odds Ratio=1.61, 95% CI=1.18–2.20, p=0.01) after adjustment for covariates with CHF having the greatest association with COPD. Within subjects with COPD, pre-existing self-reported CVD placed subjects at greater risk of hospitalization due to exacerbation, higher BODE index, and greater St. George’s questionnaire score. The presence of self-reported CVD was associated with a shorter six-minute walk distance in those with COPD (p<0.05). Conclusions Self-reported CVD was independently related to COPD with presence of both self-reported CVD and COPD associated with a markedly reduced functional status and reduced quality of life. Identification of CVD in those with COPD is an important consideration in determining functional status. PMID:24831864

Racial disparities in age at time of cardiovascular events and cardiovascular-related death in patients with systemic lupus erythematosus.

PubMed

Scalzi, Lisabeth V; Hollenbeak, Christopher S; Wang, Li

2010-09-01

To determine whether racial disparities exist with regard to the age at which patients with systemic lupus erythematosus (SLE) experience cardiovascular disease (CVD) and CVD-associated death. Using the 2003-2006 Nationwide Inpatient Sample, we calculated the age difference between patients with SLE and their race- and sex-matched controls at the time of hospitalization for a cardiovascular event and for CVD-associated death. In addition, we calculated the age difference between white patients with SLE and sex-matched controls for each minority group for the same outcomes. The mean age difference between women with and those without SLE at the time of admission for a CVD event was 10.5 years. All age differences between women with SLE (n = 3,627) and women without SLE admitted for CVD were significant (P < 0.0001). Among different racial groups with SLE, black women were the youngest to be admitted with CVD (53.9 years) and to have a CVD-associated in-hospital death (52.8 years; n = 218). Black women with SLE were 19.8 years younger than race- and sex-matched controls at the time of CVD-associated death. Admission trends for CVD were reversed for black women, such that the highest proportions of these patients were admitted before age 55 years, and then the proportions steadily decreased across age categories. Among the 805 men with SLE who were admitted with a CVD event, those who were black or Hispanic were youngest. There are significant racial disparities with regard to age at the time of hospital admission for CVD events and CVD-related hospitalization resulting in death in patients with SLE.

Challenges of developing a cardiovascular risk calculator for patients with rheumatoid arthritis.

PubMed

Crowson, Cynthia S; Rollefstad, Silvia; Kitas, George D; van Riel, Piet L C M; Gabriel, Sherine E; Semb, Anne Grete

2017-01-01

Cardiovascular disease (CVD) risk calculators designed for use in the general population do not accurately predict the risk of CVD among patients with rheumatoid arthritis (RA), who are at increased risk of CVD. The process of developing risk prediction models involves numerous issues. Our goal was to develop a CVD risk calculator for patients with RA. Thirteen cohorts of patients with RA originating from 10 different countries (UK, Norway, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico) were combined. CVD risk factors and RA characteristics at baseline, in addition to information on CVD outcomes were collected. Cox models were used to develop a CVD risk calculator, considering traditional CVD risk factors and RA characteristics. Model performance was assessed using measures of discrimination and calibration with 10-fold cross-validation. A total of 5638 RA patients without prior CVD were included (mean age: 55 [SD: 14] years, 76% female). During a mean follow-up of 5.8 years (30139 person years), 389 patients developed a CVD event. Event rates varied between cohorts, necessitating inclusion of high and low risk strata in the models. The multivariable analyses revealed 2 risk prediction models including either a disease activity score including a 28 joint count and erythrocyte sedimentation rate (DAS28ESR) or a health assessment questionnaire (HAQ) along with age, sex, presence of hypertension, current smoking and ratio of total cholesterol to high-density lipoprotein cholesterol. Unfortunately, performance of these models was similar to general population CVD risk calculators. Efforts to develop a specific CVD risk calculator for patients with RA yielded 2 potential models including RA disease characteristics, but neither demonstrated improved performance compared to risk calculators designed for use in the general population. Challenges encountered and lessons learned are discussed in detail.

Perceived and actual risk of cardiovascular disease in patients with rheumatoid arthritis in Korea: A cross-sectional study.

PubMed

Boo, Sunjoo; Froelicher, Erika S; Yun, Ju-Hui; Kim, Ye-Won; Jung, Ju-Yang; Suh, Chang-Hee

2016-10-01

The purposes of this study were to compare the perceived and actual 10-year risk for cardiovascular disease (CVD) and to evaluate the influence of cardiovascular risk factors on perceived CVD risk in patients with rheumatoid arthritis (RA) in Korea. Additionally, the attainment of CVD prevention guideline goals by 3 levels of CVD risk (low, moderate, and high) was presented.For this cross-sectional study, data were collected from 208 patients with RA. Actual CVD risk was estimated with the Systematic Coronary Risk Evaluation (SCORE), and goal attainment was assessed based on the European League Against Rheumatism guidelines. Actual CVD risk and perceived risk were compared with cross-tabulation. Chi-square tests were used to evaluate differences in cardiovascular risk factors by perceived risk. Levels of goal attainment were presented in percentages.Among patients with RA, 13.9% were identified as being at high risk for CVD, whereas 39.9% were at moderate risk, and 46.2% were at low risk. The majority of those at high risk (96.6%) underestimated their risk for CVD. The use of antihypertensive or lipid-lowering medications and having a parental history of CVD significantly increased the likelihood that subjects with RA would perceive themselves as being at high risk for CVD. Diabetes, smoking, physical inactivity, and obesity did not affect perceived risk. A substantial proportion of the subjects with RA did not meet the prevention guideline goals.Patients with RA who are at increased risk of developing CVD must be managed as soon as possible to attain the guideline goals and, accordingly, lower their risk of future CVD.

Effect of gender on awareness of cardiovascular risk factors, preventive action taken, and barriers to cardiovascular health in a group of Austrian subjects.

PubMed

Haidinger, Teresa; Zweimüller, Martin; Stütz, Lena; Demir, Dondue; Kaider, Alexandra; Strametz-Juranek, Jeanette

2012-04-01

The incidence of cardiovascular disease (CVD) is increasing in industrialized countries. Preventive action is an important factor in minimizing CVD-associated morbidity and mortality. However, it is not known whether gender differences affect CVD or risk factor awareness influencing self-assessment of personal risk and preventive action. This study was performed to assess individual CVD and risk factor awareness, preventive action taken, and barriers to cardiovascular health. The study included 573 women and 336 men, randomly chosen to complete an anonymous questionnaire to assess individual CVD and risk factor awareness, preventive action taken, and barriers to cardiovascular health. The data were analyzed using SAS software. Cardiovascular disease was identified in 75% of patients, in both sexes, as the leading cause of death; however, both groups showed significant lack of knowledge about CVD risk factors. Type 2 diabetes was identified correctly in only 27.5%. Preventive action was linked more often to family members in 66.5% of women and 62.8% of men. The primary barrier to cardiovascular health in adults was incorrect assessment of personal CVD risk. More than half of female respondents (56.4%) and male respondents (52.7%) underestimated their risk of CVD. Knowledge about risk factors for CVD needs to be improved in members of both sexes. Because women, in particular, have difficulty in correctly assessing their personal CVD risk, future education programs are warranted to inform both women and men about CVD and its risk factors, thereby helping them to correctly assess their individual risk. However, greater effort is needed to inform men, compared with women, about the various ways in which to prevent CVD and to motivate them to take preventive action. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

Rheumatoid Arthritis, Anti-CCP Positivity, and Cardiovascular Disease Risk in the Women’s Health Initiative

PubMed Central

Mackey, Rachel H.; Kuller, Lewis H.; Deane, Kevin D.; Walitt, Brian T.; Chang, Yuefang F.; Holers, V. Michael; Robinson, William H.; Tracy, Russell P.; Hlatky, Mark A.; Eaton, Charles; Liu, Simin; Freiberg, Matthew S.; Talabi, Mehret Birru; Schelbert, Erik B.; Moreland, Larry W.

2015-01-01

Objective This report evaluates incidence of cardiovascular disease (CVD) morbidity and mortality over 10 years among the >160,000 postmenopausal women in the Women’s Health Initiative (WHI) in relation to self-reported RA, disease modifying anti-rheumatic drugs (DMARD) use, anti-CCP+, RF+, CVD risk factors, joint pain, and inflammation (white blood cell (WBC) count and IL-6.) Methods Anti-CCP and RF were measured on a sample (n=9,988) of WHI participants with self-reported RA. RA was classified as self-reported RA plus anti-CCP+ positivity and/or use of DMARDs. Self-reported RA that was both anti-CCP− and DMARD− was classified as “unverified RA.” Results Age-adjusted rates of coronary heart disease (CHD), stroke, CVD, fatal CVD and total mortality were higher for women with RA vs. no RA, with multivariable-adjusted HR(95%CI) of 1.46(1.17, 1.83) for CHD, and 2.55(1.86, 3.51) for fatal CVD. Within RA, anti-CCP+ and RF+ were not significantly associated with higher risk of any outcomes, despite slightly higher risk of fatal CVD and death for anti-CCP+ vs. anti-CCP− RA. Joint pain severity and CVD risk factors were strongly associated with CVD risk, even for women with no RA. CVD incidence was increased for RA vs. no RA at almost all risk factor levels, except low levels of joint pain or inflammation. Within RA, inflammation was more strongly associated with fatal CVD and total mortality than CHD or CVD. Conclusion Among postmenopausal women, RA was associated with 1.5-2.5 higher CVD risk, strongly associated with CV risk factors, joint pain severity, and inflammation, but similar for anti-CCP+ and RF+. Clinical Trial Registration clinicaltrials.gov identifier: NCT00000611 PMID:25988241

N-terminal pro-brain-type natriuretic peptide (NT-pro-BNP) and mortality risk in early inflammatory polyarthritis: results from the Norfolk Arthritis Registry (NOAR)

PubMed Central

Mirjafari, Hoda; Welsh, Paul; Verstappen, Suzanne M M; Wilson, Paddy; Marshall, Tarnya; Edlin, Helena; Bunn, Diane; Chipping, Jacqueline; Lunt, Mark; Symmons, Deborah P M; Sattar, Naveed; Bruce, Ian N

2014-01-01

Background We measured N-terminal pro-brain natriuretic peptide (NT-pro-BNP), a marker of cardiac dysfunction, in an inception cohort with early inflammatory polyarthritis (IP) and assessed its association with disease phenotype, cardiovascular disease (CVD), all-cause and CVD related mortality. Methods Subjects with early IP were recruited to the Norfolk Arthritis Register from January 2000 to December 2008 and followed up to death or until March 2010 including any data from the national death register. The associations of baseline NT-pro-BNP with IP related factors and CVD were assessed by linear regression. Cox proportional hazards models examined the independent association of baseline NT-pro-BNP with all-cause and CVD mortality. Results We studied 960 early IP subjects; 163 (17%) had prior CVD. 373 (39%) patients had a baseline NT-pro-BNP levels ≥100 pg/ml. NT-pro-BNP was associated with age, female gender, HAQ score, CRP, current smoking, history of hypertension, prior CVD and the presence of carotid plaque. 92 (10%) IP subjects died including 31 (3%) from CVD. In an age and gender adjusted analysis, having a raised NT-pro-BNP level (≥100 pg/ml) was associated with both all-cause and CVD mortality (adjusted HR (95% CI) 2.36 (1.42 to 3.94) and 3.40 (1.28 to 9.03), respectively). These findings were robust to adjustment for conventional CVD risk factors and prevalent CVD. Conclusions In early IP patients, elevated NT-pro-BNP is related to HAQ and CRP and predicts all-cause and CVD mortality independently of conventional CVD risk factors. Further study is required to identify whether NT-pro-BNP may be clinically useful in targeting intensive interventions to IP patients at greatest risk of CVD. PMID:23511225

Alzheimer biomarkers and clinical Alzheimer disease were not associated with increased cerebrovascular disease in a memory clinic population.

PubMed

Spies, Petra E; Verbeek, Marcel M; Sjogren, Magnus J C; de Leeuw, Frank-Erik; Claassen, Jurgen A H R

2014-01-01

Preclinical and post-mortem studies suggest that Alzheimer disease (AD) causes cerebrovascular dysfunction, and therefore may enhance susceptibility to cerebrovascular disease (CVD). The objective of this study was to investigate this association in a memory clinic population. The AD biomarkers CSF amyloid β42, amyloid β40 and APOE-ε4 status have all been linked to increased CVD risk in AD, and therefore the first aim of this study was to analyze the association between these biomarkers and CVD. In 92 memory clinic patients the cross-sectional association between AD biomarkersand the severity of CVD was investigated with linear regression analysis. Additionally, we studied whether AD biomarkers modified the relation between vascular risk factors and CVD. CVD was assessed on MRI through a visual rating scale.Analyses were adjusted for age. The second aim of this study was to investigate the association between clinical AD and CVD, where 'clinical AD' was defined as follows: impairment in episodic memory, hippocampal atrophy and an aberrant concentration of cerebrospinal fluid (CSF) biomarkers. 47 of the 92 patients had AD. No association between CSF amyloid β42, amyloid β40 or APOE-ε4 status and CVD severity was found, nor did these AD biomarkers modify the relation between vascular risk factors and CVD. Clinical AD was not associated with CVD severity (p=0.83). Patients with more vascular risk factors had more CVD, but this relationship was not convincingly modified by AD (p=0.06). In this memory clinic population, CVD in patients with AD was related to vascular risk factors and age, comparable to patients without AD. Therefore, in our study, the preclinical and post-mortem evidence that AD would predispose to CVD could not be translated clinically. Further work, including replication of this work in a different and larger sample, is warranted.

Validation of a model to investigate the effects of modifying cardiovascular disease (CVD) risk factors on the burden of CVD: the rotterdam ischemic heart disease and stroke computer simulation (RISC) model.

PubMed

van Kempen, Bob J H; Ferket, Bart S; Hofman, Albert; Steyerberg, Ewout W; Colkesen, Ersen B; Boekholdt, S Matthijs; Wareham, Nicholas J; Khaw, Kay-Tee; Hunink, M G Myriam

2012-12-06

We developed a Monte Carlo Markov model designed to investigate the effects of modifying cardiovascular disease (CVD) risk factors on the burden of CVD. Internal, predictive, and external validity of the model have not yet been established. The Rotterdam Ischemic Heart Disease and Stroke Computer Simulation (RISC) model was developed using data covering 5 years of follow-up from the Rotterdam Study. To prove 1) internal and 2) predictive validity, the incidences of coronary heart disease (CHD), stroke, CVD death, and non-CVD death simulated by the model over a 13-year period were compared with those recorded for 3,478 participants in the Rotterdam Study with at least 13 years of follow-up. 3) External validity was verified using 10 years of follow-up data from the European Prospective Investigation of Cancer (EPIC)-Norfolk study of 25,492 participants, for whom CVD and non-CVD mortality was compared. At year 5, the observed incidences (with simulated incidences in brackets) of CHD, stroke, and CVD and non-CVD mortality for the 3,478 Rotterdam Study participants were 5.30% (4.68%), 3.60% (3.23%), 4.70% (4.80%), and 7.50% (7.96%), respectively. At year 13, these percentages were 10.60% (10.91%), 9.90% (9.13%), 14.20% (15.12%), and 24.30% (23.42%). After recalibrating the model for the EPIC-Norfolk population, the 10-year observed (simulated) incidences of CVD and non-CVD mortality were 3.70% (4.95%) and 6.50% (6.29%). All observed incidences fell well within the 95% credibility intervals of the simulated incidences. We have confirmed the internal, predictive, and external validity of the RISC model. These findings provide a basis for analyzing the effects of modifying cardiovascular disease risk factors on the burden of CVD with the RISC model.

Exercise and cardiovascular outcomes by hypertensive status: NHANES I epidemiological follow-up study, 1971-1992.

PubMed

Fang, Jing; Wylie-Rosett, Judith; Alderman, Michael H

2005-06-01

A favorable effect of exercise on cardiovascular longevity has been repeatedly demonstrated in the general population. The association of exercise and cardiovascular disease (CVD) outcome among persons with different blood pressure (BP) status is less well known. We examined the epidemiologic follow-up of the First National Health and Nutrition Examination Survey (NHANES I) (1971-1992). Of 14,407 participants, 9791 subjects aged 25 to 74 years met inclusion criteria. All cause, CVD, and non-CVD mortality rates, as well as CVD incidence rates were determined. The associations of levels of exercise and outcomes by BP status were examined. Age- and gender-adjusted rates, as well as Cox proportional hazard models were determined. During 17 years of follow-up, there were 3069 deaths, 1465 of which were CVD. In addition, 2808 subjects had incident CVD events. Overall, CVD incidence and mortality rates increased as BP rose. The association of exercise with CVD events differed by BP status (normal, prehypertension, and hypertension). Age- and gender-adjusted CVD mortality rate per 1000 person-years for least, moderate, and most exercise were 5.0, 3.6, and 2.4 among normotensive subjects (P > .05), 6.3, 4.7, and 5.2 among prehypertensive subjects (P > .05), and 11.8, 9.8, and 8.7 among hypertensive subjects (P < .01), respectively. In fact, exercise was a significant independent predictor of reduced CVD event only among hypertensive subjects, after adjusting for other CVD risk factors. Among prehypertensive and normotensive subjects, where events were fewer, those who exercise more vigorously also had lower mortality, but these differences did not reach statistical significance. This study, consistent with previous observational data, demonstrates that increased exercise is associated with decreased CVD event. Interestingly, this effect is most robust among hypertensive subjects, whereas for prehypertensive and normotensive subjects, a significant benefit of exercise on CVD outcome, perhaps because of lack of power, was not found.

Plasma and blood viscosity in the prediction of cardiovascular disease and mortality in the Scottish Heart Health Extended Cohort Study.

PubMed

Peters, Sanne Ae; Woodward, Mark; Rumley, Ann; Tunstall-Pedoe, Hugh D; Lowe, Gordon DO

2017-01-01

Background There is increasing evidence that blood viscosity and its major determinants (haematocrit and plasma viscosity) are associated with increased risks of cardiovascular disease (CVD) and premature mortality; however, their predictive value for CVD and mortality is not clear. Methods We prospectively assessed the added predictive value of plasma viscosity and whole blood viscosity and haematocrit in 3386 men and women aged 30-74 years participating in the Scottish Heart Health Extended Cohort study. Results Over a median follow-up of 17 years, 819 CVD events and 778 deaths were recorded. Hazard ratios (95% confidence intervals) for a 1 SD increase in plasma viscosity, adjusted for major CVD risk factors, were 1.12 (1.04-1.20) for CVD and 1.20 (1.12-1.29) for mortality. These remained significant after further adjustment for plasma fibrinogen: 1.09 (1.01-1.18) and 1.13 (1.04-1.22). The corresponding results for blood viscosity were 0.99 (0.90, 1.09) for CVD, and 1.11 (1.01, 1.22) for total mortality after adjustment for major CVD risk factors; and 0.97 (0.88, 1.08) and 1.06 (0.96, 1.18) after further adjustment for fibrinogen. Haematocrit showed similar associations to blood viscosity. When added to classical CVD risk factors, plasma viscosity improved the discrimination of CVD and mortality by 2.4% (0.7-4.4%) and 4.1% (2.0-6.5%). Conclusions Although plasma and blood viscosity may have a role in the pathogenesis of CVD and mortality, much of their association with CVD and mortality is due to the mutual effects of major CVD risk factors. However, plasma viscosity adds to the discrimination of CVD and mortality and might be considered for inclusion in multivariable risk scores.

Cerebrovascular disease, beta-amyloid and cognition in aging

PubMed Central

Marchant, Natalie L.; Reed, Bruce R.; DeCarli, Charles S.; Madison, Cindee M.; Weiner, Michael W.; Chui, Helena C.; Jagust, William J.

2011-01-01

The present study evaluated cerebrovascular disease (CVD), β-amyloid (Aβ), and cognition in clinically normal elderly adults. Fifty-four participants underwent MRI, PIB-PET imaging, and neuropsychological evaluation. High white matter hyperintensity burden and/or presence of infarct defined CVD status (CVD−: N = 27; CVD+: N = 27). PIB-PET ratios of Aβ deposition were extracted using Logan plotting (cerebellar reference). Presence of high levels of Aβ in prespecified regions determined PIB status (PIB−: N = 33; PIB+: N = 21). Executive functioning and episodic memory were measured using composite scales. CVD and Aβ, defined as dichotomous or continuous variables, were unrelated to one another. CVD+ participants showed lower executive functioning (P = 0.001) when compared to CVD− individuals. Neither PIB status nor amount of Aβ affected cognition (Ps ≥ .45), and there was no statistical interaction between CVD and PIB on either cognitive measure. Within this spectrum of normal aging CVD and Aβ aggregation appear to be independent processes with CVD primarily affecting cognition. PMID:22048124

Risk scoring for the primary prevention of cardiovascular disease.

PubMed

Karmali, Kunal N; Persell, Stephen D; Perel, Pablo; Lloyd-Jones, Donald M; Berendsen, Mark A; Huffman, Mark D

2017-03-14

The current paradigm for cardiovascular disease (CVD) emphasises absolute risk assessment to guide treatment decisions in primary prevention. Although the derivation and validation of multivariable risk assessment tools, or CVD risk scores, have attracted considerable attention, their effect on clinical outcomes is uncertain. To assess the effects of evaluating and providing CVD risk scores in adults without prevalent CVD on cardiovascular outcomes, risk factor levels, preventive medication prescribing, and health behaviours. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2016, Issue 2), MEDLINE Ovid (1946 to March week 1 2016), Embase (embase.com) (1974 to 15 March 2016), and Conference Proceedings Citation Index-Science (CPCI-S) (1990 to 15 March 2016). We imposed no language restrictions. We searched clinical trial registers in March 2016 and handsearched reference lists of primary studies to identify additional reports. We included randomised and quasi-randomised trials comparing the systematic provision of CVD risk scores by a clinician, healthcare professional, or healthcare system compared with usual care (i.e. no systematic provision of CVD risk scores) in adults without CVD. Three review authors independently selected studies, extracted data, and evaluated study quality. We used the Cochrane 'Risk of bias' tool to assess study limitations. The primary outcomes were: CVD events, change in CVD risk factor levels (total cholesterol, systolic blood pressure, and multivariable CVD risk), and adverse events. Secondary outcomes included: lipid-lowering and antihypertensive medication prescribing in higher-risk people. We calculated risk ratios (RR) for dichotomous data and mean differences (MD) or standardised mean differences (SMD) for continuous data using 95% confidence intervals. We used a fixed-effects model when heterogeneity (I²) was at least 50% and a random-effects model for substantial heterogeneity (I² > 50%). We evaluated the quality of evidence using the GRADE framework. We identified 41 randomised controlled trials (RCTs) involving 194,035 participants from 6422 reports. We assessed studies as having high or unclear risk of bias across multiple domains. Low-quality evidence evidence suggests that providing CVD risk scores may have little or no effect on CVD events compared with usual care (5.4% versus 5.3%; RR 1.01, 95% confidence interval (CI) 0.95 to 1.08; I² = 25%; 3 trials, N = 99,070). Providing CVD risk scores may reduce CVD risk factor levels by a small amount compared with usual care. Providing CVD risk scores reduced total cholesterol (MD -0.10 mmol/L, 95% CI -0.20 to 0.00; I² = 94%; 12 trials, N = 20,437, low-quality evidence), systolic blood pressure (MD -2.77 mmHg, 95% CI -4.16 to -1.38; I² = 93%; 16 trials, N = 32,954, low-quality evidence), and multivariable CVD risk (SMD -0.21, 95% CI -0.39 to -0.02; I² = 94%; 9 trials, N = 9549, low-quality evidence). Providing CVD risk scores may reduce adverse events compared with usual care, but results were imprecise (1.9% versus 2.7%; RR 0.72, 95% CI 0.49 to 1.04; I² = 0%; 4 trials, N = 4630, low-quality evidence). Compared with usual care, providing CVD risk scores may increase new or intensified lipid-lowering medications (15.7% versus 10.7%; RR 1.47, 95% CI 1.15 to 1.87; I² = 40%; 11 trials, N = 14,175, low-quality evidence) and increase new or increased antihypertensive medications (17.2% versus 11.4%; RR 1.51, 95% CI 1.08 to 2.11; I² = 53%; 8 trials, N = 13,255, low-quality evidence). There is uncertainty whether current strategies for providing CVD risk scores affect CVD events. Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher-risk people without evidence of harm. There were multiple study limitations in the identified studies and substantial heterogeneity in the interventions, outcomes, and analyses, so readers should interpret results with caution. New models for implementing and evaluating CVD risk scores in adequately powered studies are needed to define the role of applying CVD risk scores in primary CVD prevention.

Fish consumption and its motives in households with versus without self-reported medical history of CVD: A consumer survey from five European countries

PubMed Central

Pieniak, Zuzanna; Verbeke, Wim; Perez-Cueto, Federico; Brunsø, Karen; De Henauw, Stefaan

2008-01-01

Background The purpose of this study was to explore the cross-cultural differences in the frequency of fish intake and in motivations for fish consumption between people from households with (CVD+) or without (CVD-) medical history of cardiovascular disease, using data obtained in five European countries. Methods A cross-sectional consumer survey was carried out in November-December 2004 with representative household samples from Belgium, the Netherlands, Denmark, Poland and Spain. The sample consisted of 4,786 respondents, aged 18–84 and who were responsible for food purchasing and cooking in the household. Results Individuals from households in the CVD+ group consumed fish more frequently in Belgium and in Denmark as compared to those in the CVD- group. The consumption of fatty fish, which is the main sources of omega-3 PUFA associated with prevention of cardiovascular diseases, was on the same level for the two CVD groups in the majority of the countries, except in Belgium where CVD+ subjects reported to eat fatty fish significantly more frequently than CVD- subjects. All respondents perceived fish as a very healthy and nutritious food product. Only Danish consumers reported a higher subjective and objective knowledge related to nutrition issues about fish. In the other countries, objective knowledge about fish was on a low level, similar for CVD+ as for CVD- subjects, despite a higher claimed use of medical information sources about fish among CVD+ subjects. Conclusion Although a number of differences between CVD- and CVD+ subjects with respect to their frequency of fish intake are uncovered, the findings suggest that fish consumption traditions and habits – rather than a medical history of CVD – account for large differences between the countries, particularly in fatty fish consumption. This study exemplifies the need for nutrition education and more effective communication about fish, not only to the people facing chronic diseases, but also to the broader public. European consumers are convinced that eating fish is healthy, but particular emphasis should be made on communicating benefits especially from fatty fish consumption. PMID:18783593

High Frequency, High Gradient Dielectric Wakefield Acceleration Experiments at SLAC and BNL

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rosenzweig, James; /UCLA; Travish, Gil

Given the recent success of >GV/m dielectric wakefield accelerator (DWA) breakdown experiments at SLAC, and follow-on coherent Cerenkov radiation production at the UCLA Neptune, a UCLA-USC-SLAC collaboration is now implementing a new set of experiments that explore various DWA scenarios. These experiments are motivated by the opportunities presented by the approval of FACET facility at SLAC, as well as unique pulse-train wakefield drivers at BNL. The SLAC experiments permit further exploration of the multi-GeV/m envelope in DWAs, and will entail investigations of novel materials (e.g. CVD diamond) and geometries (Bragg cylindrical structures, slab-symmetric DWAs), and have an over-riding goal ofmore » demonstrating >GeV acceleration in {approx}33 cm DWA tubes. In the nearer term before FACET's commissioning, we are planning measurements at the BNL ATF, in which we drive {approx}50-200 MV/m fields with single pulses or pulse trains. These experiments are of high relevance to enhancing linear collider DWA designs, as they will demonstrate potential for efficient operation with pulse trains.« less

Globalization, Work, and Cardiovascular Disease.

PubMed

Schnall, Peter L; Dobson, Marnie; Landsbergis, Paul

2016-10-01

Cardiovascular disease (CVD), a global epidemic, is responsible for about 30% of all deaths worldwide. While mortality rates from CVD have been mostly declining in the advanced industrialized nations, CVD risk factors, including hypertension, obesity, and diabetes, have been on the increase everywhere. Researchers investigating the social causes of CVD have produced a robust body of evidence documenting the relationships between the work environment and CVD, including through the mechanisms of psychosocial work stressors. We review the empirical evidence linking work, psychosocial stressors, and CVD. These work stressors can produce chronic biologic arousal and promote unhealthy behaviors and thus, increased CVD risk. We offer a theoretical model that illustrates how economic globalization influences the labor market and work organization in high-income countries, which, in turn, exacerbates job characteristics, such as demands, low job control, effort-reward imbalance, job insecurity, and long work hours. There is also a growing interest in "upstream" factors among work stress researchers, including precarious employment, downsizing/restructuring, privatization, and lean production. We conclude with suggestions for future epidemiologic research on the role of work in the development of CVD, as well as policy recommendations for prevention of work-related CVD. © The Author(s) 2016.

Association Between Hospitalization for Pneumonia and Subsequent Risk of Cardiovascular Disease

PubMed Central

Corrales-Medina, Vicente F.; Alvarez, Karina N.; Weissfeld, Lisa A.; Angus, Derek C.; Chirinos, Julio A.; Chang, Chung-Chou H.; Newman, Anne; Loehr, Laura; Folsom, Aaron R.; Elkind, Mitchell S.; Lyles, Mary F.; Kronmal, Richard A.; Yende, Sachin

2015-01-01

IMPORTANCE The risk of cardiovascular disease (CVD) after infection is poorly understood. OBJECTIVE To determine whether hospitalization for pneumonia is associated with an increased short-term and long-term risk of CVD. DESIGN, SETTINGS, AND PARTICIPANTS We examined 2 community-based cohorts: the Cardiovascular Health Study (CHS, n = 5888; enrollment age, ≥65 years; enrollment period, 1989–1994) and the Atherosclerosis Risk in Communities study (ARIC, n = 15 792; enrollment age, 45-64 years; enrollment period, 1987–1989). Participants were followed up through December 31, 2010. We matched each participant hospitalized with pneumonia to 2 controls. Pneumonia cases and controls were followed for occurrence of CVD over 10 years after matching. We estimated hazard ratios (HRs) for CVD at different time intervals, adjusting for demographics, CVD risk factors, subclinical CVD, comorbidities, and functional status. EXPOSURES Hospitalization for pneumonia. MAIN OUTCOMES AND MEASURES Incident CVD (myocardial infarction, stroke, and fatal coronary heart disease). RESULTS Of 591 pneumonia cases in CHS, 206 had CVD events over 10 years after pneumonia hospitalization. Compared with controls, CVD risk among pneumonia cases was highest during the first year after hospitalization and remained significantly higher than among controls through 10 years. In ARIC, of 680 pneumonia cases, 112 had CVD events over 10 years after hospitalization. After the second year, CVD risk among pneumonia cases was not significantly higher than among controls. Pneumonia Cases Controls HR (95% CI) CHS No. of participants 591 1182 CVD events  0-30 d 54 6 4.07 (2.86-5.27)  31-90 d 11 9 2.94 (2.18-3.70)  91 d-1 y 22 55 2.10 (1.59-2.60)  9-10 y 4 12 1.86 (1.18-2.55) ARIC No. of participants 680 1360 CVD events  0-30 d 4 3 2.38 (1.12-3.63)  31-90 d 4 0 2.40 (1.23-3.47)  91 d-1 y 11 8 2.19 (1.20-3.19)  1-2 y 8 7 1.88 (1.10-2.66) CONCLUSIONS AND RELEVANCE Hospitalization for pneumonia was associated with increased short-term and long-term risk of CVD, suggesting that pneumonia may be a risk factor for CVD. PMID:25602997

Sick Populations and Sick Subpopulations: Reducing Disparities in Cardiovascular Disease Between Blacks and Whites in the United States.

PubMed

Lu, Yuan; Ezzati, Majid; Rimm, Eric B; Hajifathalian, Kaveh; Ueda, Peter; Danaei, Goodarz

2016-08-09

Cardiovascular disease (CVD) death rates are much higher in blacks than whites in the United States. It is unclear how CVD risk and events are distributed among blacks versus whites and how interventions reduce racial disparities. We developed risk models for fatal and for fatal and nonfatal CVD using 8 cohorts in the United States. We used 6154 adults who were 50 to 69 years of age in the National Health and Nutrition Examination Survey 1999 to 2012 to estimate the distributions of risk and events in blacks and whites. We estimated the total and disparity impacts of a range of population-wide, targeted, and risk-based interventions on 10-year CVD risks and event rates. Twenty-five percent (95% confidence interval [CI], 22-28) of black men and 12% (95% CI, 10-14) of black women were at ≥6.67% risk of fatal CVD (almost equivalent to 20% risk of fatal or nonfatal CVD) compared with 10% (95% CI, 8-12) of white men and 3% (95% CI, 2-4) of white women. These high-risk individuals accounted for 55% (95% CI, 49-59) of CVD deaths among black men and 42% (95% CI, 35-46) in black women compared with 30% (95% CI, 24-35) in white men and 18% (95% CI, 13-22) in white women. We estimated that an intervention that treated multiple risk factors in high-risk individuals could reduce black-white difference in CVD death rate from 1659 to 1244 per 100 000 in men and from 1320 to 897 in women. Rates of fatal and nonfatal CVD were generally similar between black and white men. In women, a larger proportion of women were at ≥7.5% risk of CVD (30% versus 19% in whites), and an intervention that targeted multiple risk factors among this group was estimated to reduce black-white differences in CVD rates from 1688 to 1197 per 100 000. A substantially larger proportion of blacks have a high risk of fatal CVD and bear a large share of CVD deaths. A risk-based intervention that reduces multiple risk factors could substantially reduce overall CVD rates and racial disparities in CVD death rates. © 2016 American Heart Association, Inc.

Effect of ultraviolet illumination on the charge trapping behaviour in SiN(x)/InP metal-insulator-semiconductor structure provided by plasma enhanced chemical vapour deposition

NASA Astrophysics Data System (ADS)

Kim, C. H.; Han, I. K.; Lee, J. I.; Kang, K. N.; Kwon, S. D.; Choe, B.; Park, H. L.; Her, J.; Lim, H.

1994-04-01

In this work, we investigated the effect of ultraviolet illumination, which is known to generate silicon dangling bonds, on the charge trapping behaviors, utilizing the constant capacitance technique in SiN(x)/InP structure where conventional PE CVD was used to form the SiN films on InP. We found different behaviors of this structure with ultraviolet illumination compared to the case of SiN(x)/Si structure. Both the Si-rich condition during PE CVD and ultraviolet illumination seem to not only increase the number of traps but also broaden the energy level of the traps in the insulator near the SiN(x)/InP interface. In all cases (N-rich, Si-rich, with and without ultraviolet illumination) the amphoteric nature of the traps has been observed, which is a characteristic of Si-dangling bonds. Also, the effect of ultraviolet photons on the interface of SiN(x)/InP, especially in correlation with the deficiency of phosphorus at the interface, is discussed considering the existence of net negative fixed charges at the interface.

Atomic mechanism for the growth of wafer-scale single-crystal graphene: theoretical perspective and scanning tunneling microscopy investigations

NASA Astrophysics Data System (ADS)

Niu, Tianchao; Zhang, Jialin; Chen, Wei

2017-12-01

Chemical vapor deposition (CVD) is the most promising approach for producing low-cost, high-quality, and large area graphene. Revealing the graphene growth mechanism at the atomic-scale is of great importance for realizing single crystal graphene (SCG) over wafer scale. Density functional theoretical (DFT) calculations are playing an increasingly important role in revealing the structure of the most stable carbon species, understanding the evolution processes, and disclosing the active sites. Scanning tunneling microscopy (STM) is a powerful surface characterization tool to illustrate the real space distribution and atomic structures of growth intermediates during the CVD process. Combining them together can provide valuable information to improve the atomically controlled growth of SCG. Starting from a basic concept of the substrate effect on realizing SCG, this review covers the progress made in theoretical investigations on various carbon species during graphene growth on different transition metal substrates, in the STM study of the structural intermediates on transition metal surfaces, and in synthesizing graphene nanoribbons with atomic-precise width and edge structure, ending with a perspective on the future development of 2D materials beyond graphene.

Weldability, strength, and high temperature stability of chemically vapor deposited tungsten

NASA Technical Reports Server (NTRS)

Bryant, W. A.

1972-01-01

Three types of CVD tungsten (fluoride-produced, chloride-produced and the combination of the two which is termed duplex) were evaluated to determine their weldability, high temperature strength and structural stability during 5000 hour exposure to temperatures of 1540 C and 1700 C. Each type of CVD tungsten could be successfully electron beam welded but the results for the chloride product were not as satisfactory as those of the other two materials. The high temperature strength behavior of the three materials did not differ greatly. However a large difference was noted for the grain growth behavior of the two basic CVD tungsten materials. Fluoride tungsten was found to be relatively stable while for the most part the grain size of chloride tungsten increased appreciably. The examination of freshly fractured surfaces with a scanning electron microscope revealed numerous bubbles in the fluoride material following its exposure to 1700 C for 5000 hours. Less severe thermal treatments produced relatively few bubbles in this material. Only at certain locations within the chloride material associated with the interruption of tungsten were bubbles noted.

Differences in selection drive olfactory receptor genes in different directions in dogs and wolf.

PubMed

Chen, Rui; Irwin, David M; Zhang, Ya-Ping

2012-11-01

The olfactory receptor (OR) gene family is the largest gene family found in mammalian genomes. It is known to evolve through a birth-and-death process. Here, we characterized the sequences of 16 segregating OR pseudogenes in the samples of the wolf and the Chinese village dog (CVD) and compared them with the sequences from dogs of different breeds. Our results show that the segregating OR pseudogenes in breed dogs are under strong purifying selection, while evolving neutrally in the CVD, and show a more complicated pattern in the wolf. In the wolf, we found a trend to remove deleterious polymorphisms and accumulate nondeleterious polymorphisms. On the basis of protein structure of the ORs, we found that the distribution of different types of polymorphisms (synonymous, nonsynonymous, tolerated, and untolerated) varied greatly between the wolf and the breed dogs. In summary, our results suggest that different forms of selection have acted on the segregating OR pseudogenes in the CVD since domestication, breed dogs after breed formation, and ancestral wolf population, which has driven the evolution of these genes in different directions.

Synthesis of high performance ceramic fibers by chemical vapor deposition for advanced metallics reinforcing

NASA Technical Reports Server (NTRS)

Revankar, Vithal; Hlavacek, Vladimir

1991-01-01

The chemical vapor deposition (CVD) synthesis of fibers capable of effectively reinforcing intermetallic matrices at elevated temperatures which can be used for potential applications in high temperature composite materials is described. This process was used due to its advantage over other fiber synthesis processes. It is extremely important to produce these fibers with good reproducible and controlled growth rates. However, the complex interplay of mass and energy transfer, blended with the fluid dynamics makes this a formidable task. The design and development of CVD reactor assembly and system to synthesize TiB2, CrB, B4C, and TiC fibers was performed. Residual thermal analysis for estimating stresses arising form thermal expansion mismatch were determined. Various techniques to improve the mechanical properties were also performed. Various techniques for improving the fiber properties were elaborated. The crystal structure and its orientation for TiB2 fiber is discussed. An overall view of the CVD process to develop CrB2, TiB2, and other high performance ceramic fibers is presented.

High-efficiency thin-film GaAs solar cells, phase2

NASA Technical Reports Server (NTRS)

Yeh, Y. C. M.

1981-01-01

Thin GaAs epi-layers with good crystallographic quality were grown using a (100) Si-substrate on which a thin Ge epi-interlayer was grown by CVD from germane. Both antireflection-coated metal oxide semiconductor (AMOS) and n(+)/p homojunction structures were studied. The AMOS cells were fabricated on undoped-GaAs epi-layers deposited on bulk poly-Ge substrates using organo-metallic CVD film-growth, with the best achieved AM1 conversion efficiency being 9.1%. Both p-type and n(+)-type GaAs growth were optimized using 50 ppm dimethyl zinc and 1% hydrogen sulfide, respectively. A direct GaAs deposition method in fabricating ultra-thin top layer, epitaxial n(+)/p shallow homojunction solar cells on (100) GaAs substrates (without anodic thinning) was developed to produce large area (1 sq/cm) cells, with 19.4% AM1 conversion efficiency achieved. Additionally, an AM1 conversion efficiency of 18.4% (17.5% with 5% grid coverage) was achieved for a single crystal GaAs n(+)/p cell grown by OM-CVD on a Ge wafer.

Acarbose Treatment and the Risk of Cardiovascular Disease in Type 2 Diabetic Patients: A Nationwide Seven-Year Follow-Up Study

PubMed Central

Chen, Jui-Ming; Chang, Cheng-Wei; Lin, Ying-Chieh; Horng, Jorng-Tzong; Sheu, Wayne H.-H.

2014-01-01

Objective. To investigate the potential benefits of acarbose treatment on cardiovascular disease (CVD) in patients with type 2 diabetes by using nationwide insurance claim dataset. Research Design and Methods. Among 644,792 newly diagnosed type 2 diabetic patients without preexisting CVD in a nationwide cohort study, 109,139 (16.9%) who had received acarbose treatment were analyzed for CVD risk. Those with CVD followed by acarbose therapy were also subjected to analysis. Result. During 7 years of follow-up, 5,081 patients (4.7%) developed CVD. The crude hazard ratio (HR) and adjusted HR were 0.66 and 0.99, respectively. The adjusted HR of CVD was 1.19, 0.70, and 0.38 when the duration of acarbose use was <12 months, 12–24 months, and >24 months, respectively. Adjusted HR was 1.14, 0.64, and 0.41 with acarbose cumulative doses <54,750 mg, 54,751 to 109,500 mg, and >109,500 mg, respectively. Conclusion. In patients with type 2 diabetes without preexisting CVD, treatment with acarbose showed a transient increase in incidence of CVD in the initial 12 months followed by significant reductions of CVD in prolonged acarbose users. After the first CVD events, continuous use of acarbose revealed neutral effect within the first 12 months. The underlying mechanisms require further investigations. PMID:25197673

Acarbose treatment and the risk of cardiovascular disease in type 2 diabetic patients: a nationwide seven-year follow-up study.

PubMed

Chen, Jui-Ming; Chang, Cheng-Wei; Lin, Ying-Chieh; Horng, Jorng-Tzong; Sheu, Wayne H-H

2014-01-01

To investigate the potential benefits of acarbose treatment on cardiovascular disease (CVD) in patients with type 2 diabetes by using nationwide insurance claim dataset. Among 644,792 newly diagnosed type 2 diabetic patients without preexisting CVD in a nationwide cohort study, 109,139 (16.9%) who had received acarbose treatment were analyzed for CVD risk. Those with CVD followed by acarbose therapy were also subjected to analysis. During 7 years of follow-up, 5,081 patients (4.7%) developed CVD. The crude hazard ratio (HR) and adjusted HR were 0.66 and 0.99, respectively. The adjusted HR of CVD was 1.19, 0.70, and 0.38 when the duration of acarbose use was <12 months, 12-24 months, and >24 months, respectively. Adjusted HR was 1.14, 0.64, and 0.41 with acarbose cumulative doses <54,750 mg, 54,751 to 109,500 mg, and >109,500 mg, respectively. In patients with type 2 diabetes without preexisting CVD, treatment with acarbose showed a transient increase in incidence of CVD in the initial 12 months followed by significant reductions of CVD in prolonged acarbose users. After the first CVD events, continuous use of acarbose revealed neutral effect within the first 12 months. The underlying mechanisms require further investigations.

Design, Synthesis and Characterization of Novel Graphene-Based Nanoarchitectures for Sustainability

NASA Astrophysics Data System (ADS)

Bay, Hamed Hosseini

The unique structure and properties of graphene initiated broad fundamental and technological research in recent years, and highlighted graphene as an alternative for various applications such as energy storage and nanoelectronics. Chemical vapor deposition (CVD) of graphene on copper is believed to be the most promising method for large-scale synthesis of continuous sheets. The exceptional properties of graphene however, are governed by its microstructure. The size of graphene grains and the grain boundaries affect the carrier mobility. Therefore understanding the formation mechanism of graphene is critical to control the microstructure and physical properties. We implemented Fluorescence Quenching Microscopy (FQM) in conjunction with other methods to understand a trend which is pertinent in large-scale. In order to investigate the nucleation and growth mechanism of graphene on copper and its subsequent microstructure, effect of key parameters such as density of defects in copper foils and growth pressure in the CVD chamber have been altered. Results point out that microstructure of copper regulates the structure and properties of graphene and heat treatment and electropolishing of the foil substrates as well as controlling the saturation pressure of the carbon precursor yield to large graphene domains. Water decontamination and oil/water separation are principal motives in the surge to develop novel means for sustainability. In this prospect, supplying clean water for the ecosystems is as important as the recovery of the oil spills since the supplies are scarce. Inspired to design an engineering material which not only serves this purpose, but can also be altered for other applications to preserve natural resources, a facile template-free process is suggested to fabricate a superporous, superhydrophobic graphene-based sponge. Moreover, the process is designed to be inexpensive and scalable. The fabricated sponge can be used to clean up different types of oil, organic solvents, toxic and corrosive contaminants. This versatile microstructure can retain its functionality even when pulverized. The sponge is applicable for targeted sorption and collection due to its ferromagnetic properties. We hope that such cost-effective process can be embraced and implemented widely.

Small artery elasticity predicts future cardiovascular events in chinese patients with angiographic coronary artery disease.

PubMed

Wan, Zhaofei; Liu, Xiaojun; Wang, Xinhong; Liu, Fuqiang; Liu, Weimin; Wu, Yue; Pei, Leilei; Yuan, Zuyi

2014-04-01

Arterial elasticity has been shown to predict cardiovascular disease (CVD) in apparently healthy populations. The present study aimed to explore whether arterial elasticity could predict CVD events in Chinese patients with angiographic coronary artery disease (CAD). Arterial elasticity of 365 patients with angiographic CAD was measured. During follow-up (48 months; range 6-65), 140 CVD events occurred (including 34 deaths). Univariate Cox analysis demonstrated that both large arterial elasticity and small arterial elasticity were significant predictors of CVD events. Multivariate Cox analysis indicated that small arterial elasticity remained significant. Kaplan-Meier analysis showed that the probability of having a CVD event/CVD death increased with a decrease of small arterial elasticity (P < .001, respectively). Decreased small arterial elasticity independently predicts the risk of CVD events in Chinese patients with angiographic CAD.

Evolution of Cardiovascular Disease During the Transition to End-Stage Renal Disease.

PubMed

Bansal, Nisha

2017-03-01

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The rate of death in incident dialysis patients remains high. This has led to interest in the study of the evolution of CVD during the critical transition period from CKD to ESRD. Understanding the natural history and risk factors of clinical and subclinical CVD during this transition may help guide the timing of appropriate CVD therapies to improve outcomes in patients with kidney disease. This review provides an overview of the epidemiology of subclinical and clinical CVD during the transition from CKD to ESRD and discusses clinical trials of CVD therapies to mitigate risk of CVD in CKD and ESRD patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Effect of a health literacy intervention trial on knowledge about cardiovascular disease medications among Indigenous peoples in Australia, Canada and New Zealand.

PubMed

Crengle, Sue; Luke, Joanne N; Lambert, Michelle; Smylie, Janet K; Reid, Susan; Harré-Hindmarsh, Jennie; Kelaher, Margaret

2018-01-24

To assess the effect of a customised, structured cardiovascular disease (CVD) medication health literacy programme on medication knowledge among Indigenous people with, or at high risk of, CVD. Intervention trial with premeasures and postmeasures at multiple time points. Indigenous primary care services in Australia, Canada and New Zealand. 171 Indigenous people aged ≥20 years of age who had at least one clinical diagnosis of a CVD event, or in Canada and Australia had a 5-year CVD risk ≥15%, and were prescribed at least two of the following CVD medication classes: statin, aspirin, ACE inhibitors and beta blockers. An education session delivered on three occasions over 1 month by registered nurses or health educators who had received training in health literacy and principles of adult education. An interactive tablet application was used during each session and an information booklet and pill card provided to participants. Knowledge about the CVD medications assessed before and after each session. Knowledge at baseline (presession 1) was low, with the mean per cent correct answers highest for statins (34.0% correct answers), 29.4% for aspirin, 26.0% for beta blockers and 22.7% for ACE inhibitors. Adjusted analyses showed highly significant (P<0.001) increases in knowledge scores between preassessments and postassessments at all three time points for all medication classes. For the four medications, the absolute increases in adjusted per cent correct items from presession 1 to postsession 3 assessments were 60.1% for statins, 76.8% for aspirin, 71.4% for ACE inhibitor and 69.5% for beta blocker. The intervention was highly effective in contextually diverse Indigenous primary healthcare services in Australia, Canada and New Zealand. The findings from this study have important implications for health services working with populations with low health literacy more generally. ACTRN12612001309875. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A Comparative Study of Three Different Chemical Vapor Deposition Techniques of Carbon Nanotube Growth on Diamond Films

DTIC Science & Technology

2012-11-01

microwave plasma-enhanced CVD (MPE-CVD) with presputtered metal catalyst, and floating catalyst thermal CVD (FCT-CVD) with xylene and ferrocene liquid...processes with nickel and iron catalysts, respectively. For the FCT-CVD approach, ferrocene is used as an iron source to promoteCNT growth. Based on...furnace is ramped up to the growth temperature of 750∘C. Ferrocene was dissolved into a xylene solvent in a 0.008 : 1molar volume ratio.The xylene

Evaluating Periodontal Treatment to Prevent Cardiovascular Disease: Challenges and Possible Solutions.

PubMed

Merchant, Anwar T; Virani, Salim S

2017-01-01

Periodontal disease is correlated with cardiovascular disease (CVD) in observational studies, but a causal connection has not been established. The empirical evidence linking periodontal disease and CVD consists of a large body of observational and mechanistic studies, but a limited number of clinical trials evaluating the effects of periodontal treatment on surrogate CVD endpoints. No randomized controlled trial has been conducted to evaluate the effect of periodontal treatment on CVD risk. In this review, we have summarized these data, described possible biological mechanisms linking periodontal disease and CVD, discussed barriers to conducting a randomized controlled trial to evaluate this hypothesis, and provided an alternative analytical approach using causal inference methods to answer the question. The public health implications of addressing this question can be significant because periodontal disease is under-treated, and highly prevalent among adults at risk of CVD. Even a small beneficial effect of periodontal treatment on CVD risk can be important.

Assessment of Cardiovascular Disease Risk in South Asian Populations

PubMed Central

Hussain, S. Monira; Oldenburg, Brian; Zoungas, Sophia; Tonkin, Andrew M.

2013-01-01

Although South Asian populations have high cardiovascular disease (CVD) burden in the world, their patterns of individual CVD risk factors have not been fully studied. None of the available algorithms/scores to assess CVD risk have originated from these populations. To explore the relevance of CVD risk scores for these populations, literature search and qualitative synthesis of available evidence were performed. South Asians usually have higher levels of both “classical” and nontraditional CVD risk factors and experience these at a younger age. There are marked variations in risk profiles between South Asian populations. More than 100 risk algorithms are currently available, with varying risk factors. However, no available algorithm has included all important risk factors that underlie CVD in these populations. The future challenge is either to appropriately calibrate current risk algorithms or ideally to develop new risk algorithms that include variables that provide an accurate estimate of CVD risk. PMID:24163770

Prevalence of undiagnosed cardiovascular risk factors and 10-year CVD risk in male steel industry workers.

PubMed

Gray, Benjamin J; Bracken, Richard M; Turner, Daniel; Morgan, Kerry; Mellalieu, Stephen D; Thomas, Michael; Williams, Sally P; Williams, Meurig; Rice, Sam; Stephens, Jeffrey W

2014-05-01

To assess the prevalence of undiagnosed cardiovascular disease (CVD) in a cohort of male steelworkers in South Wales, UK. Male steel industry workers (n = 221) with no prior diagnosis of CVD or diabetes accepted a CVD risk assessment within the work environment. Demographic, anthropometric, family, and medical histories were all recorded and capillary blood samples obtained. The 10-year CVD risk was predicted using the QRISK2-2012 algorithm. Up to 81.5% of workers were either overweight or obese. More than 20% of workers were found to have diastolic hypertension, high total cholesterol, and/or a total cholesterol/high-density lipoprotein ratio of six or more. Over one quarter of workers assessed had an increased 10-year CVD risk. Despite a physically demanding occupation, risk assessment in the workplace uncovered significant occult factors in CVD risk in a sample of male heavy industry workers.

