TABLE OF CONTENTS
1.2 The concept of risk assessment 3
1.3 Justification for the study. 4
1.4 Objectives of the Study. 5
2.1 Cardiovascular disease occurrence and risk factors. 6
2.2 Plasma lipids and coronary heart disease risk. 6
2.3 Diabetes and coronary heart disease risk. 13
2.4 Hypertension and cardiovascular disease risk. 18
2.5 Homocysteine and coronary heart disease risk. 24
2.5.1 Homocysteine and lifestyle. 30
2.6 C-reactive protein and cardiovascular disease risk. 31
2.7.1 Physical activity and exercise and cardiovascular disease risk. 39
2.7.2 Smoking and cardiovascular disease risk. 41
2.7.3 Alcohol consumption and cardiovascular disease risk. 45
2.7.4 Diet and cardiovascular disease risk. 49
3.3 The subjects for the study. 55
3.6 Exclusion and inclusion criteria: 55
3.8 Anthropometric Measurements. 56
3.9 Blood pressure measurements. 56
3.10 Determination of Fasting plasma glucose of Subjects. 56
3.11 Determination of Lipid Profile of Subjects. 56
3.11.3 High Density Lipoprotein Cholesterol (HDL-C) Assay. 58
3.11.4 Low Density Lipoprotein Cholesterol (LDL-C) 58
3.12 Determination of Antioxidant Status of Subjects. 58
4.1Body Weight and Cardiovascular Risk Factors among Working Class Women. 60
4.2Blood Pressure trends and Cardiovascular Risk Factors of Working Class Women. 60
4.3Obesity, Hypertension and Cardiovascular Risk Factors of Working Class Women. 63
4.4.Physical activity and Cardiovascular Risk Assessment in Working Class Women. 63
4.5 Correlates of Some Anthropometric and Biochemical Cardiovascular Risk Factors. 66
4.6 Prevalence of Cardiovascular Risk Factors among Working Class Women. 66
DISCUSSION, CONCLUSION AND RECOMMENDATIONS. 72
LIST OF TABLES
Table 4.1: Effects of BMI Variability on Cardiovascular Risk Factors in Working
Class Women………………………………………………………………….61
Table 4.2: Effects of Blood Pressure Variability on Cardiovascular Risk Factors in
Working Class Women……………………………………………………….62
Table 4.3: Cardiovascular Risk Factors in Obese and Hypertensive Working Class Women ……………………………………………………………………………………….64
Table 4.4: Effects of Physical Activity on Cardiovascular Risk Factors in Working
Class Women…………………………………………………………….……65
Table 4.5: Correlation Matrix of Some Anthropometric and Biochemical
Cardiovascular Risk Factors…………………………………………………………………..67
Table 4.6: Prevalence of Cardiovascular Risk Factors in Working Class Women………68
Table 4.7: Prevalence of Cardiovascular Risk Factors in Active and Less active
Working Class Women…………………………………………………………69
LIST OF FIGURES
Figure 2.1: Progression of atherosclerosis. 8
Figure 2.2: Potential mechanisms linking obesity to hypertension. 24
Figure 2.3: Structure of homocysteine. 25
Figure 2.4: Methionine-Homocysteine metabolism and related pathways. 26
Figure 2.5: CRP in the pathogenesis of atherosclerosis and atherothrombosis. 33
Figure 4.1: Prevalence of cardiovascular risk factors in working class women……..………………………….70
Figure 4.2: Prevalence of cardiovascular risk factors in active and less active working class women.71
DEFINITION OF TERMS
ABP Ambulatory blood pressure
ACS Acute coronary syndrome
AI Atherogenic Index (LDL–C/HDL–C ratio)
AMI Acute myocardial infarction
AP Angina pectoris
AT-1 Angiotensin type-1 receptor
BMI Body Mass Index (kg/m2)
BNP b-type natriuretic peptide
BP Blood pressure
CBS Cystathionine-beta-synthase
CETP Cholesteryl ester transfer protein
COPD Chronic obstructive pulmonary disease
CRI Coronary Risk Index (TC/HDL–C ratio)
CRP C-reactive protein
CV Cardiovascular
CVD Cardiovascular Disease
CVRF Cardiovascular Risk Factor
DBP Diastolic blood pressure
DM Diabetes Mellitus
DPPH 2,2-Diphenyl-1-picrylhydrazyl
ECM Extracellular matrix
eNOS Endothelial nitric oxide synthase
FPG Fasting plasma glucose
GFR Glomerular filtration rate
HC Hip Circumference (Inches)
HDL-C High density lipoprotein cholesterol
HT Height (m)
IHD Intermittent heart disease
IL-6 Interleukin-6
LDL-C Low density lipoprotein cholesterol
LVH Left ventricular hypertrophy
LVM Left ventricular mass
MI Myocardial infarction
MS Methionine synthase
NCD’s Non-communicable diseases
NCEP National Cholesterol Education Program
NF-κB Nuclear factor kappa B
NO Nitric oxide
NOS Nitric oxide synthase
OxLDL Oxidized LDL
PUFAs Polyunsaturated fatty acids
RAAS Renin-angiotensin-aldosterone system
ROS Reactive oxygen species
SAH S-adenosyl homocysteine
SAM S-adenosyl methionine
SBP Systolic blood pressure
TC Total cholesterol
TF Tissue factor
TG Triglyceride
tHcy Total homocysteine
TNF-α Tumor necrosis factor- α
VSMCs Vascular smooth muscle cells
WC Waist Circumference (Inches)
WCHT White-coat hypertension
WHR Waist to Hip Ratio
WT Weight (kg)
ABSTRACT
Cardiovascular disease is one of the leading cause of mortality and morbidity globally, and it is caused by interaction of several risk factors collectively described as cardio-metabolic syndrome. Consequently,cardio-metabolic syndrome have transformed from a mere physiological curiosity to a major focus of research, clinical and public health interests. The purpose of this study therefore, was to evaluate the relationship between some anthropometric and metabolic variables that reflect the existence of cardio-metabolic syndrome among working class women. Ninety (90) working class women were recruited for this cross sectional study. Descriptive statistics and Pearson moment correlation analysis were used to determine the relationship between anthropometric data and metabolic variables. Anthropometric indices, blood pressure, fasting glucose, lipid profile and total antioxidant status were among the variables assessed using standard procedures. Weight significantly correlated with height (r = .452), WC (r = .865), HC (r = .855) and BMI (r = .933). WC significantly correlated positively with HC (r = .831), BM I (r = .876) and WHR (r = .641). HC also significantly correlated positively with BMI (r = .859), AI (r = .277) and CRI (r = .289). WHR significantly correlated positively with HDL-C (r = .260). TC significantly correlated positively with LDL-C (r = .931), AI (r = .494) and CRI (r = .459). LDL-C significantly correlated positively with AI (r= .689) and CRI (r = .644). AI significantly correlated positively with CRI (r = .993). Significant negative correlation were seen between FPG and DPPH (r = -.345), HDL-C and LDL-C (r = -.281), HDL-C and AI (r= -.688), AI and CRI (r = -.696). The prevalence of cardiovascular risk factors (CVRFs) wasgenerally high in the study population.Furthermore, the less active subjects showed a higher prevalence of CVRFs than the active subjects,hence it is necessary that the subjects adopt and sustain healthy life stylesto improve their cardiovascular wellbeing.
CHAPTER ONE
INTRODUCTION
1.1 Background of Study
Today, the study about lipoproteins is very important because the mortality and morbidity due to metabolism disorders has increased. Research interest in lipids and lipoprotein metabolism has increased due to the establishment of the roles played by lipids, lipoproteins and Apo lipoproteins in the development of cardiovascular disease (CVD) (Durstine et al., 2001; Booth et al., 2002; Asikainen et al., 2004; Coelho et al., 2005; Brown et al., 2007). Suboptimal levels of lipids and lipoproteins represent a major risk factor for cardiovascular disease (CVD), the number one cause of mortality in the United States (American College of Sports Medicine, 1998).