Association of Fitness in Young Adulthood With Survival and Cardiovascular Risk: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

PubMed

Shah, Ravi V; Murthy, Venkatesh L; Colangelo, Laura A; Reis, Jared; Venkatesh, Bharath Ambale; Sharma, Ravi; Abbasi, Siddique A; Goff, David C; Carr, J Jeffrey; Rana, Jamal S; Terry, James G; Bouchard, Claude; Sarzynski, Mark A; Eisman, Aaron; Neilan, Tomas; Das, Saumya; Jerosch-Herold, Michael; Lewis, Cora E; Carnethon, Mercedes; Lewis, Gregory D; Lima, Joao A C

2016-01-01

Although cardiorespiratory fitness (CRF) is prognostic in older adults, the effect of CRF during early adulthood on long-term cardiovascular structure, function, and prognosis is less clear. To examine whether CRF in young adults is associated with long-term clinical outcome and subclinical cardiovascular disease (CVD). Prospective study of 4872 US adults aged 18 to 30 years who underwent treadmill exercise testing at a baseline study visit from March 25, 1985, to June 7, 1986, and 2472 individuals who underwent a second treadmill test 7 years later. Median follow-up was 26.9 years, with assessment of obesity, left ventricular mass and strain, coronary artery calcification (CAC), and vital status and incident CVD. Follow-up was complete on August 31, 2011, and data were analyzed from recruitment through the end of follow-up. The presence of CAC was assessed by computed tomography at years 15 (2000-2001), 20 (2005-2006), and 25 (2010-2011), and left ventricular mass was assessed at years 5 (1990-1991) and 25 (with global longitudinal strain). Incident CVD and all-cause mortality were adjudicated. Of the 4872 individuals, 273 (5.6%) died and 193 (4.0%) experienced CVD events during follow-up. After comprehensive adjustment, each additional minute of baseline exercise test duration was associated with a 15% lower hazard of death (hazard ratio [HR], 0.85; 95% CI, 0.80-0.91; P < .001) and a 12% lower hazard of CVD (HR, 0.88; 95% CI, 0.81-0.96; P = .002). Higher levels of baseline CRF were associated with significantly lower left ventricular mass index (β = -0.24; 95% CI, -0.45 to -0.03; P = .02) and significantly better lobal longitudinal strain (β = -0.09; 95% CI, -0.14 to -0.05; P < .001) at year 25. Fitness was not associated with CAC. A 1-minute reduction in fitness by year 7 was associated with 21% and 20% increased hazards of death (HR, 1.21; 95% CI, 1.07-1.37; P = .002) and CVD (HR, 1.20; 95% CI, 1.06-1.37; P = .006), respectively, along with a more impaired strain (β = 0.15; 95% CI, 0.08-0.23; P < .001). No association between change in fitness and CAC was found. Higher levels of fitness at baseline and improvement in fitness early in adulthood are favorably associated with lower risks for CVD and mortality. Fitness and changes in fitness are associated with myocardial hypertrophy and dysfunction but not CAC. Regular efforts to ascertain and improve CRF in young adulthood may play a critical role in promoting cardiovascular health and interrupting early CVD pathogenesis.

Association of educational status with cardiovascular disease: Teheran Lipid and Glucose Study.

PubMed

Hajsheikholeslami, Farhad; Hatami, Masumeh; Hadaegh, Farzad; Ghanbarian, Arash; Azizi, Fereidoun

2011-06-01

The aim of this study was to evaluate the associations between educational level and cardiovascular disease (CVD) in an older Iranian population. To estimate the odds ratio (OR) of educational level in a cross-sectional study, logistic regression analysis was used on 1,788 men and 2,204 women (222 men and 204 women positive based on their CVD status) aged ≥ 45 years. In men, educational levels of college degree and literacy level below diploma were inversely associated with CVD in the multivariate model [0.52 (0.28-0.94), 0.61 (0.40-0.92), respectively], but diploma level did not show any significant association with CVD, neither in the crude model nor in the multivariate model. In women, increase in educational level was inversely associated with risk of CVD in the crude model, but in the multivariate adjusted model, literacy level below diploma decreased risk of CVD by 39%, compared with illiteracy. Our findings support those of developed countries that, along with other CVD risk factors, educational status has an inverse association with CVD among a representative Iranian population of older men and women.

Cardiovascular risk-factor knowledge and risk perception among HIV-infected adults.

PubMed

Cioe, Patricia A; Crawford, Sybil L; Stein, Michael D

2014-01-01

Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality in HIV-infected adults. Research in noninfected populations has suggested that knowledge of CVD risk factors significantly influences perceptions of risk. This cross-sectional study describes CVD risk factor knowledge and risk perception in HIV-infected adults. We recruited 130 HIV-infected adults (mean age = 48 years, 62% male, 56% current smokers, mean years since HIV diagnosis, 14.7). The mean CVD risk factor knowledge score was fairly high. However, controlling for age, CVD risk factor knowledge was not predictive of perceived risk [F(1, 117) = 0.13, p > .05]. Estimated risk and perceived risk were weakly but significantly correlated; r (126) = .24, p = .01. HIV-infected adults are at increased risk for CVD. Despite having adequate risk-factor knowledge, CVD risk perception was inaccurate. Improving risk perception and developing CVD risk reduction interventions for this population are imperative. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Prediction of cardiovascular disease risk among low-income urban dwellers in metropolitan Kuala Lumpur, Malaysia.

PubMed

Su, Tin Tin; Amiri, Mohammadreza; Mohd Hairi, Farizah; Thangiah, Nithiah; Bulgiba, Awang; Majid, Hazreen Abdul

2015-01-01

We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.

Obesity-related inflammation & cardiovascular disease: efficacy of a yoga-based lifestyle intervention.

PubMed

Sarvottam, Kumar; Yadav, Raj Kumar

2014-06-01

Obesity is a global health burden and its prevalence is increasing substantially due to changing lifestyle. Chronic adiposity is associated with metabolic imbalance leading to dyslipidaemia, diabetes, hypertension and cardiovascular diseases (CVD). Adipose tissue acts as an endocrine organ releasing several adipocytokines, and is associated with increased levels of tissue and circulating inflammatory biomolecules causing vascular inflammation and atherogenesis. Further, inflammation is also associated independently with obesity as well as CVD. Keeping this in view, it is possible that a reduction in weight may lead to a decrease in inflammation, resulting in CVD risk reduction, and better management of patients with CVD. Lifestyle intervention has been endorsed by several health authorities in prevention and management of chronic diseases. A yoga-based lifestyle intervention appears to be a promising option in reducing the risk for CVD as well as management of patients with CVD as it is simple to follow and cost-effective with high compliance. The efficacy of such lifestyle intervention programmes is multifaceted, and is achieved via reduction in weight, obesity-related inflammation and stress, thereby culminating into risk reduction towards several chronic diseases including CVD. In this review, the association between obesity-related inflammation and CVD, and the role of yoga-based lifestyle intervention in prevention and management of CVD are discussed.

Genetic variation associated with cardiovascular risk in autoimmune diseases

PubMed Central

Perrotti, Pedro P.; Aterido, Adrià; Fernández-Nebro, Antonio; Cañete, Juan D.; Ferrándiz, Carlos; Tornero, Jesús; Gisbert, Javier P.; Domènech, Eugeni; Fernández-Gutiérrez, Benjamín; Gomollón, Fernando; García-Planella, Esther; Fernández, Emilia; Sanmartí, Raimon; Gratacós, Jordi; Martínez-Taboada, Víctor Manuel; Rodríguez-Rodríguez, Luís; Palau, Núria; Tortosa, Raül; Corbeto, Mireia L.; Lasanta, María L.; Marsal, Sara; Julià, Antonio

2017-01-01

Autoimmune diseases have a higher prevalence of cardiovascular events compared to the general population. The objective of this study was to investigate the genetic basis of cardiovascular disease (CVD) risk in autoimmunity. We analyzed genome-wide genotyping data from 6,485 patients from six autoimmune diseases that are associated with a high socio-economic impact. First, for each disease, we tested the association of established CVD risk loci. Second, we analyzed the association of autoimmune disease susceptibility loci with CVD. Finally, to identify genetic patterns associated with CVD risk, we applied the cross-phenotype meta-analysis approach (CPMA) on the genome-wide data. A total of 17 established CVD risk loci were significantly associated with CVD in the autoimmune patient cohorts. From these, four loci were found to have significantly different genetic effects across autoimmune diseases. Six autoimmune susceptibility loci were also found to be associated with CVD risk. Genome-wide CPMA analysis identified 10 genetic clusters strongly associated with CVD risk across all autoimmune diseases. Two of these clusters are highly enriched in pathways previously associated with autoimmune disease etiology (TNFα and IFNγ cytokine pathways). The results of this study support the presence of specific genetic variation associated with the increase of CVD risk observed in autoimmunity. PMID:28982122

Comparison of the quality of single-crystal diamonds grown on two types of seed substrates by MPCVD

NASA Astrophysics Data System (ADS)

Zhao, Yun; Guo, Yanzhao; Lin, Liangzhen; Zheng, Yuting; Hei, Lifu; Liu, Jinlong; Wei, Junjun; Chen, Liangxian; Li, Chengming

2018-06-01

Microwave plasma chemical vapor deposition (MPCVD) was used to grow single-crystal diamonds on two types of single-crystal diamond seed substrates prepared by high-pressure, high-temperature (HPHT) and chemical vapor deposition (CVD) methods. The quality of diamonds grown on the different seed substrates was compared. Fluorescence characteristics showed that the sectors of the HPHT seed substrates were obviously partitioned. Raman and absorption spectra showed that the CVD seed substrate produced higher-quality crystals with fewer nitrogen impurities. X-ray topography showed that the HPHT seed substrate had obvious growth sector boundaries, inclusions, dislocations, and stacking faults. The polarization characteristics of HPHT seed substrate were obvious, and the stress distribution was not uniform. When etching HPHT and CVD seed substrates using the same parameters, the etching morphology and extent of different growth sectors of the two substrates differed. Although extended defects were inevitably formed at the interface and propagated in the CVD layer, the dislocation density of a 1 mm-thick CVD layer grown on a CVD seed substrate was only half that of a 1 mm-thick CVD layer grown on an HPHT seed substrate. Therefore, the use of CVD seed substrate enabled the growth of a relatively higher-quality CVD single-crystal diamond.

Cardiovascular Disease in Latin American Patients with Systemic Lupus Erythematosus: A Cross-Sectional Study and a Systematic Review

PubMed Central

Amaya-Amaya, Jenny; Caro-Moreno, Julián; Molano-González, Nicolás; Mantilla, Rubén D.; Rojas-Villarraga, Adriana; Anaya, Juan-Manuel

2013-01-01

Objective. This study was performed to determine the prevalence of and associated risk factors for cardiovascular disease (CVD) in Latin American (LA) patients with systemic lupus erythematosus (SLE). Methods. First, a cross-sectional analytical study was conducted in 310 Colombian patients with SLE in whom CVD was assessed. Associated factors were examined by multivariate regression analyses. Second, a systematic review of the literature on CVD in SLE in LA was performed. Results. There were 133 (36.5%) Colombian SLE patients with CVD. Dyslipidemia, smoking, coffee consumption, and pleural effusion were positively associated with CVD. An independent effect of coffee consumption and cigarette on CVD was found regardless of gender and duration of disease. In the systematic review, 60 articles fulfilling the eligibility criteria were included. A wide range of CVD prevalence was found (4%–79.5%). Several studies reported ancestry, genetic factors, and polyautoimmunity as novel risk factors for such a condition. Conclusions. A high rate of CVD is observed in LA patients with SLE. Awareness of the observed risk factors should encourage preventive population strategies for CVD in patients with SLE aimed at facilitating the suppression of cigarette smoking and coffee consumption as well as at the tight control of dyslipidemia and other modifiable risk factors. PMID:24294522

Prediction of Cardiovascular Disease Risk among Low-Income Urban Dwellers in Metropolitan Kuala Lumpur, Malaysia

PubMed Central

Su, Tin Tin; Amiri, Mohammadreza; Mohd Hairi, Farizah; Thangiah, Nithiah; Majid, Hazreen Abdul

2015-01-01

We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers. PMID:25821810

Sarcopenic-obesity and cardiovascular disease risk in the elderly.

PubMed

Stephen, W C; Janssen, I

2009-05-01

To determine: 1) whether sarcopenic-obesity is a stronger predictor of cardiovascular disease (CVD) than either sarcopenia or obesity alone in the elderly, and 2) whether muscle mass or muscular strength is a stronger marker of CVD risk. Prospective cohort study. Participants included 3366 community-dwelling older (>or= 65 years) men and women who were free of CVD at baseline. Waist circumference (WC), bioimpedance analysis, and grip strength were used to measure abdominal obesity, whole-body muscle mass, and muscular strength, respectively. Subjects were classified as normal, sarcopenic, obese, or sarcopenic-obese based on measures of WC and either muscle mass or strength. Participants were followed for 8 years for CVD development and proportional hazard regression models were used to compare risk estimates for CVD in the four groups after adjusting for age, sex, race, income, smoking, alcohol, and cognitive status. Compared with the normal group, CVD risk was not significantly elevated within the obese, sarcopenic, or sarcopenic-obese groups as determined by WC and muscle mass. When determined by WC and muscle strength, CVD risk was not significantly increased in the sarcopenic or obese groups, but was increased by 23% (95% confidence interval: 0.99-1.54, P=0.06) within the sarcopenic-obese group. Sarcopenia and obesity alone were not sufficient to increase CVD risk. Sarcopenic-obesity, based on muscle strength but not muscle mass, was modestly associated with increased CVD risk. These findings imply that strength may be more important than muscle mass for CVD protection in old age.

Canada's contribution to global research in cardiovascular diseases.

PubMed

Nguyen, Hai V; de Oliveira, Claire; Wijeysundera, Harindra C; Wong, William W L; Woo, Gloria; Grootendorst, Paul; Liu, Peter P; Krahn, Murray D

2013-06-01

The burden of cardiovascular disease (CVD) in Canada and other developed countries is growing, in part because of the aging of the population and the alarming rise of obesity. Studying Canada's contribution to the global body of CVD research output will shed light on the effectiveness of investments in Canadian CVD research and inform if Canada has been responding to its CVD burden. Search was conducted using the Web-of-Science database for publications during 1981 through 2010 on major areas and specific interventions in CVD. Search was also conducted using Canadian and US online databases for patents issued between 1981 and 2010. Search data were used to estimate the proportions of the world's pool of research publications and of patents conducted by researchers based in Canada. The results indicate that Canada contributed 6% of global research in CVD during 1981 through 2010. Further, Canada's contribution shows a strong upward trend during the period. Based on patent data, Canada's contribution level was similar (5%-7%). Canada's contribution to the global pool of CVD research is on par with France and close to the UK, Japan, and Germany. Canada's contribution in global CVD research is higher than its average contribution in all fields of research (6% vs 3%). As the burden of chronic diseases including CVD rises with Canada's aging population, the increase in Canadian research into CVD is encouraging. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

"Ikigai", Subjective Wellbeing, as a Modifier of the Parity-Cardiovascular Mortality Association　- The Japan Collaborative Cohort Study.

PubMed

Yasukawa, Sumiyo; Eguchi, Eri; Ogino, Keiki; Tamakoshi, Akiko; Iso, Hiroyasu

2018-04-25

Nulliparity is associated with an excess risk of cardiovascular disease (CVD). "Ikigai", subjective wellbeing in Japan, is associated with reduced risk of CVD. The impact of ikigai on the association between parity and the risk of CVD, however, has not been reported.Methods and Results:A total of 39,870 Japanese women aged 40-79 years without a history of CVD, cancer or insufficient information at baseline in 1988-1990, were enrolled and followed until the end of 2009. They were categorized into 7 groups according to parity number 0-≥6. Using Cox regression hazard modeling, the associations between parity and mortality from stroke, coronary artery disease, and total CVD were investigated. During the follow-up period, 2,121 total CVD deaths were documented. No association was observed between parity and stroke and CVD mortality in women with ikigai, but there was an association in those without ikigai. The multivariable hazard ratios of stroke and total CVD mortality for nulliparous women without ikigai vs. those with 1 child were 1.87 (95% CI: 1.15-3.05) and 1.46 (95% CI: 1.07-2.01), respectively, and that for stroke mortality in high parity women without ikigai was 1.56 (95% CI: 1.00-2.45). Nulliparous or high parity women without ikigai had higher mortality from stroke and/or total CVD, suggesting that ikigai attenuated the association between parity and CVD mortality in Japanese women.

Cocoa Polyphenols: Evidence from Epidemiological Studies.

PubMed

Matsumoto, Chisa

2018-01-01

Accumulating evidence suggests potential preventive effects of chocolate/cocoa on the risk of cardio vascular disease (CVD). However, cocoa products also contain high levels of sugar and fat, which increase CVD risk factors. Even, the identity of the substance in chocolate/cocoa that has a favorable effect on CVD and CVD risk factors remains unclear, growing evidence from experimental studies suggests that cocoa polyphenols might be a major contributor to cardiovascular-protective effects. However, epidemiological studies, which are necessary to evaluate an association between the risk of CVD and cocoa polyphenol, remain sparse. We will discuss recent evidence regarding the association between cocoa polyphenol consumption and the risks of CVD and its risk factors by reviewing recent epidemiological studies. We shall also provide some guidance for patient counseling and will discuss the public health implications for recommending cocoa polyphenol consumption to prevent CVD. Epidemiological studies evaluating the association between cocoa polyphenol itself and the risk of CVD are sparse. However, evidence from limited epidemiological studies suggests that cocoa polyphenol consumption may lower the risk of CVD. Given the potential adverse effects of the consumption of cocoa products with high fat and sugar and the fact that the most appropriate dose of cocoa polyphenol for cardio-protective effects has not yet been established, health care providers should remain cautious about recommending cocoa/cocoa polyphenol consumption to their patients to reduce the risk of CVD, taking the characteristics of individual patients into careful consideration. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Association of resting heart rate and cardiovascular disease mortality in hypertensive and normotensive rural Chinese.

PubMed

Zhang, Ming; Han, Chengyi; Wang, Chongjian; Wang, Jinjin; Li, Linlin; Zhang, Lu; Wang, Bingyuan; Ren, Yongcheng; Zhang, Hongyan; Yang, Xiangyu; Zhao, Yang; Zhou, Junmei; Pang, Chao; Yin, Lei; Feng, Tianping; Zhao, Jingzhi; Luo, Xinping; Hu, Dongsheng

2017-05-01

Studies have demonstrated an increased risk of cardiovascular disease (CVD)-associated death (CVD death) with increased resting heart rate (RHR); however, whether the association is consistent in rural Chinese with hypertension and normotension is unknown. We examined the association of RHR and CVD death by hypertension and normotension status in rural Chinese people. Baseline data for 20,069 participants ≥18 years old were collected during July to August of 2007 and July to August of 2008; 17,151 (85.5%) participants were followed up in July to August of 2013 and July to October of 2014. The association of RHR and CVD death was determined by Cox proportional hazards regression. During a mean of 5.88 years (100,889 person-years) of follow-up, we recorded 479 CVD deaths (309 in hypertensive participants). CVD death increased significantly with increasing RHR, beginning from 80 beats per minute (bpm), for hypertensive and normotensive participants. After adjusting for pulse pressure and other covariates, for hypertensive participants, risk of CVD death was increased with RHR 80-89 and ≥90bpm. However, for normotensive participants, risk of CVD death was increased with only RHR≥90bpm. Risk of CVD death was associated with elevated RHR for both hypertensive and normotensive rural Chinese, and for hypertensive participants, even slightly elevated RHR was associated with CVD death. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Physical Therapists’ Perceptions of Knowledge and Clinical Behavior Regarding Cardiovascular Disease Prevention

PubMed Central

Van Zant, R Scott; Cape, Kelly Jo; Roach, Katrina; Sweeney, Janie

2013-01-01

Purpose The study purpose was to assess perceptions of physical therapists (PTs) regarding the role of physical therapy in cardiovascular disease (CVD) prevention. Methods A 25-item survey, validated by expert cardiovascular/pulmonary (CVP) PTs, was sent electronically to 2,673 PTs. Each item represented an element of clinical practice behavior: education of CVD/risk factors (EDCVD), administration of primary CVD prevention (PRECVD), identifying underlying CVD/risk factors (IDCVD), monitoring CV status in patients with CVD (MONCVD). Responses were assigned numeric values (strongly agree = 5 to strongly disagree = 1), and mean element scores were analyzed. Results Most of the 516 respondents were APTA Section members (34% CVP Section, 42% other Section membership) and worked in academia (53%). Items showing a high (> 95%) level of agreement included patient education of smoking (97%) and monitoring exercise intensity (99%), assessing exercise benefits (99%), clinically identifying obesity (97%) and hypertension (97%), and monitoring CV response to exercise (99%). Items failing to reach 80% overall agreement were patient education of CVD medications (79%) and blood chemistry (72%), and assessing CVD family history (75%), patient BMI (60%), and body composition (33%). Identifying underlying CVD (77.2%) was the only practice behavior failing to reach 80% agreement. Outpatient PTs agreed significantly less to all elements vs. academics, and to IDCVD vs. all PTs except home health. Conclusions Physical therapists support most CVD prevention behaviors, but not given elements of patient education and identifying underlying CVD/risk factors. PMID:23801901

Circulating interleukin-10 and risk of cardiovascular events: a prospective study in the elderly at risk.

PubMed

Welsh, Paul; Murray, Heather M; Ford, Ian; Trompet, Stella; de Craen, Anton J M; Jukema, J Wouter; Stott, David J; McInnes, Iain B; Packard, Chris J; Westendorp, Rudi G J; Sattar, Naveed

2011-10-01

The goal of this study was to examine the association of the antiinflammatory interleukin-10 (IL-10) with risk of cardiovascular disease (CVD). In the PROSPER (PROspective Study of Pravastatin in the Elderly at Risk) cohort, we related baseline concentrations of circulating IL-10 to risk of CVD events in a nested case (n=819)-control (n=1618) study of 3.2 years of follow-up. Circulating IL-10 showed few strong associations with classical risk factors but was positively correlated with IL-6 and C-reactive protein. IL-10 was positively associated with risk of CVD events (odds ratio [OR] 1.17, 95% CI 1.05 to 1.31 per unit increase in log IL-10) after adjusting for classical risk factors and C-reactive protein. Furthermore, IL-10 was associated more strongly with CVD risk among those with no previous history of CVD (OR 1.42, 95% CI 1.18 to 1.70), compared with those with previous CVD (OR 1.04, 95% CI 0.90 to 1.19; P=0.018). Overall, IL-10 showed a modest ability to add discrimination to classical risk factors (C-statistic +0.005, P=0.002). Baseline circulating levels of the antiinflammatory IL-10 are positively associated with risk of CVD among the elderly without prior CVD events, although the association is less evident in those with a history of CVD. Additional epidemiological and mechanistic studies investigating the role of IL-10 in CVD are warranted.

The health effects of US unemployment insurance policy: does income from unemployment benefits prevent cardiovascular disease?

PubMed

Walter, Stefan; Glymour, Maria; Avendano, Mauricio

2014-01-01

Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk. Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50-65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk. States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71-0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79-1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models. Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD.

Projected Impact of Salt Restriction on Prevention of Cardiovascular Disease in China: A Modeling Study

PubMed Central

Liu, Jing; Coxson, Pamela G.; Penko, Joanne; Goldman, Lee; Bibbins-Domingo, Kirsten; Zhao, Dong

2016-01-01

Objectives To estimate the effects of achieving China’s national goals for dietary salt (NaCl) reduction or implementing culturally-tailored dietary salt restriction strategies on cardiovascular disease (CVD) prevention. Methods The CVD Policy Model was used to project blood pressure lowering and subsequent downstream prevented CVD that could be achieved by population-wide salt restriction in China. Outcomes were annual CVD events prevented, relative reductions in rates of CVD incidence and mortality, quality-adjusted life-years (QALYs) gained, and CVD treatment costs saved. Results Reducing mean dietary salt intake to 9.0 g/day gradually over 10 years could prevent approximately 197 000 incident annual CVD events [95% uncertainty interval (UI): 173 000–219 000], reduce annual CVD mortality by approximately 2.5% (2.2–2.8%), gain 303 000 annual QALYs (278 000–329 000), and save approximately 1.4 billion international dollars (Int$) in annual CVD costs (Int$; 1.2–1.6 billion). Reducing mean salt intake to 6.0 g/day could approximately double these benefits. Implementing cooking salt-restriction spoons could prevent 183 000 fewer incident CVD cases (153 000–215 000) and avoid Int$1.4 billion in CVD treatment costs annually (1.2–1.7 billion). Implementing a cooking salt substitute strategy could lead to approximately three times the health benefits of the salt-restriction spoon program. More than three-quarters of benefits from any dietary salt reduction strategy would be realized in hypertensive adults. Conclusion China could derive substantial health gains from implementation of population-wide dietary salt reduction policies. Most health benefits from any dietary salt reduction program would be realized in adults with hypertension. PMID:26840409

Predictive Properties of Plasma Amino Acid Profile for Cardiovascular Disease in Patients with Type 2 Diabetes

PubMed Central

Kume, Shinji; Araki, Shin-ichi; Ono, Nobukazu; Shinhara, Atsuko; Muramatsu, Takahiko; Araki, Hisazumi; Isshiki, Keiji; Nakamura, Kazuki; Miyano, Hiroshi; Koya, Daisuke; Haneda, Masakazu; Ugi, Satoshi; Kawai, Hiromichi; Kashiwagi, Atsunori; Uzu, Takashi; Maegawa, Hiroshi

2014-01-01

Prevention of cardiovascular disease (CVD) is an important therapeutic object of diabetes care. This study assessed whether an index based on plasma free amino acid (PFAA) profiles could predict the onset of CVD in diabetic patients. The baseline concentrations of 31 PFAAs were measured with high-performance liquid chromatography-electrospray ionization-mass spectrometry in 385 Japanese patients with type 2 diabetes registered in 2001 for our prospective observational follow-up study. During 10 years of follow-up, 63 patients developed cardiovascular composite endpoints (myocardial infarction, angina pectoris, worsening of heart failure and stroke). Using the PFAA profiles and clinical information, an index (CVD-AI) consisting of six amino acids to predict the onset of any endpoints was retrospectively constructed. CVD-AI levels were significantly higher in patients who did than did not develop CVD. The area under the receiver-operator characteristic curve of CVD-AI (0.72 [95% confidence interval (CI): 0.64–0.79]) showed equal or slightly better discriminatory capacity than urinary albumin excretion rate (0.69 [95% CI: 0.62–0.77]) on predicting endpoints. A multivariate Cox proportional hazards regression analysis showed that the high level of CVD-AI was identified as an independent risk factor for CVD (adjusted hazard ratio: 2.86 [95% CI: 1.57–5.19]). This predictive effect of CVD-AI was observed even in patients with normoalbuminuria, as well as those with albuminuria. In conclusion, these results suggest that CVD-AI based on PFAA profiles is useful for identifying diabetic patients at risk for CVD regardless of the degree of albuminuria, or for improving the discriminative capability by combining it with albuminuria. PMID:24971671

Developing a synthetic national population to investigate the impact of different cardiovascular disease risk management strategies: A derivation and validation study

PubMed Central

Jackson, Rod

2017-01-01

Background Many national cardiovascular disease (CVD) risk factor management guidelines now recommend that drug treatment decisions should be informed primarily by patients’ multi-variable predicted risk of CVD, rather than on the basis of single risk factor thresholds. To investigate the potential impact of treatment guidelines based on CVD risk thresholds at a national level requires individual level data representing the multi-variable CVD risk factor profiles for a country’s total adult population. As these data are seldom, if ever, available, we aimed to create a synthetic population, representing the joint CVD risk factor distributions of the adult New Zealand population. Methods and results A synthetic population of 2,451,278 individuals, representing the actual age, gender, ethnicity and social deprivation composition of people aged 30–84 years who completed the 2013 New Zealand census was generated using Monte Carlo sampling. Each ‘synthetic’ person was then probabilistically assigned values of the remaining cardiovascular disease (CVD) risk factors required for predicting their CVD risk, based on data from the national census national hospitalisation and drug dispensing databases and a large regional cohort study, using Monte Carlo sampling and multiple imputation. Where possible, the synthetic population CVD risk distributions for each non-demographic risk factor were validated against independent New Zealand data sources. Conclusions We were able to develop a synthetic national population with realistic multi-variable CVD risk characteristics. The construction of this population is the first step in the development of a micro-simulation model intended to investigate the likely impact of a range of national CVD risk management strategies that will inform CVD risk management guideline updates in New Zealand and elsewhere. PMID:28384217

Long-term coffee consumption and risk of cardiovascular disease: a systematic review and a dose-response meta-analysis of prospective cohort studies.

PubMed

Ding, Ming; Bhupathiraju, Shilpa N; Satija, Ambika; van Dam, Rob M; Hu, Frank B

2014-02-11

Considerable controversy exists on the association between coffee consumption and cardiovascular disease (CVD) risk. A meta-analysis was performed to assess the dose-response relationship of long-term coffee consumption with CVD risk. PubMed and EMBASE were searched for prospective cohort studies of the relationship between coffee consumption and CVD risk, which included coronary heart disease, stroke, heart failure, and CVD mortality. Thirty-six studies were included with 1 279 804 participants and 36 352 CVD cases. A nonlinear relationship of coffee consumption with CVD risk was identified (P for heterogeneity=0.09, P for trend <0.001, P for nonlinearity <0.001). Compared with the lowest category of coffee consumption (median, 0 cups per day), the relative risk of CVD was 0.95 (95% confidence interval, 0.87-1.03) for the highest category (median, 5 cups per day) category, 0.85 (95% confidence interval, 0.80-0.90) for the second highest category (median, 3.5 cups per day), and 0.89 (95% confidence interval, 0.84-0.94) for the third highest category (median, 1.5 cups per day). Looking at separate outcomes, coffee consumption was nonlinearly associated with both coronary heart disease (P for heterogeneity=0.001, P for trend <0.001, P for nonlinearity <0.001) and stroke (P for heterogeneity=0.07, P for trend <0.001, P for nonlinearity <0.001; P for trend differences >0.05) risks. A nonlinear association between coffee consumption and CVD risk was observed in this meta-analysis. Moderate coffee consumption was inversely significantly associated with CVD risk, with the lowest CVD risk at 3 to 5 cups per day, and heavy coffee consumption was not associated with elevated CVD risk.

Cardiorespiratory Fitness Cutoff Points for Early Detection of Present and Future Cardiovascular Risk in Children: A 2-Year Follow-up Study.

PubMed

Castro-Piñero, José; Perez-Bey, Alejandro; Segura-Jiménez, Víctor; Aparicio, Virginia A; Gómez-Martínez, Sonia; Izquierdo-Gomez, Rocio; Marcos, Ascensión; Ruiz, Jonatan R

2017-12-01

To examine the association between cardiorespiratory fitness (CRF) at baseline and cardiovascular disease (CVD) risk in 6- to 10-year-olds (cross-sectional) and 2 years later (8- to 12-year-olds [longitudinal]) and whether changes with age in CRF are associated with CVD risk in children aged 8 to 12 years. Spanish primary schoolchildren (n=236) aged 6 to 10 years participated at baseline. Of the 23 participating primary schools, 22% (n=5) were private schools and 78% (n=18) were public schools. The dropout rate at 2-year follow-up was 9.7% (n=23). The 20-m shuttle run test was used to estimate CRF. The CVD risk score was computed as the mean of 5 CVD risk factor standardized scores: sum of 2 skinfolds, systolic blood pressure, insulin/glucose, triglycerides, and total cholesterol/high-density lipoprotein cholesterol. At baseline, CRF was inversely associated with single CVD risk factors (all P<.05) and CVD risk score at baseline and follow-up (P<.001). Cardiorespiratory fitness cutoff points of 39.0 mL/kg per minute or greater in boys and 37.5 mL/kg per minute or greater in girls are discriminative to identify CVD risk in childhood (area under the curve, >0.85; P<.001) and to predict CVD risk 2 years later (P=.004). Persistent low CRF or the decline of CRF from 6-10 to 8-12 years of age is associated with increased CVD risk at age 8 to 12 years (P<.001). During childhood, CRF is a strong predictor of CVD risk and should be monitored to identify children with potential CVD risk. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Impact of Renal Impairment on Cardiovascular Disease Mortality After Liver Transplantation for Nonalcoholic Steatohepatitis Cirrhosis

PubMed Central

VanWagner, Lisa B.; Lapin, Brittany; Skaro, Anton I.; Lloyd-Jones, Donald M.; Rinella, Mary E.

2016-01-01

BACKGROUND & AIMS Non-alcoholic steatohepatitis (NASH) is an independent risk factor for cardiovascular disease (CVD) morbidity after liver transplantation, but its impact on CVD mortality is unknown. We sought to assess the impact of NASH on CVD mortality after liver transplantation and to predict which NASH recipients are at highest risk of a CVD-related death following a liver transplant. METHODS Using the Organ Procurement and Transplantation Network database we examined associations between NASH and post liver transplant CVD mortality, defined as primary cause of death from thromboembolism, arrhythmia, heart failure, myocardial infarction, or stroke. A physician panel reviewed cause of death. RESULTS Of 48,360 liver transplants (2/2002–12/2011), 5,057 (10.5%) were performed for NASH cirrhosis. NASH recipients were more likely to be older, female, obese, diabetic, and have history of renal failure or prior CVD versus non-NASH (p<0.001 for all). Although there was no difference in overall all-cause mortality (log-rank p=0.96), both early (30-day) and long-term CVD-specific mortality was increased among NASH recipients (Odds ratio=1.30, 95% Confidence interval (CI): 1.02–1.66; Hazard ratio=1.42, 95% CI: 1.07–1.41, respectively). These associations were no longer significant after adjustment for pre-transplant diabetes, renal impairment or CVD. A risk score comprising age ≥ 55, male sex, diabetes and renal impairment was developed for prediction of post liver transplant CVD mortality (c-statistic 0.60). CONCLUSION NASH recipients have an increased risk of CVD mortality after liver transplantation explained by a high prevalence of co-morbid cardiometabolic risk factors that in aggregate identify those at highest risk of post-transplant CVD mortality. PMID:25977117

Developing a synthetic national population to investigate the impact of different cardiovascular disease risk management strategies: A derivation and validation study.

PubMed

Knight, Josh; Wells, Susan; Marshall, Roger; Exeter, Daniel; Jackson, Rod

2017-01-01

Many national cardiovascular disease (CVD) risk factor management guidelines now recommend that drug treatment decisions should be informed primarily by patients' multi-variable predicted risk of CVD, rather than on the basis of single risk factor thresholds. To investigate the potential impact of treatment guidelines based on CVD risk thresholds at a national level requires individual level data representing the multi-variable CVD risk factor profiles for a country's total adult population. As these data are seldom, if ever, available, we aimed to create a synthetic population, representing the joint CVD risk factor distributions of the adult New Zealand population. A synthetic population of 2,451,278 individuals, representing the actual age, gender, ethnicity and social deprivation composition of people aged 30-84 years who completed the 2013 New Zealand census was generated using Monte Carlo sampling. Each 'synthetic' person was then probabilistically assigned values of the remaining cardiovascular disease (CVD) risk factors required for predicting their CVD risk, based on data from the national census national hospitalisation and drug dispensing databases and a large regional cohort study, using Monte Carlo sampling and multiple imputation. Where possible, the synthetic population CVD risk distributions for each non-demographic risk factor were validated against independent New Zealand data sources. We were able to develop a synthetic national population with realistic multi-variable CVD risk characteristics. The construction of this population is the first step in the development of a micro-simulation model intended to investigate the likely impact of a range of national CVD risk management strategies that will inform CVD risk management guideline updates in New Zealand and elsewhere.

Long-Term Coffee Consumption and Risk of Cardiovascular Disease: A Systematic Review and a Dose-Response Meta-Analysis of Prospective Cohort Studies

PubMed Central

Ding, Ming; Bhupathiraju, Shilpa N; Satija, Ambika; van Dam, Rob M; Hu, Frank B

2013-01-01

Background Considerable controversy exists regarding the association between coffee consumption and cardiovascular disease (CVD) risk. A meta-analysis was performed to assess the dose-response relationship of long-term coffee consumption with CVD risk. Methods and Results Pubmed and EMBASE were searched for prospective cohort studies of the relationship between coffee consumption and CVD risk, which included coronary heart disease, stroke, heart failure, and CVD mortality. Thirty-six studies were included with 1,279,804 participants and 36,352 CVD cases. A non-linear relationship of coffee consumption with CVD risk was identified (P for heterogeneity = 0.09, P for trend < 0.001, P for non-linearity < 0.001). Compared with the lowest category of coffee consumption (median: 0 cups/d), the relative risk of CVD was 0.95 (95% CI, 0.87 to 1.03) for the highest (median: 5 cups/d) category, 0.85 (0.80 to 0.90) for the second highest (median: 3.5 cups/d), and 0.89 (0.84 to 0.94) for the third highest category (median: 1.5 cups/d). Looking at separate outcomes, coffee consumption was non-linearly associated with both CHD (P for heterogeneity = 0.001, P for trend < 0.001, P for non-linearity < 0.001) and stroke risks (P for heterogeneity = 0.07, P for trend < 0.001, P for non-linearity< 0.001) (P for trend differences > 0.05). Conclusions A non-linear association between coffee consumption with CVD risk was observed in this meta-analysis. Moderate coffee consumption was inversely significantly associated with CVD risk, with the lowest CVD risk at 3 to 5 cups/d, and heavy coffee consumption was not associated with elevated CVD risk. PMID:24201300

Outdoor temperature, blood pressure, and cardiovascular disease mortality among 23 000 individuals with diagnosed cardiovascular diseases from China.

PubMed

Yang, Ling; Li, Liming; Lewington, Sarah; Guo, Yu; Sherliker, Paul; Bian, Zheng; Collins, Rory; Peto, Richard; Liu, Yun; Yang, Rong; Zhang, Yongrui; Li, Guangchun; Liu, Shumei; Chen, Zhengming

2015-05-14

Blood pressure is a major cause of cardiovascular disease (CVD) and both may increase as outdoor temperatures fall. However, there are still limited data about seasonal variation in blood pressure and CVD mortality among patients with prior-CVD. We analysed data on 23 000 individuals with prior-CVD who were recruited from 10 diverse regions into the China Kadoorie Biobank during 2004-8. After 7 years of follow-up, 1484 CVD deaths were recorded. Baseline survey data were used to assess seasonal variation in systolic blood pressure (SBP) and its association with outdoor temperature. Cox regression was used to examine the association of usual SBP with subsequent CVD mortality, and seasonal variation in CVD mortality was assessed by Poisson regression. All analyses were adjusted for age, sex, and region. Mean SBP was significantly higher in winter than in summer (145 vs. 136 mmHg, P < 0.001), especially among those without central heating. Above 5°C, each 10°C lower outdoor temperature was associated with 6.2 mmHg higher SBP. Systolic blood pressure predicted subsequent CVD mortality, with each 10 mmHg higher usual SBP associated with 21% (95% confidence interval: 16-27%) increased risk. Cardiovascular disease mortality varied by season, with 41% (21-63%) higher risk in winter compared with summer. Among adult Chinese with prior-CVD, there is both increased blood pressure and CVD mortality in winter. Careful monitoring and more aggressive blood pressure lowering treatment in the cold months are needed to help reduce the winter excess CVD mortality in high-risk individuals. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

Late-Onset Asthma Predicts Cardiovascular Disease Events: The Wisconsin Sleep Cohort.

PubMed

Tattersall, Matthew C; Barnet, Jodi H; Korcarz, Claudia E; Hagen, Erika W; Peppard, Paul E; Stein, James H

2016-08-24

Asthma is a heterogeneous syndrome with different clinical subtypes that is associated with an increased risk for cardiovascular disease (CVD). We hypothesized that the late-onset subtype of asthma is associated with a higher risk of incident CVD. Participants from the Wisconsin Sleep Cohort free of CVD at baseline were followed for a mean (SD) of 13.9 (5.9) years for development of CVD (myocardial infarction, angina, stroke, coronary revascularization, heart failure, or CVD death). Late-onset asthma was defined as physician-diagnosed asthma at age ≥18 years. Multivariable Cox regression models adjusted for age, sex, and CVD risk factors were used to assess associations of late-onset asthma and incident CVD. The 1269 participants were 47.3 (8.0) years old; 166 participants had asthma (111 late-onset, 55 early-onset). Participants with late-onset asthma compared to nonasthmatics were more likely to be female (67% versus 44%) and to have a higher body-mass index (32.2 versus 29.4 kg/m(2)) (P<0.05). Mean age of asthma diagnosis in the late-onset group was 39.5 (9.6) years versus 8.9 (5.7) years in the early-onset group (P<0.0001). Late-onset asthmatics had a higher adjusted risk of incident CVD than nonasthmatics (hazard ratio 1.57, 95% CI 1.01-2.45, P=0.045). There was no interaction between body-mass index and age of asthma diagnosis on incident CVD (P=0.83). In a large cohort study of adults followed prospectively for over a decade, late-onset asthmatics had an increased risk of incident CVD events that persisted after adjustment for age, sex, and CVD risk factors. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Fatty acids linked to cardiovascular mortality are associated with risk factors

PubMed Central

Ebbesson, Sven O. E.; Voruganti, Venkata S.; Higgins, Paul B.; Fabsitz, Richard R.; Ebbesson, Lars O.; Laston, Sandra; Harris, William S.; Kennish, John; Umans, Benjamin D.; Wang, Hong; Devereux, Richard B.; Okin, Peter M.; Weissman, Neil J.; MacCluer, Jean W.; Umans, Jason G.; Howard, Barbara V.

2015-01-01

Background Although saturated fatty acids (FAs) have been linked to cardiovascular mortality, it is not clear whether this outcome is attributable solely to their effects on low-density lipoprotein cholesterol (LDL-C) or whether other risk factors are also associated with FAs. The Western Alaskan Native population, with its rapidly changing lifestyles, shift in diet from unsaturated to saturated fatty acids and dramatic increase in cardiovascular disease (CVD), presents an opportunity to elucidate any associations between specific FAs and known CVD risk factors. Objective We tested the hypothesis that the specific FAs previously identified as related to CVD mortality are also associated with individual CVD risk factors. Methods In this community-based, cross-sectional study, relative proportions of FAs in plasma and red blood cell membranes were compared with CVD risk factors in a sample of 758 men and women aged ≥35 years. Linear regression analyses were used to analyze relations between specific FAs and CVD risk factors (LDL-C, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, systolic blood pressure, diastolic blood pressure, heart rate, body mass index, fasting glucose and fasting insulin, 2-hour glucose and 2-hour insulin). Results The specific saturated FAs previously identified as related to CVD mortality, the palmitic and myristic acids, were adversely associated with most CVD risk factors, whereas unsaturated linoleic acid (18:2n-6) and the marine n-3 FAs were not associated or were beneficially associated with CVD risk factors. Conclusions The results suggest that CVD risk factors are more extensively affected by individual FAs than hitherto recognized, and that risk for CVD, MI and stroke can be reduced by reducing the intake of palmitate, myristic acid and simple carbohydrates and improved by greater intake of linoleic acid and marine n-3 FAs. PMID:26274054

Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015.

PubMed

Roth, Gregory A; Johnson, Catherine; Abajobir, Amanuel; Abd-Allah, Foad; Abera, Semaw Ferede; Abyu, Gebre; Ahmed, Muktar; Aksut, Baran; Alam, Tahiya; Alam, Khurshid; Alla, François; Alvis-Guzman, Nelson; Amrock, Stephen; Ansari, Hossein; Ärnlöv, Johan; Asayesh, Hamid; Atey, Tesfay Mehari; Avila-Burgos, Leticia; Awasthi, Ashish; Banerjee, Amitava; Barac, Aleksandra; Bärnighausen, Till; Barregard, Lars; Bedi, Neeraj; Belay Ketema, Ezra; Bennett, Derrick; Berhe, Gebremedhin; Bhutta, Zulfiqar; Bitew, Shimelash; Carapetis, Jonathan; Carrero, Juan Jesus; Malta, Deborah Carvalho; Castañeda-Orjuela, Carlos Andres; Castillo-Rivas, Jacqueline; Catalá-López, Ferrán; Choi, Jee-Young; Christensen, Hanne; Cirillo, Massimo; Cooper, Leslie; Criqui, Michael; Cundiff, David; Damasceno, Albertino; Dandona, Lalit; Dandona, Rakhi; Davletov, Kairat; Dharmaratne, Samath; Dorairaj, Prabhakaran; Dubey, Manisha; Ehrenkranz, Rebecca; El Sayed Zaki, Maysaa; Faraon, Emerito Jose A; Esteghamati, Alireza; Farid, Talha; Farvid, Maryam; Feigin, Valery; Ding, Eric L; Fowkes, Gerry; Gebrehiwot, Tsegaye; Gillum, Richard; Gold, Audra; Gona, Philimon; Gupta, Rajeev; Habtewold, Tesfa Dejenie; Hafezi-Nejad, Nima; Hailu, Tesfaye; Hailu, Gessessew Bugssa; Hankey, Graeme; Hassen, Hamid Yimam; Abate, Kalkidan Hassen; Havmoeller, Rasmus; Hay, Simon I; Horino, Masako; Hotez, Peter J; Jacobsen, Kathryn; James, Spencer; Javanbakht, Mehdi; Jeemon, Panniyammakal; John, Denny; Jonas, Jost; Kalkonde, Yogeshwar; Karimkhani, Chante; Kasaeian, Amir; Khader, Yousef; Khan, Abdur; Khang, Young-Ho; Khera, Sahil; Khoja, Abdullah T; Khubchandani, Jagdish; Kim, Daniel; Kolte, Dhaval; Kosen, Soewarta; Krohn, Kristopher J; Kumar, G Anil; Kwan, Gene F; Lal, Dharmesh Kumar; Larsson, Anders; Linn, Shai; Lopez, Alan; Lotufo, Paulo A; El Razek, Hassan Magdy Abd; Malekzadeh, Reza; Mazidi, Mohsen; Meier, Toni; Meles, Kidanu Gebremariam; Mensah, George; Meretoja, Atte; Mezgebe, Haftay; Miller, Ted; Mirrakhimov, Erkin; Mohammed, Shafiu; Moran, Andrew E; Musa, Kamarul Imran; Narula, Jagat; Neal, Bruce; Ngalesoni, Frida; Nguyen, Grant; Obermeyer, Carla Makhlouf; Owolabi, Mayowa; Patton, George; Pedro, João; Qato, Dima; Qorbani, Mostafa; Rahimi, Kazem; Rai, Rajesh Kumar; Rawaf, Salman; Ribeiro, Antônio; Safiri, Saeid; Salomon, Joshua A; Santos, Itamar; Santric Milicevic, Milena; Sartorius, Benn; Schutte, Aletta; Sepanlou, Sadaf; Shaikh, Masood Ali; Shin, Min-Jeong; Shishehbor, Mehdi; Shore, Hirbo; Silva, Diego Augusto Santos; Sobngwi, Eugene; Stranges, Saverio; Swaminathan, Soumya; Tabarés-Seisdedos, Rafael; Tadele Atnafu, Niguse; Tesfay, Fisaha; Thakur, J S; Thrift, Amanda; Topor-Madry, Roman; Truelsen, Thomas; Tyrovolas, Stefanos; Ukwaja, Kingsley Nnanna; Uthman, Olalekan; Vasankari, Tommi; Vlassov, Vasiliy; Vollset, Stein Emil; Wakayo, Tolassa; Watkins, David; Weintraub, Robert; Werdecker, Andrea; Westerman, Ronny; Wiysonge, Charles Shey; Wolfe, Charles; Workicho, Abdulhalik; Xu, Gelin; Yano, Yuichiro; Yip, Paul; Yonemoto, Naohiro; Younis, Mustafa; Yu, Chuanhua; Vos, Theo; Naghavi, Mohsen; Murray, Christopher

2017-07-04

The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world. The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden. CVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. In 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75. CVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Body Composition Indices and Single and Clustered Cardiovascular Disease Risk Factors in Adolescents: Providing Clinical-Based Cut-Points.

PubMed

Gracia-Marco, Luis; Moreno, Luis A; Ruiz, Jonatan R; Ortega, Francisco B; de Moraes, Augusto César Ferreira; Gottrand, Frederic; Roccaldo, Romana; Marcos, Ascensión; Gómez-Martínez, Sonia; Dallongeville, Jean; Kafatos, Anthony; Molnar, Denes; Bueno, Gloria; de Henauw, Stefaan; Widhalm, Kurt; Wells, Jonathan C

2016-01-01

The aims of the present study in adolescents were 1) to examine how various body composition-screening tests relate to single and clustered cardiovascular disease (CVD) risk factors, 2) to examine how lean mass and body fatness (independently of each other) relate to clustered CVD risk factors, and 3) to calculate specific thresholds for body composition indices associated with an unhealthier clustered CVD risk. We measured 1089 European adolescents (46.7% boys, 12.5-17.49years) in 2006-2007. CVD risk factors included: systolic blood pressure, maximum oxygen uptake, homeostasis model assessment, C-reactive protein (n=748), total cholesterol/high density lipoprotein cholesterol and triglycerides. Body composition indices included: height, body mass index (BMI), lean mass, the sum of four skinfolds, central/peripheral skinfolds, waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR). Most body composition indices are associated with single CVD risk factors. The sum of four skinfolds, WHtR, BMI, WC and lean mass are strong and positively associated with clustered CVD risk. Interestingly, lean mass is positively associated with clustered CVD risk independently of body fatness in girls. Moderate and highly accurate thresholds for the sum of four skinfolds, WHtR, BMI, WC and lean mass are associated with an unhealthier clustered CVD risk (all AUC>0.773). In conclusion, our results support an association between most of the assessed body composition indices and single and clustered CVD risk factors. In addition, lean mass (independent of body fatness) is positively associated with clustered CVD risk in girls, which is a novel finding that helps to understand why an index such as BMI is a good index of CVD risk but a bad index of adiposity. Moderate to highly accurate thresholds for body composition indices associated with a healthier clustered CVD risk were found. Further studies with a longitudinal design are needed to confirm these findings. Copyright © 2015 Elsevier Inc. All rights reserved.

Racial differences in risks for first cardiovascular events and noncardiovascular death: the Atherosclerosis Risk in Communities study, the Cardiovascular Health Study, and the Multi-Ethnic Study of Atherosclerosis.

PubMed

Feinstein, Matthew; Ning, Hongyan; Kang, Joseph; Bertoni, Alain; Carnethon, Mercedes; Lloyd-Jones, Donald M

2012-07-03

No studies have compared first cardiovascular disease (CVD) events and non-CVD death between races in a competing risks framework, which examines risks for numerous events simultaneously. We used competing Cox models to estimate hazards for first CVD events and non-CVD death within and between races in 3 multicenter, National Heart, Lung, and Blood Institute-sponsored cohorts. Of 14 569 Atherosclerosis Risk in Communities (ARIC) study participants aged 45 to 64 years with mean follow-up of 10.5 years, 11.6% had CVD and 5.0% had non-CVD death as first events; among 4237 Cardiovascular Health Study (CHS) study participants aged 65 to 84 years and followed for 8.5 years, these figures were 43.2% and 15.7%, respectively. Middle-aged blacks were significantly more likely than whites to experience any CVD as a first event; this disparity disappeared by older adulthood and after adjustment for CVD risk factors. The pattern of results was similar for Multi-Ethnic Study of Atherosclerosis (MESA) participants. Traditional Cox and competing risks models yielded different results for coronary heart disease risk. Black men appeared somewhat more likely than white men to experience coronary heart disease with use of a standard Cox model (hazard ratio 1.06; 95% CI 0.90, 1.26), whereas they appeared less likely than white men to have a first coronary heart disease event with use of a competing risks model (hazard ratio, 0.77; 95% CI, 0.60, 1.00). CVD affects blacks at an earlier age than whites; this may be attributable in part to elevated CVD risk factor levels among blacks. Racial disparities in first CVD incidence disappear by older adulthood. Competing risks analyses may yield somewhat different results than traditional Cox models and provide a complementary approach to examining risks for first CVD events.

The Burden of Cardiovascular Diseases Among US States, 1990-2016.

PubMed

Roth, Gregory A; Johnson, Catherine O; Abate, Kalkidan Hassen; Abd-Allah, Foad; Ahmed, Muktar; Alam, Khurshid; Alam, Tahiya; Alvis-Guzman, Nelson; Ansari, Hossein; Ärnlöv, Johan; Atey, Tesfay Mehari; Awasthi, Ashish; Awoke, Tadesse; Barac, Aleksandra; Bärnighausen, Till; Bedi, Neeraj; Bennett, Derrick; Bensenor, Isabela; Biadgilign, Sibhatu; Castañeda-Orjuela, Carlos; Catalá-López, Ferrán; Davletov, Kairat; Dharmaratne, Samath; Ding, Eric L; Dubey, Manisha; Faraon, Emerito Jose Aquino; Farid, Talha; Farvid, Maryam S; Feigin, Valery; Fernandes, João; Frostad, Joseph; Gebru, Alemseged; Geleijnse, Johanna M; Gona, Philimon Nyakauru; Griswold, Max; Hailu, Gessessew Bugssa; Hankey, Graeme J; Hassen, Hamid Yimam; Havmoeller, Rasmus; Hay, Simon; Heckbert, Susan R; Irvine, Caleb Mackay Salpeter; James, Spencer Lewis; Jara, Dube; Kasaeian, Amir; Khan, Abdur Rahman; Khera, Sahil; Khoja, Abdullah T; Khubchandani, Jagdish; Kim, Daniel; Kolte, Dhaval; Lal, Dharmesh; Larsson, Anders; Linn, Shai; Lotufo, Paulo A; Magdy Abd El Razek, Hassan; Mazidi, Mohsen; Meier, Toni; Mendoza, Walter; Mensah, George A; Meretoja, Atte; Mezgebe, Haftay Berhane; Mirrakhimov, Erkin; Mohammed, Shafiu; Moran, Andrew Edward; Nguyen, Grant; Nguyen, Minh; Ong, Kanyin Liane; Owolabi, Mayowa; Pletcher, Martin; Pourmalek, Farshad; Purcell, Caroline A; Qorbani, Mostafa; Rahman, Mahfuzar; Rai, Rajesh Kumar; Ram, Usha; Reitsma, Marissa Bettay; Renzaho, Andre M N; Rios-Blancas, Maria Jesus; Safiri, Saeid; Salomon, Joshua A; Sartorius, Benn; Sepanlou, Sadaf Ghajarieh; Shaikh, Masood Ali; Silva, Diego; Stranges, Saverio; Tabarés-Seisdedos, Rafael; Tadele Atnafu, Niguse; Thakur, J S; Topor-Madry, Roman; Truelsen, Thomas; Tuzcu, E Murat; Tyrovolas, Stefanos; Ukwaja, Kingsley Nnanna; Vasankari, Tommi; Vlassov, Vasiliy; Vollset, Stein Emil; Wakayo, Tolassa; Weintraub, Robert; Wolfe, Charles; Workicho, Abdulhalik; Xu, Gelin; Yadgir, Simon; Yano, Yuichiro; Yip, Paul; Yonemoto, Naohiro; Younis, Mustafa; Yu, Chuanhua; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Zipkin, Ben; Afshin, Ashkan; Gakidou, Emmanuela; Lim, Stephen S; Mokdad, Ali H; Naghavi, Mohsen; Vos, Theo; Murray, Christopher J L

2018-04-11

Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously. To quantify and describe levels and trends of lost health due to CVD within the United States from 1990 to 2016 as well as risk factors driving these changes. Using the Global Burden of Disease methodology, cardiovascular disease mortality, nonfatal health outcomes, and associated risk factors were analyzed by age group, sex, and year from 1990 to 2016 for all residents in the United States using standardized approaches for data processing and statistical modeling. Burden of disease was estimated for 10 groupings of CVD, and comparative risk analysis was performed. Data were analyzed from August 2016 to July 2017. Residing in the United States. Cardiovascular disease disability-adjusted life-years (DALYs). Between 1990 and 2016, age-standardized CVD DALYs for all states decreased. Several states had large rises in their relative rank ordering for total CVD DALYs among states, including Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa. The rate of decline varied widely across states, and CVD burden increased for a small number of states in the most recent years. Cardiovascular disease DALYs remained twice as large among men compared with women. Ischemic heart disease was the leading cause of CVD DALYs in all states, but the second most common varied by state. Trends were driven by 12 groups of risk factors, with the largest attributable CVD burden due to dietary risk exposures followed by high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity. Increases in risk-deleted CVD DALY rates between 2006 and 2016 in 16 states suggest additional unmeasured risks beyond these traditional factors. Large disparities in total burden of CVD persist between US states despite marked improvements in CVD burden. Differences in CVD burden are largely attributable to modifiable risk exposures.

Public knowledge of cardiovascular disease and its risk factors in Kuwait: a cross-sectional survey.

PubMed

Awad, Abdelmoneim; Al-Nafisi, Hala

2014-11-04

Cardiovascular disease (CVD) is estimated to cause 46% of all mortalities in Kuwait. To design effective primary and secondary prevention programs, an assessment of a population's prior CVD knowledge is of paramount importance. There is scarcity of data on the existing CVD knowledge among the general Kuwaiti population. Hence, this study was performed to assess the level of knowledge towards CVD types, warning symptoms of heart attack or stroke, and CVD risk factors. It also explored public views on the community pharmacists' role in CVD prevention and management. A descriptive cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 900 randomly selected Kuwaiti individuals. Descriptive and multivariate logistic regression analysis were used in data analysis. The response rate was 90.7%. Respondents' knowledge about types of CVD, heart attack or stroke symptoms was low. Almost 60% of respondents did not know any type of CVD, and coronary heart disease was the commonest identified type (29.0%). Two-fifths of participants were not aware of any heart attack symptoms, and the most commonly known were chest pain (50.4%) and shortness of breath (48.0%). Approximately half of respondents did not recognize any stroke symptoms, and the most commonly recognized were 'confusion or trouble speaking' (36.4%) and 'numbness or weakness' (34.7%). Respondents' knowledge regarding CVD risk factors was moderate. The commonest factors identified by over four-fifths of participants were smoking, obesity, unhealthy diet and physical inactivity. In the multivariate logistic regression analysis, independent predictors of better level of CVD knowledge were females, age 50-59 years, high level of education, regular eating of healthy diet, and had a family history of CVD. Most of respondents only identified the role that pharmacists had to play is to help patients manage their medications, with a minimal role in other aspects of CVD prevention and management. There are deficiencies in CVD knowledge among Kuwaiti population, which could turn into insufficient preventative behaviours and suboptimal patient outcomes. There is an apparent need to establish more wide-spread and effective educational interventions, which should be sensitive to the perceptions, attitudes, and abilities of targeted individuals.

Co-morbid depression is associated with poor work outcomes in persons with cardiovascular disease (CVD): A large, nationally representative survey in the Australian population

PubMed Central

2012-01-01

Background Co-morbid major depressive disorder (MDD) and cardiovascular disease (CVD) is associated with poor clinical and psychological outcomes. However, the full extent of the burden of, and interaction between, this co-morbidity on important vocational outcomes remains less clear, particularly at the population level. We examine the association of co-morbid MDD with work outcomes in persons with and without CVD. Methods This study utilised cross-sectional, population-based data from the 2007 Australian National Survey of Mental Health and Wellbeing (n = 8841) to compare work outcomes of individuals with diagnostically-defined MDD and CVD, MDD but not CVD, CVD but not MDD, with a reference group of "healthy" Australians. Workforce participation was defined as being in full- or part-time employment. Work functioning was measured using a WHO Disability Assessment Schedule item. Absenteeism was assessed using the 'days out of role' item. Results Of the four groups, those with co-morbid MDD and CVD were least likely to report workforce participation (adj OR:0.4, 95% CI: 0.3-0.6). Those with MDD only (adj OR:0.8, 95% CI:0.7-0.9) and CVD only (adj OR:0.8, 95% CI: 0.6-0.9) also reported significantly reduced odds of participation. Employed individuals with co-morbid MDD and CVD were 8 times as likely to experience impairments in work functioning (adj OR:8.1, 95% CI: 3.8- 17.3) compared with the reference group. MDD was associated with a four-fold increase in impaired functioning. Further, individuals with co-morbid MDD and CVD reported greatest likelihood of workplace absenteeism (adj. OR:3.0, 95% CI: 1.4-6.6). Simultaneous exposure to MDD and CVD conferred an even greater likelihood of poorer work functioning. Conclusions Co-morbid MDD and CVD is associated with significantly poorer work outcomes. Specifically, the effects of these conditions on work functioning are synergistic. The development of specialised treatment programs for those with co-morbid MDD and CVD is required. PMID:22257700

Status of the secondary mirrors (M2) for the Gemini 8-m telescopes

NASA Astrophysics Data System (ADS)

Knohl, Ernst-Dieter; Schoeppach, Armin; Pickering, Michael A.

1998-08-01

The 1-m diameter lightweight secondary mirrors (M2) for the Gemini 8-m telescopes will be the largest CVD-SiC mirrors ever produced. The design and manufacture of these mirrors is a very challenging task. In this paper we will discuss the mirror design, structural and mechanical analysis, and the CVD manufacturing process used to produce the mirror blanks. The lightweight design consist of a thin faceplate (4-mm) and triangular backstructure cells with ribs of varying heights. The main drivers in the design were weight (40 kg) and manufacturing limitations imposed on the backstructure cells and mirror mounts. Finite element modeling predicts that the mirror design will meet all of the Gemini M2 requirements for weight, mechanical integrity, resonances, and optical performance. Special design considerations were necessary to avoid stress concentration in the mounting areas and to meet the requirement that the mirror survive an 8-g earthquake. The highest risk step in the mirror blank manufacturing process is the near-net-shape CVD deposition of the thin, curved faceplate. Special tooling and procedures had to be developed to produce faceplates free of fractures, cracks, and stress during the cool-down from deposition temperature (1350 C) to room temperature. Due to time delay with the CVD manufacturing process in the meantime a backup solution from Zerodur has been started. This mirror is now in the advanced polishing process. Because the design of both mirrors is very similar an excellent comparison of both solutions is possible.

Growth Mechanism of Transition Metal Dichalcogenide Monolayers: The Role of Self-Seeding Fullerene Nuclei.

PubMed

Cain, Jeffrey D; Shi, Fengyuan; Wu, Jinsong; Dravid, Vinayak P

2016-05-24

Due to their unique optoelectronic properties and potential for next generation devices, monolayer transition metal dichalcogenides (TMDs) have attracted a great deal of interest since the first observation of monolayer MoS2 a few years ago. While initially isolated in monolayer form by mechanical exfoliation, the field has evolved to more sophisticated methods capable of direct growth of large-area monolayer TMDs. Chemical vapor deposition (CVD) is the technique used most prominently throughout the literature and is based on the sulfurization of transition metal oxide precursors. CVD-grown monolayers exhibit excellent quality, and this process is widely used in studies ranging from the fundamental to the applied. However, little is known about the specifics of the nucleation and growth mechanisms occurring during the CVD process. In this study, we have investigated the nucleation centers or "seeds" from which monolayer TMDs typically grow. This was accomplished using aberration-corrected scanning transmission electron microscopy to analyze the structure and composition of the nuclei present in CVD-grown MoS2-MoSe2 alloys. We find that monolayer growth proceeds from nominally oxi-chalcogenide nanoparticles which act as heterogeneous nucleation sites for monolayer growth. The oxi-chalcogenide nanoparticles are typically encased in a fullerene-like shell made of the TMD. Using this information, we propose a step-by-step nucleation and growth mechanism for monolayer TMDs. Understanding this mechanism may pave the way for precise control over the synthesis of 2D materials, heterostructures, and related complexes.

Automatic chemical vapor deposition

NASA Technical Reports Server (NTRS)

Kennedy, B. W.

1981-01-01

Report reviews chemical vapor deposition (CVD) for processing integrated circuits and describes fully automatic machine for CVD. CVD proceeds at relatively low temperature, allows wide choice of film compositions (including graded or abruptly changing compositions), and deposits uniform films of controllable thickness at fairly high growth rate. Report gives overview of hardware, reactants, and temperature ranges used with CVD machine.

Surface Design and Engineering Toward Wear-Resistant, Self-Lubricant Diamond Films and Coatings. Chapter 10

NASA Technical Reports Server (NTRS)

Miyoshi, Kazuhisa

1999-01-01

This chapter describes three studies on the surface design, surface engineering, and tribology of chemical-vapor-deposited (CVD) diamond films and coatings toward wear-resistant, self-lubricating diamond films and coatings. Friction mechanisms and solid lubrication mechanisms of CVD diamond are stated. Effects of an amorphous hydrogenated carbon on CVD diamond, an amorphous, nondiamond carbon surface layer formed on CVD diamond by carbon and nitrogen ion implantation, and a materials combination of cubic boron nitride and CVD diamond on the adhesion, friction, and wear behaviors of CVD diamond in ultrahigh vacuum are described. How surface modification and the selected materials couple improved the tribological functionality of coatings, giving low coefficient of friction and good wear resistance, is explained.

Minimizing artifact formation in magnetorheological finishing of chemical vapor deposition ZnS flats.

PubMed

Kozhinova, Irina A; Romanofsky, Henry J; Maltsev, Alexander; Jacobs, Stephen D; Kordonski, William I; Gorodkin, Sergei R

2005-08-01

The polishing performance of magnetorheological (MR) fluids prepared with a variety of magnetic and nonmagnetic ingredients was studied on four types of initial surface for chemical vapor deposition (CVD) ZnS flats from domestic and foreign sources. The results showed that it was possible to greatly improve smoothing performance of magnetorheological finishing (MRF) by altering the fluid composition, with the best results obtained for nanoalumina abrasive used with soft carbonyl iron and altered MR fluid chemistry. Surface roughness did not exceed 20 nm peak to valley and 2 nm rms after removal of 2 microm of material. The formation of orange peel and the exposure of a pebblelike structure inherent in ZnS from the CVD process were suppressed.

Computational Modeling in Structural Materials Processing

NASA Technical Reports Server (NTRS)

Meyyappan, Meyya; Arnold, James O. (Technical Monitor)

1997-01-01

High temperature materials such as silicon carbide, a variety of nitrides, and ceramic matrix composites find use in aerospace, automotive, machine tool industries and in high speed civil transport applications. Chemical vapor deposition (CVD) is widely used in processing such structural materials. Variations of CVD include deposition on substrates, coating of fibers, inside cavities and on complex objects, and infiltration within preforms called chemical vapor infiltration (CVI). Our current knowledge of the process mechanisms, ability to optimize processes, and scale-up for large scale manufacturing is limited. In this regard, computational modeling of the processes is valuable since a validated model can be used as a design tool. The effort is similar to traditional chemically reacting flow modeling with emphasis on multicomponent diffusion, thermal diffusion, large sets of homogeneous reactions, and surface chemistry. In the case of CVI, models for pore infiltration are needed. In the present talk, examples of SiC nitride, and Boron deposition from the author's past work will be used to illustrate the utility of computational process modeling.

Knowledge Gaps in Cardiovascular Care of Older Adults: A Scientific Statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society: Executive Summary.

PubMed

Rich, Michael W; Chyun, Deborah A; Skolnick, Adam H; Alexander, Karen P; Forman, Daniel E; Kitzman, Dalane W; Maurer, Mathew S; McClurken, James B; Resnick, Barbara M; Shen, Win K; Tirschwell, David L

2016-11-01

The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease (CVD) is the leading cause of death and major disability in adults aged 75 and older. Despite the effect of CVD on quality of life, morbidity, and mortality in older adults, individuals aged 75 and older have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older adults with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in nursing homes and assisted living facilities. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older adults typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision-making, and recommend future research to close existing knowledge gaps. To achieve these objectives, a detailed review was conducted of current American College of Cardiology/American Heart Association (ACC/AHA) and American Stroke Association (ASA) guidelines to identify content and recommendations that explicitly targeted older adults. A pervasive lack of evidence to guide clinical decision-making in older adults with CVD was found, as well as a paucity of data on the effect of diagnostic and therapeutic interventions on outcomes that are particularly important to older adults, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older adults representative of those seen in clinical practice and that incorporate relevant outcomes important to older adults in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older adults and enhance person-centered care of older individuals with CVD in the United States and around the world. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Cardiovascular disease in Chinese Canadians: a case-mix study from an urban tertiary care cardiology clinic.

PubMed

Tso, David K; Moe, Gordon

2002-08-01

Cardiovascular diseases (CVD) are the leading cause of death in Canada. Non-European ethnic groups such as the Chinese constitute an increasingly significant sector of the Canadian population. To compare the frequency and risk factors of CVD in Chinese and white Canadians in a cardiology referral clinic that saw a high number of ethnic Chinese patients and provided equal access to advanced diagnostic facilities. Clinic charts of patients referred between 1994 and 1999 were reviewed. Patients of Chinese descent were identified by their names. Primary cardiovascular and secondary cardiovascular diagnoses, as well as risk factors for coronary artery disease (CAD), were established. The frequency of disease and risk factors were age-standardized. The sample of patients with CVD consisted of 404 Chinese and 1129 white subjects. Chinese patients were older (median age 65 versus 62 years, P=0.006). CAD, heart failure and peripheral vascular disease were less frequent in Chinese than in white patients. On the other hand, valvular heart disease was more frequent in Chinese patients. Diabetes, smoking and family history of heart disease were less frequent in Chinese subjects, whereas the frequencies of hypertension and hypercholerolemia were similar to those of white patients. In patients who had undergone coronary angiography, the frequency of multivessel CAD was less in Chinese patients (40% versus 56%, P=0.0016). Angina pectoris was a more common manifestation of CAD in Chinese patients, whereas myocardial infarction was more common in people who were white. In patients with heart failure, the median left ventricular ejection fraction was higher in Chinese than in white patients (34% versus 28%, P=0.031). In patients referred to a cardiology clinic, the diagnosis of CAD and the majority of other CVDs was less frequent in Chinese Canadians than in white Canadians. However, selected modifiable risk factors for CAD, such as hypertension and hypercholesterolemia, were equally frequent. Further research at the population level is warranted to define the characteristics of CVD in Chinese Canadians, and may be useful to the future design of disease management and prevention programs tailored to the needs of this growing ethnic population.

The effects of a 12-week worksite physical activity intervention on anthropometric indices, blood pressure indices, and plasma biomarkers of cardiovascular disease risk among university employees.

PubMed

Corbett, Duane B; Fennell, Curtis; Peroutky, Kylene; Kingsley, J Derek; Glickman, Ellen L

2018-01-29

To determine the effectiveness of a low-cost 12-week worksite physical activity intervention targeting a goal of 10,000 steps per day on reducing anthropometric indices, blood pressure indices, and plasma biomarkers of cardiovascular disease (CVD) risk among the employees of a major university. Fifty university employees (n = 43 female, n = 7 male; mean age = 48 ± 10 years) participated in the 12-week physical activity intervention (60 min, 3 day/week). Each session included both aerobic (cardiorespiratory endurance) and muscle-strengthening (resistance) physical activity using existing university facilities and equipment. Anthropometric indices, blood pressure indices, and plasma biomarkers of CVD risk assessed included those for obesity (body mass index), hypertension (systolic blood pressure, SBP; diastolic blood pressure, DBP), dyslipidemia (high-density lipoprotein, HDL; low-density lipoprotein, LDL; total serum cholesterol), and prediabetes (impaired fasting glucose, IFG). Steps per day were assessed using a wrist-worn activity monitor. Participants were given the goal of 10,000 steps per day and categorized as either compliers (≥ 10,000 steps per day on average) or non-compliers (< 10,000 steps per day on average) based on their ability to achieve this goal. Overall, 34% of participants at baseline were already at an elevated risk of CVD due to age. On average, 28% of participants adhered to the goal of 10,000 steps per day. After 12-weeks, participants in both groups (compliers and non-compliers) had lower BMI scores (p < 0.001), lower HDL scores (p < 0.034), and higher IFG scores (p < 0.001). The non-compliers had a greater reduction of BMI scores than the compliers (p = 0.003). Participants at risk for CVD had greater reductions than those not at risk for several risk factors, including SBP (p = 0.020), DBP (p = 0.028), IFG (p = 0.002), LDL (p = 0.006), and total serum cholesterol (p = 0.009). While the physical activity intervention showed mixed results overall with both favorable changes in anthropometric indices yet unfavorable changes in plasma biomarkers, it was particularly beneficial in regards to both blood pressure indices and plasma biomarkers among those already at risk of CVD. Trial registration ClinicalTrials.gov NCT03385447; retrospectively registered.

Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP)

PubMed Central

2013-01-01

Background South Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population. Methods South Asians (≥ 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or ≥ 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar’s test (proportions) and paired t-tests (continuous measures). Results Baseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering multilingual programs/translation assistance, reducing screening wait times and increasing numbers of project staff. Conclusions SA-CHAMP demonstrated the feasibility and value of implementing a lay volunteer–led, culturally adapted, sustainable community-based CVD risk factor screening program in South Asian places of worship in Calgary, Alberta, Canada. Subsequent screening and CDM programs were refined based on the learnings from this study. Further research is needed to determine physician and patient factors associated with uptake of and adherence to risk reduction strategies. PMID:23432996

Relationship between lower urinary tract symptoms and cardiovascular risk scores including Framingham risk score and ACC/AHA risk score.

PubMed

Lee, Bora; Lee, Sang Wook; Kang, Hye Rim; Kim, Dae In; Sun, Hwa Yeon; Kim, Jae Heon

2018-01-01

This study attempted to investigate the association between lower urinary tract symptoms (LUTS) and cardiovascular disease (CVD) risk using International Prostate Symptom Score (IPSS) and CVD risk scores and to overcome the limitations of previous relevant studies. A total of 2994 ostensibly healthy males, who participated in a voluntary health check in a health promotion center from January 2010 to December 2014, were reviewed. CVD risk scores were calculated using Framingham risk score and American College of Cardiology (ACC)/American Heart Association (AHA) score. Correlation and multivariate logistic regression analysis to predict the CVD risk severity were performed. Correlation between total IPSS with CVD risk scores demonstrated significant positive associations, which showed higher correlation with ACC/AHA score than the Framingham score (r = 0.18 vs 0.09, respectively). For ACC/AHA score, the partial correlation after adjustment of body mass index (BMI) showed significant positive correlations between all LUTS parameters and PSA. For the Framingham score, all variables, except IPSS Q2 and IPSS Q6, showed significant positive correlations. After adjustment of BMI, prostate volume and PSA, only the severe LUTS group showed significant relationship with intermediate-high CVD risk severity, as compared with normal LUTS group (OR = 2.97, 95%CI (1.35-6.99)). Using two validated CVD risk calculators, we observed that LUTS is closely associated with future CVD risk. To predict the intermediate-high CVD risk severity, severe LUTS was a sentinel sign, the presence of which warrants the importance of an earlier screening for CVD. © 2017 Wiley Periodicals, Inc.

Osteoprotegerin concentrations relate independently to established cardiovascular disease in rheumatoid arthritis.

PubMed

López-Mejias, Raquel; Ubilla, Begoña; Genre, Fernanda; Corrales, Alfonso; Hernández, José L; Ferraz-Amaro, Ivan; Tsang, Linda; Llorca, Javier; Blanco, Ricardo; González-Juanatey, Carlos; Gonzalez-Gay, Miguel A; Dessein, Patrick H

2015-01-01

We determined whether osteoprotegerin (OPG) concentrations are associated with established cardiovascular disease (CVD) among patients with rheumatoid arthritis (RA). OPG concentrations were measured by ELISA in 151 patients with RA (54 with CVD) and 62 age-matched control subjects without CVD. Established CVD was composed of documented ischemic heart disease, cerebrovascular disease, and peripheral artery disease. In patients with RA, age, body mass index (BMI), rheumatoid factor (RF) positivity, anticyclic citrullinated peptide (anti-CCP) antibody positivity, and joint erosion status were associated with OPG concentrations [partial R (p) = 0.175 (0.03), -0.277 (0.0009), 0.323 (< 0.0001), 0.217 (0.008), and 0.159 (0.05), respectively]. Median (interquartile range) OPG concentrations increased from 6.38 (3.46-9.31) to 7.07 (5.04-10.65) and 8.64 (6.00-11.52) ng/ml in controls and patients with RA who had CVD and those who did not, respectively (p = 0.0002). Upon adjustment for age, sex, traditional risk factors, and BMI in mixed regression models, OPG concentrations remained lower in controls compared to patients with RA without CVD (p = 0.05) and in the latter compared to those with CVD (p = 0.03); the association of OPG concentrations with CVD among patients with RA also persisted after additional adjustment for RF and anti-CCP antibody positivity, and erosion status (p = 0.04). OPG concentrations are associated with disease severity and CVD prevalence in patients with RA. Whether consideration of OPG concentrations can improve CVD risk stratification in RA merits future longitudinal investigation.

Cardiovascular disease mortality in British merchant shipping and among British seafarers ashore in Britain.

PubMed

Roberts, Stephen E; Jaremin, Bogdan

2010-01-01

The objective was to investigate trends in work-related mortality from cardiovascular disease (CVD) among seafarers employed in British merchant shipping from 1919 to 2005, to compare CVD mortality among British seafarers at work in British shipping - and ashore in Britain - with that in the general British population, and to investigate work-related CVD mortality in British shipping during recent years according to factors such as rank, nationality, location, and type of ship. A longitudinal study based on examination of death inquiry files and death registers, official death returns, and information from occupational mortality decennial supplements. The main outcome measures were population-based mortality rates and standardised mortality ratios. There was an increase in work-related CVD mortality throughout much of the period from 1919 to 1962, but a subsequent reduction to 2005. Work-related mortality from CVD and ischaemic heart disease (IHD) was lower among seafarers employed in British shipping than in the corresponding general population (SMRs = 0.35 to 0.46), but mortality from CVD among British seafarers ashore in Britain was often increased. An elevated risk of work-related CVD mortality was also identified among the crews of North Sea offshore ships. This study shows a healthy worker effect against CVD mortality among seafarers at work in British shipping, but increased risks among British seafarers ashore in Britain, which would include seafarers discharged through CVD morbidity and other illnesses. The high risks of CVD mortality among seafarers in North Sea supply ships may reflect particular work-related hazards in this sector.

CVD and obesity in transitional Syria: a perspective from the Middle East

PubMed Central

Barakat, Hani; Barakat, Hanniya; Baaj, Mohamad K

2012-01-01

Purpose Syria is caught in the middle of a disruptive nutritional transition. Its healthcare system is distracted by challenges and successes in other areas while neglecting to address the onslaught of Syria’s cardiovascular disease (CVD) epidemic. Despite the official viewpoint touting improvement in health indicators, current trends jeopardize population health, and several surveys in the Syrian population signal the epidemic spreading far and wide. The goal is to counteract the indifference towards obesity as a threat to Syrian’s health, as the country is slowly becoming a leader in CVD mortality globally. Methods PubMed, World Health Organization, and official government websites were searched for primary surveys in Syria related to CVD morbidity, mortality, and risk factors. Inclusion criteria ensured that results maximized relevance while producing comparable studies. Statistical analysis was applied to detect the most common risk factor and significant differences in risk factor prevalence and CVD rates. Results Obesity remained the prevailing CVD risk factor except in older Syrian men, where smoking and hypertension were more common. CVD mortality was more common in males due to coronary disease, while stroke dominated female mortality. The young workforce is especially impacted, with 50% of CVD mortality occurring before age 65 years and an 81% prevalence of obesity in women over 45 years. Conclusion Syria can overcome its slow response to the CVD epidemic and curb further deterioration by reducing obesity and, thus, inheritance and clustering of risk factors. This can be achieved via multilayered awareness and intensive parental and familial involvement. Extinguishing the CVD epidemic is readily achievable as demonstrated in other countries. PMID:22454558

Prevalence of cardiovascular disease and major risk factors in patients with rheumatoid arthritis: a multinational cross-sectional study.

PubMed

Pappas, Dimitrios A; Nyberg, Fredrik; Kremer, Joel M; Lampl, Kathy; Reed, George W; Horne, Laura; Ho, Meilien; Onofrei, Alina; Malaviya, Anand N; Rillo, Oscar L; Radominski, Sebastiao C; Gal, Janos; Gibofsky, Allan; Popkova, Tatiana V; Laurindo, Leda; Kerzberg, Eduardo M; Zahora, Roman; Pons-Estel, Bernado A; Curtis, Jeffrey R; Furst, Daniel E; Greenberg, Jeffrey D

2018-04-25

To compare the prevalence of cardiovascular disease (CVD) and major CVD risk factors among rheumatoid arthritis (RA) patients enrolled in a large US and multinational registry. We compared CVD and CVD risk factor prevalence from 11 countries enrolled in the CORRONA US and CORRONA International registries; patients from the 10 ex-US participating countries were grouped by region (Eastern Europe, Latin America, and India). Unadjusted summary data were presented for demographics and disease characteristics; comparisons for prevalence of CVD risk factors and CVD were age/gender standardized to the age/gender distribution of the US enrolled patients. Overall, 25,987 patients were included in this analysis. Compared to patients from the ex-US regions, US participants had longer disease duration and lower disease activity, yet were more likely to receive a biologic agent. Additionally, CORRONA US participants had the highest body mass index (BMI). Enrolled patients in India had the lowest BMI, were more rarely smokers, and had a low prevalence of hyperlipidemia, hypertension, and prior CVD compared to the US and other ex-US regions. Participants from Eastern Europe had a higher prevalence of hypertension and hyperlipidemia and highest prevalence of all manifestations of CVD. Differences in the prevalence of both CVD and major CVD risk factors were observed across the four regions investigated. Observed differences may be influenced by variations in both non-modifiable/modifiable characteristics of patient populations, and may contribute to heterogeneity on the observed safety of investigational and approved therapies in studies involving RA patients from different origins.

Adherence to Mediterranean Diet Offers an Additive Protection Over the Use of Statin Therapy: Results from the ATTICA Study (2002-2012).

PubMed

Panagiotakos, Demosthenes B; Georgousopoulou, Ekavi N; Georgiopoulos, Georgios A; Pitsavos, Christos; Chrysohoou, Christina; Skoumas, Ioannis; Ntertimani, Maria; Laskaris, Alexandros; Papadimitriou, Lampros; Tousoulis, Dimitrios; Stefanadis, Christodoulos

2015-01-01

The protective role of Mediterranean diet on cardiovascular disease (CVD) risk has been extensively discussed in the literature, but its incremental effect over the use of CVD risk reducing agents (such as hypolipidemic treatment) has rarely been evaluated. The ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89 years). Adherence to Mediterranean diet was assessed using the MedDietScore (range 0-55) and statin use was recorded for all subjects. During 2011-2012, 2583 out of the 3042 baseline participants attended the 10-year follow-up of the ATTICA study (15% lost-to-follow-up) and CVD development was recorded. Adherence to Mediterranean diet (highest tertile) decreased CVD risk by 29.3% (Hazard Ratio (HR): 0.707, 95% Confidence Intervals (CI): 0.537-0.831) as compared with the lowest tertile, independently of statin use. Patients with hyperlipidemia on a statin that adopted unhealthy dietary habits (lowest tertile) had 75% increased CVD risk than normolipidemic subjects with healthy dietary habits (HR=1.75, 95%CI: 1.33-2.29). The addition of Mediterranean diet tertiles in the multivariable model reclassified 46.7% of the participants to CVD risk categories. Adherence to Mediterranean diet confers a considerable reduction in CVD risk, independently of gender, age, family history of CVD, diabetes mellitus, smoking status, hypertension and physical activity status. Therefore, CVD prevention strategies should involve the implementation of a Mediterranean diet in both the general population and patients on a statin.

CVD and obesity in transitional Syria: a perspective from the Middle East.

PubMed

Barakat, Hani; Barakat, Hanniya; Baaj, Mohamad K

2012-01-01

Syria is caught in the middle of a disruptive nutritional transition. Its healthcare system is distracted by challenges and successes in other areas while neglecting to address the onslaught of Syria's cardiovascular disease (CVD) epidemic. Despite the official viewpoint touting improvement in health indicators, current trends jeopardize population health, and several surveys in the Syrian population signal the epidemic spreading far and wide. The goal is to counteract the indifference towards obesity as a threat to Syrian's health, as the country is slowly becoming a leader in CVD mortality globally. PubMed, World Health Organization, and official government websites were searched for primary surveys in Syria related to CVD morbidity, mortality, and risk factors. Inclusion criteria ensured that results maximized relevance while producing comparable studies. Statistical analysis was applied to detect the most common risk factor and significant differences in risk factor prevalence and CVD rates. Obesity remained the prevailing CVD risk factor except in older Syrian men, where smoking and hypertension were more common. CVD mortality was more common in males due to coronary disease, while stroke dominated female mortality. The young workforce is especially impacted, with 50% of CVD mortality occurring before age 65 years and an 81% prevalence of obesity in women over 45 years. Syria can overcome its slow response to the CVD epidemic and curb further deterioration by reducing obesity and, thus, inheritance and clustering of risk factors. This can be achieved via multilayered awareness and intensive parental and familial involvement. Extinguishing the CVD epidemic is readily achievable as demonstrated in other countries.

The Health Effects of US Unemployment Insurance Policy: Does Income from Unemployment Benefits Prevent Cardiovascular Disease?

PubMed Central

Walter, Stefan; Glymour, Maria; Avendano, Mauricio

2014-01-01

Objective Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk. Methods Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50–65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk. Results States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71–0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79–1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models. Conclusion Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD. PMID:25025281

A cross-sectional analysis of cardiovascular disease in the hemophilia population

PubMed Central

Sood, Suman L.; Cheng, Dunlei; Ragni, Margaret; Kessler, Craig M.; Quon, Doris; Shapiro, Amy D.; Key, Nigel S.; Manco-Johnson, Marilyn J.; Cuker, Adam; Kempton, Christine; Wang, Tzu-Fei; Eyster, M. Elaine; Kuriakose, Philip; von Drygalski, Annette; Gill, Joan Cox; Wheeler, Allison; Kouides, Peter; Escobar, Miguel A.; Leissinger, Cindy; Galdzicka, Sarah; Corson, Marshall; Watson, Crystal

2018-01-01

Men with hemophilia were initially thought to be protected from cardiovascular disease (CVD), but it is now clear that atherothrombotic events occur. The primary objective of the CVD in Hemophilia study was to determine the prevalence of CVD and CVD risk factors in US older men with moderate and severe hemophilia and to compare findings with those reported in age-comparable men in the Atherosclerosis Risk in Communities (ARIC) cohort. We hypothesized if lower factor levels are protective from CVD, we would see a difference in CVD rates between more severely affected and unaffected men. Beginning in October 2012, 200 patients with moderate or severe hemophilia A or B (factor VIII or IX level ≤ 5%), aged 54 to 73 years, were enrolled at 19 US hemophilia treatment centers. Data were collected from patient interview and medical records. A fasting blood sample and electrocardiogram (ECG) were obtained and assayed and read centrally. CVD was defined as any angina, any myocardial infarction by ECG or physician diagnosis, any self-reported nonhemorrhagic stroke or transient ischemic attack verified by physicians, or any history of coronary bypass graft surgery or coronary artery angioplasty. CVD risk factors were common in the population. Compared with men of similar age in the ARIC cohort, patients with hemophilia had significantly less CVD (15% vs 25.8%; P < .001). However, on an individual patient level, CVD events occur and efforts to prevent cardiovascular events are warranted. Few men were receiving secondary prophylaxis with low-dose aspirin, despite published opinion that it can be used safely in this patient population. PMID:29895623

Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators.

PubMed

Barber, Claire E H; Esdaile, John M; Martin, Liam O; Faris, Peter; Barnabe, Cheryl; Guo, Selynne; Lopatina, Elena; Marshall, Deborah A

2016-11-01

Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice. Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate. There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively). Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.

A tragic triad: coronary artery disease, nicotine addiction, and depression.

PubMed

Thorndike, Anne N; Rigotti, Nancy A

2009-09-01

Despite the availability of multiple resources for treating smoking in patients with cardiovascular disease (CVD) and the well known risks of continued smoking, a majority of smokers resume smoking after hospitalization for acute CVD. Depression is common among patients with CVD and is associated with failure to follow recommendations to reduce cardiac risk. This review examines the complex relationship between smoking and depression in patients with CVD and current evidence for treating this triad. The prevalence of depressive symptoms among smokers hospitalized with CVD is 22-24%. Smokers with depressive symptoms are more likely to return to smoking after hospital discharge compared with nondepressed smokers. Stronger nicotine withdrawal symptoms among the depressed smokers contribute to relapse. Secondary analyses suggest that bupropion SR and cognitive behavioral therapy may be effective treatments for smokers with depression and CVD. A systematic review of smoking interventions in hospitalized patients found that only intensive counseling interventions with follow-up for more than 1 month were effective for smokers with CVD. Clinicians should consider screening all smokers with CVD for depression, particularly during hospitalization for an acute event. Smokers hospitalized with CVD need intensive counseling lasting more than 1 month after discharge, and smokers with depressive symptoms need even more prolonged treatment for quitting. The addition of pharmacotherapy to long-term counseling has the potential to further improve cessation rates.

Differences in the Cardiometabolic Control in Type 2 Diabetes according to Gender and the Presence of Cardiovascular Disease: Results from the eControl Study

PubMed Central

Mata-Cases, Manel; Vinagre, Irene; Patitucci, Flor; Hermosilla, Eduard; Casellas, Aina; Bolivar, Bonaventura; Mauricio, Dídac

2014-01-01

The objective of this cross-sectional study was to assess differences in the control and treatment of modifiable cardiovascular risk factors (CVRF: HbA1c, blood pressure [BP], LDL-cholesterol, body mass index, and smoking habit) according to gender and the presence of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) in Catalonia, Spain. The study included available data from electronic medical records for a total of 286,791 patients. After controlling for sex, age, diabetes duration, and treatment received, both men and women with prior CVD had worse cardiometabolic control than patients without previous CVD; women with prior CVD had worse overall control of CVRFs than men except for smoking; and women without prior CVD were only better than men at controlling smoking and BP, with no significant differences in glycemic control. Finally, although the proportion of women treated with lipid-lowering medications was similar to (with prior CVD) or even higher (without CVD) than men, LDL-cholesterol levels were remarkably uncontrolled in both women with and women without CVD. The results stress the need to implement measures to better prevent and treat CVRF in the subgroup of diabetic women, specifically with more intensive statin treatment in those with CVD. PMID:25328520

Effects of prediabetes mellitus alone or plus hypertension on subsequent occurrence of cardiovascular disease and diabetes mellitus: longitudinal study.

PubMed

Qiu, Miaoyan; Shen, Weili; Song, Xiaomin; Ju, Liping; Tong, Wenxin; Wang, Haiyan; Zheng, Sheng; Jin, Yan; Wu, Yixin; Wang, Weiqing; Tian, Jingyan

2015-03-01

Whether prediabetes mellitus alone or combined with other disorders means a higher risk for cardiovascular disease (CVD) is still controversial. This study aimed to investigate the association between prediabetes mellitus and CVD and diabetes mellitus and to explore whether prediabetes mellitus alone or combined with other syndromes, such as hypertension, could promote CVD risks significantly. This longitudinal population-based study of 1609 residents from Shanghai in Southern China was conducted between 2002 and 2014. Participants with a history of CVD at baseline were excluded from analysis. Multivariate log-binomial regression models were used to adjust possible coexisting factors. Incidence of CVD during follow-up was 10.1%. After adjusting for age, sex, and other factors, the association between prediabetes mellitus and CVD was not observed. When hypertension was incorporated in stratifying factors, adjusted CVD risk was elevated significantly (odds ratio, 2.41; 95% confidence interval, 1.25-4.64) in prediabetes mellitus and hypertension combined group, and coexistence of diabetes mellitus and hypertension made CVD risk highly significantly increased, reaching 3.43-fold higher than the reference group. Blood glucose level within prediabetic range is significantly associated with elevated risks for diabetes mellitus after multivariable adjustment, but only when it is concurrent with other disorders, such as hypertension, it will significantly increase CVD risk. © 2015 American Heart Association, Inc.

Plasma and serum L-selectin and clinical and subclinical the Multi-Ethnic Study of Atherosclerosis (MESA)cardiovascular disease

PubMed Central

BERARDI, CECILIA; DECKER, PAUL A.; KIRSCH, PHILLIP S.; DE ANDRADE, MARIZA; TSAI, MICHAEL Y.; PANKOW, JAMES S.; SALE, MICHELE M.; SICOTTE, HUGUES; TANG, WEIHONG; HANSON, NAOMI; POLAK, JOSEPH F.; BIELINSKI, SUZETTE J.

2014-01-01

L-selectin has been suggested to play a role in atherosclerosis. Previous studies on cardiovascular disease (CVD) and serum or plasma L-selectin are inconsistent. The association of serum L-selectin (sL-selectin) with carotid intima-media thickness, coronary artery calcium, ankle-brachial index (subclinical CVD) and incident CVD was assessed within 2403 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Regression analysis and the Tobit model were used to study subclinical disease; Cox Proportional Hazards regression for incident CVD. Mean age was 63 ± 10, 47% were males; mean sL-selectin was significantly different across ethnicities. Within each race/ethnicity, sL-selectin was associated with age and sex; among Caucasians and African Americans, it was associated with smoking status and current alcohol use. sL-selectin levels did not predict subclinical or clinical CVD after correction for multiple comparisons. Conditional logistic regression models were used to study plasma L-selectin and CVD within 154 incident CVD cases, occurred in a median follow up of 8.5 years, and 306 age-, sex-, and ethnicity-matched controls. L-selectin levels in plasma were significantly lower than in serum and the overall concordance was low. Plasma levels were not associated with CVD. In conclusion, this large multi-ethnic population, soluble L-selectin levels did not predict clinical or subclinical CVD. PMID:24631064

Relationships between the risk of cardiovascular disease in type 2 diabetes patients and both visit-to-visit variability and time-to-effect differences in blood pressure.

PubMed

Takao, Toshiko; Kimura, Kumiko; Suka, Machi; Yanagisawa, Hiroyuki; Kikuchi, Masatoshi; Kawazu, Shoji; Matsuyama, Yutaka

2015-07-01

To determine whether visit-to-visit blood pressure (BP) variability can predict cardiovascular disease (CVD) incidence in type 2 diabetes patients independently of mean BP, and to analyze the time-to-effect relationship between BP and CVD risk. We retrospectively enrolled 629 type 2 diabetes patients with no history of CVD who first visited our hospital between 1995 and 1996, made at least one hospital visit per year, were followed-up for at least 1 year, and had undergone four or more BP measurements. The patients were followed until June 2012 at the latest. CVD occurred in 66 patients. Variability in systolic or diastolic BP (SBP and DBP, respectively) was a significant predictor of CVD incidence, independent of mean SBP or DBP. CVD incidence was significantly associated with SBP during the preceding 3-5 years, with the highest risk occurring during the preceding 3 years. Visit-to-visit BP variability independently predicts CVD incidence in type 2 diabetes patients. Increased SBP over the preceding 3-5 years indicated a significant CVD risk. To prevent CVD, BP management should focus on stable and well-timed control. In particular, BP stabilization at an early phase and BP control during late phases are important. Copyright © 2015 Elsevier Inc. All rights reserved.

Current Status of Cardiovascular Disease-Related Smartphone Apps Downloadable in China.

PubMed

Xiao, Qian; Lu, Sai; Wang, Yanling; Sun, Liu; Wu, Ying

2017-03-01

Smartphone apps present a great opportunity for the management of cardiovascular disease (CVD) as the adoption of apps becomes increasingly popular in China. Yet, little is known about the status of CVD-related Smartphone apps in the country. The aim of this study was to examine the current status of CVD-related smartphone apps available for download in China. Using CVD-related keywords written either in Chinese or English, the top 6 most popular smartphone app online stores in China were searched in September 2015. The information accountability of the selected apps was assessed with the Silberg scale. The key topic areas identified from the European Guidelines on cardiovascular disease prevention served to determine information coverage of the top 5 downloaded apps. The average Silberg score of 151 apps was 2.87 (out of 9) with most apps not revealing authors' qualifications and information references. There was also a lack of sponsorship disclosure and information update. Moreover, none of the top 5 downloaded apps covered all key areas of CVD management as recommended by the European Guidelines on cardiovascular disease prevention. There was little evidence of health professionals' involvement in the formation of the CVD-related apps. This study identified areas for improvement concerning information accountability and the scope of coverage of CVD-related apps downloadable in China. The findings may guide the future advancement of CVD-related apps and benefit CVD management in China.

Assessment of medium-term cardiovascular disease risk after Japan’s 2011 Fukushima Daiichi nuclear accident: a retrospective analysis

PubMed Central

Nomura, Shuhei; Gilmour, Stuart; Oikawa, Tomoyoshi; Lee, Kiwon; Kiyabu, Grace Y; Shibuya, Kenji

2017-01-01

Objective To assess the medium-term indirect impact of the 2011 Fukushima Daiichi nuclear accident on cardiovascular disease (CVD) risks and to identify whether risk factors for CVD changed after the accident. Participants Residents aged 40 years and over participating in annual public health check-ups from 2009 to 2012, administered by Minamisoma city, located about 10 to 40 km from the Fukushima Daiichi nuclear plant. Methods The sex-specific Framingham CVD risk score was considered as the outcome measure and was compared before (2009–2010) and after the accident (2011–2012). A multivariate regression analysis was employed to evaluate risk factors for CVD. Results Data from 563 individuals (60.2% women) aged 40 to 74 years who participated in the check-ups throughout the study period was analysed. After adjusting for covariates, no statistically significant change was identified in the CVD risk score postaccident in both sexes, which may suggest no obvious medium-term health impact of the Fukushima nuclear accident on CVD risk. The risk factors for CVD and their magnitude and direction (positive/negative) did not change after the accident. Conclusions There was no obvious increase in CVD risks in Minamisoma city, which may indicate successful management of health risks associated with CVD in the study sample. PMID:29275343

Chemical-Vapor-Deposited Diamond Film

NASA Technical Reports Server (NTRS)

Miyoshi, Kazuhisa

1999-01-01

This chapter describes the nature of clean and contaminated diamond surfaces, Chemical-vapor-deposited (CVD) diamond film deposition technology, analytical techniques and the results of research on CVD diamond films, and the general properties of CVD diamond films. Further, it describes the friction and wear properties of CVD diamond films in the atmosphere, in a controlled nitrogen environment, and in an ultra-high-vacuum environment.

Predictors of CVD among breast cancer survivors in an integrated health system | Division of Cancer Prevention

Cancer.gov

PROJECT SUMMARY / ABSTRACT Breast cancer survivors are at high risk of developing and dying from cardiovascular disease (CVD) following breast cancer diagnosis, but subpopulations at increased risk and targets for intervention have not been well- characterized. A growing body of literature links CVD with specific cardiotoxic cancer treatments. CVD risk among breast cancer

Cumulative Lifetime Marijuana Use and Incident Cardiovascular Disease in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

PubMed

Reis, Jared P; Auer, Reto; Bancks, Michael P; Goff, David C; Lewis, Cora E; Pletcher, Mark J; Rana, Jamal S; Shikany, James M; Sidney, Stephen

2017-04-01

To investigate the effects of marijuana in the development of incident cardiovascular and cerebrovascular outcomes. Participants were 5113 adults aged 18 to 30 years at baseline (1985-1986) from the Coronary Artery Risk Development in Young Adults study, who were followed for more than 25 years. We estimated cumulative lifetime exposure to marijuana using repeated assessments collected at examinations every 2 to 5 years. The primary outcome was incident cardiovascular disease (CVD) through 2013. A total of 84% (n = 4286) reported a history of marijuana use. During a median 26.9 years (131 990 person-years), we identified 215 CVD events, including 62 strokes or transient ischemic attacks, 104 cases of coronary heart disease, and 50 CVD deaths. Compared with no marijuana use, cumulative lifetime and recent marijuana use showed no association with incident CVD, stroke or transient ischemic attacks, coronary heart disease, or CVD mortality. Marijuana use was not associated with CVD when stratified by age, gender, race, or family history of CVD. Neither cumulative lifetime nor recent use of marijuana is associated with the incidence of CVD in middle age.

[Ecological Correlates of Cardiovascular Disease Risk in Korean Blue-collar Workers: A Multi-level Study].

PubMed

Hwang, Won Ju; Park, Yunhee

2015-12-01

The purpose of this study was to investigate individual and organizational level of cardiovascular disease (CVD) risk factors associated with CVD risk in Korean blue-collar workers working in small sized companies. Self-report questionnaires and blood sampling for lipid and glucose were collected from 492 workers in 31 small sized companies in Korea. Multilevel modeling was conducted to estimate effects of related factors at the individual and organizational level. Multilevel regression analysis showed that workers in the workplace having a cafeteria had 1.81 times higher CVD risk after adjusting for factors at the individual level (p=.022). The explanatory power of variables related to organizational level variances in CVD risk was 17.1%. The results of this study indicate that differences in the CVD risk were related to organizational factors. It is necessary to consider not only individual factors but also organizational factors when planning a CVD risk reduction program. The factors caused by having cafeteria in the workplace can be reduced by improvement in the CVD-related risk environment, therefore an organizational-level intervention approach should be available to reduce CVD risk of workers in small sized companies in Korea.

25th anniversary article: CVD polymers: a new paradigm for surface modification and device fabrication.

PubMed

Coclite, Anna Maria; Howden, Rachel M; Borrelli, David C; Petruczok, Christy D; Yang, Rong; Yagüe, Jose Luis; Ugur, Asli; Chen, Nan; Lee, Sunghwan; Jo, Won Jun; Liu, Andong; Wang, Xiaoxue; Gleason, Karen K

2013-10-11

Well-adhered, conformal, thin (<100 nm) coatings can easily be obtained by chemical vapor deposition (CVD) for a variety of technological applications. Room temperature modification with functional polymers can be achieved on virtually any substrate: organic, inorganic, rigid, flexible, planar, three-dimensional, dense, or porous. In CVD polymerization, the monomer(s) are delivered to the surface through the vapor phase and then undergo simultaneous polymerization and thin film formation. By eliminating the need to dissolve macromolecules, CVD enables insoluble polymers to be coated and prevents solvent damage to the substrate. CVD film growth proceeds from the substrate up, allowing for interfacial engineering, real-time monitoring, and thickness control. Initiated-CVD shows successful results in terms of rationally designed micro- and nanoengineered materials to control molecular interactions at material surfaces. The success of oxidative-CVD is mainly demonstrated for the deposition of organic conducting and semiconducting polymers. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Childhood obesity and cardiovascular disease: links and prevention strategies

PubMed Central

Nadeau, Kristen J.; Maahs, David M.; Daniels, Stephen R.; Eckel, Robert H.

2015-01-01

The prevalence and severity of pediatric obesity have dramatically increased since the late 1980s, raising concerns about a subsequent increase in cardiovascular outcomes. Strong evidence, particularly from autopsy studies, supports the concept that precursors of adult cardiovascular disease (CVD) begin in childhood, and that pediatric obesity has an important influence on overall CVD risk. Lifestyle patterns also begin early and impact CVD risk. In addition, obesity and other CVD risk factors tend to persist over time. However, whether childhood obesity causes adult CVD directly, or does so by persisting as adult obesity, or both, is less clear. Regardless, sufficient data exist to warrant early implementation of both obesity prevention and treatment in youth and adults. In this Review, we examine the evidence supporting the impact of childhood obesity on adult obesity, surrogate markers of CVD, components of the metabolic syndrome, and the development of CVD. We also evaluate how obesity treatment strategies can improve risk factors and, ultimately, adverse clinical outcomes. PMID:21670745

Nutrition and Cardiovascular Disease: Finding the Perfect Recipe for Cardiovascular Health

PubMed Central

Ravera, Alice; Carubelli, Valentina; Sciatti, Edoardo; Bonadei, Ivano; Gorga, Elio; Cani, Dario; Vizzardi, Enrico; Metra, Marco; Lombardi, Carlo

2016-01-01

The increasing burden of cardiovascular disease (CVD) despite the progress in management entails the need of more effective preventive and curative strategies. As dietary-associated risk is the most important behavioral factor influencing global health, it appears the best target in the challenge against CVD. Although for many years, since the formulation of the cholesterol hypothesis, a nutrient-based approach was attempted for CVD prevention and treatment, in recent years a dietary-based approach resulted more effective in reducing cardiovascular risk worldwide. After the publication of randomized trials on the remarkable effects of the Mediterranean diet and the Dietary Approach to Stop Hypertension (DASH) diet on CVD, new efforts were put on research about the effects of complex dietary interventions on CVD. The purpose of this paper is to review the evidence on dietary interventions in the prevention and disease modification of CVD, focusing on coronary artery disease and heart failure, the main disease responsible for the enormous toll taken by CVD worldwide. PMID:27314382

Emerging Burden of Cardiovascular Diseases in Bangladesh.

PubMed

Al Mamun, Mohammad; Rumana, Nahid; Pervin, Kumkum; Azad, Muhammad Chanchal; Shahana, Nahid; Choudhury, Sohel Reza; Zaman, M Mostafa; Turin, Tanvir Chowdhury

2016-01-01

As a result of an epidemiological transition from communicable to non-communicable diseases for last few decades, cardiovascular diseases (CVD) are being considered as an important cause of mortality and morbidity in many developing countries including Bangladesh. Performing an extensive literature search, we compiled, summarized, and categorized the existing information about CVD mortality and morbidity among different clusters of Bangladeshi population. The present review reports that the burden of CVD in terms of mortality and morbidity is on the rise in Bangladesh. Despite a few non-communicable disease prevention and control programs currently running in Bangladesh, there is an urgent need for well-coordinated national intervention strategies and public health actions to minimize the CVD burden in Bangladesh. As the main challenge for CVD control in a developing country is unavailability of adequate epidemiological data related to various CVD events, the present review attempted to accumulate such data in the current context of Bangladesh. This may be of interest to all stakeholder groups working for CVD prevention and control across the country and globe.

Nutrition and Cardiovascular Disease: Finding the Perfect Recipe for Cardiovascular Health.

PubMed

Ravera, Alice; Carubelli, Valentina; Sciatti, Edoardo; Bonadei, Ivano; Gorga, Elio; Cani, Dario; Vizzardi, Enrico; Metra, Marco; Lombardi, Carlo

2016-06-14

The increasing burden of cardiovascular disease (CVD) despite the progress in management entails the need of more effective preventive and curative strategies. As dietary-associated risk is the most important behavioral factor influencing global health, it appears the best target in the challenge against CVD. Although for many years, since the formulation of the cholesterol hypothesis, a nutrient-based approach was attempted for CVD prevention and treatment, in recent years a dietary-based approach resulted more effective in reducing cardiovascular risk worldwide. After the publication of randomized trials on the remarkable effects of the Mediterranean diet and the Dietary Approach to Stop Hypertension (DASH) diet on CVD, new efforts were put on research about the effects of complex dietary interventions on CVD. The purpose of this paper is to review the evidence on dietary interventions in the prevention and disease modification of CVD, focusing on coronary artery disease and heart failure, the main disease responsible for the enormous toll taken by CVD worldwide.

Is procrastination a vulnerability factor for hypertension and cardiovascular disease? Testing an extension of the procrastination-health model.

PubMed

Sirois, Fuschia M

2015-06-01

Personality is an important epidemiological factor for understanding health outcomes. This study investigated the associations of trait procrastination with hypertension and cardiovascular disease (HT/CVD) and maladaptive coping by testing an extension of the procrastination-health model among individuals with and without HT/CVD. Individuals with self-reported HT/CVD (N = 182) and healthy controls (N = 564), from a community sample, completed an online survey including measures of personality, coping, and health outcomes. Logistic regression analysis controlling for demographic and higher order personality factors found that older age, lower education level and higher procrastination scores were associated with HT/CVD. Moderated mediation analyses with bootstrapping revealed that procrastination was more strongly associated with maladaptive coping behaviours in participants with HT/CVD than the healthy controls, and the indirect effects on stress through maladaptive coping were larger for the HT/CVD sample. Results suggest procrastination is a vulnerability factor for poor adjustment to and management of HT/CVD.

Rheumatoid Arthritis and Cardiovascular Disease: Update on Treatment Issues

PubMed Central

Barbhaiya, Medha; Solomon, Daniel H.

2016-01-01

Purpose of review This review examines thresholds for treatment of traditional cardiovascular disease (CVD) risk factors among RA patients and whether RA-specific treatment modulates cardiovascular risk. Recent findings There are substantial data demonstrating an increased CVD risk among patients with RA. Both traditional CVD risk factors and inflammation contribute to this risk. Recent epidemiologic studies strengthen the case that aggressive immunosuppression with biologic DMARDs, such as TNF antagonists, is associated with a reduced risk of CVD events. However, to data, there are no randomized controlled trials published regarding the management of CVD in RA. Summary Epidemiologic evidence continues to accumulate regarding the relationship between the effects of traditional CVD risk factors and RA-specific treatments on CV outcomes in RA. The field needs randomized controlled trials to better guide management. PMID:23466960

Rationale, design and baseline characteristics of a randomized controlled trial of a web-based computer-tailored physical activity intervention for adults from Quebec City.

PubMed

Boudreau, François; Walthouwer, Michel Jean Louis; de Vries, Hein; Dagenais, Gilles R; Turbide, Ginette; Bourlaud, Anne-Sophie; Moreau, Michel; Côté, José; Poirier, Paul

2015-10-09

The relationship between physical activity and cardiovascular disease (CVD) protection is well documented. Numerous factors (e.g. patient motivation, lack of facilities, physician time constraints) can contribute to poor PA adherence. Web-based computer-tailored interventions offer an innovative way to provide tailored feedback and to empower adults to engage in regular moderate- to vigorous-intensity PA. To describe the rationale, design and content of a web-based computer-tailored PA intervention for Canadian adults enrolled in a randomized controlled trial (RCT). 244 men and women aged between 35 and 70 years, without CVD or physical disability, not participating in regular moderate- to vigorous-intensity PA, and familiar with and having access to a computer at home, were recruited from the Quebec City Prospective Urban and Rural Epidemiological (PURE) study centre. Participants were randomized into two study arms: 1) an experimental group receiving the intervention and 2) a waiting list control group. The fully automated web-based computer-tailored PA intervention consists of seven 10- to 15-min sessions over an 8-week period. The theoretical underpinning of the intervention is based on the I-Change Model. The aim of the intervention was to reach a total of 150 min per week of moderate- to vigorous-intensity aerobic PA. This study will provide useful information before engaging in a large RCT to assess the long-term participation and maintenance of PA, the potential impact of regular PA on CVD risk factors and the cost-effectiveness of a web-based computer-tailored intervention. ISRCTN36353353 registered on 24/07/2014.

Numerical Simulations of a 96-rod Polysilicon CVD Reactor

NASA Astrophysics Data System (ADS)

Guoqiang, Tang; Cong, Chen; Yifang, Cai; Bing, Zong; Yanguo, Cai; Tihu, Wang

2018-05-01

With the rapid development of the photovoltaic industry, pressurized Siemens belljar-type polysilicon CVD reactors have been enlarged from 24 rods to 96 rods in less than 10 years aimed at much greater single-reactor productivity. A CFD model of an industry-scale 96-rod CVD reactor was established to study the internal temperature distribution and the flow field of the reactor. Numerical simulations were carried out and compared with actual growth results from a real CVD reactor. Factors affecting polysilicon depositions such as inlet gas injections, flow field, and temperature distribution in the CVD reactor are studied.

Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations

PubMed Central

2013-01-01

Background All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. Methods We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Results Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score. Conclusions We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa. PMID:23880010

Excessive and premature new-onset cardiovascular disease among adults with bipolar disorder in the US NESARC cohort.

PubMed

Goldstein, Benjamin I; Schaffer, Ayal; Wang, Shuai; Blanco, Carlos

2015-02-01

Cross-sectional studies demonstrate increased prevalence of cardiovascular disease (CVD) among adults with bipolar disorder. However, there is a paucity of prospective data regarding new-onset CVD among adults with bipolar disorder. Analyses compared the 3-year incidence of CVD (via participant-reported physician diagnoses) among participants with DSM-IV diagnoses of bipolar I disorder (n = 1,047), bipolar II disorder (n = 392), major depressive disorder (MDD; n = 4,396), or controls (n = 26,266), who completed Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Analyses also compared the age of participants with new-onset CVD across groups. Multivariable analyses controlled for age, sex, race, cigarette smoking, hypertension, obesity, and alcohol and drug use disorders. The 3-year incidence of CVD among adults with bipolar I disorder, bipolar II disorder, MDD, and among controls was 6.30%, 5.74%, 3.98%, and 3.70%, respectively. The covariate-adjusted incidence of CVD was significantly greater among participants with bipolar I and II disorders versus controls and versus participants with MDD. Adjusted odds ratios (95% CI) were 2.58 (1.84-3.61; P < .0001) for bipolar I disorder vs controls; 2.76 (1.60-4.74; P = .0004) for bipolar II disorder vs controls; 2.11 (1.46-3.04; P = .0001) for bipolar I disorder vs MDD; 2.25 (1.26-4.01; P = .007) for bipolar II disorder vs MDD; and 1.22 (0.99-1.51; P = .06) for MDD vs controls. Bipolar I disorder participants with new-onset CVD were 10.70 ± 2.77 years younger than MDD participants with new-onset CVD and 16.78 ± 2.51 years younger than controls. Bipolar II disorder participants with new-onset CVD were 7.92 ± 3.27 years younger than MDD participants with new-onset CVD and 13.99 ± 2.79 years younger than controls. Adults with bipolar disorder are at significantly and meaningfully increased risk to develop CVD over the course of 3 years, even as compared to adults with MDD, and despite controlling for multiple potential confounds. Combined with very early age of CVD onset, this finding underscores the need for early and assertive CVD prevention strategies for people with bipolar disorder. © Copyright 2015 Physicians Postgraduate Press, Inc.

Cardiovascular risk prediction in HIV-infected patients: comparing the Framingham, atherosclerotic cardiovascular disease risk score (ASCVD), Systematic Coronary Risk Evaluation for the Netherlands (SCORE-NL) and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk prediction models.

PubMed

Krikke, M; Hoogeveen, R C; Hoepelman, A I M; Visseren, F L J; Arends, J E

2016-04-01

The aim of the study was to compare the predictions of five popular cardiovascular disease (CVD) risk prediction models, namely the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) model, the Framingham Heart Study (FHS) coronary heart disease (FHS-CHD) and general CVD (FHS-CVD) models, the American Heart Association (AHA) atherosclerotic cardiovascular disease risk score (ASCVD) model and the Systematic Coronary Risk Evaluation for the Netherlands (SCORE-NL) model. A cross-sectional design was used to compare the cumulative CVD risk predictions of the models. Furthermore, the predictions of the general CVD models were compared with those of the HIV-specific D:A:D model using three categories (< 10%, 10-20% and > 20%) to categorize the risk and to determine the degree to which patients were categorized similarly or in a higher/lower category. A total of 997 HIV-infected patients were included in the study: 81% were male and they had a median age of 46 [interquartile range (IQR) 40-52] years, a known duration of HIV infection of 6.8 (IQR 3.7-10.9) years, and a median time on ART of 6.4 (IQR 3.0-11.5) years. The D:A:D, ASCVD and SCORE-NL models gave a lower cumulative CVD risk, compared with that of the FHS-CVD and FHS-CHD models. Comparing the general CVD models with the D:A:D model, the FHS-CVD and FHS-CHD models only classified 65% and 79% of patients, respectively, in the same category as did the D:A:D model. However, for the ASCVD and SCORE-NL models, this percentage was 89% and 87%, respectively. Furthermore, FHS-CVD and FHS-CHD attributed a higher CVD risk to 33% and 16% of patients, respectively, while this percentage was < 6% for ASCVD and SCORE-NL. When using FHS-CVD and FHS-CHD, a higher overall CVD risk was attributed to the HIV-infected patients than when using the D:A:D, ASCVD and SCORE-NL models. This could have consequences regarding overtreatment, drug-related adverse events and drug-drug interactions. © 2015 British HIV Association.

Fabricating Large-Area Sheets of Single-Layer Graphene by CVD

NASA Technical Reports Server (NTRS)

Bronikowski, Michael; Manohara, Harish

2008-01-01

This innovation consists of a set of methodologies for preparing large area (greater than 1 cm(exp 2)) domains of single-atomic-layer graphite, also called graphene, in single (two-dimensional) crystal form. To fabricate a single graphene layer using chemical vapor deposition (CVD), the process begins with an atomically flat surface of an appropriate substrate and an appropriate precursor molecule containing carbon atoms attached to substituent atoms or groups. These molecules will be brought into contact with the substrate surface by being flowed over, or sprayed onto, the substrate, under CVD conditions of low pressure and elevated temperature. Upon contact with the surface, the precursor molecules will decompose. The substituent groups detach from the carbon atoms and form gas-phase species, leaving the unfunctionalized carbon atoms attached to the substrate surface. These carbon atoms will diffuse upon this surface and encounter and bond to other carbon atoms. If conditions are chosen carefully, the surface carbon atoms will arrange to form the lowest energy single-layer structure available, which is the graphene lattice that is sought. Another method for creating the graphene lattice includes metal-catalyzed CVD, in which the decomposition of the precursor molecules is initiated by the catalytic action of a catalytic metal upon the substrate surface. Another type of metal-catalyzed CVD has the entire substrate composed of catalytic metal, or other material, either as a bulk crystal or as a think layer of catalyst deposited upon another surface. In this case, the precursor molecules decompose directly upon contact with the substrate, releasing their atoms and forming the graphene sheet. Atomic layer deposition (ALD) can also be used. In this method, a substrate surface at low temperature is covered with exactly one monolayer of precursor molecules (which may be of more than one type). This is heated up so that the precursor molecules decompose and form one monolayer of the target material.

Association between history of psychosis and cardiovascular disease in bipolar disorder.

PubMed

Prieto, Miguel L; McElroy, Susan L; Hayes, Sharonne N; Sutor, Bruce; Kung, Simon; Bobo, William V; Fuentes, Manuel E; Cuellar-Barboza, Alfredo B; Crow, Scott; Ösby, Urban; Chauhan, Mohit; Westman, Jeanette; Geske, Jennifer R; Colby, Colin L; Ryu, Euijung; Biernacka, Joanna M; Frye, Mark A

2015-08-01

To determine whether clinical features of bipolar disorder, such as history of psychosis, and cardiovascular disease (CVD) risk factors contribute to a higher risk of CVD among patients with bipolar disorder. This cross-sectional study included a sample of 988 patients with bipolar I or bipolar II disorder or schizoaffective bipolar type confirmed by the Structured Clinical Interview for DSM-IV-TR disorders (SCID). Medical comorbidity burden was quantified utilizing the Cumulative Illness Severity Rating Scale (CIRS). This 13-item organ-based scale includes cardiac disease severity quantification. Confirmed by medical record review, patients who scored 1 (current mild or past significant problem) or higher in the cardiac item were compared by logistic regression to patients who scored 0 (no impairment), adjusting for CVD risk factors that were selected using a backwards stepwise approach or were obtained from the literature. In a multivariate model, age [odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.66-5.54, p < 0.0001], hypertension (OR = 2.43, 95% CI: 1.69-3.55, p < 0.0001), and history of psychosis (OR = 1.48, 95% CI: 1.03-2.13, p = 0.03) were associated with CVD. When CVD risk factors from the literature were added to the analysis, age (OR = 3.19, 95% CI: 1.67-6.10, p = 0.0005) and hypertension (OR = 2.46, 95% CI: 1.61-3.76, p < 0.01) remained significant, with psychosis being at the trend level (OR = 1.43, 95% CI: 0.96-2.13, p = 0.08). The phenotype of psychotic bipolar disorder may reflect higher illness severity with associated cardiac comorbidity. Further studies are encouraged to clarify the effect of the disease burden (i.e., depression), lifestyle, and treatment interventions (i.e., atypical antipsychotics) on this risk association. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Preventing cardiovascular disease in primary care: role of a national risk factor management program.

PubMed

McGrath, Emer R; Glynn, Liam G; Murphy, Andrew W; O Conghaile, Aengus; Canavan, Michelle; Reid, Claire; Moloney, Brian; O'Donnell, Martin J

2012-04-01

Heartwatch, a structured risk factor modification program for secondary prevention of cardiovascular (CV) disease (CVD) in primary care, is associated with improvements in CV risk factors in participating patients. However, it is not known whether Heartwatch translates into reductions in clinically important CV events. The aim of the study was to determine the association between participation in Heartwatch and future risk of CV events in patients with CVD. The study consisted of a prospective cohort of 1,609 patients with CVD in primary care practices. Of these, 97.5% had data available on Heartwatch participation status, of whom 15.2% were Heartwatch participants. Cox proportional hazards models were used to determine the association between Heartwatch participation and risk of the CV composite (CV death, nonfatal myocardial infarction, heart failure, and nonfatal stroke). All-cause mortality and CV mortality were secondary outcome measures. During follow-up, the CV composite occurred in 208 patients (13.6%). Of Heartwatch participants, 8.4% experienced the CV composite compared with 14.5% of nonparticipants (P = .003). Participation in Heartwatch was associated with a significantly reduced risk of the CV composite (hazard ratio [HR] 0.52, 95% CI, 0.31-0.87), CV mortality (HR 0.31, 95% CI, 0.11-0.89), and all-cause mortality (HR 0.32, 95% CI, 0.15-0.68). Heartwatch participation was also associated with greater reductions in mean systolic blood pressure (P = .047), mean diastolic blood pressure (P < .001), and greater use of secondary preventative therapies for CVD, such as lipid-lowering agents (P < .001), β-blockers (P < .001), and angiotensin-converting enzyme inhibitors (P < .001). Heartwatch is associated with a reduced risk of major vascular events and improved risk factor modification, supporting its potential as a nationwide program for secondary prevention of CVD. Copyright © 2012 Mosby, Inc. All rights reserved.

Relationship between cardiovascular disease knowledge and race/ethnicity, education, and weight status.

PubMed

Giardina, Elsa-Grace V; Mull, Lorraine; Sciacca, Robert R; Akabas, Sharon; Flink, Laura E; Moise, Nathalie; Paul, Tracy K; Dumas, Nicole E; Bier, Michael L; Mattina, Deirdre

2012-01-01

Inadequate cardiovascular disease (CVD) knowledge has been cited to account for the imperfect decline in CVD among women over the last 2 decades. Due to concerns that at-risk women might not know the leading cause of death or symptoms of a heart attack, our goal was to assess the relationship between CVD knowledge race/ethnicity, education, and body mass index (BMI). Using a structured questionnaire, CVD knowledge, socio-demographics, risk factors, and BMI were evaluated in 681 women. Participants included Hispanic, 42.1% (n = 287); non-Hispanic white (NHW), 40.2% (n = 274); non-Hispanic black (NHB), 7.3% (n = 50); and Asian/Pacific Islander (A/PI), 8.7% (n = 59). Average BMI was 26.3 ± 6.1 kg/m(2) . Hypertension was more frequent among overweight (45%) and obese (62%) than normal weight (24%) (P < 0.0001), elevated total cholesterol was more frequent among overweight (41%) and obese (44%) than normal weight (30%) (P < 0.05 and P < 0.01, respectively), and diabetes was more frequent among obese (25%) than normal weight (5%) (P < 0.0001). Knowledge of the leading cause of death and symptoms of a heart attack varied by race/ethnicity and education (P < 0.001) but not BMI. Concerning the leading cause of death among women in the United States, 87.6% (240/274) NHW answered correctly compared to 64% (32/50) NHB (P < 0.05), 28.3% (80/283) Hispanic (P < 0.0001), and 55.9% (33/59) A/PI (P < 0.001). Among participants with ≤12 years of education, 21.2% knew the leading cause of death and 49.3% knew heart attack symptoms vs 75.7% and 75.5%, respectively, for >12 years (both P < 0.0001). Effective prevention strategies for at-risk populations need to escalate CVD knowledge and awareness among the undereducated and minority women. © 2011 Wiley Periodicals, Inc.

Increased Carotid Intima-Media Thickness and Reduced Distensibility in Human Class III Obesity: Independent and Differential Influences of Adiposity and Blood Pressure on the Vasculature

PubMed Central

Moore, Xiao L.; Michell, Danielle; Lee, Sabrina; Skilton, Michael R.; Nair, Rajesh; Dixon, John B.; Dart, Anthony M.; Chin-Dusting, Jaye

2013-01-01

Carotid intima-media-thickness (cIMT) and carotid distensibility (distensibility), structural and functional properties of carotid arteries respectively, are early markers, as well as strong predictors of cardiovascular disease (CVD). The characteristic of these two parameters in individuals with BMI>40.0 kg/m2 (Class III obesity), however, are largely unknown. The present study was designed to document cIMT and distensibility in this population and to relate these to other factors with established association with CVD in obesity. The study included 96 subjects (65 with BMI>40.0 kg/m2 and 31, age- and gender-matched, with BMI of 18.5 to 30.0 kg/m2). cIMT and distensibility were measured by non-invasive high resolution ultrasonography, circulatory CD133+/KDR+ angiogenic cells and endothelial microparticles (EMP) by flow cytometry, and plasma levels of adipokines, growth factors and cytokines by Luminex immunoassay kits. The study results demonstrated increased cIMT (0.62±0.11 mm vs. 0.54±0.08 mm, P = 0.0002) and reduced distensibility (22.52±10.79 10−3kpa−1 vs. 29.91±12.37 10−3kpa−1, P<0.05) in individuals with BMI>40.0 kg/m2. Both cIMT and distensibility were significantly associated with traditional CVD risk factors, adiposity/adipokines and inflammatory markers but had no association with circulating angiogenic cells. We also demonstrated, for the first time, elevated plasma EMP levels in individuals with BMI>40.0 kg/m2. In conclusion, cIMT is increased and distensibility reduced in Class III obesity with the changes predominantly related to conventional CVD risk factors present in this condition, demonstrating that both cIMT and distensibility remain as CVD markers in Class III obesity. PMID:23342053

Racial discrimination & cardiovascular disease risk: my body my story study of 1005 US-born black and white community health center participants (US).

PubMed

Krieger, Nancy; Waterman, Pamela D; Kosheleva, Anna; Chen, Jarvis T; Smith, Kevin W; Carney, Dana R; Bennett, Gary G; Williams, David R; Thornhill, Gisele; Freeman, Elmer R

2013-01-01

To date, limited and inconsistent evidence exists regarding racial discrimination and risk of cardiovascular disease (CVD). Cross-sectional observational study of 1005 US-born non-Hispanic black (n = 504) and white (n = 501) participants age 35-64 randomly selected from community health centers in Boston, MA (2008-2010; 82.4% response rate), using 3 racial discrimination measures: explicit self-report; implicit association test (IAT, a time reaction test for self and group as target vs. perpetrator of discrimination); and structural (Jim Crow status of state of birth, i.e. legal racial discrimination prior 1964). Black and white participants both had adverse cardiovascular and socioeconomic profiles, with black participants most highly exposed to racial discrimination. Positive crude associations among black participants occurred for Jim Crow birthplace and hypertension (odds ratio (OR) 1.92, 95% confidence interval (CI) 1.28, 2.89) and for explicit self-report and the Framingham 10 year CVD risk score (beta = 0.04; 95% CI 0.01, 0.07); among white participants, only negative crude associations existed (for IAT for self, for lower systolic blood pressure (SBP; beta = -4.86; 95% CI -9.08, -0.64) and lower Framingham CVD score (beta = -0.36, 95% CI -0.63, -0.08)). All of these associations were attenuated and all but the white IAT-Framingham risk score association were rendered null in analyses that controlled for lifetime socioeconomic position and additional covariates. Controlling for racial discrimination, socioeconomic position, and other covariates did not attenuate the crude black excess risk for SBP and hypertension and left unaffected the null excess risk for the Framingham CVD score. Despite worse exposures among the black participants, racial discrimination and socioeconomic position were not associated, in multivariable analyses, with risk of CVD. We interpret results in relation to constrained variability of exposures and outcomes and discuss implications for valid research on social determinants of health.

Pharmacogenomic Challenges in Cardiovascular Diseases: Examples of Drugs and Considerations for Future Integration in Clinical Practice.

PubMed

Chatelin, Jerome; Stathopoulou, Maria G; Arguinano, Alex-Ander A; Xie, Ting; Visvikis-Siest, Sophie

2017-01-01

Even if cardiovascular disease (CVD) drugs are supported by high level proofs, the results of CVD treatment present great disparities: there are still patients dying with supposed optimal treatment, patients facing adverse events and CVD remains the primary cause of death in the world. Pharmacogenomics is the basis of personalisation of the treatment able to allow higher medication success rates. In this review, we will present detailed examples of CVD drugs to highlight the complexity of this challenging field and we will discuss novel concepts that should be considered for a fastest integration of pharmacogenomics in clinical practice of CVD. Areas Covered: The complexity of pharmacogenetics and pharmacogenomics of CVD drugs are presented though examples of medications such as statins, with a focus on their effectiveness and adverse effects. Expert Opinion: The application of personalised medicine in the CVD medical practice requires the study of human genome with regard to drugs pharmacokinetics, pharmacodynamics, interactions and tolerance profile. The existing state -of-the-art of CVD drugs gives hopes for a future revolution in the drug development that will maximise cardiovascular patients benefit while decreasing their risks for adverse effects. Article Highlights Box: • Coronary heart disease (CHD) remains the first cause of death worldwide. • Cardiovascular treatment has a significant percentage of insufficient efficacy, poor tolerance and compliance. • Predicting the response to therapy while diminishing the side effects is the basis of personalised medicine; pharmacogenomics is leading towards this direction. • The response to CVD therapy and side effects are in the heart of CVD pharmacogenomics and significant progress has been noted. • The application of pharmacogenomics in the CVD medical practice is facing many methodological, technical, ethical, behavioral and financial issues, while cost-effectiveness is the main prerequisite. • The consideration of gene × gene × environment interactions and the inclusion of "omics" data in pharmacogenomic studies of CVD drugs will facilitate the generation of reliable results and will promote tailored treatments and new strategies of drug research and development. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Glycated hemoglobin measurement and prediction of cardiovascular disease.

PubMed

Di Angelantonio, Emanuele; Gao, Pei; Khan, Hassan; Butterworth, Adam S; Wormser, David; Kaptoge, Stephen; Kondapally Seshasai, Sreenivasa Rao; Thompson, Alex; Sarwar, Nadeem; Willeit, Peter; Ridker, Paul M; Barr, Elizabeth L M; Khaw, Kay-Tee; Psaty, Bruce M; Brenner, Hermann; Balkau, Beverley; Dekker, Jacqueline M; Lawlor, Debbie A; Daimon, Makoto; Willeit, Johann; Njølstad, Inger; Nissinen, Aulikki; Brunner, Eric J; Kuller, Lewis H; Price, Jackie F; Sundström, Johan; Knuiman, Matthew W; Feskens, Edith J M; Verschuren, W M M; Wald, Nicholas; Bakker, Stephan J L; Whincup, Peter H; Ford, Ian; Goldbourt, Uri; Gómez-de-la-Cámara, Agustín; Gallacher, John; Simons, Leon A; Rosengren, Annika; Sutherland, Susan E; Björkelund, Cecilia; Blazer, Dan G; Wassertheil-Smoller, Sylvia; Onat, Altan; Marín Ibañez, Alejandro; Casiglia, Edoardo; Jukema, J Wouter; Simpson, Lara M; Giampaoli, Simona; Nordestgaard, Børge G; Selmer, Randi; Wennberg, Patrik; Kauhanen, Jussi; Salonen, Jukka T; Dankner, Rachel; Barrett-Connor, Elizabeth; Kavousi, Maryam; Gudnason, Vilmundur; Evans, Denis; Wallace, Robert B; Cushman, Mary; D'Agostino, Ralph B; Umans, Jason G; Kiyohara, Yutaka; Nakagawa, Hidaeki; Sato, Shinichi; Gillum, Richard F; Folsom, Aaron R; van der Schouw, Yvonne T; Moons, Karel G; Griffin, Simon J; Sattar, Naveed; Wareham, Nicholas J; Selvin, Elizabeth; Thompson, Simon G; Danesh, John

2014-03-26

The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain. To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk. Analysis of individual-participant data available from 73 prospective studies involving 294,998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories of low (<5%), intermediate (5% to <7.5%), and high (≥ 7.5%) risk. During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20,840 incident fatal and nonfatal CVD outcomes (13,237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional cardiovascular risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification improvement of 0.42 (-0.63 to 1.48) for the categories of predicted 10-year CVD risk. The improvement provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated improvements for measurement of fasting, random, or postload plasma glucose levels. In a study of individuals without known CVD or diabetes, additional assessment of HbA1c values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk.

Prediction of Cardiovascular Disease by the Framingham-REGICOR Equation in the High-Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata.

PubMed

Amor, Antonio J; Serra-Mir, Mercè; Martínez-González, Miguel A; Corella, Dolores; Salas-Salvadó, Jordi; Fitó, Montserrat; Estruch, Ramón; Serra-Majem, Lluis; Arós, Fernando; Babio, Nancy; Ros, Emilio; Ortega, Emilio

2017-03-13

The usefulness of cardiovascular disease (CVD) predictive equations in different populations is debatable. We assessed the efficacy of the Framingham-REGICOR scale, validated for the Spanish population, to identify future CVD in participants, who were predefined as being at high-risk in the PREvención con DIeta MEDiterránea (PREDIMED) study-a nutrition-intervention primary prevention trial-and the impact of adherence to the Mediterranean diet on CVD across risk categories. In a post hoc analysis, we assessed the CVD predictive value of baseline estimated risk in 5966 PREDIMED participants (aged 55-74 years, 57% women; 48% with type 2 diabetes mellitus). Major CVD events, the primary PREDIMED end point, were an aggregate of myocardial infarction, stroke, and cardiovascular death. Multivariate-adjusted Cox regression was used to calculate hazard ratios for major CVD events and effect modification from the Mediterranean diet intervention across risk strata (low, moderate, high, very high). The Framingham-REGICOR classification of PREDIMED participants was 25.1% low risk, 44.5% moderate risk, and 30.4% high or very high risk. During 6-year follow-up, 188 major CVD events occurred. Hazard ratios for major CVD events increased in parallel with estimated risk (2.68, 4.24, and 6.60 for moderate, high, and very high risk), particularly in men (7.60, 13.16, and 15.85, respectively, versus 2.16, 2.28, and 3.51, respectively, in women). Yet among those with low or moderate risk, 32.2% and 74.3% of major CVD events occurred in men and women, respectively. Mediterranean diet adherence was associated with CVD risk reduction regardless of risk strata ( P >0.4 for interaction). Incident CVD increased in parallel with estimated risk in the PREDIMED cohort, but most events occurred in non-high-risk categories, particularly in women. Until predictive tools are improved, promotion of the Mediterranean diet might be useful to reduce CVD independent of baseline risk. URL: http://www.Controlled-trials.com. Unique identifier: ISRCTN35739639. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Elevated lipoprotein(a) levels predict cardiovascular disease in type 2 diabetes mellitus: a 10-year prospective cohort study.

PubMed

Lim, Tae-Seok; Yun, Jae-Seung; Cha, Seon-Ah; Song, Ki-Ho; Yoo, Ki-Dong; Ahn, Yu-Bae; Park, Yong-Moon; Ko, Seung-Hyun

2016-11-01

Elevated lipoprotein(a) (Lp[a]) level is known to be a risk factor for cardiovascular disease (CVD). However, the data that has been reported on the association between the Lp(a) level and CVD in type 2 diabetes has been limited and incoherent. The aim of this study was to investigate the relationship between the Lp(a) concentration and new onset CVD in type 2 diabetes. From March 2003 to December 2004, patients with type 2 diabetes without a prior history of CVD were consecutively enrolled. CVD was defined as the occurrence of coronary artery disease or ischemic stroke. Cox proportional hazards models were used to identify the associations between the Lp(a) and CVD after adjusting for confounding variables. Of the 1,183 patients who were enrolled, 833 participants were evaluated with a median follow-up time of 11.1 years. A total of 202 participants were diagnosed with CVD (24.2%). The median Lp(a) level for 1st and 4th quartile group was 5.4 (3.5 to 7.1) and 55.7 mg/dL (43.1 to 75.3). Compared with patients without CVD, those with CVD were older, had a longer duration of diabetes and hypertension, and used more insulin and angiotensin converting enzyme inhibitors/angiotensin receptor blockers at baseline. A Cox hazard regression analysis revealed that the development of CVD was significantly associated with serum Lp(a) level (hazard ratio, 1.92; 95% confidence interval [CI], 1.26 to 2.92; p < 0.001, comparing the 4th vs. 1st quartile of Lp[a]). Elevated Lp(a) level was an independent predictable risk factor for CVD in type 2 diabetes. Other cardiovascular risk factors should be treated more intensively in type 2 diabetic patients with high Lp(a) levels.

Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study

PubMed Central

Goh, Louise G H; Dhaliwal, Satvinder S; Welborn, Timothy A; Lee, Andy H; Della, Phillip R

2014-01-01

Objectives It is important to ascertain which anthropometric measurements of obesity, general or central, are better predictors of cardiovascular disease (CVD) risk in women. 10-year CVD risk was calculated from the Framingham risk score model, SCORE risk chart for high-risk regions, general CVD and simplified general CVD risk score models. Increase in CVD risk associated with 1 SD increment in each anthropometric measurement above the mean was calculated, and the diagnostic utility of obesity measures in identifying participants with increased likelihood of being above the treatment threshold was assessed. Design Cross-sectional data from the National Heart Foundation Risk Factor Prevalence Study. Setting Population-based survey in Australia. Participants 4487 women aged 20–69 years without heart disease, diabetes or stroke. Outcome measures Anthropometric obesity measures that demonstrated the greatest increase in CVD risk as a result of incremental change, 1 SD above the mean, and obesity measures that had the greatest diagnostic utility in identifying participants above the respective treatment thresholds of various risk score models. Results Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio had larger effects on increased CVD risk compared with body mass index (BMI). These central obesity measures also had higher sensitivity and specificity in identifying women above and below the 20% treatment threshold than BMI. Central obesity measures also recorded better correlations with CVD risk compared with general obesity measures. WC and WHR were found to be significant and independent predictors of CVD risk, as indicated by the high area under the receiver operating characteristic curves (>0.76), after controlling for BMI in the simplified general CVD risk score model. Conclusions Central obesity measures are better predictors of CVD risk compared with general obesity measures in women. It is equally important to maintain a healthy weight and to prevent central obesity concurrently. PMID:24503301

Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study.

PubMed

Goh, Louise G H; Dhaliwal, Satvinder S; Welborn, Timothy A; Lee, Andy H; Della, Phillip R

2014-02-06

It is important to ascertain which anthropometric measurements of obesity, general or central, are better predictors of cardiovascular disease (CVD) risk in women. 10-year CVD risk was calculated from the Framingham risk score model, SCORE risk chart for high-risk regions, general CVD and simplified general CVD risk score models. Increase in CVD risk associated with 1 SD increment in each anthropometric measurement above the mean was calculated, and the diagnostic utility of obesity measures in identifying participants with increased likelihood of being above the treatment threshold was assessed. Cross-sectional data from the National Heart Foundation Risk Factor Prevalence Study. Population-based survey in Australia. 4487 women aged 20-69 years without heart disease, diabetes or stroke. Anthropometric obesity measures that demonstrated the greatest increase in CVD risk as a result of incremental change, 1 SD above the mean, and obesity measures that had the greatest diagnostic utility in identifying participants above the respective treatment thresholds of various risk score models. Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio had larger effects on increased CVD risk compared with body mass index (BMI). These central obesity measures also had higher sensitivity and specificity in identifying women above and below the 20% treatment threshold than BMI. Central obesity measures also recorded better correlations with CVD risk compared with general obesity measures. WC and WHR were found to be significant and independent predictors of CVD risk, as indicated by the high area under the receiver operating characteristic curves (>0.76), after controlling for BMI in the simplified general CVD risk score model. Central obesity measures are better predictors of CVD risk compared with general obesity measures in women. It is equally important to maintain a healthy weight and to prevent central obesity concurrently.

Changes in erectile dysfunction over time in relation to Framingham cardiovascular risk in the Boston Area Community Health (BACH) Survey.

PubMed

Fang, Shona C; Rosen, Raymond C; Vita, Joseph A; Ganz, Peter; Kupelian, Varant

2015-01-01

Erectile dysfunction (ED) is associated with cardiovascular disease (CVD); however, the association between change in ED status over time and future underlying CVD risk is unclear. The aim of this study was to investigate the association between change in ED status and Framingham CVD risk, as well change in Framingham risk. We studied 965 men free of CVD in the Boston Area Community Health (BACH) Survey, a longitudinal cohort study with three assessments. ED was assessed with the five-item International Index of Erectile Function at BACH I (2002-2005) and BACH II (2007-2010) and classified as no ED/transient ED/persistent ED. CVD risk was assessed with 10-year Framingham CVD risk algorithm at BACH I and BACH III (2010-2012). Linear regression models controlled for baseline age, socio-demographic and lifestyle factors, as well as baseline Framingham risk. Models were also stratified by age (≥/< 50 years). Framingham CVD risk and change in Framingham CVD risk were the main outcome measures. Transient and persistent ED was significantly associated with increased Framingham risk and change in risk over time in univariate and age-adjusted models. In younger men, persistent ED was associated with a Framingham risk that was 1.58 percentage points higher (95% confidence interval [CI]: 0.11, 3.06) and in older men, a Framingham risk that was 2.54 percentage points higher (95% CI: -1.5, 6.59), compared with those without ED. Change in Framingham risk over time was also associated with transient and persistent ED in men <50 years, but not in older men. Data suggest that even after taking into account other CVD risk factors, transient and persistent ED is associated with Framingham CVD risk and a greater increase in Framingham risk over time, particularly in younger men. Findings further support clinical assessment of CVD risk in men presenting with ED, especially those under 50 years. © 2014 International Society for Sexual Medicine.

Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association.

PubMed

Sacks, Frank M; Lichtenstein, Alice H; Wu, Jason H Y; Appel, Lawrence J; Creager, Mark A; Kris-Etherton, Penny M; Miller, Michael; Rimm, Eric B; Rudel, Lawrence L; Robinson, Jennifer G; Stone, Neil J; Van Horn, Linda V

2017-07-18

Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans. © 2017 American Heart Association, Inc.

Depression and Anxiety Screens as Predictors of 8-Year Incidence of Myocardial Infarction and Stroke in Primary Care Patients.

PubMed

Stewart, Jesse C; Hawkins, Misty A W; Khambaty, Tasneem; Perkins, Anthony J; Callahan, Christopher M

2016-06-01

Because depression and anxiety are typically studied in isolation, our purpose was to examine the relative importance of these overlapping emotional factors in predicting incident cardiovascular disease (CVD). We examined depression and anxiety screens, and their individual items, as predictors of incident hard CVD events, myocardial infarction, and stroke for 8 years in a diverse sample of 2041 older primary care patients initially free of CVD. At baseline, participants completed self-report depression and anxiety screens. Data regarding CVD events were obtained from an electronic medical record system and the Centers for Medicare and Medicaid Services analytic files. During follow-up, 683 (33%) experienced a CVD event. Cox proportional hazards models-adjusted for demographic and CVD risk factors-revealed that a positive anxiety screen, but not a positive depression screen, was associated with an increased risk of a hard CVD event in separate models (Years 0-3: anxiety hazard ratio [HR] = 1.54, 95% confidence interval [CI] = 1.21-1.96, p < .001; Years 3+: anxiety HR = 0.99, CI = 0.81-1.21), p = .93; depression HR = 1.10, CI = 0.88-1.36, p = .41), as well as when entered into the same model (Years 0-3: anxiety HR = 1.53, CI = 1.20-1.95, p < .001; Years 3+: anxiety HR = 0.99, CI = 0.80-1.21, p = .99; depression HR = 1.03, CI = 0.82-1.29, p = .82). Analyses examining individual items and secondary outcomes showed that the anxiety-CVD association was largely driven by the feeling anxious item and the myocardial infarction outcome. Anxiety, especially feeling anxious, is a unique risk factor for CVD events in older adults, independent of conventional risk factors and depression. Anxiety deserves increased attention as a potential factor relevant to CVD risk stratification and a potential target of CVD primary prevention efforts.

Does sufficient evidence exist to support a causal association between vitamin D status and cardiovascular disease risk? An assessment using Hill's criteria for causality.

PubMed

Weyland, Patricia G; Grant, William B; Howie-Esquivel, Jill

2014-09-02

Serum 25-hydroxyvitamin D (25(OH)D) levels have been found to be inversely associated with both prevalent and incident cardiovascular disease (CVD) risk factors; dyslipidemia, hypertension and diabetes mellitus. This review looks for evidence of a causal association between low 25(OH)D levels and increased CVD risk. We evaluated journal articles in light of Hill's criteria for causality in a biological system. The results of our assessment are as follows. Strength of association: many randomized controlled trials (RCTs), prospective and cross-sectional studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Consistency of observed association: most studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors in various populations, locations and circumstances. Temporality of association: many RCTs and prospective studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Biological gradient (dose-response curve): most studies assessing 25(OH)D levels and CVD risk found an inverse association exhibiting a linear biological gradient. Plausibility of biology: several plausible cellular-level causative mechanisms and biological pathways may lead from a low 25(OH)D level to increased risk for CVD with mediators, such as dyslipidemia, hypertension and diabetes mellitus. Experimental evidence: some well-designed RCTs found increased CVD risk factors with decreasing 25(OH)D levels. Analogy: the association between serum 25(OH)D levels and CVD risk is analogous to that between 25(OH)D levels and the risk of overall cancer, periodontal disease, multiple sclerosis and breast cancer. all relevant Hill criteria for a causal association in a biological system are satisfied to indicate a low 25(OH)D level as a CVD risk factor.

Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women

PubMed Central

Sumner, Jennifer A.; Kubzansky, Laura D.; Elkind, Mitchell S. V.; Roberts, Andrea L.; Agnew-Blais, Jessica; Chen, Qixuan; Cerdá, Magdalena; Rexrode, Kathryn M.; Rich-Edwards, Janet W.; Spiegelman, Donna; Suglia, Shakira F.; Rimm, Eric B.; Koenen, Karestan C.

2015-01-01

Background Psychological stress is a proposed risk factor for cardiovascular disease (CVD), and posttraumatic stress disorder (PTSD), the sentinel stress-related mental disorder, occurs twice as frequently in women as men. However, whether PTSD contributes to CVD risk in women is not established. Methods and Results We examined trauma exposure and PTSD symptoms in relation to incident CVD over a 20-year period in 49,978 women in the Nurses’ Health Study II. Proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD events confirmed by additional information or medical record review [n=548, including myocardial infarction (n=277) and stroke (n=271)]. Trauma exposure and PTSD symptoms were assessed using the Brief Trauma Questionnaire and a PTSD screen. Compared to no trauma exposure, endorsing 4 or more PTSD symptoms was associated with increased CVD risk after adjusting for age, family history, and childhood factors (HR=1.60 [95% CI, 1.20–2.13]). Being trauma-exposed and endorsing no PTSD symptoms was associated with elevated CVD risk (HR=1.45 [95% CI, 1.15–1.83]), although being trauma-exposed and endorsing 1–3 PTSD symptoms was not. After adjusting for adult health behaviors and medical risk factors, this pattern of findings was maintained. Health behaviors and medical risk factors accounted for 14% of the trauma/no symptoms-CVD association and 47% of the trauma/4+ symptoms-CVD association. Conclusion Trauma exposure and elevated PTSD symptoms may increase risk of CVD in this population of women. These findings suggest screening for CVD risk and reducing health risk behaviors in trauma-exposed women may be promising avenues for prevention and intervention. PMID:26124186

Association of central blood pressure and cardiovascular diseases in diabetic patients with hypertension.

PubMed

Yang, Lei; Qin, Bo; Zhang, Xiaojuan; Chen, Yanrong; Hou, Jian

2017-10-01

To evaluate association of central blood pressure (BP) and cardiovascular disease (CVD) in diabetic patients with hypertension.This was a cross-section study and 360 participants were enrolled. Baseline characteristics were collected and indices of central BP including central systolic/diastolic BP (SBP/DBP), augmentation index adjusted for 75 beats per minute of heart rate (AIx@75) were measured. Participants were separated into with and without CVD groups and between-group differences were assessed. Linear regression analysis was used to evaluate potential risk factors for increased AIx@75. Logistic regression analysis was used to evaluate association between central SBP and AIx@75 with CVD.Mean age was 50.6 years and male participants accounted for 57.8%. Thirty-five and 43 participants had coronary heart disease and ischemic stroke. Compared with participants without CVD, those with CVD were more likely to be male and smokers and had higher glycated hemoglobin level. Additionally, participants with CVD had significantly higher central SBP and AIx@75 compared with those without CVD. Ageing, male gender, and presence of coronary heart disease and ischemic stroke were associated with increased AIx@75, whereas renin-angiotensin-axis inhibitor was associated with reduced AIx@75. After adjusted for traditional risk factors including brachial SBP, both central SBP, and AIx@75 remained significantly associated with CVD, with odds ratio and 95% confidence interval of 1.09 (1.08-1.31) and 1.20 (1.15-1.42), respectively.Diabetic patients with hypertension, ageing, male gender, and presence of CVD are independent risk factors of central BP increase; and increased central SBP and AIx@75 are significantly associated with CVD.

Risk of Cardiovascular and All-Cause Mortality: Impact of Impaired Health-Related Functioning and Diabetes

PubMed Central

Williams, Emily D.; Rawal, Lal; Oldenburg, Brian F.; Renwick, Carla; Shaw, Jonathan E.; Tapp, Robyn J.

2012-01-01

OBJECTIVE There is an established link between health-related functioning (HRF) and cardiovascular disease (CVD) mortality, and it is known that those with diabetes predominantly die of CVD. However, few studies have determined the combined impact of diabetes and impaired HRF on CVD mortality. We investigated whether this combination carries a higher CVD risk than either component alone. RESEARCH DESIGN AND METHODS The Australian Diabetes, Obesity and Lifestyle (AusDiab) study included 11,247 adults aged ≥25 years from 42 randomly selected areas of Australia. At baseline (1999–2000), diabetes status was defined using the World Health Organization criteria and HRF was assessed using the SF-36 questionnaire. RESULTS Overall, after 7.4 years of follow-up, 57 persons with diabetes and 105 without diabetes had died from CVD. In individuals with and without diabetes, HRF measures were significant predictors of increased CVD mortality. The CVD mortality risks among those with diabetes or impaired physical health component summary (PCS) alone were similar (diabetes only: hazard ratio 1.4 [95% CI 0.7–2.7]; impaired PCS alone: 1.5 [1.0–2.4]), while those with both diabetes and impaired PCS had a much higher CVD mortality (2.8 [1.6–4.7]) compared with those without diabetes and normal PCS (after adjustment for multiple covariates). Similar results were found for the mental health component summary. CONCLUSIONS This study demonstrates that the combination of diabetes and impaired HRF is associated with substantially higher CVD mortality. This suggests that, among those with diabetes, impaired HRF is likely to be important in the identification of individuals at increased risk of CVD mortality. PMID:22446177

Evidence for increased cardiovascular events in the fathers but not mothers of women with polycystic ovary syndrome.

PubMed

Taylor, Mary C; Reema Kar, A; Kunselman, Allen R; Stetter, Christy M; Dunaif, Andrea; Legro, Richard S

2011-08-01

Polycystic ovary syndrome (PCOS) is a familial syndrome, associated with multiple cardiovascular disease (CVD) risk factors. Thus, parents of affected women may have a higher prevalence of CVD events than the general population. PCOS probands (n = 410) and their participating parents (n = 180 fathers and 211 mothers) were queried for CVD events in themselves and non-participating family members. In order to include the family CVD history of all parents, agreement between the proband and parental reports of CVD events was assessed. Estimated 10-year coronary heart disease (CHD) risk was calculated using the Framingham risk calculator. The National Health and Nutrition Examination Survey (NHANES) 2001-2002 database was used to generate gender, age and body mass index-relevant population parameters of CVD prevalence in the USA population. Ninety-eight percent of the parents' self-reporting of CVD events agreed with the proband's report of parental heart attack history [Kappa = 0.82; 95% CI: (0.69, 0.94)] and 99% with parental stroke history [Kappa = 0.79; 95% CI: (0.62, 0.97)]. Fathers of women with PCOS had a higher prevalence of heart attack and stroke compared with the reference NHANES population (heart attack: 11.1 versus 5.3%, P < 0.0001; stroke: 3.0 versus 1.0%, P = 0.002). Fathers of women with PCOS had an elevated 10-year risk for CHD (11.5 versus 9.9% in NHANES, P = 0.03). No statistically significant increased prevalence of CVD events or 10-year risk was noted in probands or mothers. Fathers, and not mothers, may be disproportionately burdened with CVD in PCOS families. The strengths of this study include the size of our cohort, the consistent phenotyping and the validation of proband's reporting of parental CVD events.

Common genetic variants and subclinical atherosclerosis: The Multi-Ethnic Study of Atherosclerosis (MESA).

PubMed

Vargas, Jose D; Manichaikul, Ani; Wang, Xin-Qun; Rich, Stephen S; Rotter, Jerome I; Post, Wendy S; Polak, Joseph F; Budoff, Matthew J; Bluemke, David A

2016-02-01

Subclinical atherosclerosis (sCVD), measured by coronary artery calcium (CAC) and carotid intima media thickness (CIMT) is associated with cardiovascular disease (CVD). Genome-Wide Association Studies (GWAS) of sCVD and CVD have focused primarily on Caucasian populations. We hypothesized that these associations may differ in populations from distinct genetic backgrounds. The associations between sCVD and 66 single nucleotide polymorphisms (SNPs) from published GWAS of sCVD and CVD were tested in 8224 Multi-Ethnic Study of Atherosclerosis (MESA) and MESA Family participants [2329 Caucasians (EUA), 691 Chinese (CHN), 2482 African Americans (AFA), and 2012 Hispanic (HIS)] using an additive model adjusting for CVD risk factors, with SNP significance defined by a Bonferroni-corrected p < 7.6 × 10(-4) (0.05/66). In EUA there were significant associations for CAC with SNPs in 9p21 (rs1333049, P = 2 × 10(-9); rs4977574, P = 4 × 10(-9)), COL4A1 (rs9515203, P = 9 × 10(-6)), and PHACTR1 (rs9349379, P = 4 × 10(-4)). In HIS, CAC was associated with SNPs in 9p21 (rs1333049, P = 8 × 10(-5); rs4977574, P = 5 × 10(-5)), APOA5 (rs964184, P = 2 × 10(-4)), and ADAMTS7 (rs7173743, P = 4 × 10(-4)). There were no associations between CAC and 9p21 SNPs for AFA and CHN. Fine mapping of the 9p21 region revealed SNPs with robust associations with CAC in EUA and HIS but no significant associations in AFA and CHN. Our results suggest some shared genetic architecture for sCVD across ethnic groups, while also underscoring the possibility of novel variants and/or pathways in risk of CVD in ethnically diverse populations. Published by Elsevier Ireland Ltd.

Total antioxidant capacity of diet and risk of stroke: a population-based prospective cohort of women.

PubMed

Rautiainen, Susanne; Larsson, Susanna; Virtamo, Jarmo; Wolk, Alicja

2012-02-01

Consumption of antioxidant-rich foods may reduce the risk of stroke by inhibition of oxidative stress and inflammation. Total antioxidant capacity (TAC) takes into account all antioxidants and the synergistic effects between them. We examined the association between dietary TAC and stroke incidence in cardiovascular disease (CVD)-free women and in women with CVD history at baseline. The study included women (31,035 CVD-free and 5680 with CVD history at baseline), aged 49 to 83 years, from the Swedish Mammography Cohort. Diet was assessed with a food frequency questionnaire. Dietary TAC was calculated using oxygen radical absorbance capacity values. Stroke cases were ascertained by linkage with the Swedish Hospital Discharge Registry. During follow-up (September 1997 to December 2009), we identified 1322 stroke cases (988 cerebral infarctions, 226 hemorrhagic strokes, and 108 unspecified strokes) among CVD-free women and 1007 stroke cases (796 cerebral infarctions, 100 hemorrhagic strokes, and 111 unspecified strokes) among women with a CVD history. The multivariable hazard ratio of total stroke comparing the highest with the lowest quintile of dietary TAC was 0.83 (95% CI, 0.70-0.99; P for trend=0.04) in CVD-free women. Among women with a CVD history, the hazard ratios for the highest versus lowest quartile of TAC were 0.90 (95% CI, 0.75-1.07; P for trend=0.30) for total stroke and 0.55 (95% CI, 0.32-0.95; P for trend=0.03) for hemorrhagic stroke. These findings suggest that dietary TAC is inversely associated with total stroke among CVD-free women and hemorrhagic stroke among women with CVD history.

The multi-faceted outcomes of conjunct diabetes and cardiovascular familial history in type 2 diabetes.

PubMed

Hermans, Michel P; Ahn, Sylvie A; Rousseau, Michel F

2012-01-01

Familial history of early-onset CHD (EOCHD) is a major risk factor for CHD. Familial diabetes history (FDH) impacts β-cell function. Some transmissible, accretional gradient of CHD risk may exist when diabetes and EOCHD familial histories combine. We investigated whether the impact of such combination is neutral, additive, or potentiating in T2DM descendants, as regards cardiometabolic phenotype, glucose homeostasis and micro-/macroangiopathies. Cross-sectional retrospective cohort study of 796 T2DM divided according to presence (Diab[+]) or absence (Diab[-]) of 1st-degree diabetes familial history and/or EOCHD (CVD(+) and (-)). Four subgroups: (i) [Diab(-)CVD(-)] (n=355); (ii) [Diab(+)CVD(-)] (n=338); (iii) [Diab(-)CVD(+)] (n=47); and (iv) [Diab(+)CVD(+)] (n=56). No interaction on subgroup distribution between presence of both familial histories, the combination of which translated into additive detrimental outcomes and higher rates of fat mass, sarcopenia, (hs)CRP and retinopathy. FDH(+) had lower insulinemia, insulin secretion, hyperbolic product, and accelerated hyperbolic product loss. An EOCHD family history affected neither insulin secretion nor sensitivity. There were significant differences regarding macroangiopathy/CAD, more prevalent in [Diab(-)CVD(+)] and [Diab(+)CVD(+)]. Among CVD(+), the highest macroangiopathy prevalence was observed in [Diab(-)CVD(+)], who had 66% macroangiopathy, and 57% CAD, rates higher (absolute-relative) by 23%-53% (overall) and 21%-58% (CAD) than [Diab(+)CVD(+)], who inherited the direst cardiometabolic familial history (p 0.0288 and 0.0310). A parental history for diabetes markedly affects residual insulin secretion and secretory loss rate in T2DM offspring without worsening insulin resistance. It paradoxically translated into lower macroangiopathy with concurrent familial EOCHD. Conjunct diabetes and CV familial histories generate multi-faceted vascular outcomes in offspring, including lesser macroangiopathy/CAD. Copyright © 2012 Elsevier Inc. All rights reserved.

A point-based prediction model for cardiovascular risk in orthotopic liver transplantation: The CAR-OLT score.

PubMed

VanWagner, Lisa B; Ning, Hongyan; Whitsett, Maureen; Levitsky, Josh; Uttal, Sarah; Wilkins, John T; Abecassis, Michael M; Ladner, Daniela P; Skaro, Anton I; Lloyd-Jones, Donald M

2017-12-01

Cardiovascular disease (CVD) complications are important causes of morbidity and mortality after orthotopic liver transplantation (OLT). There is currently no preoperative risk-assessment tool that allows physicians to estimate the risk for CVD events following OLT. We sought to develop a point-based prediction model (risk score) for CVD complications after OLT, the Cardiovascular Risk in Orthotopic Liver Transplantation risk score, among a cohort of 1,024 consecutive patients aged 18-75 years who underwent first OLT in a tertiary-care teaching hospital (2002-2011). The main outcome measures were major 1-year CVD complications, defined as death from a CVD cause or hospitalization for a major CVD event (myocardial infarction, revascularization, heart failure, atrial fibrillation, cardiac arrest, pulmonary embolism, and/or stroke). The bootstrap method yielded bias-corrected 95% confidence intervals for the regression coefficients of the final model. Among 1,024 first OLT recipients, major CVD complications occurred in 329 (32.1%). Variables selected for inclusion in the model (using model optimization strategies) included preoperative recipient age, sex, race, employment status, education status, history of hepatocellular carcinoma, diabetes, heart failure, atrial fibrillation, pulmonary or systemic hypertension, and respiratory failure. The discriminative performance of the point-based score (C statistic = 0.78, bias-corrected C statistic = 0.77) was superior to other published risk models for postoperative CVD morbidity and mortality, and it had appropriate calibration (Hosmer-Lemeshow P = 0.33). The point-based risk score can identify patients at risk for CVD complications after OLT surgery (available at www.carolt.us); this score may be useful for identification of candidates for further risk stratification or other management strategies to improve CVD outcomes after OLT. (Hepatology 2017;66:1968-1979). © 2017 by the American Association for the Study of Liver Diseases.

Comorbid depression and anxiety symptoms as predictors of cardiovascular events: results from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study.

PubMed

Rutledge, Thomas; Linke, Sarah E; Krantz, David S; Johnson, B Delia; Bittner, Vera; Eastwood, Jo-Ann; Eteiba, Wafia; Pepine, Carl J; Vaccarino, Viola; Francis, Jennifer; Vido, Diane A; Merz, C Noel Bairey

2009-11-01

To study the independent and interactive effects of depression and anxiety symptoms as predictors of cardiovascular disease (CVD) events in a sample of women with suspected myocardial ischemia. Symptoms of depression and anxiety overlap strongly and are independent predictors of CVD events. Although these symptoms commonly co-occur in medical patients, little is known about combined effects of depression and anxiety on CVD risk. A total of 489 women completed a baseline protocol including coronary angiogram, CVD risk factor assessment, and questionnaire-based measures of depression and anxiety symptoms, using the Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI), respectively. Participants were followed for a median 5.9 years to track the prevalence of CVD events (stroke, myocardial infarction, heart failure, and CVD-related mortality). We tested the BDI x STAI interaction effect in addition to the BDI and STAI main effects. Seventy-five women (15.3% of sample) experienced a CVD event, of which 18 were deaths attributed to cardiovascular causes. Results using Cox regression indicated a significant BDI x STAI interaction effect in the prediction of CVD events (p = .02) after covariate adjustment. Simple effect analyses indicated that depression scores were significant predictors of CVD events among women with low anxiety scores (hazard ratio [HR] = 2.3 [in standard deviation units]; 95% Confidence Interval [CI] = 1.3-3.9; p = .005) but not among women with higher levels of anxiety (HR = 0.99; 95% CI = 0.70-1.4; p = .95). Among women with suspected myocardial ischemia, the value of depression symptoms for predicting CVD events varied by the severity of comorbid anxiety. These results suggest that the clinical utility of depression measures may be improved by using them in combination with measures of anxiety.

The efficiency of cardiovascular risk assessment: do the right patients get statin treatment?

PubMed Central

van Staa, Tjeerd-Pieter; Smeeth, Liam; Ng, Edmond S-W; Goldacre, Ben; Gulliford, Martin

2013-01-01

Objective To evaluate targeting of statin prescribing for primary prevention to those with high cardiovascular disease (CVD) risk. Design Two cohort studies including the general population and initiators of statins aged 35–74 years. Setting UK primary care records in the Clinical Practice Research Datalink. Patients 3.8 million general population patients and 300 914 statin users. Intervention Statin prescribing. Main outcome measures Statin prescribing by CVD risk; observed 5-year CVD risks; variability between practices. Results Statin prescribing increased substantially over time to patients with high 10-year CVD risk (≥20%): 7.0% of these received a statin prior to 2007, and 30.4% in 2007 onwards. Prescribing to patients with low risk (<15%) also increased (from 1.9% to 5.0%). Only about half the patients initiating statin treatment were high risk according to CVD risk score. The 5-year CVD risks, as observed during statin treatment, reduced over calendar time (from 17.0% to 7.1%). There was a large variation between general practices in the percentage of high-risk patients prescribed a statin in 2007 onwards, ranging from 8.2% to 61.5%. For low-risk patients, these varied from 2.1% to 29.1%. Conclusions There appeared to be substantive overuse in low CVD risk and underuse in high CVD risk (600 000 and 850 000 patients, respectively, in the UK since 2007). There is wide variation between practices in statin prescribing to patients at high CVD risk. There is a clear need for randomised trials for the best strategy to target statin treatment and manage CVD risk for primary prevention. PMID:23735939

Development of Micro and Nano Crystalline CVD Diamond TL/OSL Radiation Detectors for Clinical Applications

NASA Astrophysics Data System (ADS)

Barboza-Flores, Marcelino

2015-03-01

Modern radiotherapy methods requires the use of high photon radiation doses delivered in a fraction to small volumes of cancer tumors. An accurate dose assessment for highly energetic small x-ray beams in small areas, as in stereotactic radiotherapy, is necessary to avoid damage to healthy tissue surrounding the tumor. Recent advances on the controlled synthesis of CVD diamond have demonstrated the possibility of using high quality micro and nano crystalline CVD as an efficient detector and dosimeter suitable for high energy photons and energetic particle beams. CVD diamond is a very attractive material for applications in ionizing radiation dosimetry, particularly in the biomedical field since the radiation absorption by a CVD diamond is very close to that of soft tissue. Furthermore, diamond is stable, non-toxic and radiation hard. In the present work we discuss the CVD diamond properties and dosimeter performance and discuss its relevance and advantages of various dosimetry methods, including thermally stimulated luminescence (TL) as well as optically stimulated luminescence (OSL). The recent CVD improved method of growth allows introducing precisely controlled impurities into diamond to provide it with high dosimetry sensitivity. For clinical dosimetry applications, high accuracy of dose measurements, low fading, high sensitivity, good reproducibility and linear dose response characteristics are very important parameters which all are found in CVD diamonds specimens. In some cases, dose linearity and reproducibility in CVD diamond have been found to be higher than standard commercial TLD materials like LiF. In the present work, we discuss the state-of-the art developments in dosimetry applications using CVD diamond. The financial support from Conacyt (Mexico) is greatly acknowledged

Mapping eQTLs in the Norfolk Island Genetic Isolate Identifies Candidate Genes for CVD Risk Traits

PubMed Central

Benton, Miles C.; Lea, Rod A.; Macartney-Coxson, Donia; Carless, Melanie A.; Göring, Harald H.; Bellis, Claire; Hanna, Michelle; Eccles, David; Chambers, Geoffrey K.; Curran, Joanne E.; Harper, Jacquie L.; Blangero, John; Griffiths, Lyn R.

2013-01-01

Cardiovascular disease (CVD) affects millions of people worldwide and is influenced by numerous factors, including lifestyle and genetics. Expression quantitative trait loci (eQTLs) influence gene expression and are good candidates for CVD risk. Founder-effect pedigrees can provide additional power to map genes associated with disease risk. Therefore, we identified eQTLs in the genetic isolate of Norfolk Island (NI) and tested for associations between these and CVD risk factors. We measured genome-wide transcript levels of blood lymphocytes in 330 individuals and used pedigree-based heritability analysis to identify heritable transcripts. eQTLs were identified by genome-wide association testing of these transcripts. Testing for association between CVD risk factors (i.e., blood lipids, blood pressure, and body fat indices) and eQTLs revealed 1,712 heritable transcripts (p < 0.05) with heritability values ranging from 0.18 to 0.84. From these, we identified 200 cis-acting and 70 trans-acting eQTLs (p < 1.84 × 10−7) An eQTL-centric analysis of CVD risk traits revealed multiple associations, including 12 previously associated with CVD-related traits. Trait versus eQTL regression modeling identified four CVD risk candidates (NAAA, PAPSS1, NME1, and PRDX1), all of which have known biological roles in disease. In addition, we implicated several genes previously associated with CVD risk traits, including MTHFR and FN3KRP. We have successfully identified a panel of eQTLs in the NI pedigree and used this to implicate several genes in CVD risk. Future studies are required for further assessing the functional importance of these eQTLs and whether the findings here also relate to outbred populations. PMID:24314549

The association between major depressive disorder in childhood and risk factors for cardiovascular disease in adolescence.

PubMed

Rottenberg, Jonathan; Yaroslavsky, Ilya; Carney, Robert M; Freedland, Kenneth E; George, Charles J; Baji, Ildikó; Dochnal, Roberta; Gádoros, Júlia; Halas, Kitti; Kapornai, Krisztina; Kiss, Eniko; Osváth, Viola; Varga, Hedvig; Vetró, Agnes; Kovacs, Maria

2014-02-01

Depression in adults is associated with risk factors for cardiovascular disease (CVD). It is unclear, however, when the association between clinical depression and cardiac risk factors develops or how early in life this association can be detected. In an ongoing study of pediatric depression, we compared CVD risk factors including smoking, obesity, physical activity level, sedentary behavior, and parental history of CVD across three samples of adolescents: probands with established histories of childhood-onset major depressive disorder (n = 210), never-depressed siblings of probands (n = 195), and controls with no history of any major psychiatric disorder (n = 161). When assessed during adolescence, 85% of the probands were not in a major depressive episode. Nevertheless, at that assessment, probands had a higher prevalence of regular smoking (odds ratio [OR] = 12.54, 95% confidence interval [CI] = 4.36-36.12) and were less physically active than controls (OR = 0.59, CI = 0.43-0.81) and siblings (OR = 0.70, CI = 0.52-0.94) and had a higher rate of obesity than did controls (OR = 3.67, CI = 1.42-9.52). Parents of probands reported high rates of CVD (significantly higher than did parents of controls), including myocardial infarction and CVD-related hospitalization (ORs = 1.62-4.36, CIs = 1.03-15.40). Differences in CVD risk factors between probands and controls were independent of parental CVD. Major depression in childhood is associated with an unfavorable CVD risk profile in adolescence, and risks for pediatric depression and CVD may coincide in families. Effective prevention and treatment of childhood depression may be a means to reduce the incidence of adult CVD.

Trajectories of Metabolic Risk Factors and Biochemical Markers prior to the Onset of Cardiovascular Disease – The Doetinchem Cohort Study

PubMed Central

Hulsegge, Gerben; Spijkerman, Annemieke M. W.; van der Schouw, Yvonne T.; Bakker, Stephan J. L.; Gansevoort, Ron T.; Smit, Henriette A.; Verschuren, W. M. Monique

2016-01-01

Risk factors often develop at young age and are maintained over time, but it is not fully understood how risk factors develop over time preceding cardiovascular disease (CVD). Our objective was to examine how levels and trajectories of metabolic risk factors and biochemical markers prior to diagnosis differ between people with and without CVD over a period of up to 15–20 years. A total of 449 incident non-fatal and fatal CVD cases and 1,347 age- and sex-matched controls were identified in a prospective cohort between 1993 and 2011. Metabolic risk factors and biochemical markers were measured at five-year intervals prior to diagnosis. Trajectories of metabolic risk factors and biochemical markers were analysed using random coefficient analyses. Although not always statistically significant, participants with CVD had slightly more unfavourable levels for most metabolic risk factors and biochemical markers 15–20 years before diagnosis than controls. Subsequent trajectories until diagnosis were similar in participants with incident CVD and controls for body mass index, diastolic blood pressure, total cholesterol, HDL cholesterol, random glucose, triglycerides, gamma glutamyltransferase, C-reactive protein and uric acid. Trajectories were more unfavourable in participants with CVD than controls for systolic blood pressure, waist circumference and estimated glomerular filtration rate (p≤0.05). For example, among participants with CVD, systolic blood pressure increased on average by 9 mmHg over the 18-year period preceding diagnosis, whereas the increase among controls was 4 mmHg. In conclusion, unfavourable levels of metabolic risk factors and biochemical markers are present long before CVD, which indicates that the risk of CVD is already partly determined in young adulthood. This underscores the need for early prevention to reduce the burden of CVD. PMID:27203599

Atherosclerosis profile and incidence of cardiovascular events: a population-based survey.

PubMed

Robinson, Jennifer G; Fox, Kathleen M; Bullano, Michael F; Grandy, Susan

2009-09-15

Atherosclerosis is a chronic progressive disease often presenting as clinical cardiovascular disease (CVD) events. This study evaluated the characteristics of individuals with a diagnosis of atherosclerosis and estimated the incidence of CVD events to assist in the early identification of high-risk individuals. Respondents to the US SHIELD baseline survey were followed for 2 years to observe incident self-reported CVD. Respondents had subclinical atherosclerosis if they reported a diagnosis of narrow or blocked arteries/carotid artery disease without a past clinical CVD event (heart attack, stroke or revascularization). Characteristics of those with atherosclerosis and incident CVD were compared with those who did not report atherosclerosis at baseline but had CVD in the following 2 years using chi-square tests. Logistic regression model identified characteristics associated with atherosclerosis and incident events. Of 17,640 respondents, 488 (2.8%) reported having subclinical atherosclerosis at baseline. Subclinical atherosclerosis was associated with age, male gender, dyslipidemia, circulation problems, hypertension, past smoker, and a cholesterol test in past year (OR = 2.2) [all p < 0.05]. Incident CVD was twice as high in respondents with subclinical atherosclerosis (25.8%) as in those without atherosclerosis or clinical CVD (12.2%). In individuals with subclinical atherosclerosis, men (RR = 1.77, p = 0.050) and individuals with circulation problems (RR = 2.36, p = 0.003) were at greatest risk of experiencing CVD events in the next 2 years. Self-report of subclinical atherosclerosis identified an extremely high-risk group with a >25% risk of a CVD event in the next 2 years. These characteristics may be useful for identifying individuals for more aggressive diagnostic and therapeutic efforts.

Wrist circumference as a novel predictor of hypertension and cardiovascular disease: results of a decade follow up in a West Asian cohort.

PubMed

Mohebi, Reza; Mohebi, Ahmad; Sheikholeslami, Farhad; Azizi, Fereidoun; Hadaegh, Farzad

2014-11-01

No study has yet evaluated the effect of wrist circumference on risk of incident hypertension and cardiovascular disease (CVD) in an adult population. The present study included 3642 women, aged ≥30 years, free of CVD at baseline, who had undergone health examinations between January 1999 and 2001 and were followed up until March 2010. Cox proportional hazard regression was performed to assess the hazard ratios (HRs) of wrist circumference for CVD and hypertension events. During 10 years of follow-up, 284 cases of first CVD and 615 cases of incident hypertension occurred. In a model adjusted for conventional CVD risk factors, the HR of 1 cm increase in wrist circumference was 1.15 (1.06-1.25) for hypertension and was marginally significant for CVD (HR, 1.12 [1.00-1.25]; P-value 0.052). After considering body mass index and waist circumference in the model, we found significant interaction between waist circumference and wrist circumference in risk prediction of hypertension and CVD (P < .001). In non-centrally obese women (waist circumference <95 cm), in multivariable model plus body mass index and waist circumference, increase in wrist circumference was independently associated with both hypertension (HR, 1.17 [1.02-1.35]) and CVD (HR, 1.29 [1.03-1.61]). However, among centrally obese women (waist circumference ≥95 cm), wrist circumference increase could not predict either hypertension (HR, 0.97 [0.84-1.18]) or CVD events (HR, 0.90 [0.75-1.07]). Wrist circumference as a novel anthropometric measure was an independent predictor for incident hypertension and CVD events among non-centrally obese women. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Aortic Arch Pulse Wave Velocity Assessed by Magnetic Resonance Imaging as a Predictor of Incident Cardiovascular Events: The MESA (Multi-Ethnic Study of Atherosclerosis).

PubMed

Ohyama, Yoshiaki; Ambale-Venkatesh, Bharath; Noda, Chikara; Kim, Jang-Young; Tanami, Yutaka; Teixido-Tura, Gisela; Chugh, Atul R; Redheuil, Alban; Liu, Chia-Ying; Wu, Colin O; Hundley, W Gregory; Bluemke, David A; Guallar, Eliseo; Lima, Joao A C

2017-09-01

The predictive value of aortic arch pulse wave velocity (PWV) assessed by magnetic resonance imaging for cardiovascular disease (CVD) events has not been fully established. The aim of the present study was to evaluate the association of arch PWV with incident CVD events in MESA (Multi-Ethnic Study of Atherosclerosis). Aortic arch PWV was measured using magnetic resonance imaging at baseline in 3527 MESA participants (mean age, 62±10 years at baseline; 47% men) free of overt CVD. Cox regression was used to evaluate the risk of incident CVD (coronary heart disease, stroke, transient ischemic attack, or heart failure) in relation to arch PWV adjusted for age, sex, race, and CVD risk factors. The median value of arch PWV was 7.4 m/s (interquartile range, 5.6-10.2). There was significant interaction between arch PWV and age for outcomes, so analysis was stratified by age categories (45-54 and >54 years). There were 456 CVD events during the 10-year follow-up. Forty-five to 54-year-old participants had significant association of arch PWV with incident CVD independent of CVD risk factors (hazard ratio, 1.44; 95% confidence interval, 1.07-1.95; P =0.018; per 1-SD increase for logarithmically transformed PWV), whereas >54-year group did not ( P =0.93). Aortic arch PWV assessed by magnetic resonance imaging is a significant predictor of CVD events among middle-aged (45-54 years old) individuals, whereas arch PWV is not associated with CVD among an elderly in a large multiethnic population. © 2017 American Heart Association, Inc.

The Association between Major Depressive Disorder in Childhood and Risk Factors for Cardiovascular Disease in Adolescence

PubMed Central

Rottenberg, Jonathan; Yaroslavsky, Ilya; Carney, Robert M.; Freedland, Kenneth E.; George, Charles J.; Baji, Ildikó; Dochnal, Roberta; Gádoros, Júlia; Halas, Kitti; Kapornai, Krisztina; Kiss, Enikő; Osváth, Viola; Varga, Hedvig; Vetró, Ágnes; Kovacs, Maria

2014-01-01

Objective Depression in adults is associated with risk factors for cardiovascular disease (CVD). It is unclear, however, when the association between clinical depression and cardiac risk factors develops, or how early in life this association can be detected. Methods In an ongoing study of pediatric depression, we compared CVD risk factors, including smoking, obesity, physical activity level, sedentary behavior, and parental history of CVD, across three samples of adolescents: probands with established histories of childhood-onset major depressive disorder (MDD; N=210), never-depressed siblings of probands (N=195), and controls with no history of any major psychiatric disorder (N=161). Results When assessed during adolescence, 85% of the probands were not in a major depressive episode. Nevertheless, at that assessment, probands had a higher prevalence of regular smoking ([odds ratio [OR] 12.54, 95% confidence interval [CI] = 4.36–36.12) and were less physically active than controls (OR .59, CI = .43–.81) and siblings (OR .70, CI = .52–.94), and had a higher rate of obesity than did controls (OR 3.67, CI = 1.42–9.52). Parents of probands reported high rates of CVD (significantly higher than did parents of controls), including myocardial infarction and CVD-related hospitalization (ORs 1.62–4.36; CIs = 1.03–15.40). Differences in CVD risk factors between probands and controls were independent of parental CVD. Conclusions Major depression in childhood is associated with an unfavorable CVD risk profile in adolescence, and risks for pediatric depression and CVD may coincide in families. Effective prevention and treatment of childhood depression may be a means to reduce the incidence of adult CVD. PMID:24470130

Diet quality and the risk of cardiovascular disease: the Women's Health Initiative (WHI)123

PubMed Central

Belin, Rashad J; Greenland, Philip; Allison, Matthew; Martin, Lisa; Shikany, James M; Larson, Joseph; Tinker, Lesley; Howard, Barbara V; Lloyd-Jones, Donald

2011-01-01

Background: The association between diet quality and risk of incident cardiovascular disease (CVD) or heart failure (HF) in postmenopausal women is uncertain. Objective: This study aimed to determine whether a conventional index [Alternate Healthy Eating Index (AHEI)] or a novel index [Women's Health Initiative (WHI) Dietary Modification Index (DMI)] of diet quality was associated with the risk of incident CVD or HF in the WHI Observational Study (WHI-OS). Design: The WHI-OS is an observational cohort study of 93,676 women aged 50–79 y of diverse ethnicity and backgrounds followed for an average of 10.0 y for CVD events. The individual components of the AHEI and DMI were determined from the baseline WHI food-frequency questionnaire. Incident CVD was a composite of nonfatal myocardial infarction, coronary heart disease death, stroke, coronary revascularization, and incident HF. The association between AHEI or DMI and incident CVD or incident HF was determined by using Cox models adjusted for traditional CVD and HF risk factors. Results: Women with a DMI in the highest quintile had hazard ratios (HRs) of 0.88 (95% CI: 0.80, 0.95) and 0.91 (95% CI: 0.78, 1.06) for incident CVD and HF, respectively. Women with an AHEI in the highest quintile had HRs of 0.77 (95% CI: 0.70, 0.84) and 0.70 (95% CI: 0.59, 0.82) for incident CVD and HF, respectively. Conclusion: Overall, adherence to current nutrient guidelines (as indexed by the DMI) are associated with lower total CVD risk, and additional dietary factors (as indexed by the AHEI) were associated with a lower risk of CVD and HF. PMID:21613562

Progressively Worsening Premature Coronary Artery Disease: Adding Anticoagulation Stabilizes-Reverses Clinical Symptomatic Disease Progression in Thrombophilic-Atherothrombotic Patients: A Pilot Study.

PubMed

Rothschild, Matan; Jetty, Vybhav; Mahida, Christopher; Wang, Ping; Prince, Marloe; Goldenberg, Naila; Glueck, Charles J

2017-11-01

In 35 patients with 116 severe premature cardiovascular disease (CVD) events (median age: 48 years), 14 having worsening CVD despite maximal intervention, we evaluated thrombophilia and speculated that anticoagulation might arrest-reverse progressive thrombophilic-atherothrombotic CVD. Thrombophilia-hypofibrinolysis in the 35 patients was compared to 110 patients with venous thromboembolism (VTE) without CVD and to 110 healthy normal controls. Efficacy-safety of anticoagulation was prospectively assessed in 14 of the 35 patients whose CVD worsened over 2 years despite maximal medical-surgical intervention. At entry on maximally tolerated lipid-lowering therapy, median low-density lipoprotein was 88 mg/dL. Measures of thrombophilia-hypofibrinolysis in the 35 cases differed from 110 VTE controls only for the lupus anticoagulant, present in 6 (21%) of 28 cases versus 4 (4%) of 91 VTE controls ( P = .01), and for high anticardiolipin antibodies (ACLAs) immunoglobulin G, 5 (14%) of 35 cases versus 4 of 108 VTE controls (4%), P = .04. The 14 patients who were anticoagulated differed from 110 VTE controls only for the lupus anticoagulant, 38% versus 4%, P = .001, and for high lipoprotein (a), 46% versus 17%, P = .028, respectively. The 14 patients with atherothrombosis having inexorably worsening CAD despite maximal medical-surgical therapy were anticoagulated for 6.5 years (median), with clinical CVD progression arrested in 12 (86%), and all 12 became asymptomatic. In the 35 patients with premature CVD, thrombophilia was pervasive, comparable to or more severe than in VTE controls without CVD. When CVD progressively worsens despite maximal intervention, thrombophilia and atherosclerosis (atherothrombosis) are commonly concurrent, and the downhill course of CVD may be arrested-stabilized by anticoagulation.

Low-grade albuminuria and incidence of cardiovascular disease and all-cause mortality in nondiabetic and normotensive individuals.

PubMed

Tanaka, Fumitaka; Komi, Ryosuke; Makita, Shinji; Onoda, Toshiyuki; Tanno, Kozo; Ohsawa, Masaki; Itai, Kazuyoshi; Sakata, Kiyomi; Omama, Shinichi; Yoshida, Yuki; Ogasawara, Kuniaki; Ishibashi, Yasuhiro; Kuribayashi, Toru; Okayama, Akira; Nakamura, Motoyuki

2016-03-01

Recent studies indicate that, in people with diabetes or hypertension and in the general population, low-grade albuminuria (LGA) below the microalbuminuria threshold is a predictor for incidence of cardiovascular disease (CVD) and mortality. However, it remains unclear whether LGA predicts the risk of CVD incidence and death in nondiabetic and normotensive individuals. A total of 3599 individuals aged not less than 40 years from the general population who are free of CVD in nondiabetic and normotensive individuals with preserved glomerular filtration rate were followed for CVD incidence and all-cause death. LGA was defined as urinary albumin to creatinine ratio (UACR) less than 30  mg/g. It was examined whether there is an association between LGA and CVD incidence or all-cause death. During the average 5.9 years of follow-up, 61 individuals had first CVD events, and 85 individuals died. The hazard ratios (HRs) for CVD incidence and all-cause death after full adjustment by potential confounders increased significantly in the top tertile of LGA (UACR ≥ 9.6  mg/g for men, ≥ 12.0  mg/g for women) compared with the first tertile [HR = 2.79, 95% confidence interval (CI), 1.41-5.52, HR = 1.69, 95% CI, 1.00-2.84, respectively]. Population-attributable fractions of the top tertile of LGA for CVD incidence and all-cause death were 37.9 and 20.1%, respectively. In apparently healthy individuals with optimal blood pressure and no diabetes, LGA independently predicts CVD incidence and all-cause death, particularly with the large contribution to the excessive incidence of CVD.

Raman studied of undoped amorphous carbon thin film deposited by bias assisted-CVD

NASA Astrophysics Data System (ADS)

Ishak, A.; Fadzilah, A. N.; Dayana, K.; Saurdi, I.; Malek, M. F.; Nurbaya, Z.; Shafura, A. K.; Rusop, M.

2018-05-01

The undoped amorphous carbon thin film carbon was deposited at 200°C-350°C by bias assisted-CVD using palm oil as a precursor material. The effect of different substrate deposition temperatures on structural and electrical properties of undoped doped amorphous carbon film was discussed. The structural of undoped amorphous carbon films were correlated with Raman analysis through the evolution of D and G bands, Fourier spectra, and conductivity measurement. The spectral evolution observed showed the increase of upward shift of D and G peaks as substrate deposition temperatures increased. The spectral evolution observed at different substrate deposition temperatures show progressive formation of crystallites. It was predicted that small number of hydrogen is terminated with carbon at surface of thin film as shown by FTIR spectra since palm oil has high number of hydrogen (C67H127O8). These structural changes were further correlated with conductivity and the results obtained are discussed and compared. The conductivity is found in the range of 10-8 Scm-1. The increase of conductivity is correlated by the change of structural properties as correlated with characteristic parameters of Raman spectra including the position of G peak, full width at half maximum of G peak, and ID/IG and FTIR result.

Scanning Tunneling Microscopy Studies of Diamond Films and Optoelectronic Materials

NASA Technical Reports Server (NTRS)

Perez, Jose M.

1996-01-01

We present a summary of the research, citations of publications resulting from the research and abstracts of such publications. We have made no inventions in the performance of the work in this project. The main goals of the project were to set up a Chemical Vapor Deposition (CVD) diamond growth system attached to an UltraHigh Vacuum (UHV) atomic resolution Scanning Tunneling Microscopy (STM) system and carry out experiments aimed at studying the properties and growth of diamond films using atomic resolution UHV STM. We successfully achieved these goals. We observed, for the first time, the atomic structure of the surface of CVD grown epitaxial diamond (100) films using UHV STM. We studied the effects of atomic hydrogen on the CVD diamond growth process. We studied the electronic properties of the diamond (100) (2x1) surface, and the effect of alkali metal adsorbates such as Cs on the work function of this surface using UHV STM spectroscopy techniques. We also studied, using STM, new electronic materials such as carbon nanotubes and gold nanostructures. This work resulted in four publications in refereed scientific journals and five publications in refereed conference proceedings.

Nonaligned carbon nanotubes anchored on porous alumina: formation, process modeling, gas-phase analysis, and field-emission properties.

PubMed

Lysenkov, Dmitry; Engstler, Jörg; Dangwal, Arti; Popp, Alexander; Müller, Günter; Schneider, Jörg J; Janardhanan, Vinod M; Deutschmann, Olaf; Strauch, Peter; Ebert, Volker; Wolfrum, Jürgen

2007-06-01

We have developed a chemical vapor deposition (CVD) process for the catalytic growth of carbon nanotubes (CNTs), anchored in a comose-type structure on top of porous alumina substrates. The mass-flow conditions of precursor and carrier gases and temperature distributions in the CVD reactor were studied by transient computational fluid dynamic simulation. Molecular-beam quadrupole mass spectroscopy (MB-QMS) has been used to analyze the gas phase during ferrocene CVD under reaction conditions (1073 K) in the boundary layer near the substrate. Field-emission (FE) properties of the nonaligned CNTs were measured for various coverages and pore diameters of the alumina. Samples with more dense CNT populations provided emitter-number densities up to 48,000 cm(-2) at an electric field of 6 V microm(-1). Samples with fewer but well-anchored CNTs in 22-nm pores yielded the highest current densities. Up to 83 mA cm(-2) at 7 V microm(-1) in dc mode and more than 200 mA cm(-2) at 11 V microm(-1) in pulsed diode operation have been achieved from a cathode size of 24 mm2.

Structural analysis of ion-implanted chemical-vapor-deposited diamond by transmission electron microscope

NASA Astrophysics Data System (ADS)

Jiang, N.; Deguchi, M.; Wang, C. L.; Won, J. H.; Jeon, H. M.; Mori, Y.; Hatta, A.; Kitabatake, M.; Ito, T.; Hirao, T.; Sasaki, T.; Hiraki, A.

1997-04-01

A transmission electron microscope (TEM) study of ion-implanted chemical-vapor-deposited (CVD) diamond is presented. CVD diamond used for transmission electron microscope observation was directly deposited onto Mo TEM grids. As-deposited specimens were irradiated by C (100 keV) ions at room temperature with a wide range of implantation doses (10 12-10 17/cm 2). Transmission electron diffraction (TED) patterns indicate that there exists a critical dose ( Dc) for the onset of amorphization of CVD diamond as a result of ion induced damage and the value of critical dose is confirmed to be about 3 × 10 15/cm 2. The ion-induced transformation process is clearly revealed by high resolution electron microscope (HREM) images. For a higher dose implantation (7 × 10 15/cm 2) a large amount of diamond phase is transformed into amorphous carbon and many tiny misoriented diamond blocks are found to be left in the amorphous solid. The average size of these misoriented diamond blocks is only about 1-2 nm. Further bombardment (10 17/cm 2) almost kills all of the diamond phase within the irradiated volume and moreover leads to local formation of micropolycrystalline graphite.

CVD Rhenium Engines for Solar-Thermal Propulsion Systems

NASA Technical Reports Server (NTRS)

Williams, Brian E.; Fortini, Arthur J.; Tuffias, Robert H.; Duffy, Andrew J.; Tucker, Stephen P.

1999-01-01

Solar-thermal upper-stage propulsion systems have the potential to provide specific impulse approaching 900 seconds, with 760 seconds already demonstrated in ground testing. Such performance levels offer a 100% increase in payload capability compared to state-of-the-art chemical upper-stage systems, at lower cost. Although alternatives such as electric propulsion offer even greater performance, the 6- to 18- month orbital transfer time is a far greater deviation from the state of the art than the one to two months required for solar propulsion. Rhenium metal is the only material that is capable of withstanding the predicted thermal, mechanical, and chemical environment of a solar-thermal propulsion device. Chemical vapor deposition (CVD) is the most well-established and cost-effective process for the fabrication of complex rhenium structures. CVD rhenium engines have been successfully constructed for the Air Force ISUS program (bimodal thrust/electricity) and the NASA Shooting Star program (thrust only), as well as under an Air Force SBIR project (thrust only). The bimodal engine represents a more long-term and versatile approach to solar-thermal propulsion, while the thrust-only engines provide a potentially lower weight/lower cost and more near-term replacement for current upper-stage propulsion systems.

Food Polyamine and Cardiovascular Disease -An Epidemiological Study-

PubMed Central

Soda, Kuniyasu; Kano, Yoshihiko; Chiba, Fumihiro

2012-01-01

The purpose of this study was to examine the contribution of dietary polyamines toward preventing cardiovascular disease (CVD). Age-standardized mortality rates as well as other relevant information regarding individuals with CVD were gathered from the World Health Organization and the International Monetary Fund in 48 different European and other Western countries. Food supply data were collected from the database of the United Nations, and the amount of dietary polyamines was estimated by using polyamine concentrations in foods from published sources. The association between CVD mortality and the amount of polyamines was investigated by performing a series of multiple linear regression analyses. Analyses using factors known to modulate the risk of CVD including: Gross Domestic Product (GDP) (standardized regression coefficient (r) = -0.786, p < 0.001) and the amount of fruits, vegetable, nuts, and beans (r = -0.183, p = 0.001) but not including polyamines, showed negative associations with CVD, while smoking rate (r = 0.139, p = 0.041) and whole milk amount (r = 0.131, p = 0.028) showed positive associations with CVD. When the amount of polyamines was added to the analyses as a covariate, GDP (r = -0.864, p < 0.001) and polyamines (r = -0.355, p = 0.007) showed negative associations with CVD, while smoking rate (r = 0.183, p = 0.006) and whole milk (r = 0.113, p = 0.041) showed positive associations with CVD. The inverse association between dietary polyamines and CVD mortality revealed by the present study merits further evaluation. PMID:23121753

Food polyamine and cardiovascular disease--an epidemiological study.

PubMed

Soda, Kuniyasu; Kano, Yoshihiko; Chiba, Fumihiro

2012-09-28

The purpose of this study was to examine the contribution of dietary polyamines toward preventing cardiovascular disease (CVD). Age-standardized mortality rates as well as other relevant information regarding individuals with CVD were gathered from the World Health Organization and the International Monetary Fund in 48 different European and other Western countries. Food supply data were collected from the database of the United Nations, and the amount of dietary polyamines was estimated by using polyamine concentrations in foods from published sources. The association between CVD mortality and the amount of polyamines was investigated by performing a series of multiple linear regression analyses. Analyses using factors known to modulate the risk of CVD including: Gross Domestic Product (GDP) (standardized regression coefficient (r) = -0.786, p < 0.001) and the amount of fruits, vegetable, nuts, and beans (r = -0.183, p = 0.001) but not including polyamines, showed negative associations with CVD, while smoking rate (r = 0.139, p = 0.041) and whole milk amount (r = 0.131, p = 0.028) showed positive associations with CVD. When the amount of polyamines was added to the analyses as a covariate, GDP (r = -0.864, p < 0.001) and polyamines (r = -0.355, p = 0.007) showed negative associations with CVD, while smoking rate (r = 0.183, p = 0.006) and whole milk (r = 0.113, p = 0.041) showed positive associations with CVD. The inverse association between dietary polyamines and CVD mortality revealed by the present study merits further evaluation.

Hyperlipidemia and Medical Expenditures by Cardiovascular Disease Status in US Adults.

PubMed

Zhang, Donglan; Wang, Guijing; Fang, Jing; Mercado, Carla

2017-01-01

Hyperlipidemia is a major risk factor for cardiovascular disease (CVD), affecting 73.5 million American adults. Information about health care expenditures associated with hyperlipidemia by CVD status is needed to evaluate the economic benefit of primary and secondary prevention programs for CVD. The study sample includes 48,050 men and nonpregnant women ≥18 from 2010 to 2012 Medical Expenditure Panel Survey. A 2-part econometric model was used to estimate annual hyperlipidemia-associated medical expenditures by CVD status. The estimation results from the 2-part model were used to calculate per-capita and national medical expenditures associated with hyperlipidemia. We adjusted the medical expenditures into 2012 dollars. Among those with CVD, per person hyperlipidemia-associated expenditures were $1105 [95% confidence interval (CI), $877-$1661] per year, leading to an annual national expenditure of $15.47 billion (95% CI, $5.23-$27.75 billion). Among people without CVD, per person hyperlipidemia-associated expenditures were $856 (95% CI, $596-$1211) per year, resulting in an annual national expenditure of $23.11 billion (95% CI, $16.09-$32.71 billion). Hyperlipidemia-associated expenditures were attributable mostly to the costs of prescription medication (59%-90%). Among people without CVD, medication expenditures associated with hyperlipidemia were $13.72 billion (95% CI, $10.55-$15.74 billion), higher in men than in women. Hyperlipidemia significantly increased medical expenditures and the increase was higher in people with CVD than without. The information on estimated expenditures could be used to evaluate and develop effective programs for CVD prevention.

The Veterans Affairs Cardiac Risk Score: Recalibrating the Atherosclerotic Cardiovascular Disease Score for Applied Use.

PubMed

Sussman, Jeremy B; Wiitala, Wyndy L; Zawistowski, Matthew; Hofer, Timothy P; Bentley, Douglas; Hayward, Rodney A

2017-09-01

Accurately estimating cardiovascular risk is fundamental to good decision-making in cardiovascular disease (CVD) prevention, but risk scores developed in one population often perform poorly in dissimilar populations. We sought to examine whether a large integrated health system can use their electronic health data to better predict individual patients' risk of developing CVD. We created a cohort using all patients ages 45-80 who used Department of Veterans Affairs (VA) ambulatory care services in 2006 with no history of CVD, heart failure, or loop diuretics. Our outcome variable was new-onset CVD in 2007-2011. We then developed a series of recalibrated scores, including a fully refit "VA Risk Score-CVD (VARS-CVD)." We tested the different scores using standard measures of prediction quality. For the 1,512,092 patients in the study, the Atherosclerotic cardiovascular disease risk score had similar discrimination as the VARS-CVD (c-statistic of 0.66 in men and 0.73 in women), but the Atherosclerotic cardiovascular disease model had poor calibration, predicting 63% more events than observed. Calibration was excellent in the fully recalibrated VARS-CVD tool, but simpler techniques tested proved less reliable. We found that local electronic health record data can be used to estimate CVD better than an established risk score based on research populations. Recalibration improved estimates dramatically, and the type of recalibration was important. Such tools can also easily be integrated into health system's electronic health record and can be more readily updated.

Depression and cardiovascular disease: a clinical review.

PubMed

Hare, David L; Toukhsati, Samia R; Johansson, Peter; Jaarsma, Tiny

2014-06-01

Cardiovascular disease (CVD) and depression are common. Patients with CVD have more depression than the general population. Persons with depression are more likely to eventually develop CVD and also have a higher mortality rate than the general population. Patients with CVD, who are also depressed, have a worse outcome than those patients who are not depressed. There is a graded relationship: the more severe the depression, the higher the subsequent risk of mortality and other cardiovascular events. It is possible that depression is only a marker for more severe CVD which so far cannot be detected using our currently available investigations. However, given the increased prevalence of depression in patients with CVD, a causal relationship with either CVD causing more depression or depression causing more CVD and a worse prognosis for CVD is probable. There are many possible pathogenetic mechanisms that have been described, which are plausible and that might well be important. However, whether or not there is a causal relationship, depression is the main driver of quality of life and requires prevention, detection, and management in its own right. Depression after an acute cardiac event is commonly an adjustment disorder than can improve spontaneously with comprehensive cardiac management. Additional management strategies for depressed cardiac patients include cardiac rehabilitation and exercise programmes, general support, cognitive behavioural therapy, antidepressant medication, combined approaches, and probably disease management programmes. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.

Rheumatologist and Primary Care Management of Cardiovascular Disease Risk in Rheumatoid Arthritis: Patient and Provider Perspectives.

PubMed

Bartels, Christie M; Roberts, Tonya J; Hansen, Karen E; Jacobs, Elizabeth A; Gilmore, Andrea; Maxcy, Courtney; Bowers, Barbara J

2016-04-01

Despite increased cardiovascular disease (CVD) risk, rheumatoid arthritis (RA) patients often lack CVD preventive care. We examined CVD preventive care processes from RA patient and provider perspectives to develop a process map for identifying targets for future interventions to improve CVD preventive care. Thirty-one participants (15 patients, 7 rheumatologists, and 9 primary care physicians [PCPs]) participated in interviews that were coded using NVivo software and analyzed using grounded theory techniques. Patients and providers reported that receipt of preventive care depends upon identifying and acting on risk factors, although most noted that both processes rarely occurred. Engagement in these processes was influenced by various provider-, system-, visit-, and patient-related conditions, such as patient activation or patients' knowledge about their risk. While nearly half of patients and PCPs were unaware of RA-CVD risk, all rheumatologists were aware of risk. Rheumatologists reported not systematically identifying risk factors, or, if identified, they described communicating about CVD risk factors via clinic notes to PCPs instead of acting directly due to perceived role boundaries. PCPs suggested that scheduling PCP visits could improve CVD risk management, and all participants viewed comanagement positively. Findings from this study illustrate important gaps and opportunities to support identifying and acting on CVD risk factors in RA patients from the provider, system, visit, and patient levels. Future work should investigate professional role support through improved guidelines, patient activation, and system-based RA-CVD preventive care strategies. © 2016, American College of Rheumatology.

Dietary Inflammatory Index and Cardiovascular Risk and Mortality-A Meta-Analysis.

PubMed

Shivappa, Nitin; Godos, Justyna; Hébert, James R; Wirth, Michael D; Piuri, Gabriele; Speciani, Attilio F; Grosso, Giuseppe

2018-02-12

Diet and chronic inflammation have been suggested to be risk factors in the development of cardiovascular disease (CVD) and related mortality. The possible link between the inflammatory potential of diet measured through the Dietary Inflammatory Index (DII ® ) and CVD has been investigated in several populations across the world. The aim of this study was to conduct a meta-analysis on studies exploring this association. Data from 14 studies were eligible, of which two were case-control, eleven were cohort, and one was cross-sectional. Results from the random-effects meta-analysis showed a positive association between increasing DII, indicating a pro-inflammatory diet, and CVD. Individuals in the highest versus the lowest (reference) DII category showed a 36% increased risk of CVD incidence and mortality, with moderate evidence of heterogeneity (relative risk (RR) = 1.36, 95% confidence interval (CI): 1.19, 1.57; heterogeneity index I ² = 69%, p < 0.001). When analyzed as a continuous variable, results showed an increased risk of CVD risk and mortality of 8% for each one-point increase in the DII score. Results remained unchanged when analyses were restricted to the prospective studies. Results of our meta-analysis support the importance of adopting a healthier anti-inflammatory diet for preventing CVD incidence and related mortality. In conclusion, a pro-inflammatory diet is associated with increased risk of CVD and CVD mortality. These results further substantiate the utility of DII as tool to characterize the inflammatory potential of diet and to predict CVD incidence and mortality.

The significance of the psychosocial factors influence in pathogenesis of cardiovascular disease.

PubMed

Masic, Izet; Alajbegovic, Jasmin

2013-11-01

Cardiovascular diseases (CVD) are the leading cause of death in the world today. Risk factors are those factors that influence the development of CVD. Risk factors can be divided into materialistic (genetic predisposition, smoking, alcohol) and non-materialistic (psychosocial factors). Our goal is to note the role of the health system, to emphasize the importance of psychosocial factors in the pathogenesis of CVD, explain the relationship between psychosocial factors and other risk factors, stress the importance of prevention through the provision of management of the cardiovascular system (CVS) diseases. A DESCRIPTIVE ANALYSIS WAS PERFORMED ON SCIENTIFIC STUDIES IN SEVERAL PUBLISHED ARTICLES IN JOURNALS ON CVS: Public Health Reviews, CVD, European Heart Journal, Materia Socio Medica and other indexed journals that publish articles on CVS. THE IMPORTANCE AND ROLE OF THE HEALTH SYSTEM IN THE EARLY DETECTION, DIAGNOSIS, THERAPY AND CVS DISEASE PREVENTION IS PRESENTED THROUGH THREE THEMATIC AREAS: (a) The incidence and prevalence of CVS diseases; (b) treatment of CVS diseases and (c) promotion of health in patients with CVS disease and those the risk of their occurrence. Health promotion is the most important aspect of the health system monitoring. Health promotion is adequately implemented ifthe management ofCVD is proper. The main objectives of CVD management are: Preventing or delaying the occurrence of CVD, reducing the number and severity of worsening and complications of CVD. Management Includes: Individual and family, the health system and the community. Materialistic and non-materialistic risk factors together contribute to the development of CVD.

DNA damage in children and adolescents with cardiovascular disease risk factors.

PubMed

Kliemann, Mariele; Prá, Daniel; Müller, Luiza L; Hermes, Liziane; Horta, Jorge A; Reckziegel, Miriam B; Burgos, Miria S; Maluf, Sharbel W; Franke, Silvia I R; Silva, Juliana da

2012-09-01

The risk of developing cardiovascular disease (CVD) is related to lifestyle (e.g. diet, physical activity and smoking) as well as to genetic factors. This study aimed at evaluating the association between CVD risk factors and DNA damage levels in children and adolescents. Anthropometry, diet and serum CVD risk factors were evaluated by standard procedures. DNA damage levels were accessed by the comet assay (Single cell gel electrophoresis; SCGE) and cytokinesis-blocked micronucleus (CBMN) assays in leukocytes. A total of 34 children and adolescents selected from a population sample were divided into three groups according to their level of CVD risk. Moderate and high CVD risk subjects showed significantly higher body fat and serum CVD risk markers than low risk subjects (P<0.05). High risk subjects also showed a significant increase in DNA damage, which was higher than that provided by low and moderate risk subjects according to SCGE, but not according to the CBMN assay. Vitamin C intake was inversely correlated with DNA damage by SCGE, and micronucleus (MN) was inversely correlated with folate intake. The present results indicate an increase in DNA damage that may be a consequence of oxidative stress in young individuals with risk factors for CVD, indicating that the DNA damage level can aid in evaluating the risk of CVD.

Self-perceived health versus actual cardiovascular disease risks.

PubMed

Ko, Young; Boo, Sunjoo

2016-01-01

Self-perceived poor health is related to cardiovascular disease (CVD) risk perception, cardiovascular event, hospital readmission, and death from CVD. This study evaluated the associations between self-perceived health and actual CVD risk in South Koreans as well as the influence of sociodemographic and cardiovascular risk factors on self-perceived poor health. This is a secondary data analysis of the 2010 Korea National Health and Nutrition Examination Survey. The sample was 4535 South Koreans aged 30-74 years without CVD. Self-perceived health status was compared with actual cardiovascular risk separately by sex using χ(2) -tests. Logistic regressions were used to identify potential sociodemographic and cardiovascular risk factors of self-perceived poor health. Self-perceived poor health was related to higher CVD risk but there were substantial gaps between them. Among cardiovascular risk factors, dyslipidemia, obesity, smoking, and a family history of CVD did not affect self-perceived health. Gaps between perceived health and actual CVD risk should be closed to optimize cardiovascular health of South Koreans. Koreans need to increase risk perception to a level commensurate with their actual risk. Healthcare providers should try to provide individuals at increased CVD risk with better information more frequently, especially those who have favorable perceptions of their health but smoke or have elevated cholesterol levels and bodyweight. © 2015 Japan Academy of Nursing Science.

Cardiovascular disease biomarkers on cognitive function in older adults: Joint effects of cardiovascular disease biomarkers and cognitive function on mortality risk.

PubMed

Loprinzi, Paul D; Crush, Elizabeth; Joyner, Chelsea

2017-01-01

Previous research demonstrates an inverse association between age and cardiovascular disease (CVD) biomarkers with cognitive function; however, little is known about the combined associations of CVD risk factors and cognitive function with all-cause mortality in an older adult population, which was the purpose of this study. Data from the 1999-2002 NHANES were used (N=2,097; 60+yrs), with mortality follow-up through 2011. Evaluated individual biomarkers included mean arterial pressure (MAP), high-sensitivity C-reactive protein (CRP), HDL-C, total cholesterol (TC), A1C, and measured body mass index (BMI). Cognitive function was assessed using the Digit Symbol Substitution Test (DSST). Further, 4 groups were created based on CVD risk and cognitive function. Group 1: high cognitive function and low CVD risk; Group 2: high cognitive function and high CVD risk; Group 3: low cognitive function and low CVD risk; Group 4: low cognitive function and high CVD risk. An inverse relationship was observed where those with more CVD risk factors had a lower (worse) cognitive function score. Compared to those in Group 1, only those in Group 3 and 4 had an increase mortality risk. Copyright © 2016 Elsevier Inc. All rights reserved.

Treatment and Response to Statins: Gender-related Differences.

PubMed

Raparelli, Valeria; Pannitteri, Gaetano; Todisco, Tommaso; Toriello, Filippo; Napoleone, Laura; Manfredini, Roberto; Basili, Stefania

2017-01-01

Response to drug administration is a primary determinant for treatment success. Sex and gender disparities play a role in determining the efficacy and safety of the most commonly used medications suggesting the need for a sex-tailored approach in prescription. Statins are a cost-effective strategy for cardiovascular disease (CVD) prevention. While statins are similarly effective in secondary CVD prevention, some concerns raised by conflicting data reported in primary CVD prevention clinical trials. The small representation of women in clinical trials and the fewer rates of events due to the lower female baseline CVD risk may have conditioned contradictory meta-analysis findings. Specifically, benefits outweigh disadvantages of statin therapy in women with a high CVD risk, while several doubts exist for the primary prevention of women at low-intermediate CVD risk. Furthermore, disparities between women and men in medication adherence may influence statin efficacy in CVD prevention. The sex-dependent impact of adverse side effects is one of the reasons advocated for explaining the gender gap, but it is not evidence-proved. The present review summarizes the sex and gender differences in the use of statins, pointing out new perspectives and opening issues in sex-tailored CVD prevention strategy. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Low physical activity as a predictor for total and cardiovascular disease mortality in middle-aged men and women in Finland.

PubMed

Barengo, Noël C; Hu, Gang; Lakka, Timo A; Pekkarinen, Heikki; Nissinen, Aulikki; Tuomilehto, Jaakko

2004-12-01

To investigate separately for men and women whether moderate or high leisure time physical activity, occupational physical activity, and commuting activity are associated with a reduced cardiovascular disease (CVD) and all-cause mortality, independent of CVD risk factors and other forms of physical activity. Prospective follow-up of 15,853 men and 16,824 women aged 30-59 years living in eastern and south-western Finland (median follow-up time 20 years). CVD and all-cause mortality were lower (9-21%) in men and women (2-17%) who were moderately or highly physically active during leisure time. Moderate and high levels of occupational physical activity decreased CVD and all-cause mortality by 21-27% in both sexes. Women spending daily 15 min or more in walking or cycling to and from work had a reduced CVD and all-cause mortality before adjustment for occupational and leisure time physical activity. Commuting activity was not associated with CVD or all-cause mortality in men. Moderate and high levels of leisure time and occupational physical activity are associated with a reduced CVD and all-cause mortality among both sexes. Promoting already moderate levels of leisure time and occupational physical activity are essential to prevent premature CVD and all-cause mortality.

Cardiovascular disease in women and noncontraceptive use of hormones: a feminist analysis.

PubMed

MacPherson, K I

1992-06-01

Cardiovascular disease (CVD) in women is being defined by biomedical researchers and physicians as part of the menopausal syndrome. Postmenopausal lowered levels of estrogen are presented as a prime cause of changes in cholesterol levels that are a risk factor for CVD. The biomedical model and hormone debate are described and analyzed, followed by a feminist perspective of CVD. This includes new federal policies that support CVD research. Nurses are encouraged to present a broader picture of CVD and its risks than that presented by the biomedical model and to empower women's understanding of this complex health issue through educational, clinical, and research endeavors.

New developments in CVD diamond for detector applications

NASA Astrophysics Data System (ADS)

Adam, W.; Berdermann, E.; Bergonzo, P.; de Boer, W.; Bogani, F.; Borchi, E.; Brambilla, A.; Bruzzi, M.; Colledani, C.; Conway, J.; D'Angelo, P.; Dabrowski, W.; Delpierre, P.; Dulinski, W.; Doroshenko, J.; van Eijk, B.; Fallou, A.; Fischer, P.; Fizzotti, F.; Furetta, C.; Gan, K. K.; Ghodbane, N.; Grigoriev, E.; Hallewell, G.; Han, S.; Hartjes, F.; Hrubec, J.; Husson, D.; Kagan, H.; Kaplon, J.; Kass, R.; Keil, M.; Knoepfle, K. T.; Koeth, T.; Krammer, M.; Logiudice, A.; Lu, R.; Mac Lynne, L.; Manfredotti, C.; Meier, D.; Menichelli, D.; Meuser, S.; Mishina, M.; Moroni, L.; Noomen, J.; Oh, A.; Pernicka, M.; Perera, L.; Potenza, R.; Riester, J. L.; Roe, S.; Rudge, A.; Sala, S.; Sampietro, M.; Schnetzer, S.; Sciortino, S.; Stelzer, H.; Stone, R.; Sutera, C.; Trischuk, W.; Tromson, D.; Tuve, C.; Vincenzo, B.; Weilhammer, P.; Wermes, N.; Wetstein, M.; Zeuner, W.; Zoeller, M.

Chemical Vapor Deposition (CVD) diamond has been discussed extensively as an alternative sensor material for use very close to the interaction region of the LHC and other machines where extreme radiation conditions exist. During the last seven years the RD42 collaboration has developed diamond detectors and tested them with LHC electronics towards the end of creating a device usable by experiments. The most recent results of this work are presented. Recently, a new form of CVD diamond has been developed: single crystal CVD diamond which resolves many of the issues associated with poly-crystalline CVD material. The first tests of this material are also presented.

The Chemistry of Inorganic Precursors during the Chemical Deposition of Films on Solid Surfaces.

PubMed

Barry, Seán T; Teplyakov, Andrew V; Zaera, Francisco

2018-03-20

The deposition of thin solid films is central to many industrial applications, and chemical vapor deposition (CVD) methods are particularly useful for this task. For one, the isotropic nature of the adsorption of chemical species affords even coverages on surfaces with rough topographies, an increasingly common requirement in microelectronics. Furthermore, by splitting the overall film-depositing reactions into two or more complementary and self-limiting steps, as it is done in atomic layer depositions (ALD), film thicknesses can be controlled down to the sub-monolayer level. Thanks to the availability of a vast array of inorganic and metalorganic precursors, CVD and ALD are quite versatile and can be engineered to deposit virtually any type of solid material. On the negative side, the surface chemistry that takes place in these processes is often complex, and can include undesirable side reactions leading to the incorporation of impurities in the growing films. Appropriate precursors and deposition conditions need to be chosen to minimize these problems, and that requires a proper understanding of the underlying surface chemistry. The precursors for CVD and ALD are often designed and chosen based on their known thermal chemistry from inorganic chemistry studies, taking advantage of the vast knowledge developed in that field over the years. Although a good first approximation, however, this approach can lead to wrong choices, because the reactions of these precursors at gas-solid interfaces can be quite different from what is seen in solution. For one, solvents often aid in the displacement of ligands in metalorganic compounds, providing the right dielectric environment, temporarily coordinating to the metal, or facilitating multiple ligand-complex interactions to increase reaction probabilities; these options are not available in the gas-solid reactions associated with CVD and ALD. Moreover, solid surfaces act as unique "ligands", if these reactions are to be viewed from the point of view of the metalorganic complexes used as precursors: they are bulky and rigid, can provide multiple binding sites for a single reaction, and can promote unique bonding modes, especially on metals, which have delocalized electronic structures. The differences between the molecular and surface chemistry of CVD and ALD precursors can result in significant variations in their reactivity, ultimately leading to unpredictable properties in the newly grown films. In this Account, we discuss some of the main similarities and differences in chemistry that CVD/ALD precursors follow on surfaces when contrasted against their known behavior in solution, with emphasis on our own work but also referencing other key contributions. Our approach is unique in that it combines expertise from the inorganic, surface science, and quantum-mechanics fields to better understand the mechanistic details of the chemistry of CVD and ALD processes and to identify new criteria to consider when designing CVD/ALD precursors.

Association of Fitness in Young Adulthood With Survival and Cardiovascular Risk The Coronary Artery Risk Development in Young Adults (CARDIA) Study

PubMed Central

Shah, Ravi V.; Murthy, Venkatesh L.; Colangelo, Laura A.; Reis, Jared; Venkatesh, Bharath Ambale; Sharma, Ravi; Abbasi, Siddique A.; Goff, David C.; Carr, J. Jeffrey; Rana, Jamal S.; Terry, James G.; Bouchard, Claude; Sarzynski, Mark A.; Eisman, Aaron; Neilan, Tomas; Das, Saumya; Jerosch-Herold, Michael; Lewis, Cora E.; Carnethon, Mercedes; Lewis, Gregory D.; Lima, Joao A. C.

2017-01-01

Importance Although cardiorespiratory fitness (CRF) is prognostic in older adults, the effect of CRF during early adulthood on long-term cardiovascular structure, function, and prognosis is less clear. Objective To examine whether CRF in young adults is associated with long-term clinical outcome and subclinical cardiovascular disease (CVD). Design, Setting, and Participants Prospective study of 4872 US adults aged 18 to 30 years who underwent treadmill exercise testing at a baseline study visit from March 25, 1985, to June 7, 1986, and 2472 individuals who underwent a second treadmill test 7 years later. Median follow-up was 26.9 years, with assessment of obesity, left ventricular mass and strain, coronary artery calcification (CAC), and vital status and incident CVD. Follow-up was complete on August 31, 2011, and data were analyzed from recruitment through the end of follow-up. Main Outcomes and Measures The presence of CAC was assessed by computed tomography at years 15 (2000-2001), 20 (2005-2006), and 25 (2010-2011), and left ventricular mass was assessed at years 5 (1990-1991) and 25 (with global longitudinal strain). Incident CVD and all-cause mortality were adjudicated. Results Of the 4872 individuals, 273 (5.6%) died and 193 (4.0%) experienced CVD events during follow-up. After comprehensive adjustment, each additional minute of baseline exercise test duration was associated with a 15% lower hazard of death (hazard ratio [HR], 0.85; 95% CI, 0.80-0.91; P < .001) and a 12% lower hazard of CVD (HR, 0.88; 95% CI, 0.81-0.96; P = .002). Higher levels of baseline CRF were associated with significantly lower left ventricular mass index (β = −0.24; 95% CI, −0.45 to −0.03; P = .02) and significantly better lobal longitudinal strain (β = −0.09; 95% CI, −0.14 to −0.05; P < .001) at year 25. Fitness was not associated with CAC. A 1-minute reduction in fitness by year 7 was associated with 21% and 20% increased hazards of death (HR, 1.21; 95% CI, 1.07-1.37; P = .002) and CVD (HR, 1.20; 95% CI, 1.06-1.37; P = .006), respectively, along with a more impaired strain (β = 0.15; 95% CI, 0.08-0.23; P < .001). No association between change in fitness and CAC was found. Conclusions and Relevance Higher levels of fitness at baseline and improvement in fitness early in adulthood are favorably associated with lower risks for CVD and mortality. Fitness and changes in fitness are associated with myocardial hypertrophy and dysfunction but not CAC. Regular efforts to ascertain and improve CRF in young adulthood may play a critical role in promoting cardiovascular health and interrupting early CVD pathogenesis. PMID:26618471

Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association.

PubMed

Mehta, Laxmi S; Watson, Karol E; Barac, Ana; Beckie, Theresa M; Bittner, Vera; Cruz-Flores, Salvador; Dent, Susan; Kondapalli, Lavanya; Ky, Bonnie; Okwuosa, Tochukwu; Piña, Ileana L; Volgman, Annabelle Santos

2018-02-20

Cardiovascular disease (CVD) remains the leading cause of mortality in women, yet many people perceive breast cancer to be the number one threat to women's health. CVD and breast cancer have several overlapping risk factors, such as obesity and smoking. Additionally, current breast cancer treatments can have a negative impact on cardiovascular health (eg, left ventricular dysfunction, accelerated CVD), and for women with pre-existing CVD, this might influence cancer treatment decisions by both the patient and the provider. Improvements in early detection and treatment of breast cancer have led to an increasing number of breast cancer survivors who are at risk of long-term cardiac complications from cancer treatments. For older women, CVD poses a greater mortality threat than breast cancer itself. This is the first scientific statement from the American Heart Association on CVD and breast cancer. This document will provide a comprehensive overview of the prevalence of these diseases, shared risk factors, the cardiotoxic effects of therapy, and the prevention and treatment of CVD in breast cancer patients. © 2018 American Heart Association, Inc.

Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.

PubMed

Heidenreich, Paul A; Trogdon, Justin G; Khavjou, Olga A; Butler, Javed; Dracup, Kathleen; Ezekowitz, Michael D; Finkelstein, Eric Andrew; Hong, Yuling; Johnston, S Claiborne; Khera, Amit; Lloyd-Jones, Donald M; Nelson, Sue A; Nichol, Graham; Orenstein, Diane; Wilson, Peter W F; Woo, Y Joseph

2011-03-01

Cardiovascular disease (CVD) is the leading cause of death in the United States and is responsible for 17% of national health expenditures. As the population ages, these costs are expected to increase substantially. To prepare for future cardiovascular care needs, the American Heart Association developed methodology to project future costs of care for hypertension, coronary heart disease, heart failure, stroke, and all other CVD from 2010 to 2030. This methodology avoided double counting of costs for patients with multiple cardiovascular conditions. By 2030, 40.5% of the US population is projected to have some form of CVD. Between 2010 and 2030, real (2008$) total direct medical costs of CVD are projected to triple, from $273 billion to $818 billion. Real indirect costs (due to lost productivity) for all CVD are estimated to increase from $172 billion in 2010 to $276 billion in 2030, an increase of 61%. These findings indicate CVD prevalence and costs are projected to increase substantially. Effective prevention strategies are needed if we are to limit the growing burden of CVD.

Arterial stiffness is increased in asymptomatic nondiabetic postmenopausal women with a polycystic ovary syndrome phenotype.

PubMed

Armeni, Eleni; Stamatelopoulos, Kimon; Rizos, Demetrios; Georgiopoulos, George; Kazani, Maria; Kazani, Aikaterini; Kolyviras, Athanasios; Stellos, Konstantinos; Panoulis, Konstantinos; Alexandrou, Andreas; Creatsa, Maria; Papamichael, Christos; Lambrinoudaki, Irene

2013-10-01

The metabolic dysfunction accompanying the polycystic ovary syndrome (PCOS) may increase the risk of hypertension and cardiovascular disease (CVD). Although menopause per se may be an additional risk factor of CVD, the association between PCOS in postmenopausal women and cardiovascular risk has not been adequately investigated. We aimed to evaluate the effect of PCOS on markers of subclinical atherosclerosis in nondiabetic postmenopausal women. This cross-sectional study included 286 postmenopausal women with intact ovaries. PCOS phenotype was defined if three of the following were present: insulin resistance, current hyperandrogenism or history of clinical androgen excess, history of infertility, central obesity and history of irregular menses. Traditional CVD risk factors, as well as indices of arterial structure (intima-media thickness, atheromatous plaques presence) and function [flow-mediated dilation, pulse wave velocity (PWV), augmentation index] were compared between women with a PCOS phenotype and the rest of the sample, who served as controls. Women with the PCOS phenotype (N=43) had higher SBP and triglycerides and lower high-density lipoprotein (HDL)-cholesterol than controls. Mean values of PWV differed significantly between PCOS cases and controls (9.46±1.74 vs. 8.60±1.51 m/s, P=0.001, univariate). Multivariate regression analysis showed that the PCOS phenotype, age and SBP were the only independent predictors of PWV. Arterial stiffness is increased in asymptomatic, nondiabetic women with a putative PCOS phenotype, independently of age, BMI or blood pressure. This might present one mechanism through which PCOS increases the risk of CVD and hypertension later in life.

Edward F. Adolph Distinguished Lecture: The remarkable anti-aging effects of aerobic exercise on systemic arteries

PubMed Central

2014-01-01

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in modern societies, and advancing age is the major risk factor for CVD. Arterial dysfunction, characterized by large elastic artery stiffening and endothelial dysfunction, is the key event leading to age-associated CVD. Our work shows that regular aerobic exercise inhibits large elastic artery stiffening with aging (optimizes arterial compliance) and preserves endothelial function. Importantly, among previously sedentary late middle-aged and older adults, aerobic exercise improves arterial stiffness and enhances endothelial function in most groups and, therefore, also can be considered a treatment for age-associated arterial dysfunction. The mechanisms by which regular aerobic exercise destiffens large elastic arteries are incompletely understood, but existing evidence suggests that reductions in oxidative stress associated with decreases in both adventitial collagen (fibrosis) and advanced glycation end-products (structural protein cross-linking molecules), play a key role. Aerobic exercise preserves endothelial function with aging by maintaining nitric oxide bioavailability via suppression of excessive superoxide-associated oxidative stress, and by inhibiting the development of chronic low-grade vascular inflammation. Recent work from our laboratory supports the novel hypothesis that aerobic exercise may exert these beneficial effects by directly inducing protection to aging arteries against multiple adverse factors to which they are chronically exposed. Regular aerobic exercise should be viewed as a “first line” strategy for prevention and treatment of arterial aging and a vital component of a contemporary public health approach for reducing the projected increase in population CVD burden. PMID:24855137

Edward F. Adolph Distinguished Lecture: The remarkable anti-aging effects of aerobic exercise on systemic arteries.

PubMed

Seals, Douglas R

2014-09-01

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in modern societies, and advancing age is the major risk factor for CVD. Arterial dysfunction, characterized by large elastic artery stiffening and endothelial dysfunction, is the key event leading to age-associated CVD. Our work shows that regular aerobic exercise inhibits large elastic artery stiffening with aging (optimizes arterial compliance) and preserves endothelial function. Importantly, among previously sedentary late middle-aged and older adults, aerobic exercise improves arterial stiffness and enhances endothelial function in most groups and, therefore, also can be considered a treatment for age-associated arterial dysfunction. The mechanisms by which regular aerobic exercise destiffens large elastic arteries are incompletely understood, but existing evidence suggests that reductions in oxidative stress associated with decreases in both adventitial collagen (fibrosis) and advanced glycation end-products (structural protein cross-linking molecules), play a key role. Aerobic exercise preserves endothelial function with aging by maintaining nitric oxide bioavailability via suppression of excessive superoxide-associated oxidative stress, and by inhibiting the development of chronic low-grade vascular inflammation. Recent work from our laboratory supports the novel hypothesis that aerobic exercise may exert these beneficial effects by directly inducing protection to aging arteries against multiple adverse factors to which they are chronically exposed. Regular aerobic exercise should be viewed as a "first line" strategy for prevention and treatment of arterial aging and a vital component of a contemporary public health approach for reducing the projected increase in population CVD burden. Copyright © 2014 the American Physiological Society.

Early physiological markers of cardiovascular risk in community based adolescents with a depressive disorder.

PubMed

Waloszek, Joanna M; Byrne, Michelle L; Woods, Michael J; Nicholas, Christian L; Bei, Bei; Murray, Greg; Raniti, Monika; Allen, Nicholas B; Trinder, John

2015-04-01

Depression is recognised as an independent cardiovascular risk factor in adults. Identifying this relationship early on in life is potentially important for the prevention of cardiovascular disease (CVD). This study investigated whether clinical depression is associated with multiple physiological markers of CVD risk in adolescents from the general community. Participants aged 12-18 years were recruited from the general community and screened for depressive symptoms. Individuals with high and low depressive symptoms were administered a diagnostic interview. Fifty participants, 25 with a current depressive episode and 25 matched healthy controls, subsequently completed cardiovascular assessments. Variables assessed were automatic brachial and continuous beat-to-beat finger arterial blood pressure, heart rate, vascular functioning by pulse amplitude tonometry following reactive hyperaemia and pulse transit time (PTT) at rest. Blood samples were collected to measure cholesterol, glucose and glycohaemoglobin levels and an index of cumulative risk of traditional cardiovascular risk factors was calculated. Depressed adolescents had a significantly lower reactive hyperaemia index and shorter PTT, suggesting deterioration in vascular integrity and structure. Higher fasting glucose and triglyceride levels were also observed in the depressed group, who also had higher cumulative risk scores indicative of increased engagement in unhealthy behaviours and higher probability of advanced atherosclerotic lesions. The sample size and number of males who completed all cardiovascular measures was small. Clinically depressed adolescents had poorer vascular functioning and increased CVD risk compared to controls, highlighting the need for early identification and intervention for the prevention of CVD in depressed youth. Copyright © 2015 Elsevier B.V. All rights reserved.

Fabrication of AlN/BN bishell hollow nanofibers by electrospinning and atomic layer deposition

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haider, Ali; Kayaci, Fatma; Uyar, Tamer

2014-09-01

Aluminum nitride (AlN)/boron nitride (BN) bishell hollow nanofibers (HNFs) have been fabricated by successive atomic layer deposition (ALD) of AlN and sequential chemical vapor deposition (CVD) of BN on electrospun polymeric nanofibrous template. A four-step fabrication process was utilized: (i) fabrication of polymeric (nylon 6,6) nanofibers via electrospinning, (ii) hollow cathode plasma-assisted ALD of AlN at 100 °C onto electrospun polymeric nanofibers, (iii) calcination at 500 °C for 2 h in order to remove the polymeric template, and (iv) sequential CVD growth of BN at 450 °C. AlN/BN HNFs have been characterized for their chemical composition, surface morphology, crystal structure, and internal nanostructuremore » using X-ray photoelectron spectroscopy, scanning electron microscopy, transmission electron microscopy, energy dispersive X-ray spectroscopy, and selected area electron diffraction. Measurements confirmed the presence of crystalline hexagonal BN and AlN within the three dimensional (3D) network of bishell HNFs with relatively low impurity content. In contrast to the smooth surface of the inner AlN layer, outer BN coating showed a highly rough 3D morphology in the form of BN nano-needle crystallites. It is shown that the combination of electrospinning and plasma-assisted low-temperature ALD/CVD can produce highly controlled multi-layered bishell nitride ceramic hollow nanostructures. While electrospinning enables easy fabrication of nanofibrous template, self-limiting reactions of plasma-assisted ALD and sequential CVD provide control over the wall thicknesses of AlN and BN layers with sub-nanometer accuracy.« less

HIV and Cardiovascular Disease

MedlinePlus

... Select a Language: Fact Sheet 652 HIV and Cardiovascular Disease HIV AND CARDIOVASCULAR DISEASE WHY SHOULD PEOPLE WITH HIV CARE ABOUT CVD? ... OF CVD? WHAT ABOUT CHANGING MEDICATIONS? HIV AND CARDIOVASCULAR DISEASE Cardiovascular disease (CVD) includes a group of problems ...

Comparative study of passively Q-switched c-cut Nd:YVO4/Nd:YAG lasers based on CVD graphene and controlled operation

NASA Astrophysics Data System (ADS)

Jia, Fuqiang; Liu, Pei; Li, Kang; Chen, Hao; Cheng, Yongjie; Cai, Zhiping; Copner, Nigel

2017-07-01

In this paper, a comparative study of passively Q-switched c-cut Nd:YVO4 and Nd:YAG lasers using four different layers CVD graphene as saturable absorber are demonstrated experimentally for the first time. Moreover, it is successful to accurately control the frequency of repetition rates of the CVD graphern passively Q-switched lasers by pulsed pump. The impacts of laser materials, layers of CVD graphene and cavity length on output parameters are investigated intensively as well, the result shows that the c-cut Nd:YVO4 is a promising laser media compared with Nd:YAG for passively Q-switched lasers based on CVD graphene, as it has better performances in pulse width, pulse energy and peak power. A useful and cost-effective way to generate stable pulsed lasers by CVD graphene or other novel saturable materials are demonstrated.

Injection drug use: an understudied cause of venous disease.

PubMed

Pieper, Barbara; Kirsner, Robert S; Templin, Thomas N; Birk, Thomas J

2007-10-01

Injection drug use has devastating effects on the veins, skin, muscles, and joints of the lower extremities, thus increasing the risk of chronic venous disease (CVD). We examined the following risk factors for CVD in persons who injected drugs: health and drug use history, ankle mobility, pain, and skin and wound assessment. Because of deep venous thrombosis and injury and immobility to the calf muscle pump from injected drugs, CVD occurs at a young age. Decreased ankle joint movement, decreased walking, and increased pain are associated with worsening CVD clinical classification. Associated venous ulcers tend to be multiple and large by the time wound care is sought. Cellulitis and abscesses may also be present. Injection drug users serve as a model for the multifactorial nature of CVD including vein damage, diminished ankle range of motion, and decreased calf muscle strength. Persons who inject drugs need to have their lower extremities assessed for CVD on a routine basis.

Can dental pulp calcification predict the risk of ischemic cardiovascular disease?

PubMed

Khojastepour, Leila; Bronoosh, Pegah; Khosropanah, Shahdad; Rahimi, Elham

2013-09-01

To report the association of pulp calcification with that of cardiovascular disease (CVD) using digital panoramic dental radiographs. Digital panoramic radiographs of patients referred from the angiography department were included if the patient was under 55 years old and had non-restored or minimally restored molars and canines. An oral and maxillofacial radiologist evaluated the images for pulpal calcifications in the selected teeth. The sensitivity, specificity, positive predictive value and negative predictive value of panoramic radiography in predicting CVD were calculated. Out of 122 patients who met the criteria, 68.2% of the patients with CVD had pulp chamber calcifications. Pulp calcification in panoramic radiography had a sensitivity of 68.9% to predict CVD. This study demonstrates that patients with CVD show an increased incidence of pulp calcification compared with healthy patients. The findings suggest that pulp calcification on panoramic radiography may have possibilities for use in CVD screening.

Cardiovascular Disease and Primary Ovarian Insufficiency

PubMed Central

Wellons, Melissa

2012-01-01

Cardiovascular disease (CVD) is the number-one killer of women. Women with primary ovarian insufficiency (POI) may be more burdened by cardiovascular disease, such as myocardial infarction and stroke, as compared with women with normal menopause. The increased burden may be mediated by a worsening of cardiovascular risk factors, such as lipids, corresponding with the loss of ovarian function. In contrast, the increased burden may be caused by factors that precede and potentially contribute to both CVD events and ovarian decline, such as X-chromosome abnormalities and smoking. Regardless of the cause, women with POI may serve as an important population to target for CVD screening and prevention strategies. These strategies should include the use of CVD risk stratification tools to identify women that may benefit from lifestyle modification and pharmacological therapy to prevent CVD. Sex steroid therapy for the sole purpose of CVD prevention in women with POI cannot be recommended, based on a lack of evidence. PMID:21969267

Association of Educational Attainment With Lifetime Risk of Cardiovascular Disease: The Atherosclerosis Risk in Communities Study.

PubMed

Kubota, Yasuhiko; Heiss, Gerardo; MacLehose, Richard F; Roetker, Nicholas S; Folsom, Aaron R

2017-08-01

Estimates of lifetime risk may help raise awareness of the extent to which educational inequalities are associated with risk of cardiovascular disease (CVD). To estimate lifetime risks of CVD according to categories of educational attainment. Participants were followed from 1987 through December 31, 2013. All CVD events (coronary heart disease, heart failure, and stroke) were confirmed by physician review and International Classification of Diseases codes. A total of 13 948 whites and African Americans who were 45 to 64 years old and free of CVD at baseline were included from 4 US communities (Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and suburbs of Minneapolis, Minnesota). The data analysis was performed from June 7 to August 31, 2016. Educational attainment. We used a life table approach to estimate lifetime risks of CVD from age 45 through 85 years according to educational attainment. We adjusted for competing risks of death from underlying causes other than CVD. The sample of 13 948 participants was 56% female and 27% African American. During 269 210 person-years of follow-up, we documented 4512 CVD events and 2401 non-CVD deaths. Educational attainment displayed an inverse dose-response relation with cumulative risk of CVD, which became evident in middle age, with the most striking gap between those not completing vs completing high school. In men, lifetime risks of CVD were 59.0% (95% CI, 54.0%-64.1%) for grade school, 52.5% (95% CI, 47.7%-56.8%) for high school education without graduation, 50.9% (95% CI, 47.3%-53.9%) for high school graduation, 47.2% (95% CI, 41.5%-52.5%) for vocational school, 46.4% (95% CI, 42.8%-49.6%) for college with or without graduation, and 42.2% (95% CI, 36.6%-47.0%) for graduate/professional school; in women, 50.8% (95% CI, 45.7%-55.8%), 49.3% (95% CI, 45.1%-53.1%), 36.3% (95% CI, 33.4%-39.1%), 32.2% (95% CI, 26.0%-37.3%), 32.8% (95% CI, 29.1%-35.9%), and 28.0% (95% CI, 21.9%-33.3%), respectively. Educational attainment was inversely associated with CVD even within categories of family income, income change, occupation, or parental educational level. More than 1 in 2 individuals with less than high school education had a lifetime CVD event. Educational attainment was inversely associated with the lifetime risk of CVD, regardless of other important socioeconomic characteristics. Our findings emphasize the need for further efforts to reduce CVD inequalities related to educational disparities.

Chinese Cardiovascular Disease Mobile Apps’ Information Types, Information Quality, and Interactive Functions for Self-Management: Systematic Review

PubMed Central

Xie, Bo; Su, Zhaohui; Zhang, Wenhui

2017-01-01

Background China has a large population with cardiovascular disease (CVD) that requires extensive self-management. Mobile health (mHealth) apps may be a useful tool for CVD self-management. Little is currently known about the types and quality of health information provided in Chinese CVD mobile apps and whether app functions are conducive to promoting CVD self-management. Objective We undertook a systematic review to evaluate the types and quality of health information provided in Chinese CVD mobile apps and interactive app functions for promoting CVD self-management. Methods Mobile apps targeting end users in China with CVD conditions were selected in February 2017 through a multi-stage process. Three frameworks were used to evaluate the selected apps: (1) types of health information offered were assessed using our Health Information Wants framework, which encompasses 7 types of information; (2) quality of information provided in the apps was assessed using the 11 guidelines recommended by the National Library of Medicine of the National Institutes of Health; and (3) types of interactive app functions for CVD self-management were assessed using a 15-item framework adapted from the literature, including our own prior work. Results Of 578 apps identified, 82 were eligible for final review. Among these, information about self-care (67/82, 82%) and information specifically regarding CVD (63/82, 77%) were the most common types of information provided, while information about health care providers (22/82, 27%) and laboratory tests (5/82, 6%) were least common. The most common indicators of information quality were the revealing of apps’ providers (82/82, 100%) and purpose (82/82, 100%), while the least common quality indicators were the revealing of how apps’ information was selected (1/82, 1%) and app sponsorship (0/82, 0%). The most common interactive functions for CVD self-management were those that enabled user interaction with the app provider (57/82, 70%) and with health care providers (36/82, 44%), while the least common interactive functions were those that enabled lifestyle management (13/82, 16%) and psychological health management (6/82, 7%). None of the apps covered all 7 types of health information, all 11 indicators of information quality, or all 15 interactive functions for CVD self-management. Conclusions Chinese CVD apps are insufficient in providing comprehensive health information, high-quality information, and interactive functions to facilitate CVD self-management. End users should exercise caution when using existing apps. Health care professionals and app developers should collaborate to better understand end users’ preferences and follow evidence-based guidelines to develop mHealth apps conducive to CVD self-management. PMID:29242176

Chinese Cardiovascular Disease Mobile Apps' Information Types, Information Quality, and Interactive Functions for Self-Management: Systematic Review.

PubMed

Xie, Bo; Su, Zhaohui; Zhang, Wenhui; Cai, Run

2017-12-14

China has a large population with cardiovascular disease (CVD) that requires extensive self-management. Mobile health (mHealth) apps may be a useful tool for CVD self-management. Little is currently known about the types and quality of health information provided in Chinese CVD mobile apps and whether app functions are conducive to promoting CVD self-management. We undertook a systematic review to evaluate the types and quality of health information provided in Chinese CVD mobile apps and interactive app functions for promoting CVD self-management. Mobile apps targeting end users in China with CVD conditions were selected in February 2017 through a multi-stage process. Three frameworks were used to evaluate the selected apps: (1) types of health information offered were assessed using our Health Information Wants framework, which encompasses 7 types of information; (2) quality of information provided in the apps was assessed using the 11 guidelines recommended by the National Library of Medicine of the National Institutes of Health; and (3) types of interactive app functions for CVD self-management were assessed using a 15-item framework adapted from the literature, including our own prior work. Of 578 apps identified, 82 were eligible for final review. Among these, information about self-care (67/82, 82%) and information specifically regarding CVD (63/82, 77%) were the most common types of information provided, while information about health care providers (22/82, 27%) and laboratory tests (5/82, 6%) were least common. The most common indicators of information quality were the revealing of apps' providers (82/82, 100%) and purpose (82/82, 100%), while the least common quality indicators were the revealing of how apps' information was selected (1/82, 1%) and app sponsorship (0/82, 0%). The most common interactive functions for CVD self-management were those that enabled user interaction with the app provider (57/82, 70%) and with health care providers (36/82, 44%), while the least common interactive functions were those that enabled lifestyle management (13/82, 16%) and psychological health management (6/82, 7%). None of the apps covered all 7 types of health information, all 11 indicators of information quality, or all 15 interactive functions for CVD self-management. Chinese CVD apps are insufficient in providing comprehensive health information, high-quality information, and interactive functions to facilitate CVD self-management. End users should exercise caution when using existing apps. Health care professionals and app developers should collaborate to better understand end users' preferences and follow evidence-based guidelines to develop mHealth apps conducive to CVD self-management. ©Bo Xie, Zhaohui Su, Wenhui Zhang, Run Cai. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 14.12.2017.

Dietary B Vitamin Intake Is Associated with Lower Urinary Monomethyl Arsenic and Oxidative Stress Marker 15-F2t-Isoprostane among New Hampshire Adults.

PubMed

Howe, Caitlin G; Li, Zhigang; Zens, Michael S; Palys, Thomas; Chen, Yu; Channon, Jacqueline Y; Karagas, Margaret R; Farzan, Shohreh F

2017-12-01

Background: Arsenic exposure has been associated with an increased risk of cardiovascular disease (CVD). Growing evidence suggests that B vitamins facilitate arsenic metabolism and may protect against arsenic toxicity. However, to our knowledge, few studies have evaluated this in US populations. Objective: Our objective was to examine whether higher B vitamin intake is associated with enhanced arsenic metabolism and lower concentrations of preclinical markers of CVD among New Hampshire adults. Methods: We used weighted quantile sum (WQS) regression to evaluate the collective impact of 6 dietary B vitamins (thiamin, riboflavin, folate, niacin, and vitamins B-6 and B-12) on 1 ) the proportion of arsenic metabolites in urine and 2 ) 6 CVD-related markers [including urinary 15-F 2t -isoprostane (15-F 2t -IsoP)] among 418 participants (26-75 y of age) from the New Hampshire Health Study. Contributions of arsenic metabolites to B vitamin-CVD marker associations were also explored in structural equation models. Results: In WQS models, the weighted sum of B vitamin intakes from food sources was inversely associated with the proportion of monomethyl arsenic species in urine (uMMA) (β: -1.03; 95% CI: -1.91, -0.15; P = 0.02). Thiamin and vitamins B-6 and B-12 contributed the most to this association, whereas riboflavin had a negligible effect. Higher overall B vitamin intake was also inversely associated with 15-F 2t -IsoP (β: -0.21; 95% CI: -0.32, -0.11; P < 0.01), with equal contributions from the 6 B vitamins, which was partially explained by differences in the proportion of uMMA (indirect effect β: -0.01; 95% CI: -0.04, -0.00). Conclusions: Among New Hampshire adults, higher intakes of certain B vitamins (particularly thiamin and vitamins B-6 and B-12 from food sources) may reduce the proportion of uMMA, an intermediate of arsenic metabolism that has been associated with an increased risk of CVD. Higher overall B vitamin intake may also reduce urinary 15-F 2t -IsoP, a marker of oxidative stress and potential risk factor for CVD, in part by reducing the proportion of uMMA. © 2017 American Society for Nutrition.

Cardiovascular Disease Death Before Age 65 in 168 Countries Correlated Statistically with Biometrics, Socioeconomic Status, Tobacco, Gender, Exercise, Macronutrients, and Vitamin K

PubMed Central

Agutter, Paul S

2016-01-01

Background Nutrition researchers recently recognized that deficiency of vitamin K2 (menaquinone: MK-4–MK-13) is widespread and contributes to cardiovascular disease (CVD). The deficiency of vitamin K2 or vitamin K inhibition with warfarin leads to calcium deposition in the arterial blood vessels. Methods Using publicly available sources, we collected food commodity availability data and derived nutrient profiles including vitamin K2 for people from 168 countries. We also collected female and male cohort data on early death from CVD (ages 15–64 years), insufficient physical activity, tobacco, biometric CVD risk markers, socioeconomic risk factors for CVD, and gender. The outcome measures included (1) univariate correlations of early death from CVD with each risk factor, (2) a multiple regression-derived formula relating early death from CVD (dependent variable) to macronutrient profile, vitamin K1 and K2 and other risk factors (independent variables), (3) for each risk factor appearing in the multiple regression formula, the portion of CVD risk attributable to that factor, and (4) similar univariate and multivariate analyses of body mass index (BMI), fasting blood sugar (FBS) (simulated from diabetes prevalence), systolic blood pressure (SBP), and cholesterol/ HDL-C ratio (simulated from serum cholesterol) (dependent variables) and dietary and other risk factors (independent variables). Results Female and male cohorts in countries that have vitamin K2 < 5µg per 2000 kcal/day per capita (n = 70) had about 2.2 times the rate of early CVD deaths as people in countries with > 24 µg/day of vitamin K2 per 2000 kcal/day (n = 72). A multiple regression-derived formula relating early death from CVD to dietary nutrients and other risk factors accounted for about 50% of the variance between cohorts in early CVD death. The attributable risks of the variables in the CVD early death formula were: too much alcohol (0.38%), too little vitamin K2 (6.95%), tobacco (6.87%), high blood pressure (9.01%), air pollution (9.15%), early childhood death (3.64%), poverty (7.66%), and male gender (6.13%). Conclusions Worldwide dietary vitamin K2 data derived from food commodities add much understanding to the analysis of CVD risk factors and the etiology of CVD. Vitamin K2 in food products should be systematically quantified. Public health programs should be considered to increase the intake of vitamin K2-containing fermented plant foods such as sauerkraut, miso, and natto. PMID:27688985

Cardiovascular Disease Death Before Age 65 in 168 Countries Correlated Statistically with Biometrics, Socioeconomic Status, Tobacco, Gender, Exercise, Macronutrients, and Vitamin K.

PubMed

Cundiff, David K; Agutter, Paul S

2016-08-24

Nutrition researchers recently recognized that deficiency of vitamin K2 (menaquinone: MK-4-MK-13) is widespread and contributes to cardiovascular disease (CVD). The deficiency of vitamin K2 or vitamin K inhibition with warfarin leads to calcium deposition in the arterial blood vessels. Using publicly available sources, we collected food commodity availability data and derived nutrient profiles including vitamin K2 for people from 168 countries. We also collected female and male cohort data on early death from CVD (ages 15-64 years), insufficient physical activity, tobacco, biometric CVD risk markers, socioeconomic risk factors for CVD, and gender. The outcome measures included (1) univariate correlations of early death from CVD with each risk factor, (2) a multiple regression-derived formula relating early death from CVD (dependent variable) to macronutrient profile, vitamin K1 and K2 and other risk factors (independent variables), (3) for each risk factor appearing in the multiple regression formula, the portion of CVD risk attributable to that factor, and (4) similar univariate and multivariate analyses of body mass index (BMI), fasting blood sugar (FBS) (simulated from diabetes prevalence), systolic blood pressure (SBP), and cholesterol/ HDL-C ratio (simulated from serum cholesterol) (dependent variables) and dietary and other risk factors (independent variables). Female and male cohorts in countries that have vitamin K2 < 5µg per 2000 kcal/day per capita (n = 70) had about 2.2 times the rate of early CVD deaths as people in countries with > 24 µg/day of vitamin K2 per 2000 kcal/day (n = 72). A multiple regression-derived formula relating early death from CVD to dietary nutrients and other risk factors accounted for about 50% of the variance between cohorts in early CVD death. The attributable risks of the variables in the CVD early death formula were: too much alcohol (0.38%), too little vitamin K2 (6.95%), tobacco (6.87%), high blood pressure (9.01%), air pollution (9.15%), early childhood death (3.64%), poverty (7.66%), and male gender (6.13%). Worldwide dietary vitamin K2 data derived from food commodities add much understanding to the analysis of CVD risk factors and the etiology of CVD. Vitamin K2 in food products should be systematically quantified. Public health programs should be considered to increase the intake of vitamin K2-containing fermented plant foods such as sauerkraut, miso, and natto.

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association.

PubMed

Dunbar, Sandra B; Khavjou, Olga A; Bakas, Tamilyn; Hunt, Gail; Kirch, Rebecca A; Leib, Alyssa R; Morrison, R Sean; Poehler, Diana C; Roger, Veronique L; Whitsel, Laurie P

2018-05-08

In a recent report, the American Heart Association estimated that medical costs and productivity losses of cardiovascular disease (CVD) are expected to grow from $555 billion in 2015 to $1.1 trillion in 2035. Although the burden is significant, the estimate does not include the costs of family, informal, or unpaid caregiving provided to patients with CVD. In this analysis, we estimated projections of costs of informal caregiving attributable to CVD for 2015 to 2035. We used data from the 2014 Health and Retirement Survey to estimate hours of informal caregiving for individuals with CVD by age/sex/race using a zero-inflated binomial model and controlling for sociodemographic factors and health conditions. Costs of informal caregiving were estimated separately for hypertension, coronary heart disease, heart failure, stroke, and other heart disease. We analyzed data from a nationally representative sample of 16 731 noninstitutionalized adults ≥54 years of age. The value of caregiving hours was monetized by the use of home health aide workers' wages. The per-person costs were multiplied by census population counts to estimate nation-level costs and to be consistent with other American Heart Association analyses of burden of CVD, and the costs were projected from 2015 through 2035, assuming that within each age/sex/racial group, CVD prevalence and caregiving hours remain constant. The costs of informal caregiving for patients with CVD were estimated to be $61 billion in 2015 and are projected to increase to $128 billion in 2035. Costs of informal caregiving of patients with stroke constitute more than half of the total costs of CVD informal caregiving ($31 billion in 2015 and $66 billion in 2035). By age, costs are the highest among those 65 to 79 years of age in 2015 but are expected to be surpassed by costs among those ≥80 years of age by 2035. Costs of informal caregiving for patients with CVD represent an additional 11% of medical and productivity costs attributable to CVD. The burden of informal caregiving for patients with CVD is significant; accounting for these costs increases total CVD costs to $616 billion in 2015 and $1.2 trillion in 2035. These estimates have important research and policy implications, and they may be used to guide policy development to reduce the burden of CVD on patients and their caregivers. © 2018 American Heart Association, Inc.

A Field Synopsis of Sex in Clinical Prediction Models for Cardiovascular Disease

PubMed Central

Paulus, Jessica K.; Wessler, Benjamin S.; Lundquist, Christine; Lai, Lana L.Y.; Raman, Gowri; Lutz, Jennifer S.; Kent, David M.

2017-01-01

Background Several widely-used risk scores for cardiovascular disease (CVD) incorporate sex effects, yet there has been no systematic summary of the role of sex in clinical prediction models (CPMs). To better understand the potential of these models to support sex-specific care, we conducted a field synopsis of sex effects in CPMs for CVD. Methods and Results We identified CPMs in the Tufts Predictive Analytics and Comparative Effectiveness (PACE) CPM Registry, a comprehensive database of CVD CPMs published from 1/1990–5/2012. We report the proportion of models including sex effects on CVD incidence or prognosis, summarize the directionality of the predictive effects of sex, and explore factors influencing the inclusion of sex. Of 592 CVD-related CPMs, 193 (33%) included sex as a predictor or presented sex-stratified models. Sex effects were included in 78% (53/68) of models predicting incidence of CVD in a general population, versus only 35% (59/171), 21% (12/58) and 17% (12/72) of models predicting outcomes in patients with coronary artery disease (CAD), stroke, and heart failure, respectively. Among sex-including CPMs, women with heart failure were at lower mortality risk in 8/8 models; women undergoing revascularization for CAD were at higher mortality risk in 10/12 models. Factors associated with the inclusion of sex effects included the number of outcome events and using cohorts at-risk for CVD (rather than with established CVD). Conclusions While CPMs hold promise for supporting sex-specific decision making in CVD clinical care, sex effects are included in only one third of published CPMs. PMID:26908865

Cardiovascular risk assessment in elderly adults using SCORE OP model in a Latin American population: The experience from Ecuador.

PubMed

Sisa, Ivan

2018-02-09

Cardiovascular disease (CVD) mortality is predicted to increase in Latin America countries due to their rapidly aging population. However, there is very little information about CVD risk assessment as a primary preventive measure in this high-risk population. We predicted the national risk of developing CVD in Ecuadorian elderly population using the Systematic COronary Risk Evaluation in Older Persons (SCORE OP) High and Low models by risk categories/CVD risk region in 2009. Data on national cardiovascular risk factors were obtained from the Encuesta sobre Salud, Bienestar y Envejecimiento. We computed the predicted 5-year risk of CVD risk and compared the extent of agreement and reclassification in stratifying high-risk individuals between SCORE OP High and Low models. Analyses were done by risk categories, CVD risk region, and sex. In 2009, based on SCORE OP Low model almost 42% of elderly adults living in Ecuador were at high risk of suffering CVD over a 5-year period. The extent of agreement between SCORE OP High and Low risk prediction models was moderate (Cohen's kappa test of 0.5), 34% of individuals approximately were reclassified into different risk categories and a third of the population would benefit from a pharmacologic intervention to reduce the CVD risk. Forty-two percent of elderly Ecuadorians were at high risk of suffering CVD over a 5-year period, indicating an urgent need to tailor primary preventive measures for this vulnerable and high-risk population. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Predicting 10-Year Risk of Fatal Cardiovascular Disease in Germany: An Update Based on the SCORE-Deutschland Risk Charts

PubMed Central

Rücker, Viktoria; Keil, Ulrich; Fitzgerald, Anthony P; Malzahn, Uwe; Prugger, Christof; Ertl, Georg; Heuschmann, Peter U; Neuhauser, Hannelore

2016-01-01

Estimation of absolute risk of cardiovascular disease (CVD), preferably with population-specific risk charts, has become a cornerstone of CVD primary prevention. Regular recalibration of risk charts may be necessary due to decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for fatal CVD risk assessment were first calibrated for Germany with 1998 risk factor level data and 1999 mortality statistics. We present an update of these risk charts based on the SCORE methodology including estimates of relative risks from SCORE, risk factor levels from the German Health Interview and Examination Survey for Adults 2008–11 (DEGS1) and official mortality statistics from 2012. Competing risks methods were applied and estimates were independently validated. Updated risk charts were calculated based on cholesterol, smoking, systolic blood pressure risk factor levels, sex and 5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower according to the updated risk charts compared to the first calibration for Germany. In a nationwide sample of 3062 adults aged 40–65 years free of major CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated charts was lower by 29% and the estimated proportion of high risk people (10-year risk > = 5%) by 50% compared to the older risk charts. This recalibration shows a need for regular updates of risk charts according to changes in mortality and risk factor levels in order to sustain the identification of people with a high CVD risk. PMID:27612145

Does Your Heart Forecast help practitioner understanding and confidence with cardiovascular disease risk communication?

PubMed

Wells, Sue; Kerr, Andrew; Broadbent, Elizabeth; MacKenzie, Craig; Cole, Karl; McLachlan, Andy

2011-03-01

Explaining what cardiovascular disease (CVD) risk means and engaging in shared decision-making regarding risk factor modification is challenging. An electronic CVD risk visualisation tool containing multiple risk communication strategies (Your Heart Forecast) was designed in 2009. To assess whether this tool facilitated explaining CVD risk to primary care patients. Health professionals who accessed a Primary Health Organisation website or who attended educational peer groups over a three-month period were invited to complete questionnaires before and after viewing a four-minute video about the tool. Respondents were asked to make an informed guess of the CVD risk of a 35-year-old patient (actual CVD risk 5%) and rate the following sentence as being true or false: 'If there were 100 people like Mr Andrews, five would go on to have a cardiac event in the next five years.' They also were asked to rank their understanding of CVD risk and confidence in explaining the concept to patients. Fifty health professionals (37 GPs, 12 practice nurses, one other) completed before and after questionnaires. Respondents' CVD risk estimates pre-video ranged from <5% to 25% and nine rated the sentence as being false. After the video, all respondents answered these questions correctly. Personal rankings from zero to 10 about understanding CVD risk and confidence in explaining risk reduced in range and shifted towards greater efficacy. Whether this tool facilitates discussions of CVD risk with patients and improves patient understanding and lifestyle behaviour needs to be evaluated in a randomised trial.

Neighborhood Environmental Health and Premature Death From Cardiovascular Disease.

PubMed

Gaglioti, Anne H; Xu, Junjun; Rollins, Latrice; Baltrus, Peter; O'Connell, Laura Kathryn; Cooper, Dexter L; Hopkins, Jammie; Botchwey, Nisha D; Akintobi, Tabia Henry

2018-02-01

Cardiovascular disease (CVD) is the leading cause of death in the United States and disproportionately affects racial/ethnic minority groups. Healthy neighborhood conditions are associated with increased uptake of health behaviors that reduce CVD risk, but minority neighborhoods often have poor food access and poor walkability. This study tested the community-driven hypothesis that poor access to food at the neighborhood level and poor neighborhood walkability are associated with racial disparities in premature deaths from CVD. We examined the relationship between neighborhood-level food access and walkability on premature CVD mortality rates at the census tract level for the city of Atlanta using multivariable logistic regression models. We produced maps to illustrate premature CVD mortality, food access, and walkability by census tract for the city. We found significant racial differences in premature CVD mortality rates and geographic disparities in food access and walkability among census tracts in Atlanta. Improved food access and walkability were associated with reduced overall premature CVD mortality in unadjusted models, but this association did not persist in models adjusted for census tract population composition and poverty. Census tracts with high concentrations of minority populations had higher levels of poor food access, poor walkability, and premature CVD mortality. This study highlights disparities in premature CVD mortality and neighborhood food access and walkability at the census tract level in the city of Atlanta. Improving food access may have differential effects for subpopulations living in the same area. These results can be used to calibrate neighborhood-level interventions, and they highlight the need to examine race-specific health outcomes.

A Community-Engaged Cardiovascular Health Disparities Research Training Curriculum: Implementation and Preliminary Outcomes

PubMed Central

Golden, Sherita Hill; Purnell, Tanjala; Halbert, Jennifer P.; Matens, Richard; Miller, Edgar R. “Pete”; Levine, David M.; Nguyen, Tam H.; Gudzune, Kimberly A.; Crews, Deidra C.; Mahlangu-Ngcobo, Mankekolo; Cooper, Lisa A.

2014-01-01

To overcome cardiovascular disease (CVD) disparities impacting high-risk populations, it is critical to train researchers and leaders in conducting community-engaged CVD disparities research. The authors summarize the key elements, implementation, and preliminary outcomes of the CVD Disparities Fellowship and Summer Internship Programs at the Johns Hopkins University Schools of Medicine, Nursing, and Bloomberg School of Public Health. In 2010, program faculty and coordinators established a trans-disciplinary CVD disparities training and career development fellowship program for scientific investigators who desire to conduct community-engaged clinical and translational disparities research. The program was developed to enhance mentorship support and research training for faculty, post-doctoral fellows, and pre-doctoral students interested in conducting CVD disparities research. A CVD Disparities Summer Internship Program for undergraduate and pre-professional students was also created to provide a broad experience in public health and health disparities in Baltimore, Maryland, with a focus on CVD. Since 2010, 39 pre-doctoral, post-doctoral, and faculty fellows have completed the program. Participating fellows have published disparities-related research and given presentations both nationally and internationally. Five research grant awards have been received by faculty fellows. Eight undergraduates, 1 post-baccalaureate, and 2 medical professional students representing seven universities have participated in the summer undergraduate internship. Over half of the undergraduate students are applying to or have been accepted into medical or graduate school. The tailored CVD health disparities training curriculum has been successful at equipping varying levels of trainees (from undergraduate students to faculty) with clinical research and public health expertise to conducting community-engaged CVD disparities research. PMID:25054421

Relation between age and carotid artery intima-medial thickness: a systematic review.

PubMed

van den Munckhof, Inge C L; Jones, Helen; Hopman, Maria T E; de Graaf, Jacqueline; Nyakayiru, Jean; van Dijk, Bart; Eijsvogels, Thijs M H; Thijssen, Dick H J

2018-05-12

Carotid artery intima-medial thickness (cIMT) represents a popular measure of atherosclerosis and is predictive of future cardiovascular and cerebrovascular events. Although older age is associated with a higher cIMT, little is known about whether this increase in cIMT follows a linear relationship with age or it is affected under influence of cardiovascular diseases (CVD) or CVD risk factors. We hypothesize that the relationship between cIMT and age is nonlinear and is affected by CVD or risk factors. A systematic review of studies that examined cIMT in the general population and human populations free from CVD/risk factors was undertaken. The literature search was conducted in PubMed, Scopus, and Web of Science. Seventeen studies with 32 unique study populations, involving 10,124 healthy individuals free from CVD risk factors, were included. Furthermore, 58 studies with 115 unique study populations were included, involving 65,774 individuals from the general population (with and without CVD risk factors). A strong positive association was evident between age and cIMT in the healthy population, demonstrating a gradual, linear increase in cIMT that did not differ between age decades (r = 0.91, P < 0.001). Although populations with individuals with CVD demonstrated a higher cIMT compared to populations free of CVD, a linear relation between age and cIMT was also present in this population. Our data suggest that cIMT is strongly and linearly related to age. This linear relationship was not affected by CVD or risk factors. © 2018 Wiley Periodicals, Inc.

Neighborhood Environmental Health and Premature Death From Cardiovascular Disease

PubMed Central

Xu, Junjun; Rollins, Latrice; Baltrus, Peter; O’Connell, Laura Kathryn; Cooper, Dexter L.; Hopkins, Jammie; Botchwey, Nisha D.; Akintobi, Tabia Henry

2018-01-01

Introduction Cardiovascular disease (CVD) is the leading cause of death in the United States and disproportionately affects racial/ethnic minority groups. Healthy neighborhood conditions are associated with increased uptake of health behaviors that reduce CVD risk, but minority neighborhoods often have poor food access and poor walkability. This study tested the community-driven hypothesis that poor access to food at the neighborhood level and poor neighborhood walkability are associated with racial disparities in premature deaths from CVD. Methods We examined the relationship between neighborhood-level food access and walkability on premature CVD mortality rates at the census tract level for the city of Atlanta using multivariable logistic regression models. We produced maps to illustrate premature CVD mortality, food access, and walkability by census tract for the city. Results We found significant racial differences in premature CVD mortality rates and geographic disparities in food access and walkability among census tracts in Atlanta. Improved food access and walkability were associated with reduced overall premature CVD mortality in unadjusted models, but this association did not persist in models adjusted for census tract population composition and poverty. Census tracts with high concentrations of minority populations had higher levels of poor food access, poor walkability, and premature CVD mortality. Conclusion This study highlights disparities in premature CVD mortality and neighborhood food access and walkability at the census tract level in the city of Atlanta. Improving food access may have differential effects for subpopulations living in the same area. These results can be used to calibrate neighborhood-level interventions, and they highlight the need to examine race-specific health outcomes. PMID:29389312

Childhood hospitalisation with infection and cardiovascular disease in early-mid adulthood: a longitudinal population-based study.

PubMed

Burgner, David P; Cooper, Matthew N; Moore, Hannah C; Stanley, Fiona J; Thompson, Peter L; de Klerk, Nicholas H; Carter, Kim W

2015-01-01

Pathogen-specific and overall infection burden may contribute to atherosclerosis and cardiovascular disease (CVD), but the effect of infection severity and timing is unknown. We investigated whether childhood infection-related hospitalisation (IRH, a marker of severity) was associated with subsequent adult CVD hospitalisation. Using longitudinal population-based statutorily-collected administrative health data from Western Australia (1970-2009), we identified adults hospitalised with CVD (ischaemic heart disease, ischaemic stroke, and peripheral vascular disease) and matched them (10:1) to population controls. We used Cox regression to assess relationships between number and type of childhood IRH and adulthood CVD hospitalisation, adjusting for sex, age, Indigenous status, socioeconomic status, and birth weight. 631 subjects with CVD-related hospitalisation in adulthood (≥ 18 years) were matched with 6310 controls. One or more childhood (< 18 years) IRH was predictive of adult CVD-related hospitalisation (adjusted hazard ratio, 1.3; 95% CI 1.1-1.6; P < 0.001). The association showed a dose-response; ≥ 3 childhood IRH was associated with a 2.2 times increased risk of CVD-related hospitalisation in adulthood (adjusted hazard ratio, 2.2; 95% CI 1.7-2.9; P < 0.001). The association was observed across all clinical diagnostic groups of infection (upper respiratory tract infection, lower respiratory tract infection, infectious gastroenteritis, urinary tract infection, skin and soft tissue infection, and other viral infection), and individually with CVD diagnostic categories (ischaemic heart disease, ischaemic stroke and peripheral vascular disease). Severe childhood infection is associated with CVD hospitalisations in adulthood in a dose-dependent manner, independent of population-level risk factors.

Soluble form of receptor for advanced glycation end products and incidence of new cardiovascular events among patients with cardiovascular disease.

PubMed

Reichert, Stefan; Triebert, Ulrike; Santos, Alexander Navarrete; Hofmann, Britt; Schaller, Hans-Günter; Schlitt, Axel; Schulz, Susanne

2017-11-01

Soluble RAGE (sRAGE) serum level could be a biomarker for atherosclerosis and subsequent diseases such as cardiovascular disease (CVD). Therefore, we wanted to investigate whether peripheral sRAGE level is associated with new cardiovascular events among patients with CVD using the Cox's regression analysis. In this three-year longitudinal cohort study, 1002 in-patients with angiographically proven CVD were included. In 933 patients, sRAGE levels were determined by a commercial available ELISA kit at the time of baseline examination. The combined endpoint was defined as myocardial infarction, stroke/TIA (non-fatal, fatal), and cardiovascular death. For risk analysis, sRAGE values were distributed in quartiles. For generation of adjusted hazard ratios (HR), other risk factors for CVD, such as age, gender, current smoking, body mass index, diabetes, hypertension, dyslipoproteinemia, family history of CVD, severe periodontitis, serum levels for C-reactive protein and interleukin-6, were recorded. 886 patients completed the 3-year follow-up. The overall incidence of the combined endpoint was 16%. Patients with sRAGE levels >838.19 pg/ml (fourth quartile) had the highest incidence of recurrent CVD events (24.9% versus 13.1%, p < 0.0001). In multivariate Cox regression with respect to further confounders for CVD, the association between sRAGE and new CVD events was confirmed (HR = 1.616, 95% CI 1.027-2.544, p = 0.038). Elevated sRAGE serum level is associated with further adverse events in patients with CVD. Copyright © 2017 Elsevier B.V. All rights reserved.

Risk stratification of patients with familial hypercholesterolemia in a multi-ethnic cohort

PubMed Central

2014-01-01

Background Heterozygous Familial hypercholesterolemia (FH) is a common autosomal dominant disorder resulting in in very high blood cholesterol levels and premature cardiovascular disease (CVD). However, there is a wide variation in the occurrence of CVD in these patients. The aim of this study is to determine risk factors that are responsible for the variability of CVD events in FH patients. Methods This is a retrospective analysis of a large multiethnic cohort of patients with definite FH attending the Healthy Heart Prevention Clinic in Vancouver, Canada. Cox proportional hazard regression analysis was used to assess the association of the risk factors to the hard cardiovascular outcomes. Results 409 patients were identified as having “definite” FH, according to the Dutch Lipid Clinic Network Criteria (DLCNC), with 111 (27%) having evidence of CVD. Male sex, family history of premature CVD, diabetes mellitus, low high density lipoprotein cholesterol (HDL-C) and high lipoprotein (a) (Lp (a)) were significant, independent risk factors for CVD. In men, family history, diabetes and low levels of HDL-C were significant risk factors while in women smoking, diabetes mellitus and high Lp (a) were significant risk factors for CVD. There were no significant differences in risk factors between ethnicities. Conclusion In conclusion, men and women differ in the impact of the risk factors on the presence of CVD with family history of CVD and low HDL-C being a significant factor in men while smoking and increased Lp (a) were significant factors in women. Diabetes was a significant factor in both men and women. PMID:24712315

Defining the relationship between COPD and CVD: what are the implications for clinical practice?

PubMed Central

Morgan, Ann D; Zakeri, Rosita; Quint, Jennifer K

2018-01-01

Cardiovascular diseases (CVDs) are arguably the most important comorbidities in chronic obstructive pulmonary disease (COPD). CVDs are common in people with COPD, and their presence is associated with increased risk for hospitalization, longer length of stay and all-cause and CVD-related mortality. The economic burden associated with CVD in this population is considerable and the cumulative cost of treating comorbidities may even exceed that of treating COPD itself. Our understanding of the biological mechanisms that link COPD and various forms of CVD has improved significantly over the past decade. But despite broad acceptance of the prognostic significance of CVDs in COPD, there remains widespread under-recognition and undertreatment of comorbid CVD in this population. The reasons for this are unclear; however institutional barriers and a lack of evidence-based guidelines for the management of CVD in people with COPD may be contributory factors. In this review, we summarize current knowledge relating to the prevalence and incidence of CVD in people with COPD and the mechanisms that underlie their coexistence. We discuss the implications for clinical practice and highlight opportunities for improved prevention and treatment of CVD in people with COPD. While we advocate more active assessment for signs of cardiovascular conditions across all age groups and all stages of COPD severity, we suggest targeting those aged under 65 years. Evidence indicates that the increased risks for CVD are particularly pronounced in COPD patients in mid-to-late-middle-age and thus it is in this age group that the benefits of early intervention may prove to be the most effective. PMID:29355081

The Evidence for α-Linolenic Acid and Cardiovascular Disease Benefits: Comparisons with Eicosapentaenoic Acid and Docosahexaenoic Acid12

PubMed Central

Fleming, Jennifer A.; Kris-Etherton, Penny M.

2014-01-01

Our understanding of the cardiovascular disease (CVD) benefits of α-linolenic acid (ALA, 18:3n–3) has advanced markedly during the past decade. It is now evident that ALA benefits CVD risk. The expansion of the ALA evidence base has occurred in parallel with ongoing research on eicosapentaenoic acid (EPA, 20:5n–3) and docosahexaenoic acid (DHA, 22:6n–3) and CVD. The available evidence enables comparisons to be made for ALA vs. EPA + DHA for CVD risk reduction. The epidemiologic evidence suggests comparable benefits of plant-based and marine-derived n–3 (omega-3) PUFAs. The clinical trial evidence for ALA is not as extensive; however, there have been CVD event benefits reported. Those that have been reported for EPA + DHA are stronger because only EPA + DHA differed between the treatment and control groups, whereas in the ALA studies there were diet differences beyond ALA between the treatment and control groups. Despite this, the evidence suggests many comparable CVD benefits of ALA vs. EPA + DHA. Thus, we believe that it is time to revisit what the contemporary dietary recommendation should be for ALA to decrease the risk of CVD. Our perspective is that increasing dietary ALA will decrease CVD risk; however, randomized controlled clinical trials are necessary to confirm this and to determine what the recommendation should be. With a stronger evidence base, the nutrition community will be better positioned to revise the dietary recommendation for ALA for CVD risk reduction. PMID:25398754

The Significance of the Psychosocial Factors Influence in Pathogenesis of Cardiovascular Disease

PubMed Central

Masic, Izet; Alajbegovic, Jasmin

2013-01-01

Background: Cardiovascular diseases (CVD) are the leading cause of death in the world today. Risk factors are those factors that influence the development of CVD. Risk factors can be divided into materialistic (genetic predisposition, smoking, alcohol) and non-materialistic (psychosocial factors). Our goal is to note the role of the health system, to emphasize the importance of psychosocial factors in the pathogenesis of CVD, explain the relationship between psychosocial factors and other risk factors, stress the importance of prevention through the provision of management of the cardiovascular system (CVS) diseases. Methods: A descriptive analysis was performed on scientific studies in several published articles in journals on CVS: Public Health Reviews, CVD, European Heart Journal, Materia Socio Medica and other indexed journals that publish articles on CVS. Results and Conclusions: The importance and role of the health system in the early detection, diagnosis, therapy and CVS disease prevention is presented through three thematic areas: (a) The incidence and prevalence of CVS diseases; (b) treatment of CVS diseases and (c) promotion of health in patients with CVS disease and those the risk of their occurrence. Health promotion is the most important aspect of the health system monitoring. Health promotion is adequately implemented ifthe management ofCVD is proper. The main objectives of CVD management are: Preventing or delaying the occurrence of CVD, reducing the number and severity of worsening and complications of CVD. Management Includes: Individual and family, the health system and the community. Materialistic and non-materialistic risk factors together contribute to the development of CVD. PMID:24404370

Micro-strip sensors based on CVD diamond

NASA Astrophysics Data System (ADS)

Adam, W.; Berdermann, E.; Bergonzo, P.; Bertuccio, G.; Bogani, F.; Borchi, E.; Brambilla, A.; Bruzzi, M.; Colledani, C.; Conway, J.; D'Angelo, P.; Dabrowski, W.; Delpierre, P.; Deneuville, A.; Dulinski, W.; van Eijk, B.; Fallou, A.; Fizzotti, F.; Foulon, F.; Friedl, M.; Gan, K. K.; Gheeraert, E.; Hallewell, G.; Han, S.; Hartjes, F.; Hrubec, J.; Husson, D.; Kagan, H.; Kania, D.; Kaplon, J.; Kass, R.; Koeth, T.; Krammer, M.; Logiudice, A.; Lu, R.; mac Lynne, L.; Manfredotti, C.; Meier, D.; Mishina, M.; Moroni, L.; Oh, A.; Pan, L. S.; Pernicka, M.; Peitz, A.; Perera, L.; Pirollo, S.; Procario, M.; Riester, J. L.; Roe, S.; Rousseau, L.; Rudge, A.; Russ, J.; Sala, S.; Sampietro, M.; Schnetzer, S.; Sciortino, S.; Stelzer, H.; Stone, R.; Suter, B.; Tapper, R. J.; Tesarek, R.; Trischuk, W.; Tromson, D.; Vittone, E.; Walsh, A. M.; Wedenig, R.; Weilhammer, P.; Wetstein, M.; White, C.; Zeuner, W.; Zoeller, M.; RD42 Collaboration

2000-10-01

In this article we present the performance of recent chemical vapour deposition (CVD) diamond micro-strip sensors in beam tests. In addition, we present the first comparison of a CVD diamond micro-strip sensor before and after proton irradiation.

Cardiovascular health among adults in Syria: a model from developing countries.

PubMed

Maziak, Wasim; Rastam, Samer; Mzayek, Fawaz; Ward, Kenneth D; Eissenberg, Thomas; Keil, Ulrich

2007-09-01

Despite the considerable mortality and morbidity associated with cardiovascular disease (CVD), many developing countries lack reliable surveillance of these ailments and their risk factors to guide intervention. This study aims to provide the first population-based estimates of CVD morbidity and mortality among adults in Aleppo, Syria and the distribution of their risk factors. A cross-sectional survey of adults 18 to 65 years old residing in Aleppo, Syria was carried out in 2004, involving 2038 household representatives (45.2% men; mean age, 35.3 years; response rate, 86%). Main outcomes of interest were physician-diagnosed CVD (infarction, angina, failure, stroke) among survey participants, and past 5-year mortality due to CVD among their household members older than 20 years of age (N = 6252, 49.5% men). Measurement of blood pressure (BP), height and weight, and smoking history were obtained as well. Prevalence of CVD was 4.8% for heart disease and 1.0% for stroke. CVD was responsible for 45.0% of overall mortality reported in the past 5 years, whereby 49% of CVD deaths occurred before the age of 65 years. Mean age of death was 62.6 years (63.6 years for heart disease and 61.4 years for stroke). Annual crude death rate due to CVD was 314 per 100,000 (95% confidence interval [95% CI]: 215-414); of these, 179 were due to heart disease, and 135 due to stroke. More men than women died from heart disease, whereas the opposite was true for stroke. Hypertension was detected in 40.6% (47.7% men, 34.9%women), obesity in 38.2% (28.8% men, 46.4% women), and smoking (cigarettes or waterpipe) in 38.7% (63.6% men, 19.2% women) of participants. Of those surveyed, 39.3% had one CVD risk factor, 27.4% had two risk factors, and 8.3% had 3 risk factors. Main predictors of clustering of risk factors were older age, male gender, and low education. Syria is currently undergoing a stage in which morbidity and mortality from CVD are high but likely to increase based on the population's risk profile. CVD risk distribution in Syrian society highlights the non-generalizability of CVD models from developed societies, and calls for local studies to inform effective interventions and policies.

Living healthier for longer: Comparative effects of three heart-healthy behaviors on life expectancy with and without cardiovascular disease

PubMed Central

2009-01-01

Background Non-smoking, having a normal weight and increased levels of physical activity are perhaps the three key factors for preventing cardiovascular disease (CVD). However, the relative effects of these factors on healthy longevity have not been well described. We aimed to calculate and compare the effects of non-smoking, normal weight and physical activity in middle-aged populations on life expectancy with and without cardiovascular disease. Methods Using multi-state life tables and data from the Framingham Heart Study (n = 4634) we calculated the effects of three heart healthy behaviours among populations aged 50 years and over on life expectancy with and without cardiovascular disease. For the life table calculations, we used hazard ratios for 3 transitions (No CVD to CVD, no CVD to death, and CVD to death) by health behaviour category, and adjusted for age, sex, and potential confounders. Results High levels of physical activity, never smoking (men), and normal weight were each associated with 20-40% lower risks of developing CVD as compared to low physical activity, current smoking and obesity, respectively. Never smoking and high levels of physical activity reduced the risks of dying in those with and without a history of CVD, but normal weight did not. Never-smoking was associated with the largest gains in total life expectancy (4.3 years, men, 4.1 years, women) and CVD-free life expectancy (3.8 and 3.4 years, respectively). High levels of physical activity and normal weight were associated with lesser gains in total life expectancy (3.5 years, men and 3.4 years, women, and 1.3 years, men and 1.0 year women, respectively), and slightly lesser gains in CVD-free life expectancy (3.0 years, men and 3.1 years, women, and 3.1 years men and 2.9 years women, respectively). Normal weight was the only behaviour associated with a reduction in the number of years lived with CVD (1.8 years, men and 1.9 years, women). Conclusions Achieving high levels of physical activity, normal weight, and never smoking, are effective ways to prevent cardiovascular disease and to extend total life expectancy and the number of years lived free of CVD. Increasing the prevalence of normal weight could further reduce the time spent with CVD in the population. PMID:20034381

Glycated Hemoglobin Measurement and Prediction of Cardiovascular Disease

PubMed Central

Angelantonio, Emanuele Di; Gao, Pei; Khan, Hassan; Butterworth, Adam S.; Wormser, David; Kaptoge, Stephen; Kondapally Seshasai, Sreenivasa Rao; Thompson, Alex; Sarwar, Nadeem; Willeit, Peter; Ridker, Paul M; Barr, Elizabeth L.M.; Khaw, Kay-Tee; Psaty, Bruce M.; Brenner, Hermann; Balkau, Beverley; Dekker, Jacqueline M.; Lawlor, Debbie A.; Daimon, Makoto; Willeit, Johann; Njølstad, Inger; Nissinen, Aulikki; Brunner, Eric J.; Kuller, Lewis H.; Price, Jackie F.; Sundström, Johan; Knuiman, Matthew W.; Feskens, Edith J. M.; Verschuren, W. M. M.; Wald, Nicholas; Bakker, Stephan J. L.; Whincup, Peter H.; Ford, Ian; Goldbourt, Uri; Gómez-de-la-Cámara, Agustín; Gallacher, John; Simons, Leon A.; Rosengren, Annika; Sutherland, Susan E.; Björkelund, Cecilia; Blazer, Dan G.; Wassertheil-Smoller, Sylvia; Onat, Altan; Marín Ibañez, Alejandro; Casiglia, Edoardo; Jukema, J. Wouter; Simpson, Lara M.; Giampaoli, Simona; Nordestgaard, Børge G.; Selmer, Randi; Wennberg, Patrik; Kauhanen, Jussi; Salonen, Jukka T.; Dankner, Rachel; Barrett-Connor, Elizabeth; Kavousi, Maryam; Gudnason, Vilmundur; Evans, Denis; Wallace, Robert B.; Cushman, Mary; D’Agostino, Ralph B.; Umans, Jason G.; Kiyohara, Yutaka; Nakagawa, Hidaeki; Sato, Shinichi; Gillum, Richard F.; Folsom, Aaron R.; van der Schouw, Yvonne T.; Moons, Karel G.; Griffin, Simon J.; Sattar, Naveed; Wareham, Nicholas J.; Selvin, Elizabeth; Thompson, Simon G.; Danesh, John

2015-01-01

IMPORTANCE The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain. OBJECTIVE To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk. DESIGN, SETTING, AND PARTICIPANTS Analysis of individual-participant data available from 73 prospective studies involving 294 998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. MAIN OUTCOMES AND MEASURES Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories of low (<5%), intermediate (5%to <7.5%), and high (≥7.5%) risk. RESULTS During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20 840 incident fatal and nonfatal CVD outcomes (13 237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional cardiovascular risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification improvement of 0.42 (−0.63 to 1.48) for the categories of predicted 10-year CVD risk. The improvement provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated improvements for measurement of fasting, random, or postload plasma glucose levels. CONCLUSIONS AND RELEVANCE In a study of individuals without known CVD or diabetes, additional assessment of HbA1c values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk. PMID:24668104

Circulating Vitamin K Is Inversely Associated with Incident Cardiovascular Disease Risk among Those Treated for Hypertension in the Health, Aging, and Body Composition Study (Health ABC).

PubMed

Shea, M Kyla; Booth, Sarah L; Weiner, Daniel E; Brinkley, Tina E; Kanaya, Alka M; Murphy, Rachel A; Simonsick, Eleanor M; Wassel, Christina L; Vermeer, Cees; Kritchevsky, Stephen B

2017-05-01

Background: A role for vitamin K in coronary artery calcification (CAC), a subclinical manifestation of cardiovascular disease (CVD), has been proposed because vitamin K-dependent proteins, including the calcification inhibitor matrix Gla protein (MGP), are present in vascular tissue. Observational studies found that low circulating phylloquinone (vitamin K-1) was associated with increased CAC progression, especially in persons treated for hypertension. It is unknown whether hypertension treatment modifies this putative role of vitamin K in clinical CVD risk. Objective: We determined the association between vitamin K status and incident clinical CVD in older adults in the Health ABC (Health, Aging, and Body Composition Study) and whether the association differed by hypertension treatment status. Methods: Plasma phylloquinone was measured in 1061 participants free of CVD (70-79 y of age, 58% women, 39% black). Plasma uncarboxylated MGP [(dp)ucMGP] was measured in a subset of 635 participants. Multivariate Cox models estimated the HR for incident CVD over 12.1 follow-up years. Effect modification by hypertension was tested with the use of interaction terms. Results: Neither low plasma phylloquinone (<0.2 nmol/L) nor elevated (dp)ucMGP (≥574 pmol/L) was significantly associated with incident CVD [respective HRs (95% CIs): 1.27 (0.75, 2.13) and 1.02 (0.72, 1.45)]. In participants treated for hypertension ( n = 489; 135 events), low plasma phylloquinone was associated with higher CVD risk overall (HR: 2.94; 95% CI: 1.41, 6.13). In those with untreated hypertension ( n = 153; 48 events) and without hypertension ( n = 418; 92 events), low plasma phylloquinone was not associated with incident CVD. The association between high (dp)ucMGP did not differ by hypertension treatment status ( P -interaction = 0.72). Conclusions: Vitamin K status was not significantly associated with CVD risk overall, but low plasma phylloquinone was associated with a higher CVD risk in older adults treated for hypertension. Additional evidence from larger clinical studies is needed to clarify the importance of vitamin K to CVD in persons treated for hypertension, a segment of the population at high risk of clinical CVD events. © 2017 American Society for Nutrition.

Cardiovascular health among adults in Syria: a model from developing countries

PubMed Central

Maziak, Wasim; Rastam, Samer; Mzayek, Fawaz; Ward, Kenneth D; Eissenberg, Thomas; Keil, Ulrich

2007-01-01

Background Despite the considerable mortality and morbidity associated with cardiovascular disease (CVD) many developing countries lack reliable surveillance of these ailments and their risk factors to guide intervention. This study aims to provide the first population-based estimates of CVD morbidity and mortality among adults in Aleppo-Syria and the distribution of their risk factors. Methods A cross-sectional survey of adults 18-65 years old residing in Aleppo-Syria was carried out in 2004 involving 2038 household representatives (45.2% men, mean age 35.3 years, response rate 86%). Main outcomes of interest were physician-diagnosed CVD (infarction, angina, failure, stroke) among survey participants, and past 5 year mortality due to CVD among their household members > 20 years of age (n=6252, 49.5% men). Measurement of blood pressure (BP), height and weight, and smoking history were obtained as well. Findings Prevalence of CVD was 4.8% for heart disease and 1.0% for stroke. CVD was responsible for 45.0% of overall mortality reported in the past 5 years, whereby 49% of CVD deaths occurred before the age of 65 year. Mean age of death was 62.6 years (63.6 years for HD and 61.4 years for stroke). Annual crude death rate due to CVD was 314 per 100,000 (95%CI: 215-414), of these 179 were due to heart disease, and 135 due to stroke. More men died from heart disease than women, while the opposite was true for stroke. Hypertension was detected in 40.6% (47.7% men, 34.9%women), obesity in 38.2% (28.8% men, 46.4% women), and smoking (cigarettes or waterpipe) in 38.7% (63.6% men, 19.2% women) of participants. Of those surveyed, 39.3% had 1 CVD risk factor, 27.4% had 2 risk factors, and 8.3% had 3 risk factors. Main predictors of clustering of risk factors were older age, male gender, and low education. Conclusions Syria is currently undergoing a stage, where morbidity and mortality from CVD are high but likely to increase based on the population's risk profile. CVD risk distribution in the Syrian society highlights the non-generalizability of CVD models from developed societies, and calls for local studies to inform effective interventions and policies. PMID:17553700

The influence of socioeconomic factors on cardiovascular disease risk factors in the context of economic development in the Samoan archipelago.

PubMed

Ezeamama, Amara E; Viali, Satupaitea; Tuitele, John; McGarvey, Stephen T

2006-11-01

Early in economic development there are positive associations between socioeconomic status (SES) and cardiovascular disease (CVD) risk factors, and in the most developed market economy societies there are negative associations. The purpose of this report is to describe cross-sectional and longitudinal associations between indicators of SES and CVD risk factors in a genetically homogenous population of Samoans at different levels of economic development. At baseline 1289 participants 25-58yrs, and at 4-year follow-up, 963 participants were studied in less economically developed Samoa and in more developed American Samoa. SES was assessed by education, occupation, and material lifestyle at baseline. The CVD risk factors, obesity, type-2 diabetes and hypertension were measured at baseline and 4-year follow-up, and an index of any incident CVD risk factor at follow-up was calculated. Sex and location (Samoa and American Samoa) specific multivariable logistic regression models were used to test for relationships between SES and CVD risk factors at baseline after adjustment for age and the other SES indicators. In addition an ordinal SES index was constructed for each individual based on all three SES indicators, and used in a multivariable model to estimate the predicted probability of CVD risk factors across the SES index for the two locations. In both the models using specific SES measures and CVD risk factor outcomes, and the models using the ordinal SES index and predicted probabilities of CVD risk factors, we detected a pattern of high SES associated with: (1) elevated odds of CVD risk factors in less developed Samoa, and (2) decreased odds of CVD risk factors in more developed American Samoa. We conclude that the pattern of inverse associations between SES and CVD risk factors in Samoa and direct associations in American Samoa is attributable to the heterogeneity across the Samoas in specific exposures to social processes of economic development and the natural history of individual CVD risk factors. The findings suggest that interventions on non-communicable diseases in the Samoas must be devised based on the level of economic development, the socio-economic context of risk factor exposures, and individual characteristics such as age, sex and education level.

Cardiovascular Update: Risk, Guidelines, and Recommendations.

PubMed

Pearson, Tamera

2015-09-01

This article provides an update of the current status of cardiovascular disease (CVD) in the United States, including a brief review of the underlying pathophysiology and epidemiology. This article presents a discussion of the latest American Heart Association guidelines that introduce the concept of promoting ideal cardiovascular health, defined by seven identified metrics. Specific CVD risk factors and utilization of the 10-year CVD event prediction calculator are discussed. In addition, current management recommendations of health-related conditions that increase risk for CVD, such as hypertension and hypercholesterolemia, are provided. Finally, a discussion of detailed evidence-based lifestyle recommendations to promote cardiovascular health and reduce CVD risks concludes the update. © 2015 The Author(s).

Role of Glycans in Cholesteryl Ester Transfer Protein revealed by MD simulation.

PubMed

Hao, Dongxiao; Yang, Zhiwei; Gao, Teng; Tian, Zhiqi; Zhang, Lei; Zhang, Shengli

2018-05-03

Current cholesteryl ester transfer protein (CETP) inhibitors are designed based on the unglycosylated crystal structure, and most of them have failed to cure cardiovascular disease (CVD). It is particularly important for us to investigate the glycosylation structure of CETP (CETP-G) and effect of glycans on the structure and function of CETP. Here, we used a total of 3.0-μs molecular dynamics trajectories of nascent structure of CETP (CETP-N) and CETP-G to study their structural differentiations, to shed new light on the CETP-mediated lipid exchange. In accordance with our simulations and previous mutation studies, relative to CETP-N, CETP-G adopts a more stretched shape with higher hydrophobic and hydrophilic SASA of N-terminal oscillating with larger amplitude, in which Glycan88 provides partial assistance for CEs through the N-terminal. Glycan341 reduces the flexibility of neck flap, with the interference of CEs through the neck region. Besides, Glycan240 reduces the flexibility of Helix-X to interfere the CEs transfer. Glycan396 decreases the flexibility and increases the hydrophobic SASA of C-terminal. Overall, these glycans affect the dynamics and structure of CETP through forming H-bonds with surrounding residues, and the sampled conformations of glycan is also affected by its surrounding residues. Thus, glycans are an integral part of CETP, further studies on the CETP inhibition and treatment of CVD should fully consider the effect of glycans. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

The Association between Cardiovascular Disease Risk and Parental Educational Level in Portuguese Children

PubMed Central

Duncan, Michael J.; Vale, Susana; Santos, Maria Paula; Ribeiro, José Carlos; Mota, Jorge

2012-01-01

The aim of this study was to examine any differences in cardiovascular disease (CVD) risk in Portuguese children split by parental educational level. A cross-sectional school-based study was conducted in 2011 on 359 Portuguese children (202 girls and 157 boys) aged 10 to 17 years (mean age ± SD = 13.9 ± 1.98 years). Height and body mass were assessed to determine body mass index (BMI). Parental education level (PEL) was used as a surrogate for socioeconomic status (SES). Capillary blood sampling was used to determine: Total Cholesterol (TC), Triglycerides (TG), Fasting Glucos (GLUC), High and Low Density Lipoprotein (HDL/LDL). These measurements were combined with measures of systolic blood pressure and cardiorespiratory fitness as z-scores. CVD risk was constructed by summing the z-scores. Analysis of covariance, controlling for BMI, indicated that CVD risk was significantly different across PEL groups (p = 0.01), with CVD risk score being significantly lower in low (p = 0.04) and middle (p = 0.008) PEL groups, compared to high PEL. Moreover, the covariate, BMI was also significant (p = 0.0001, β = 0.023), evidencing a significant positive association between BMI and CVD risk, with higher BMI associated with greater CVD risk. In Portuguese children, significantly greater CVD risk was found for children of high PEL, while higher BMI was associated with greater CVD risk. PMID:23330223

Resource Effective Strategies to Prevent and Treat Cardiovascular Disease

PubMed Central

Schwalm, Jon-David; McKee, Martin; Huffman, Mark D.; Yusuf, Salim

2016-01-01

Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries (LMIC). The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in LMIC. Barriers at the patient, health-care provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including: (1) effective measures for tobacco control; (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of health care through task-sharing (non-physician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above, will lead to substantial reductions in CVD and related mortality. PMID:26903017

Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study

PubMed Central

Gray, Sarah Yu Weng; Ching, Siew Mooi; Lim, Hooi Min; Chinna, Karuthan

2015-01-01

Objective This study aims to examine the validity of the Framingham general cardiovascular disease (CVD) risk chart in a primary care setting. Design This is a 10-year retrospective cohort study. Setting A primary care clinic in a teaching hospital in Malaysia. Participants 967 patients’ records were randomly selected from patients who were attending follow-up in the clinic. Main outcome measures Baseline demographic data, history of diabetes and smoking, blood pressure (BP), and serum lipids were captured from patient records in 1998. Each patient's Framingham CVD score was computed from these parameters. All atherosclerotic CVD events occurring between 1998 and 2007 were counted. Results In 1998, mean age was 57 years with 33.8% men, 6.1% smokers, 43.3% diabetics and 59.7% hypertensive. Median BP was 140/80 mm Hg and total cholesterol 6.0 mmol/L (1.3). The predicted median Framingham general CVD risk score for the study population was 21.5% (IQR 1.2–30.0) while the actual CVD events that occurred in the 10 years was 13.1% (127/967). The median CVD points for men was 30.0, giving them a CVD risk of more than 30%; for women it is 18.5, a CVD risk of 21.5%. Our study found that the Framingham general CVD risk score to have moderate discrimination with an area under the receiver operating characteristic curve (AUC) of 0.63. It also discriminates well for Malay (AUC 0.65, p=0.01), Chinese (AUC 0.60, p=0.03), and Indians (AUC 0.65, p=0.001). There was good calibration with Hosmer-Lemeshow test χ2=3.25, p=0.78. Conclusions Taking into account that this cohort of patients were already on treatment, the Framingham General CVD Risk Prediction Score predicts fairly accurately for men and overestimates somewhat for women. In the absence of local risk prediction charts, the Framingham general CVD risk prediction chart is a reasonable alternative for use in a multiethnic group in a primary care setting. PMID:25991451

Adiposity, post-diagnosis weight change, and risk of cardiovascular events among early-stage breast cancer survivors.

PubMed

Cespedes Feliciano, Elizabeth M; Kwan, Marilyn L; Kushi, Lawrence H; Weltzien, Erin K; Castillo, Adrienne L; Caan, Bette J

2017-04-01

Little research examines whether adiposity or post-diagnosis weight changes influence Cardiovascular disease (CVD) among breast cancer patients for whom effects may differ due to treatment and recovery. We studied Stage I-III breast cancer survivors 18 to  <80 years, without pre-existing CVD, diagnosed from 1997 to 2013 at Kaiser Permanente. Women reported weight at diagnosis and weight and waist circumference (WC) around 24 months post diagnosis. Using Cox models for time to incident coronary artery disease, heart failure, valve abnormality, arrhythmia, stroke, or CVD death, we examined at-diagnosis body mass index (BMI, n = 3109) and post-diagnosis WC (n = 1898) and weight change (n = 1903, stable, ±5 to  <10-lbs or ±≥10-lbs). Mean (SD) age was 57 (11) years, and BMI was 28 (6) kg-m 2 . Post diagnosis, 25% of women gained and 14% lost ≥10-lbs; mean (SD) WC was 90 (15) cm. Over a median of 8.28 years, 915 women developed CVD. BMI 25-30-kg/m 2 (vs. BMI < 25-kg/m 2 ) was not associated with CVD, while BMI ≥ 35-kg/m 2 increased risk by 33% (HR: 1.33; 95%CI 1.08-1.65), independent of lifestyle and tumor/treatment factors. The increased risk at BMI ≥ 35-kg/m 2 attenuated with adjustment for pre-existing CVD risk factors to HR: 1.20; 95%CI 0.97-1.50. By contrast, even moderate elevations in WC increased risk of CVD, independent of pre-existing risk factors (HR: 1.93; 95%CI 1.31-2.84 comparing ≥100-cm vs. ≤80-cm). Post-diagnosis weight change had no association with CVD. Extreme adiposity and any elevation in WC increased risk of CVD among breast cancer survivors; however, changes in weight in the early post-diagnosis period were not associated with CVD. Survivors with high WC and existing CVD risk factors should be monitored.

Outline of the report on cardiovascular disease in China, 2010.

PubMed

Hu, Sheng Shou; Kong, Ling Zhi; Gao, Run Lin; Zhu, Man Lu; Wang, Wen; Wang, Yong Jun; Wu, Zhao Su; Chen, Wei Wei; Liu, Ming Bo

2012-06-01

Major and profound changes have taken place in China over the past 30 years. Rapid socioeconomic progress has exerted a great impact on lifestyle, ranging from food, clothing, working and living conditions, and means of transportation to leisure activities and entertainment. At the same time, new health problems have emerged, and health services are facing new challenges. Presently, cardiovascular diseases (CVD) are among the top health problems of the Chinese people, and pose a serious challenge to all engaged in the prevention and control of these diseases. An epidemic of CVD in China is emerging as a result of lifestyle changes, urbanization and longevity. Both national policy decision-making and medical practice urgently need an authoritative report which comprehensively reflects the trends in the epidemic of CVD and current preventive measures. Since 2005, guided by the Bureau of Disease Prevention of the Ministry of Health of the People's Republic of China and the National Center for Cardiovascular Diseases of China, nationwide experts in the fields of epidemiology, clinical medicine and health economics in the realms of CVD, cerebrovascular disease, diabetes and chronic kidney disease, completed the Report on Cardiovascular Diseases in China every year. The report aims to provide a timely review of the trend of the epidemic and to assess the progress of prevention and control of CVD. In addition, as the report is authoritative, representative and readable, it will become an information platform in the CVD field and an important reference book for government, academic institutes, medical organizations and clinical physicians. This publication is expected to play a positive role in the prevention and control of CVD in China. We present an abstract from the Report on Cardiovascular Diseases in China (2010), including trends in CVD, morbidity and mortality of major CVDs, up-to-date assessment of risk factors, as well as health resources for CVD, and a profile of medical expenditure, with the aim of providing evidence for decision-making in CVD prevention and control programs in China, and of delivering the most authoritative information on CVD prevention and control for all citizens. 2012 The Editorial Board of Biomedical and Environmental Sciences. Published by Elsevier B.V. All rights reserved.

Coronary Artery Calcium Volume and Density: Potential Interactions and Overall Predictive Value: The Multi-Ethnic Study of Atherosclerosis.

PubMed

Criqui, Michael H; Knox, Jessica B; Denenberg, Julie O; Forbang, Nketi I; McClelland, Robyn L; Novotny, Thomas E; Sandfort, Veit; Waalen, Jill; Blaha, Michael J; Allison, Matthew A

2017-08-01

This study sought to determine the possibility of interactions between coronary artery calcium (CAC) volume or CAC density with each other, and with age, sex, ethnicity, the new atherosclerotic cardiovascular disease (ASCVD) risk score, diabetes status, and renal function by estimated glomerular filtration rate, and, using differing CAC scores, to determine the improvement over the ASCVD risk score in risk prediction and reclassification. In MESA (Multi-Ethnic Study of Atherosclerosis), CAC volume was positively and CAC density inversely associated with cardiovascular disease (CVD) events. A total of 3,398 MESA participants free of clinical CVD but with prevalent CAC at baseline were followed for incident CVD events. During a median 11.0 years of follow-up, there were 390 CVD events, 264 of which were coronary heart disease (CHD). With each SD increase of ln CAC volume (1.62), risk of CHD increased 73% (p < 0.001) and risk of CVD increased 61% (p < 0.001). Conversely, each SD increase of CAC density (0.69) was associated with 28% lower risk of CHD (p < 0.001) and 25% lower risk of CVD (p < 0.001). CAC density was inversely associated with risk at all levels of CAC volume (i.e., no interaction was present). In multivariable Cox models, significant interactions were present for CAC volume with age and ASCVD risk score for both CHD and CVD, and CAC density with ASCVD risk score for CVD. Hazard ratios were generally stronger in the lower risk groups. Receiver-operating characteristic area under the curve and Net Reclassification Index analyses showed better prediction by CAC volume than by Agatston, and the addition of CAC density to CAC volume further significantly improved prediction. The inverse association between CAC density and incident CHD and CVD events is robust across strata of other CVD risk factors. Added to the ASCVD risk score, CAC volume and density provided the strongest prediction for CHD and CVD events, and the highest correct reclassification. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

The association between eGFR in the normal or mildly impaired range and incident cadiovascular disease: Age and sex analysis.

PubMed

Eisen, Alon; Porter, Avital; Hoshen, Moshe; Balicer, Ran D; Reges, Orna; Rabi, Yardena; Leibowitz, Morton; Iakobishvili, Zaza; Hasdai, David

2018-05-14

Worse renal function, even in the normal or mildly impaired range, is associated with incident cardiovascular disease (CVD). Whether this association exists in both sexes across all ages is not known. A population based cohort of individuals >22 years with no prior CVD and with an eGFR 60-130 ml/min/1.73 m 2 . eGFR was calculated using the CKD-EPI formula. Incident CVD was defined as either myocardial infarction, unstable angina pectoris, coronary revascularization, or cerebrovascular event. Incident CVD was examined separately in men and women in 3 age-groups (young, 22-40 years; middle-aged, 41-60 years; and elderly, ≥61 years), during a median follow-up of 96.0 months. Among 1,341,400 individuals (57% women, mean age 49.2 ± 16.6 years), men had more incident CVD as compared to women (34,968 vs. 23,515 total incident CVD) in all age-groups (0.6% vs. 0.2% in young; 6.2% vs. 2.0% in middle-aged; 13.4% vs. 8.4% in elderly, respectively). After adjustment for CVD risk factors, an increment of 10 units in eGFR was independently associated with a decrease of 5.4%, 3.4% and 5.4% in incident CVD in young, middle-aged and elderly men (p < 0.001 for each) and a decrease of 6.3%, 3.4% and 6.8% in the same age-groups in women (p < 0.001 for each). There was no significant age-sex interaction in the association between eGFR and incident CVD. Although incident CVD differs in men and women, as well as in different age-groups, a higher eGFR even in the normal or mildly impaired range is associated with lesser incident CVD in men and women of all ages. Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Longitudinal Associations of High-Fructose Diet with Cardiovascular Events and Potential Risk Factors: Tehran Lipid and Glucose Study.

PubMed

Bahadoran, Zahra; Mirmiran, Parvin; Tohidi, Maryam; Azizi, Fereidoun

2017-08-21

The relationship between fructose and cardiovascular disease (CVD) remains controversial. In this study, we aimed to assess possible association of dietary intakes of fructose with the risk of CVD events in a prospective population-based study. Participants without CVD ( n = 2369) were recruited from the Tehran Lipid and Glucose Study and followed a mean of 6.7 years. Dietary data were collected using a validated 168 item semi-quantitative food frequency questionnaire. Dietary total fructose (TF) intake was calculated by sum of natural fructose (NF) in fruits and vegetables and added fructose (AF) in commercial foods. Multivariate Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate the risk of CVD across tertiles of dietary fructose. Linear regression models were used to indicate association of fructose intakes with changes of CVD risk factors over the study period. The mean age of participants (43.5% men) was 38.1 ± 13.3 years at baseline. During an average of 6.7 ± 1.4 years of follow-up, 79 participants experienced CVD outcomes. The mean daily intake of TF was 6.4 ± 3.7% of total energy (3.6 ± 2.0 from AF and 2.7 ± 1.8 from NF). Higher consumption of TF (≥7.4% vs. <4.5% of total energy) was accompanied with an increased risk of CVD (HR = 1.81, 95% CI = 1.04-3.15); higher energy intake from AF was also related to incidence of CVD (HR = 1.80, 95% CI = 1.04-3.12), whereas NF was not associated with the risk of CVD outcomes. Both AF and TF were also related to changes of systolic and diastolic blood pressures, waist circumference, serum insulin and creatinine levels, as well as HDL-C. Our data provides further evidence regarding undesirable effects of fructose intake in relation to risk of CVD events.

Utility of overnight pulse oximeter as a screening tool for sleep apnea to assess the 8-year risk of cardiovascular disease: Data from a large-scale bus driver cohort study.

PubMed

Wu, Wei-Te; Tsai, Su-Shan; Lin, Yu-Jen; Lin, Ming-Hsiu; Wu, Trong-Neng; Shih, Tung-Sheng; Liou, Saou-Hsing

2016-12-15

Professional drivers' work under conditions predisposes them for development of sleep-disordered breathing (SDB) and cardiovascular disease (CVD). However, the effect of SDB on CVD risk among professional drivers has never been investigated. A cohort study was used to evaluate the effectiveness of overnight pulse oximeter as a sleep apnea screening tool to assess the 8-year risk of CVD events. The Taiwan Bus Driver Cohort Study (TBDCS) recruited 1014 professional drivers in Taiwan since 2005. The subjects completed questionnaire interview and overnight pulse oximeter survey. This cohort was linked to the National Health Insurance Research Dataset (NHIRD). Researchers found 192 CVD cases from 2005 to 2012. Cox proportional hazards model was performed to estimate the hazard ratio for CVD. The statistical analysis was performed using SAS software in 2015. ODI4 and ODI3 levels increased the 8-year CVD risk, even adjusting for CVD risk factors (HR: 1.36, 95% CI: 1.05 to 1.78; p=0.022, and HR: 1.40, 95% CI: 1.03 to 1.90; p=0.033). ODI4 and ODI3 thresholds of 6.5 and 10events/h revealed differences of CVD risks (HR: 1.72, 95% CI: 1.00 to 2.95; p=0.048, and HR: 1.76, 95% CI: 1.03 to 3.03; p=0.041). Moreover, the ODI levels had an increased risk for hypertensive disease (not including essential hypertension). This study concludes that ODI for a sign of SDB is an independent predictor of elevated risk of CVD. Further research should be conducted regarding measures to prevent against SDB in order to reduce CVD risk in professional drivers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Dose-response relationship between dietary magnesium intake and cardiovascular mortality: A systematic review and dose-based meta-regression analysis of prospective studies.

PubMed

Fang, Xin; Liang, Chun; Li, Mei; Montgomery, Scott; Fall, Katja; Aaseth, Jan; Cao, Yang

2016-12-01

Although epidemiology studies have reported the relationship, including a dose-response relationship, between dietary magnesium intake and risk of cardiovascular disease (CVD), the risk for CVD mortality is inconclusive and the evidence for a dose-response relationship has not been summarized. We conducted a systematic review and meta-analysis of prospective studies to summarize the evidence regarding the association of dietary magnesium intake with risk of CVD mortality and describe their dose-response relationship. We identified relevant studies by searching major scientific literature databases and grey literature resources from their inception to August 2015, and reviewed references lists of retrieved articles. We included population-based studies that reported mortality risks, i.e. relative risks (RRs), odds ratios (ORs) or hazard ratios (HRs) of CVD mortality or cause-specific CVD death. Linear dose-response relationships were assessed using random-effects meta-regression. Potential nonlinear associations were evaluated using restricted cubic splines. Out of 3002 articles, 9 articles from 8 independent studies met the eligibility criteria. These studies comprised 449,748 individuals and 10,313 CVD deaths. Compared with the lowest dietary magnesium consumption group in the population, the risk of CVD mortality was reduced by 16% in women and 8% in men. No significant linear dose-response relationship was found between increment in dietary magnesium intake and CVD mortality across all the studies. After adjusting for age and BMI, the risk of CVD mortality was reduced by 24-25% per 100mg/d increment in dietary magnesium intake in women of all the participants and in all the US participants. Although the combined data confirm the role of dietary magnesium intake in reducing CVD mortality, the dose-response relationship was only found among women and in US population. Copyright © 2016 Elsevier GmbH. All rights reserved.

Reported gum disease as a cardiovascular risk factor in adults with intellectual disabilities.

PubMed

Hsieh, K; Murthy, S; Heller, T; Rimmer, J H; Yen, G

2018-03-01

Several risk factors for cardiovascular disease (CVD) have been identified among adults with intellectual disabilities (ID). Periodontitis has been reported to increase the risk of developing a CVD in the general population. Given that individuals with ID have been reported to have a higher prevalence of poor oral health than the general population, the purpose of this study was to determine whether adults with ID with informant reported gum disease present greater reported CVD than those who do not have reported gum disease and whether gum disease can be considered a risk factor for CVD. Using baseline data from the Longitudinal Health and Intellectual Disability Study from which informant survey data were collected, 128 participants with reported gum disease and 1252 subjects without reported gum disease were identified. A series of univariate logistic regressions was conducted to identify potential confounding factors for a multiple logistic regression. The series of univariate logistic regressions identified age, Down syndrome, hypercholesterolemia, hypertension, reported gum disease, daily consumption of fruits and vegetables and the addition of table salt as significant risk factors for reported CVD. When the significant factors from the univariate logistic regression were included in the multiple logistic analysis, reported gum disease remained as an independent risk factor for reported CVD after adjusting for the remaining risk factors. Compared with the adults with ID without reported gum disease, adults in the gum disease group demonstrated a significantly higher prevalence of reported CVD (19.5% vs. 9.7%; P = .001). After controlling for other risk factors, reported gum disease among adults with ID may be associated with a higher risk of CVD. However, further research that also includes clinical indices of periodontal disease and CVD for this population is needed to determine if there is a causal relationship between gum disease and CVD. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Multivitamin-mineral use is associated with reduced risk of cardiovascular disease mortality among women in the United States.

PubMed

Bailey, Regan L; Fakhouri, Tala H; Park, Yikyung; Dwyer, Johanna T; Thomas, Paul R; Gahche, Jaime J; Miller, Paige E; Dodd, Kevin W; Sempos, Christopher T; Murray, David M

2015-03-01

Multivitamin-mineral (MVM) products are the most commonly used supplements in the United States, followed by multivitamin (MV) products. Two randomized clinical trials (RCTs) did not show an effect of MVMs or MVs on cardiovascular disease (CVD) mortality; however, no clinical trial data are available for women with MVM supplement use and CVD mortality. The objective of this research was to examine the association between MVM and MV use and CVD-specific mortality among US adults without CVD. A nationally representative sample of adults from the restricted data NHANES III (1988-1994; n = 8678; age ≥40 y) were matched with mortality data reported by the National Death Index through 2011 to examine associations between MVM and MV use and CVD mortality by using Cox proportional hazards models, adjusting for multiple potential confounders. We observed no significant association between CVD mortality and users of MVMs or MVs compared with nonusers; however, when users were classified by the reported length of time products were used, a significant association was found with MVM use of >3 y compared with nonusers (HR: 0.65; 95% CI: 0.49, 0.85). This finding was largely driven by the significant association among women (HR: 0.56; 95% CI: 0.37, 0.85) but not men (HR: 0.79; 95% CI: 0.44, 1.42). No significant association was observed for MV products and CVD mortality in fully adjusted models. In this nationally representative data set with detailed information on supplement use and CVD mortality data ∼20 y later, we found an association between MVM use of >3 y and reduced CVD mortality risk for women when models controlled for age, race, education, body mass index, alcohol, aspirin use, serum lipids, blood pressure, and blood glucose/glycated hemoglobin. Our results are consistent with the 1 available RCT in men, indicating no relation with MVM use and CVD mortality. © 2015 American Society for Nutrition.

Does Sufficient Evidence Exist to Support a Causal Association between Vitamin D Status and Cardiovascular Disease Risk? An Assessment Using Hill’s Criteria for Causality

PubMed Central

Weyland, Patricia G.; Grant, William B.; Howie-Esquivel, Jill

2014-01-01

Serum 25-hydroxyvitamin D (25(OH)D) levels have been found to be inversely associated with both prevalent and incident cardiovascular disease (CVD) risk factors; dyslipidemia, hypertension and diabetes mellitus. This review looks for evidence of a causal association between low 25(OH)D levels and increased CVD risk. We evaluated journal articles in light of Hill’s criteria for causality in a biological system. The results of our assessment are as follows. Strength of association: many randomized controlled trials (RCTs), prospective and cross-sectional studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Consistency of observed association: most studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors in various populations, locations and circumstances. Temporality of association: many RCTs and prospective studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Biological gradient (dose-response curve): most studies assessing 25(OH)D levels and CVD risk found an inverse association exhibiting a linear biological gradient. Plausibility of biology: several plausible cellular-level causative mechanisms and biological pathways may lead from a low 25(OH)D level to increased risk for CVD with mediators, such as dyslipidemia, hypertension and diabetes mellitus. Experimental evidence: some well-designed RCTs found increased CVD risk factors with decreasing 25(OH)D levels. Analogy: the association between serum 25(OH)D levels and CVD risk is analogous to that between 25(OH)D levels and the risk of overall cancer, periodontal disease, multiple sclerosis and breast cancer. Conclusion: all relevant Hill criteria for a causal association in a biological system are satisfied to indicate a low 25(OH)D level as a CVD risk factor. PMID:25184368

Counterclockwise and Clockwise Rotation of QRS Transitional Zone: Prospective Correlates of Change and Time-Varying Associations With Cardiovascular Outcomes.

PubMed

Patel, Siddharth; Kwak, Lucia; Agarwal, Sunil K; Tereshchenko, Larisa G; Coresh, Josef; Soliman, Elsayed Z; Matsushita, Kunihiro

2017-11-03

A few studies have recently reported clockwise and counterclockwise rotations of QRS transition zone as predictors of mortality. However, their prospective correlates and associations with individual cardiovascular disease (CVD) outcomes are yet to be investigated. Among 13 567 ARIC (Atherosclerosis Risk in Communities) study participants aged 45 to 64 years, we studied key correlates of changes in the status of clockwise and counterclockwise rotation over time as well as the association of rotation status with incidence of coronary heart disease (2408 events), heart failure (2196 events), stroke (991 events), composite CVD (4124 events), 898 CVD deaths, and 3469 non-CVD deaths over 23 years of follow-up. At baseline, counterclockwise rotation was most prevalent (52.9%), followed by no (40.5%) and clockwise (6.6%) rotation. Of patients with no rotation, 57.9% experienced counterclockwise or clockwise rotation during follow-up, with diabetes mellitus and black race significantly predicting clockwise and counterclockwise conversion, respectively. Clockwise rotation was significantly associated with higher risk of heart failure (hazard ratio, 1.20; 95% confidence interval [CI], 1.02-1.41) and non-CVD death (hazard ratio, 1.28; 95% CI, 1.12-1.46) after adjusting for potential confounders including other ECG parameters. On the contrary, counterclockwise rotation was significantly related to lower risk of composite CVD (hazard ratio, 0.93; 95% CI, 0.87-0.99]), CVD mortality (hazard ratio, 0.76; 95% CI, 0.65-0.88), and non-CVD deaths (hazard ratio, 0.92; 95% CI, 0.85-0.99 [borderline significance with heart failure]). Counterclockwise rotation, the most prevalent QRS transition zone pattern, demonstrated the lowest risk of CVD and mortality, whereas clockwise rotation was associated with the highest risk of heart failure and non-CVD mortality. These results have implications on how to interpret QRS transition zone rotation when ECG was recorded. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Job Strain, Job Insecurity, and Incident Cardiovascular Disease in the Women’s Health Study: Results from a 10-Year Prospective Study

PubMed Central

Slopen, Natalie; Glynn, Robert J.; Buring, Julie E.; Lewis, Tené T.; Williams, David R.; Albert, Michelle A.

2012-01-01

Objectives Research about work-related stressors and cardiovascular disease (CVD) has produced mixed findings. Moreover, a paucity of data exists regarding the long-term associations between job strain and job insecurity and CVD among women. Methods We used Cox proportional hazard models to examine the relationship between job strain, job insecurity, and incident CVD over 10 years of follow-up among 22,086 participants in the Women’s Health Study (mean age 57±5 years). Results During 10 years of follow-up there were 170 myocardial infarctions (MI), 163 ischemic strokes, 440 coronary revascularizations, and 52 CVD deaths. In models adjusted for age, race, education, and income, women with high job strain (high demand, low control) were 38% more likely to experience a CVD event than their counterparts who reported low job strain (low demand, high control; Rate Ratio (RR) = 1.38, 95% Confidence Interval (CI) = 1.08–1.77), and women with active jobs (high demand, high control) were 38% more likely to experience a CVD event relative to women who reported low job strain (95% CI = 1.07–1.77). Outcome-specific analyses revealed that high job strain predicted non-fatal myocardial infarction (RR = 1.67, CI = 1.04–2.70), and coronary revascularization (RR = 1.41, CI = 1.05–1.90). No evidence of an association between job insecurity and long-term CVD risk was observed. Conclusion High strain and active jobs, but not job insecurity, were related to increased CVD risk among women. Both job strain and job insecurity were significantly related to CVD risk factors. With the increase of women in the workforce, these data emphasize the importance of addressing job strain in CVD prevention efforts among working women. PMID:22815754

Low-density lipoprotein electronegativity is a novel cardiometabolic risk factor.

PubMed

Hsu, Jing-Fang; Chou, Tzu-Chieh; Lu, Jonathan; Chen, Shu-Hua; Chen, Fang-Yu; Chen, Ching-Chu; Chen, Jeffrey L; Elayda, MacArthur; Ballantyne, Christie M; Shayani, Steven; Chen, Chu-Huang

2014-01-01

Low-density lipoprotein (LDL) plays a central role in cardiovascular disease (CVD) development. In LDL chromatographically resolved according to charge, the most electronegative subfraction-L5-is the only subfraction that induces atherogenic responses in cultured vascular cells. Furthermore, increasing evidence has shown that plasma L5 levels are elevated in individuals with high cardiovascular risk. We hypothesized that LDL electronegativity is a novel index for predicting CVD. In 30 asymptomatic individuals with metabolic syndrome (MetS) and 27 healthy control subjects, we examined correlations between plasma L5 levels and the number of MetS criteria fulfilled, CVD risk factors, and CVD risk according to the Framingham risk score. L5 levels were significantly higher in MetS subjects than in control subjects (21.9±18.7 mg/dL vs. 11.2±10.7 mg/dL, P:0.01). The Jonckheere trend test revealed that the percent L5 of total LDL (L5%) and L5 concentration increased with the number of MetS criteria (P<0.001). L5% correlated with classic CVD risk factors, including waist circumference, body mass index, waist-to-height ratio, smoking status, blood pressure, and levels of fasting plasma glucose, triglyceride, and high-density lipoprotein. Stepwise regression analysis revealed that fasting plasma glucose level and body mass index contributed to 28% of L5% variance. The L5 concentration was associated with CVD risk and contributed to 11% of 30-year general CVD risk variance when controlling the variance of waist circumference. Our findings show that LDL electronegativity was associated with multiple CVD risk factors and CVD risk, suggesting that the LDL electronegativity index may have the potential to be a novel index for predicting CVD. Large-scale clinical trials are warranted to test the reliability of this hypothesis and the clinical importance of the LDL electronegativity index.

Low-Density Lipoprotein Electronegativity Is a Novel Cardiometabolic Risk Factor

PubMed Central

Lu, Jonathan; Chen, Shu-Hua; Chen, Fang-Yu; Chen, Ching-Chu; Chen, Jeffrey L.; Elayda, MacArthur; Ballantyne, Christie M.; Shayani, Steven; Chen, Chu-Huang

2014-01-01

Background Low-density lipoprotein (LDL) plays a central role in cardiovascular disease (CVD) development. In LDL chromatographically resolved according to charge, the most electronegative subfraction–L5–is the only subfraction that induces atherogenic responses in cultured vascular cells. Furthermore, increasing evidence has shown that plasma L5 levels are elevated in individuals with high cardiovascular risk. We hypothesized that LDL electronegativity is a novel index for predicting CVD. Methods In 30 asymptomatic individuals with metabolic syndrome (MetS) and 27 healthy control subjects, we examined correlations between plasma L5 levels and the number of MetS criteria fulfilled, CVD risk factors, and CVD risk according to the Framingham risk score. Results L5 levels were significantly higher in MetS subjects than in control subjects (21.9±18.7 mg/dL vs. 11.2±10.7 mg/dL, P:0.01). The Jonckheere trend test revealed that the percent L5 of total LDL (L5%) and L5 concentration increased with the number of MetS criteria (P<0.001). L5% correlated with classic CVD risk factors, including waist circumference, body mass index, waist-to-height ratio, smoking status, blood pressure, and levels of fasting plasma glucose, triglyceride, and high-density lipoprotein. Stepwise regression analysis revealed that fasting plasma glucose level and body mass index contributed to 28% of L5% variance. The L5 concentration was associated with CVD risk and contributed to 11% of 30-year general CVD risk variance when controlling the variance of waist circumference. Conclusion Our findings show that LDL electronegativity was associated with multiple CVD risk factors and CVD risk, suggesting that the LDL electronegativity index may have the potential to be a novel index for predicting CVD. Large-scale clinical trials are warranted to test the reliability of this hypothesis and the clinical importance of the LDL electronegativity index. PMID:25203525

Lifelong Exercise Patterns and Cardiovascular Health.

PubMed

Maessen, Martijn F H; Verbeek, André L M; Bakker, Esmée A; Thompson, Paul D; Hopman, Maria T E; Eijsvogels, Thijs M H

2016-06-01

To determine the relationship between lifelong exercise dose and the prevalence of cardiovascular morbidity. From June 1, 2011, through December 31, 2014, 21,266 individuals completed an online questionnaire regarding their lifelong exercise patterns and cardiovascular health status. Cardiovascular disease (CVD) was defined as a diagnosis of myocardial infarction, stroke, or heart failure, and cardiovascular risk factors (CVRFs) were defined as hypertension, hypercholesterolemia, or type 2 diabetes. Lifelong exercise patterns were measured over a median of 32 years for 405 patients with CVD, 1379 patients with CVRFs, and 10,656 controls. Participants were categorized into nonexercisers and quintiles (Q1-Q5) of exercise dose (metabolic equivalent task [MET] minutes per week). The CVD/CVRF prevalence was lower for each exercise quintile compared with nonexercisers (CVD: nonexercisers, 9.6% vs Q1: 4.4%, Q2: 2.8%, Q3: 2.4%, Q4: 3.6%, Q5: 3.9%; P<.001; CVRF: nonexercisers, 24.6% vs Q1: 13.8%, Q2: 10.2%, Q3: 9.0%, Q4: 9.4%, Q5: 12.0%; P<.001). The lowest exercise dose (Q1) significantly reduced CVD and CVRF prevalence, but the largest reductions were found at 764 to 1091 MET-min/wk for CVD (adjusted odds ratio=0.31; 95% CI, 0.20-0.48) and CVRFs (adjusted odds ratio=0.36; 95% CI, 0.28-0.47). The CVD/CVRF prevalence did not further decrease in higher exercise dose groups. Exercise intensity did not influence the relationship between exercise patterns and CVD or CVRFs. These findings demonstrate a curvilinear relationship between lifelong exercise patterns and cardiovascular morbidity. Low exercise doses can effectively reduce CVD/CVRF prevalence, but engagement in exercise for 764 to 1091 MET-min/wk is associated with the lowest CVD/CVRF prevalence. Higher exercise doses do not yield additional benefits. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Dietary Compliance, Dietary Supplementation and Traditional Remedy Usage of Type 2 Diabetic Patients With and Without Cardiovascular Disease

PubMed Central

Ng, Ooi Chuan; Wong, Teck Wee; Joseph, Anthony; Hejar, Abdul Rahman; Rushdan, Abdul Aziz

2015-01-01

This analytical cross-sectional study examined the nutrient intakes, dietary compliance, dietary supplementation and traditional remedy usage in type 2 diabetes mellitus (T2DM) patients from selected tertiary hospitals in multi-racial Malaysia. We compared the different characteristics of T2DM patients with and without cardiovascular disease (CVD). Socio-demographic status, dietary intakes, dietary supplementation, traditional remedy use, medical history, anthropometric measurements and clinical characteristics were obtained from face-to-face interviews. A total of 313 patients who were treated for T2DM participated in this study, in which 36.1% of them had CVD. The mean age of study subjects was 55.7 ± 9.2 years; mean diabetes duration was 10.1 ± 8.1 years; 52.1% were females; and 47.0% were Malays. The mean total energy intake of the subjects was 1674 ± 694 kcal/day, and patients with CVD consumed higher total calories (p = 0.001). Likewise, the mean carbohydrate, protein and total fat intake of CVD patients were significantly higher than non-CVD patients (p < 0.05), while mean intakes of cholesterol, fibre, minerals and all vitamins were comparable between CVD and non-CVD patients. Regardless of CVD status, a notably high proportion of the subjects did not meet the recommendations of the Medical Nutrition Therapy Guidelines for Type 2 Diabetes for total energy, carbohydrate, protein, total fat, and fibre intakes. Meanwhile, 52.4% used at least one dietary supplement and 12.1% took single traditional remedy or in various combinations. Traditional remedies and supplement intake did not differ between CVD and non-CVD subjects. It is suggested that T2DM patients should be educated based on their personalized dietary intake, dietary supplementation and traditional remedy usage. The recommendations for T2DM patients shall be met to achieve the optimal metabolic goals and minimize the potential diabetic complications. PMID:25713789

Contribution of fibroblast growth factor 23 to Framingham risk score for identifying subclinical atherosclerosis in Chinese men.

PubMed

Hu, X; Ma, X; Luo, Y; Xu, Y; Xiong, Q; Pan, X; Bao, Y; Jia, W

2017-02-01

Fibroblast growth factor 23 (FGF23) was demonstrated to be involved in the occurrence and development of cardiovascular disease (CVD). The goal of the present study was to investigate the relationship between serum FGF23 levels and carotid intima-media thickness (C-IMT) in men with a low-to-moderate CVD risk. Subjects with normal kidney function were selected from the Shanghai Obesity Study. Serum FGF23 levels were determined by sandwich enzyme-linked immunosorbent assay. C-IMT was measured by ultrasonography. The Framingham risk score (FRS) was used to assess CVD risk. A total of 392 men with low CVD risk and 372 men with moderate CVD risk were enrolled. The recognition rate of an elevated C-IMT was 85.66% with the combination of a moderate CVD risk and high serum FGF23 levels, which was greater than that with either parameter alone (65.44% and 61.03%, respectively). Subjects with high serum FGF23 levels, and either low or moderate CVD risk, were more likely to have elevated C-IMT than those with low serum FGF23 levels and low CVD risk (P = 0.014 and 0.001, respectively). The serum FGF23 levels were independently and positively associated with C-IMT in subjects with low or moderate CVD risk (both P = 0.007). In men with low-to-moderate CVD risk, serum FGF23 levels were associated independently and positively with C-IMT. As a complementary index, serum FGF23 levels strengthen the capacity of the FRS to identify subclinical atherosclerosis. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

The Impact of Lifecourse Socioeconomic Position on Cardiovascular Disease Events in African Americans: The Jackson Heart Study

PubMed Central

Gebreab, Samson Y; Diez Roux, Ana V; Brenner, Allison B; Hickson, DeMarc A; Sims, Mario; Subramanyam, Malavika; Griswold, Michael E; Wyatt, Sharon B; James, Sherman A

2015-01-01

Background Few studies have examined the impact of lifecourse socioeconomic position (SEP) on cardiovascular disease (CVD) risk among African Americans. Methods and Results We used data from the Jackson Heart Study (JHS) to examine the associations of multiple measures of lifecourse SEP with CVD events in a large cohort of African Americans. During a median of 7.2-year follow-up, 362 new or recurrent CVD events occurred in a sample of 5301 participants aged 21 to 94. Childhood SEP was assessed by using mother’s education, parental home ownership, and childhood amenities. Adult SEP was assessed by using education, income, wealth, and public assistance. Adult SEP was more consistently associated with CVD risk in women than in men: age-adjusted hazard ratios for low versus high income (95% CIs), 2.46 (1.19 to 5.09) in women and 1.50 (0.87 to 2.58) in men, P for interaction=0.1244, and hazard ratio for low versus high wealth, 2.14 (1.39 to 3.29) in women and 1.06 (0.62 to 1.81) in men, P for interaction=0.0224. After simultaneous adjustment for all adult SEP measures, wealth remained a significant predictor of CVD events in women (HR=1.73 [1.04, 2.85] for low versus high). Education and public assistance were less consistently associated with CVD. Adult SEP was a stronger predictor of CVD events in younger than in older participants (HR for high versus low summary adult SEP score 3.28 [1.43, 7.53] for participants ≤50 years, and 1.90 (1.36 to 2.66) for participants >50 years, P for interaction 0.0846). Childhood SEP was not associated with CVD risk in women or men. Conclusions Adult SEP is an important predictor of CVD events in African American women and in younger African Americans. Childhood SEP was not associated with CVD events in this population. PMID:26019130

Parental History of Premature Cardiovascular Disease, Estimated GFR, and Rate of Estimated GFR Decline: Results From the Aerobics Center Longitudinal Study

PubMed Central

Huang, Xiaoyan; Sui, Xuemei; Ruiz, Jonatan R.; Hirth, Victor; Ortega, Francisco B.; Blair, Steven N.; Carrero, Juan J.

2015-01-01

Background Despite cardiovascular disease (CVD) and chronic kidney disease (CKD) sharing similar etiologies and interplay, it remains unknown if a broader relationship between these diseases exists across generations. We investigated the association between parental CVD history and estimated glomerular filtration rate (eGFR) in the community. Study Design Cross-sectional and longitudinal analyses. Setting & Participants A total of 13,241 community-based adults with serum creatinine measurement and follow-up visits (from 1 to 8 visits, approximately 2 years apart) from the Aerobics Center Longitudinal Study. Predictors Premature parental CVD history (before age of 50 years). Outcomes eGFR, decreased eGFR (<60 mL/min/1.73m2), and rate of eGFR decline. Measurements Information of parental history was collected by protocol-standardized questionnaires. eGFR was assessed with serum creatinine. Results A total of 3,339 (25.2%) participants reported a history of parental CVD. Individuals with parental CVD had significantly lower eGFR compared with those without parental CVD (69.4 ± 12.9 vs. 74.8 ± 14.2 mL/min/1.73m2; P<0.001). After multivariable adjustment, parental CVD was independently associated with higher odds of having decreased eGFR (adjusted OR, 1.68; 95% CI, 1.52–1.86). Random-coefficient models showed that individuals with parental CVD had a faster decline in eGFR compared with those without parental CVD (sex- and ethnicity-adjusted annual change of −0.47 vs. −0.41 mL/min/1.73 m2; P=0.06). Limitations Approximately 70% of the participants did not attend a second examination. Conclusions Parental history of CVD was associated with lower baseline eGFR, higher odds of decreased eGFR, and a nominally faster rate of eGFR decline in the offspring. Such findings may imply previously unrecognized cross-generational links between both diseases and be of support in community screening programs. PMID:25600488

Movers and stayers: The geography of residential mobility and CVD hospitalisations in Auckland, New Zealand.

PubMed

Exeter, Daniel J; Sabel, Clive E; Hanham, Grant; Lee, Arier C; Wells, Susan

2015-05-01

The association between area-level disadvantage and health and social outcomes is unequivocal. However, less is known about the health impact of residential mobility, particularly at intra-urban scales. We used an encrypted National Health Index (eNHI) number to link individual-level data recorded in routine national health databases to construct a cohort of 641,532 participants aged 30+ years to investigate the association between moving and CVD hospitalisations in Auckland, New Zealand. Residential mobility was measured for participants according to changes in the census Meshblock of usual residence, obtained from the Primary Health Organisation (PHO) database for every calendar quarter between 1/1/2006 and 31/12/2012. The NZDep2006 area deprivation score at the start and end of a participant's inclusion in the study was used to measure deprivation mobility. We investigated the relative risk of movers being hospitalised for CVD relative to stayers using multi-variable binomial regression models, controlling for age, gender, deprivation and ethnicity. Considered together, movers were 1.22 (1.19-1.26) times more likely than stayers to be hospitalised for CVD. Using the 5×5 deprivation origin-destination matrix to model a patient's risk of CVD based on upward, downward or sideways deprivation mobility, movers within the least deprived (NZDep2006 Quintile 1) areas were 10% less likely than stayers to be hospitalised for CVD, while movers within the most deprived (NZDep2006 Q5) areas were 45% more likely than stayers to have had their first CVD hospitalisation in 2006-2012 (RR: 1.45 [1.35-1.55]). Participants who moved upward also had higher relative risks of having a CVD event, although their risk was less than those observed for participants experiencing downward deprivation mobility. This research suggests that residential mobility is an important determinant of CVD in Auckland. Further investigation is required to determine the impact moving has on the risk of CVD by ethnicity. Copyright © 2014 Elsevier Ltd. All rights reserved.

The influence of pharmacy and pharmacist characteristics on the secondary prevention of cardiovascular disease.

PubMed

Puspitasari, Hanni Prihhastuti; Aslani, Parisa; Krass, Ines

2015-10-01

A range of extended/enhanced pharmacy services (EPS) are increasingly being offered in community pharmacies following a global paradigm shift in professional pharmacy practice from a product-oriented focus to a patient-centered approach. A number of pharmacy/pharmacist characteristics have been reported to influence EPS provision. To investigate the association between EPS provision and community pharmacists' support in CVD secondary prevention and to identify pharmacy/pharmacist characteristics which predict EPS provision and CVD support. Setting Australian community pharmacies. Mail surveys to 1350 randomly selected pharmacies, stratified by state/territory, exploring professional activities provided to clients with CVD, characteristics of pharmacies (including EPS provision), and pharmacist characteristics. The survey data were analyzed using univariate analyses and multiple linear regression analysis. The level of community pharmacists' CVD support, determined by summing respondents' score for seven CVD support-related activities, and the pharmacies' level of involvement in EPS provision, determined by summing respondents' score for four types of EPS. EPS provision was then used as an independent variable in the regression analysis of CVD support. A response rate of 15.8% (209/1320) was obtained after three waves of the survey. Pharmacy documentation, a private area, Quality Care Pharmacy Program accreditation, number of pharmacists, and pharmacists' resource adequacy were predictors of EPS provision (adjusted R2 = 0.299, p < 0.001). The provision of CVD support was predicted by EPS provision (β = 0.290, p < 0.001), pharmacists' frequent contacts with general practitioners (β = 0.298, p < 0.001), and pharmacy documentation (β = 0.134, p = 0.033). The regression model of CVD support explained 34.2% of the variation (p < 0.001). Community pharmacists could contribute to CVD secondary prevention if they had frequent contacts with general practitioners and worked in pharmacies with a higher level of involvement in EPS provision. Of all influencing factors, documentation was a predictor of both EPS provision and CVD support, indicating the importance of documentation in supporting the management of chronic conditions.

Using impedance cardiography to detect subclinical cardiovascular disease in women with multiple risk factors: a pilot study.

PubMed

Demarzo, Arthur P

2009-01-01

Early detection of cardiovascular disease (CVD) could initiate appropriate treatment and prevent progression. This study used impedance cardiography (ICG) waveform analysis with postural change to detect functional CVD in women older than 40 years with no history of CVD and >or=2 of the following risk factors: cigarette smoking, poor diet, physical inactivity, central adiposity, family history of premature CVD, hypertension, and dyslipidemia. A study group of 32 women underwent ICG in standing and supine positions. An age-matched control group had 20 women with an active lifestyle, no risk factors, and no history of CVD. All women in the control group had normal ICG data. All women in the study group had some abnormal ICG data, with 28 (87.5%) having multiple ICG abnormalities. ICG data indicated that 13 (40.6%) had ventricular dysfunction, 14 (43.8%) had high vascular resistive load, and 30 (93.8%) had elevated vascular pulsatile load. The data suggest that subclinical CVD, detectable by ICG, is prevalent in women older than 40 years with multiple risk factors. Abnormal ICG results could expedite the initiation of customized treatment as part of a preventive approach to CVD. (c) 2009 Wiley Periodicals, Inc.

From 1960s Evans County Georgia to present-day Jackson, Mississippi: an exploration of the evolution of cardiovascular disease in African Americans.

PubMed

Crook, Errol D; Clark, Bobby L; Bradford, Shayna T J; Golden, Kimberly; Calvin, Rosie; Taylor, Herman A; Flack, John M

2003-06-01

Cardiovascular disease (CVD) is the No. 1 cause of mortality in the United States and it disproportionately affects African Americans. However, there are earlier reports that African Americans had significantly less CVD than whites. This racial discrepancy in CVD rates was noticed primarily for coronary heart disease (CHD). This issue was examined in the Evans County (Georgia) Cardiovascular Disease Study conducted in the 1960s. It showed that African American men had significantly lower rates of CHD than white men. Over the last couple of decades, the rates of CVD have been declining. However, the rate of decline of CVD in African Americans has not been equal to that seen in whites, such that African Americans now have a disproportionate share of CVD in the United States. In the 1990s, the Jackson Heart Study was designed to explore the reasons for the current racial discrepancy. This articles reviews the findings of the Evans County Study and explores various hypotheses for why CVD in African Americans has evolved from a disease from which African Americans may have been "protected" to one in which they shoulder a disproportionate burden.

The increasing financial impact of chronic kidney disease in australia.

PubMed

Tucker, Patrick S; Kingsley, Michael I; Morton, R Hugh; Scanlan, Aaron T; Dalbo, Vincent J

2014-01-01

The aim of this investigation was to determine and compare current and projected expenditure associated with chronic kidney disease (CKD), renal replacement therapy (RRT), and cardiovascular disease (CVD) in Australia. Data published by Australia and New Zealand Dialysis and Transplant Registry, Australian Institute of Health and Welfare, and World Bank were used to compare CKD-, RRT-, and CVD-related expenditure and prevalence rates. Prevalence and expenditure predictions were made using a linear regression model. Direct statistical comparisons of rates of annual increase utilised indicator variables in combined regressions. Statistical significance was set at P < 0.05. Dollar amounts were adjusted for inflation prior to analysis. Between 2012 and 2020, prevalence, per-patient expenditure, and total disease expenditure associated with CKD and RRT are estimated to increase significantly more rapidly than CVD. RRT prevalence is estimated to increase by 29%, compared to 7% in CVD. Average annual RRT per-patient expenditure is estimated to increase by 16%, compared to 8% in CVD. Total CKD- and RRT-related expenditure had been estimated to increase by 37%, compared to 14% in CVD. Per-patient, CKD produces a considerably greater financial impact on Australia's healthcare system, compared to CVD. Research focusing on novel preventative/therapeutic interventions is warranted.

Dietary fats and cardiovascular disease: putting together the pieces of a complicated puzzle.

PubMed

Michas, George; Micha, Renata; Zampelas, Antonis

2014-06-01

Dietary fatty acids play significant roles in the cause and prevention of cardiovascular disease (CVD). Trans fatty acids from partially hydrogenated vegetable oils have well-established adverse effects and should be eliminated from the human diet. CVD risk can be modestly reduced by decreasing saturated fatty acids (SFA) and replacing it by a combination of polyunsaturated fatty acids (PUFA) and monounsaturated fatty acids (MUFA). Although the ideal type of unsaturated fat for this replacement is unclear, the benefits of PUFA appear strongest. Both n-6 and n-3 PUFA are essential and reduce CVD risk. However, additional research is needed to better define the optimal amounts of both and to discern the patients and/or general population that would benefit from supplemental n-3 fatty acid intake. Furthermore, consumption of animal products, per se, is not necessarily associated with increased CVD risk, whereas nut and olive oil intake is associated with reduced CVD risk. In conclusion, the total matrix of a food is more important than just its fatty acid content in predicting the effect of a food on CVD risk, and a healthy diet should be the cornerstone of CVD prevention. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Panic disorder and cardiovascular diseases: an overview.

PubMed

Machado, Sergio; Sancassiani, Federica; Paes, Flavia; Rocha, Nuno; Murillo-Rodriguez, Eric; Nardi, Antonio Egidio

2017-10-01

The association between panic disorder (PD) and cardiovascular diseases (CVD) has been extensively studied in recent years and, although some studies have shown anxiety disorders co-existing or increasing the risk of heart disease, no causal hypothesis has been well established. Thus, a critical review was performed of the studies that evaluated the association between PD and cardiovascular diseases; synthesizing the evidence on the mechanisms mediators that theoretically would be the responsible for the causal pathway between PD and CVD, specifically. This overview shows epidemiological studies, and discusses biological mechanisms that could link PD to CVD, such as pleiotropy, heart rate variability, unhealthy lifestyle, atherosclerosis, mental stress, and myocardial perfusion defects. This study tried to provide a comprehensive narrative synthesis of previously published information regarding PD and CVD and open new possibilities of clinical management and pathophysiological understanding. Some epidemiological studies have indicated that PD could be a risk factor for CVD, raising morbidity and mortality in PD, suggesting an association between them. These studies argue that PD pathophysiology could cause or potentiate CVD. However, there is no evidence in favour of a causal relationship between PD and CVD. Therefore, PD patients with suspicions of cardiovascular symptoms need redoubled attention.

Blood Pressure Response to Exercise and Cardiovascular Disease.

PubMed

Schultz, Martin G; La Gerche, Andre; Sharman, James E

2017-10-18

This review aimed to provide a clinical update on exercise blood pressure (BP) and its relationship to cardiovascular disease (CVD), outlining key determinants of abnormal exercise BP responses. We also highlight current evidence gaps that need addressing in order to optimise the relevance of exercise BP as clinical CVD risk factor. Abnormal exercise BP manifests as either exercise hypotension (low BP response) or as exaggerated exercise BP (high BP response). Exercise hypotension is an established sign of existing and likely severe CVD, but exaggerated exercise BP also carries elevated CVD risk due to its association with sub-clinical hypertension. Although exaggerated exercise BP is related to heightened CVD risk at any exercise intensity, recent data suggest that the BP response to submaximal intensity exercise holds greater prognostic and clinical significance than BP achieved at peak/maximal intensity exercise. Cardiorespiratory fitness is a strong modifier of the exercise BP response, and should be taken into consideration when assessing the association with CVD. Both exercise hypotension and exaggerated exercise BP serve as markers that should prompt evaluation for potential underlying CVD. However, the clinical utility of these markers is currently inhibited by the lack of consensus informing the definitions and thresholds for abnormalities in exercise BP.

Numerical modeling tools for chemical vapor deposition

NASA Technical Reports Server (NTRS)

Jasinski, Thomas J.; Childs, Edward P.

1992-01-01

Development of general numerical simulation tools for chemical vapor deposition (CVD) was the objective of this study. Physical models of important CVD phenomena were developed and implemented into the commercial computational fluid dynamics software FLUENT. The resulting software can address general geometries as well as the most important phenomena occurring with CVD reactors: fluid flow patterns, temperature and chemical species distribution, gas phase and surface deposition. The physical models are documented which are available and examples are provided of CVD simulation capabilities.

High thermal stability of abrupt SiO2/GaN interface with low interface state density

NASA Astrophysics Data System (ADS)

Truyen, Nguyen Xuan; Taoka, Noriyuki; Ohta, Akio; Makihara, Katsunori; Yamada, Hisashi; Takahashi, Tokio; Ikeda, Mitsuhisa; Shimizu, Mitsuaki; Miyazaki, Seiichi

2018-04-01

The effects of postdeposition annealing (PDA) on the interface properties of a SiO2/GaN structure formed by remote oxygen plasma-enhanced chemical vapor deposition (RP-CVD) were systematically investigated. X-ray photoelectron spectroscopy clarified that PDA in the temperature range from 600 to 800 °C has almost no effects on the chemical bonding features at the SiO2/GaN interface, and that positive charges exist at the interface, the density of which can be reduced by PDA at 800 °C. The capacitance-voltage (C-V) and current density-SiO2 electric field characteristics of the GaN MOS capacitors also confirmed the reduction in interface state density (D it) and the improvement in the breakdown property of the SiO2 film after PDA at 800 °C. Consequently, a high thermal stability of the SiO2/GaN structure with a low fixed charge density and a low D it formed by RP-CVD was demonstrated. This is quite informative for realizing highly robust GaN power devices.

Chemical vapor deposition growth

NASA Technical Reports Server (NTRS)

Ruth, R. P.; Manasevit, H. M.; Johnson, R. E.; Kenty, J. L.; Moudy, L. A.; Simpson, W. I.; Yang, J. J.

1976-01-01

A laboratory type CVD reactor system with a vertical deposition chamber and sample pedestal heated by an external RF coil has been extensively modified by installation of mass flow controllers, automatic process sequence timers, and special bellows-sealed air-operated valves for overall improved performance. Various film characterization procedures, including classical metallography, SEM analyses, X ray diffraction analyses, surface profilometry, and electrical measurements (resistivity, carrier concentration, mobility, spreading resistance profiles, and minority-carrier lifetime by the C-V-t method) area used to correlate Si sheet properties with CVD parameters and substrate properties. Evaluation procedures and measurements are given. Experimental solar cell structures were made both in epitaxial Si sheet (on sapphire substrates) and in polycrystalline material on alumina substrates, the former to provide an indication of what might be an upper limit on performance of the latter. Preliminary results are given, as obtained in cell structures not specially designed to allow for the unique properties of the sheet material, and fabricated in material known to be far from optimum for photovoltaic performance. Low power conversion efficiencies have been obtained in the epitaxial as well as the polycrystalline Si sheet.

Electrochemical characteristics of discrete, uniform, and monodispersed hollow mesoporous carbon spheres in double-layered supercapacitors.

PubMed

Chen, Xuecheng; Kierzek, Krzysztof; Wenelska, Karolina; Cendrowski, Krzystof; Gong, Jiang; Wen, Xin; Tang, Tao; Chu, Paul K; Mijowska, Ewa

2013-11-01

Core-shell-structured mesoporous silica spheres were prepared by using n-octadecyltrimethoxysilane (C18TMS) as the surfactant. Hollow mesoporous carbon spheres with controllable diameters were fabricated from core-shell-structured mesoporous silica sphere templates by chemical vapor deposition (CVD). By controlling the thickness of the silica shell, hollow carbon spheres (HCSs) with different diameters can be obtained. The use of ethylene as the carbon precursor in the CVD process produces the materials in a single step without the need to remove the surfactant. The mechanism of formation and the role played by the surfactant, C18TMS, are investigated. The materials have large potential in double-layer supercapacitors, and their electrochemical properties were determined. HCSs with thicker mesoporous shells possess a larger surface area, which in turn increases their electrochemical capacitance. The samples prepared at a lower temperature also exhibit increased capacitance as a result of the Brunauer-Emmett-Teller (BET) area and larger pore size. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Matrix Gelatinases in Atherosclerosis and Diabetic Nephropathy: Progress and Challenges.

PubMed

Dimas, Grigorios G; Didangelos, Triantafyllos P; Grekas, Dimitrios M

2017-01-01

Matrix metalloproteinases (MMPs) are zinc-dependent proteases that degrade components of the extracellular matrix (ECM). In glomerular disease, MMPs are major regulators of ECM degradation as well as structural and functional integrity in the glomerulus. In altered matrix composition diseases, glomerular damage is due to increased degradation of kidney and vessel basement membranes (BMs) by MMPs. MMP -2 and -9 are both considered as the main enzymes that degrade collagen type-IV (coll-IV), which represents the key collagenous component of ECM and constitutes the architectural structure of vessels and glomerular BM. There is growing evidence implicating MMPs in atherosclerosis as well as in cardiovascular disease (CVD) and chronic kidney disease (CKD). Specific endogenous tissue inhibitors of MMPs (TIMPs) are also implicated in CKD, CVD and diabetic nephropathy (DN). The present review discusses the role of MMPs -2 and -9 in DN, as a leading cause of endstage renal disease and as a model of the link between progressive glomerulosclerosis and MMP expression. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Health system challenges for the management of cardiovascular disease and diabetes: an empirical qualitative study from Syria.

PubMed

Ahmad, Balsam; Fouad, Fouad M; Elias, Madonna; Zaman, Shahaduz; Phillimore, Peter; Maziak, Wasim

2015-01-01

To explore through empirical qualitative data health system barriers to effective management of cardiovascular disease and diabetes in Syria before the crisis, and how such analysis can inform the building of a post-crisis system. Data were collected through document review, semi-structured key informant interviews, and fieldwork in clinics. Institutional commitment to address the increasing burden of CVD and diabetes in Syria was limited and uncoordinated. Challenges included an increasingly split healthcare system, with private provision for those who could afford it, and a residual state health sector for the majority. Public trust in the system had been declining. We conclude that lack of effective management of CVD and diabetes indicated weaknesses of the state and its retracting role in providing effective healthcare. Such weaknesses that existed before the crisis are now compounded by new challenges resulting from wide destruction of the health system due to the ongoing war. The rebuilding of post-conflict heath care system may benefit from insights into the structural problems of the pre-crisis system.

Spatially resolved mapping of electrical conductivity across individual domain (grain) boundaries in graphene.

PubMed

Clark, Kendal W; Zhang, X-G; Vlassiouk, Ivan V; He, Guowei; Feenstra, Randall M; Li, An-Ping

2013-09-24

All large-scale graphene films contain extended topological defects dividing graphene into domains or grains. Here, we spatially map electronic transport near specific domain and grain boundaries in both epitaxial graphene grown on SiC and CVD graphene on Cu subsequently transferred to a SiO2 substrate, with one-to-one correspondence to boundary structures. Boundaries coinciding with the substrate step on SiC exhibit a significant potential barrier for electron transport of epitaxial graphene due to the reduced charge transfer from the substrate near the step edge. Moreover, monolayer-bilayer boundaries exhibit a high resistance that can change depending on the height of substrate step coinciding at the boundary. In CVD graphene, the resistance of a grain boundary changes with the width of the disordered transition region between adjacent grains. A quantitative modeling of boundary resistance reveals the increased electron Fermi wave vector within the boundary region, possibly due to boundary induced charge density variation. Understanding how resistance change with domain (grain) boundary structure in graphene is a crucial first step for controlled engineering of defects in large-scale graphene films.

Pravastatin reduces the risk for cardiovascular disease in Japanese hypercholesterolemic patients with impaired fasting glucose or diabetes: diabetes subanalysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study.

PubMed

Tajima, Naoko; Kurata, Hideaki; Nakaya, Noriaki; Mizuno, Kyoichi; Ohashi, Yasuo; Kushiro, Toshio; Teramoto, Tamio; Uchiyama, Shinichiro; Nakamura, Haruo

2008-08-01

Diabetes mellitus (DM) is a major risk factor for cardiovascular disease (CVD) in patients with no history of CVD. Evidence for the effect of statins on CVD in the diabetic population in low-risk populations (e.g., Japanese) is limited. We evaluated the effect of pravastatin on risk reduction of CVD related to baseline glucose status in a primary prevention setting. The Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study, in patients with mild-to-moderate hypercholesterolemia (220-270 mg/dL), showed that low-dose pravastatin significantly reduced the risk for CVD by 26%. This exploratory subanalyses examined the efficacy of diet plus pravastatin on CVD in 2210 patients with abnormal fasting glucose (AFG, including 1746 patients with DM and 464 patients with impaired fasting glucose (IFG) at 5 years in the MEGA Study. CVD was threefold higher in AFG patients (threefold higher in DM, and twofold higher in IFG) compared with normal fasting glucose (NFG) patients in the diet group. Diet plus pravastatin treatment significantly reduced the risk of CVD by 32% (hazard ratio 0.68, 95% CI 0.48-0.96, number needed to treat, 42) in the AFG group compared with the diet alone group, and no significant interaction between AFG and NFG (interaction P=0.85) was found. Safety problems were not observed during long-term treatment with pravastatin. In conclusion, pravastatin reduces the risk of CVD in subjects with hypercholesterolemia and abnormal fasting glucose in the primary prevention setting in Japan.

Sex Differences in Type-2 Diabetes: Implications for Cardiovascular Risk Management.

PubMed

Raparelli, Valeria; Morano, Susanna; Franconi, Flavia; Lenzi, Andrea; Basili, Stefania

2017-01-01

Among individuals with Type 2 diabetes (T2DM), cardiovascular disease (CVD) is the leading cause of morbidity and mortality. Sex and gender differences (SGDs) in the cardiovascular consequences of T2DM are relevant suggesting the need for a more aggressive CVD preventive strategy in diabetic women as they lose the so-called &quot;female advantage&quot; in terms of CVD risk comparing with the nondiabetic population. Multiple factors may explain the disproportion in CVD risk among women with diabetes comparing with diabetic men or non-diabetic women. Both genetic and hormonal factors only partially explain SGDs in CVD risk in diabetes. However, women likely reach diagnosis later and in worse conditions, they undergo both diagnostic and therapeutic supports in lower percentage and, finally, they are not able to obtain therapeutic goals recommended by guidelines. Concerning the cardiovascular system, diabetes amplifies the extent of damage at both micro- and macrovascular level differently among sexes. The aim of this review is to clarify, in a sex and gender perspective, the impact of diabetes in CVD risk and to summarize the most important SGDs in CVD primary and secondary prevention strategies such as antiplatelet drugs and statins. The efficacy of ASA and/or statins in secondary prevention is documented in both sexes independently by the presence of T2DM. A different approach to CVD primary prevention with ASA using the age cut-off to discriminate sex differences has been recommended. The use of statins for primary prevention in women should be accurately monitored for the occurrence of myalgia and risk of developing diabetes. A gender approach in CVD prevention strategies is urgently required to achieve a sensible reduction of adverse CV events. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Assessment of the agreement between the Framingham and DAD risk equations for estimating cardiovascular risk in adult Africans living with HIV infection: a cross-sectional study.

PubMed

Noumegni, Steve Raoul; Ama, Vicky Jocelyne Moor; Assah, Felix K; Bigna, Jean Joel; Nansseu, Jobert Richie; Kameni, Jenny Arielle M; Katte, Jean-Claude; Dehayem, Mesmin Y; Kengne, Andre Pascal; Sobngwi, Eugene

2017-01-01

The Absolute cardiovascular disease (CVD) risk evaluation using multivariable CVD risk models is increasingly advocated in people with HIV, in whom existing models remain largely untested. We assessed the agreement between the general population derived Framingham CVD risk equation and the HIV-specific Data collection on Adverse effects of anti-HIV Drugs (DAD) CVD risk equation in HIV-infected adult Cameroonians. This cross-sectional study involved 452 HIV infected adults recruited at the HIV day-care unit of the Yaoundé Central Hospital, Cameroon. The 5-year projected CVD risk was estimated for each participant using the DAD and Framingham CVD risk equations. Agreement between estimates from these equations was assessed using the spearman correlation and Cohen's kappa coefficient. The mean age of participants (80% females) was 44.4 ± 9.8 years. Most participants (88.5%) were on antiretroviral treatment with 93.3% of them receiving first-line regimen. The most frequent cardiovascular risk factors were abdominal obesity (43.1%) and dyslipidemia (33.8%). The median estimated 5-year CVD risk was 0.6% (25th-75th percentiles: 0.3-1.3) using the DAD equation and 0.7% (0.2-2.0) with the Framingham equation. The Spearman correlation between the two estimates was 0.93 ( p  < 0.001). The kappa statistic was 0.61 (95% confident interval: 0.54-0.67) for the agreement between the two equations in classifying participants across risk categories defined as low, moderate, high and very high. Most participants had a low-to-moderate estimated CVD risk, with acceptable level of agreement between the general and HIV-specific equations in ranking CVD risk.

Chronic kidney disease, inflammation, and cardiovascular disease risk in rheumatoid arthritis.

PubMed

Kochi, Masako; Kohagura, Kentaro; Shiohira, Yoshiki; Iseki, Kunitoshi; Ohya, Yusuke

2018-03-01

Rheumatoid arthritis (RA), a prototypic systemic autoimmune inflammatory condition, confers an increased risk of cardiovascular disease (CVD). Recently, chronic kidney disease (CKD) was suggested to increase the risk of CVD in RA patients, and inflammation was identified as a critical, nontraditional CKD-associated risk factor for CVD. This study aimed to examine the combined effects of CKD and CVD in RA patients. In this retrospective evaluation of 428 RA patients, the outcome of interest was the incidence of CVD. CKD was defined as an estimated glomerular filtration rate of <60mL/min/1.73m 2 and/or positive dipstick tests for proteinuria of ≥3 months duration. C-reactive protein (CRP) was used as an inflammation marker, and a high CRP level was defined as a mean CRP value of ≥0.57mg/dL during the first 6 months of follow-up. Patients were categorized as follows: non-CKD with low CRP, non-CKD with high CRP, CKD with low CRP, and CKD with high CRP. During a median follow-up of 89 months, 67 patients (16%) had CKD, and 38 (9%) developed CVD. Using patients with non-CKD and low CRP as a reference group, the adjusted hazard ratios (HR, 95% confidence interval) for CVD were 1.88 (0.25-9.44) for patients with CKD/low CRP and 9.71 (3.27-31.97) for those with CKD/high CRP. The coexistence of CKD and inflammation was associated with a higher risk of CVD than either condition alone in RA patients. Inflammation might increase the risk of CVD especially in patients with CKD. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Association of Ideal Cardiovascular Health and Long-term Healthcare Costs.

PubMed

Willis, Benjamin L; DeFina, Laura F; Bachmann, Justin M; Franzini, Luisa; Shay, Christina M; Gao, Ang; Leonard, David; Berry, Jarett D

2015-11-01

The American Heart Association's (AHA's) 2020 Strategic Impact Goals introduced the concept of ideal cardiovascular (CV) health based on seven health factors and behaviors associated with lower CV disease (CVD) risk. The association between CV health and healthcare costs has not been reported; therefore, we evaluated the association between CV health profile and later-life healthcare costs. Cooper Center Longitudinal Study participants (N=4,906; mean age, 56 years) receiving Medicare coverage from 1999 to 2009 were included. CV health behaviors (diet, physical activity, BMI, smoking) and CV health factors (blood pressure, total cholesterol, blood glucose) were categorized as unfavorable (zero to two ideal components); intermediate (two to four); and favorable (five to seven). Healthcare costs were cumulated from Medicare claims data, adjusted for inflation. Associations between midlife CV health status and non-CVD and CVD-related costs were estimated using multivariable quantile regression. Analyses were conducted in 2013 and 2014. Favorable CV health was prevalent in 14.8% of men and 30.1% of women, with <1% having ideal levels of all health metrics. After 31,945 person-years of Medicare follow-up, individuals with favorable CV health exhibited 24.9% (95% CI=11.7%, 36.0%) lower median annual non-CVD costs and 74.5% (57.5%, 84.7%) lower median CVD costs than those with unfavorable CV health. Annualized differences were greater for non-CVD costs than for CVD costs ($1,175 vs $566). Having more ideal CV health components in middle age, as outlined by the AHA 2020 Goals, is associated with lower non-CVD and CVD healthcare costs in later life. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Systolic blood pressure and cardiovascular mortality in middle-aged and elderly adults - The Singapore Chinese Health Study.

PubMed

Koh, Angela S; Talaei, Mohammad; Pan, An; Wang, Renwei; Yuan, Jian-Min; Koh, Woon-Puay

2016-09-15

While elevated systolic blood pressure (SBP) is related to cardiovascular disease (CVD) mortality, it is unclear if the optimal SBP level may differ by age or the presence of underlying CVD. We investigated the association between SBP categories and CVD mortality among middle-aged and elderly adults with and without CVD history. We used data from 30,692 participants of the population-based Singapore Chinese Health Study who had blood pressures measured using a standard protocol at ages 48-85years between 1994 and 2005. Information on lifestyle factors were collected at recruitment (1993-1998) and during follow-up interviews (1999 and 2004). Mortality was identified via nationwide registry linkage up to 31 December 2014. SBP 120-139mmHg category was associated with lowest risk of CVD mortality in both age-groups of <60 and 60+years, as well as in those with and without underlying coronary heart disease or stroke. Overall, compared to this category, CVD risk was non-significantly increased in lower SBP categories and significantly increased in the higher SBP categories. The risk estimates associated with elevated SBP were higher among those <60years compared to their older counterparts, but less distinct between those with and without underlying CVD. SBP 120-139mmHg was associated with the lowest risk of CVD mortality in middle aged and elderly adults, regardless of underlying CVD. Although risks in both adult groups were similar, there is a greater risk associated with higher SBP among those aged below 60years, highlighting a greater urgency of treatment in this younger group. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Metabolic Syndrome and Diabetes, Alone and in Combination, as Predictors of Cardiovascular Disease Mortality Among Men

PubMed Central

Church, Timothy S.; Thompson, Angela M.; Katzmarzyk, Peter T.; Sui, Xuemei; Johannsen, Neil; Earnest, Conrad P.; Blair, Steven N.

2009-01-01

OBJECTIVE To examine cardiovascular disease (CVD) mortality risk in men with diabetes only, metabolic syndrome only, and concurrent metabolic syndrome and diabetes. RESEARCH DESIGN AND METHODS We examined CVD mortality risk by metabolic syndrome and diabetes status in men from the Aerobics Center Longitudinal Study (ACLS) (mean ± SD age 45.1 ± 10.2 years). Participants were categorized as having neither diabetes nor metabolic syndrome (n = 23,770), metabolic syndrome only (n = 8,780), diabetes only (n = 532), or both (n = 1,097). The duration of follow-up was 14.6 ± 7.0 years with a total of 483,079 person-years of exposure and 1,085 CVD deaths. RESULTS Age-, examination year–, and smoking-adjusted CVD death rates (per 1,000 man-years) in men with neither metabolic syndrome nor diabetes, metabolic syndrome only, diabetes only, and both were 1.9, 3.3, 5.5, and 6.5, respectively. CVD mortality was higher in men with metabolic syndrome only (hazard ratio 1.8 [95% CI 1.5–2.0]), diabetes only (2.9 [2.1–4.0]), and both (3.4 [2.8–4.2]) compared with men with neither. The presence of metabolic syndrome was not associated (1.2 [0.8–1.7]) with higher CVD mortality risk in individuals with diabetes. In contrast, the presence of diabetes substantially increased (2.1 [1.7–2.6]) CVD mortality risk in individuals with metabolic syndrome. CONCLUSIONS The presence of diabetes was associated with a threefold higher CVD mortality risk, and metabolic syndrome status did not modify this risk. Our findings support the fact that physicians should be aggressive in using CVD risk–reducing therapies in all diabetic patients regardless of metabolic syndrome status. PMID:19366967

Association of measles and mumps with cardiovascular disease: The Japan Collaborative Cohort (JACC) study.

PubMed

Kubota, Yasuhiko; Iso, Hiroyasu; Tamakoshi, Akiko

2015-08-01

Although it has been suggested that exposure to infections during childhood could decrease risk of atherosclerotic cardiovascular disease (CVD), the evidence is scarce. We investigated the association of measles and mumps with CVD. 43,689 men and 60,147 women aged 40-79 years at baseline (1988-1990) completed a lifestyle questionnaire, including their history of measles and mumps, and were followed until 2009. Histories of infections were categorized as having no infection (reference), measles only, mumps only, or both infections. Hazard ratios (HR) for mortality from CVD across histories of infections were calculated. Men with measles only had multivariable HR (95% confidence interval) of 0.92 (0.85-0.99) for total CVD, those with mumps only had 0.52 (0.28-0.94) for total stroke and 0.21 (0.05-0.86) for hemorrhagic stroke, and those with both infections had 0.80 (0.71-0.90) for total CVD, 0.71 (0.53-0.93) for myocardial infarction, and 0.83 (0.69-0.98) for total stroke. Women with both infections had 0.83 (0.74-0.92) for total CVD and 0.84 (0.71-0.99) for total stroke. We also compared subjects with measles only or mumps only (reference) and those with both infections. Men with both infections had 0.88 (0.78-0.99) for total CVD. Women with both infections had 0.85 (0.76-0.94) for total CVD, 0.79 (0.67-0.93) for total stroke, 0.78 (0.62-0.98) for ischemic stroke and 0.78 (0.62-0.98) for hemorrhagic stroke. Measles and mumps, especially in case of both infections, were associated with lower risks of mortality from atherosclerotic CVD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Economic Impact of Moderate-Vigorous Physical Activity Among Those With and Without Established Cardiovascular Disease: 2012 Medical Expenditure Panel Survey.

PubMed

Valero-Elizondo, Javier; Salami, Joseph A; Osondu, Chukwuemeka U; Ogunmoroti, Oluseye; Arrieta, Alejandro; Spatz, Erica S; Younus, Adnan; Rana, Jamal S; Virani, Salim S; Blankstein, Ron; Blaha, Michael J; Veledar, Emir; Nasir, Khurram

2016-09-07

Physical activity (PA) has an established favorable impact on cardiovascular disease (CVD) outcomes and quality of life. In this study, we aimed to estimate the economic effect of moderate-vigorous PA on medical expenditures and utilization from a nationally representative cohort with and without CVD. The 2012 Medical Expenditure Panel Survey data were analyzed. Our study population was limited to noninstitutionalized US adults ≥18 years of age. Variables of interest included CVD (coronary artery disease, stroke, heart failure, dysrhythmias, or peripheral artery disease) and cardiovascular modifiable risk factors (CRFs; hypertension, diabetes mellitus, hypercholesterolemia, smoking, and/or obesity). Two-part econometric models were utilized to study cost data; a generalized linear model with gamma distribution and link log was used to assess expenditures per capita. The final study sample included 26 239 surveyed individuals. Overall, 47% engaged in moderate-vigorous PA ≥30 minutes, ≥5 days/week, translating to 111.5 million adults in the United States stratifying by CVD status; 32% reported moderate-vigorous PA among those with CVD versus 49% without CVD. Generally, participants reporting moderate-vigorous PA incurred significantly lower health care expenditures and resource utilization, displaying a step-wise lower total annual health care expenditure as moving from CVD to non-CVD (and each CRF category). Moderate-vigorous PA ≥30 minutes, ≥5 days/week is associated with significantly lower health care spending and resource utilization among individuals with and without established CVD. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Socio-economic inequalities in the financing of cardiovascular & diabetes inpatient treatment in India.

PubMed

Rao, Krishna D; Bhatnagar, Aarushi; Murphy, Adrianna

2011-01-01

Cardiovascular disease (CVD) and diabetes have become a leading threat to public health in India. This study examines socio-economic differences in self-reported morbidity due to CVD and diabetes, where people having these conditions seek care, how much households pay for and how they finance hospital treatment for these conditions. Data for this study are taken from the National Sample Survey Organization (NSSO) 60 th round on 'Morbidity and Health Care' conducted between January and June 2004. Information from 2,129 and 438 individuals hospitalized for CVD and diabetes was analyzed. The self-reported prevalence among adults was 12 per cent for CVD, 4 per cent (7% urban and 3% rural) for heart disease and 6 per cent (10% in urban and 4% in rural) for diabetes. Both self-reported CVD and diabetes appeared to afflict the wealthier more. The private sector was the main provider of outpatient and inpatient care for CVD and diabetes treatment, though the poor depended more on the public sector. Out-of-pocket payments (OOPS) for hospital treatment claimed a large share of annual household expenditures; 30 per cent for CVD and 17 per cent for diabetes. The OOPS share for diabetes treatment declined with increasing income. The majority of OOPS for hospital treatment paid by the poor was financed through borrowings. The considerable financial strain which households, particularly the poor, face in treating CVD and diabetes is alarming. As the burden due to CVD and diabetes increases in India, more households will be subject to these financial strains and unfortunately, the economically vulnerable among them will be the worst affected. While primary prevention of these conditions need more emphasis, in addition, insurance schemes targeted at the poor like the RSBY have an important role to play in financially protecting vulnerable households.

Estimating the future burden of cardiovascular disease and the value of lipid and blood pressure control therapies in China.

PubMed

Stevens, Warren; Peneva, Desi; Li, Jim Z; Liu, Larry Z; Liu, Gordon; Gao, Runlin; Lakdawalla, Darius N

2016-05-10

Lifestyle and dietary changes reflect an ongoing epidemiological transition in China, with cardiovascular disease (CVD) playing an ever-increasing role in China's disease burden. This study assessed the burden of CVD and the potential value of lipid and blood pressure control strategies in China. We estimated the likely burden of CVD between 2016 and 2030 and how expanded use of lipid lowering and blood pressure control medication would impact that burden in the next 15 years. Accounting for the costs of drug use, we assessed the net social value of a policy that expands the utilization of lipid and blood pressure lowering therapies in China. Rises in prevalence of CVD risk and population aging would likely increase the incidence of acute myocardial infarctions (AMIs) by 75 million and strokes by 118 million, while the number of CVD deaths would rise by 39 million in total between 2016 and 2030. Universal treatment of hypertension and dyslipidemia patients with lipid and blood pressure lowering therapies could avert between 10 and 20 million AMIs, between 8 and 30 million strokes, and between 3 and 10 million CVD deaths during the 2016-2030 period, producing a positive social value net of health care costs as high as $932 billion. In light of its aging population and epidemiological transition, China faces near-certain increases in CVD morbidity and mortality. Preventative measures such as effective lipid and blood pressure management may reduce CVD burden substantially and provide large social value. While the Chinese government is implementing more systematic approaches to health care delivery, prevention of CVD should be high on the agenda.