Coronary heart disease (CHD) is the most important cause of mortality in developed countries. All heart attacks, with rare exceptions, are caused by atherosclerosis, or a narrowing and “hardening” of the coronary arteries resulting from fatty deposits called plaque. This process, by which the wall of the artery is infiltrated by deposits of cholesterol and calcium, narrows the lumen (the internal orifice) of the artery. When the degree of narrowing reaches a critical level, blood flow to the portion of the heart supplied by that artery is stopped and this causes injury to the heart muscle, thus, a heart- attack occurs. If the reduction in blood flow is not total and is only temporary, relative to muscle needs, permanent damage does not result but the individual may experience angina pectoris – chest pain as a result of too little blood and oxygen to a portion of the heart in response to its needs (a process called ischemia) (Münzel et al., 2010).
According to Bimenya et al. (2006), public servants, who were mainly University graduates, were found to have abnormally high levels of plasma lipids. Plasma lipid and lipoprotein levels have been shown to be influenced by age, sex, socioeconomic status, genetics, race, diet, cigarette smoking coffee and alcohol intake, and medication as well as habitual and leisure time physical activity. Increased physical activity has been reported to produce favorable changes in the lipid and lipoprotein profiles (Kraus et al., 2002; Nieman et al., 2002). Apo lipoprotein B is combined with heparin and glucose amino glycan; this chemical interaction leads to atherosclerosis (LeMura et al., 2000; Meilahn et al., 1988; Lakshman et al., 1996).
An increasing number of studies focus on the role of reactive oxygen species (ROS) in the pathogenesis of premature ageing as well as of numerous civilization diseases, such as cardiovascular diseases (Karaouzene et al., 2011). It has been suggested that higher antioxidant potential can protect the organism against undesirable ROS activity and thus prevent disease incidence (Briasoulis et al., 2009).
Relationship of CHD to antioxidant defenses may be modified not only by many demographic, anthropometric, physiological, and biochemical confounders but also by different exogenic substances such as applied medications or cigarette smoking (Hutcheson and Rocic, 2012; Ndrepepa et al., 2013). Total antioxidant capacity (TAC) assessment is an established methodology to measure different elements of antioxidant defense system together (Cervellati et al., 2014).
Coronary heart disease can be classified as “typical” CVD such as fatal myocardial infarction(MI) and sudden death, and “atypical” CVD, such as fatal heart failure and chronic arrhythmias. When further explored, the etiologies of these coronary diseases in relation to major cardiovascular risk factors are different. Death rates from typical and atypical CVD are inversely related, with mean age at death for atypical being significantly higher than typical.
The relationship of risk factors with typical CVD is direct and significant for age, systolic blood pressure, serum cholesterol and smoking habits (Menotti et al., 2006). Atherosclerosis, being a chronic process, undergoes a series of changes in the arterial walls before the clinical endpoints set in. Rupture of the plaque is the final event that results in a clinical endpoint, often stroke or MI (Kanjilal et al., 2008). The increasing pressure on health resources has led to risk stratification as a primary prevention effort to accurately determine and intervene early in the natural history of disease by moving closer to the proximal direct causes of disease and improving prediction (Stampfer et al., 2004).
1.2 The concept of risk assessment
Risk factors are traits and life-style habits that increase a person’s chances of having cardiovascular diseases. Some risk factors cannot be changed or modified, while other risk factors are modifiable (Münzel et al., 2010). The most important risk factors for cardiovascular disease are high blood pressure, high blood cholesterol and cigarette smoking. Other factors that may increase the risk for cardiovascular disease are diabetes, obesity, being physically inactive and having an unhealthy reaction to stress. The concept of risk factors has evolved only over the past 45 years or so, and new factors are periodically added to the list as our comprehension of the disease process grows
Although risk-scoring systems that evaluate conventional risk factors greatly improve risk prediction, multiple studies demonstrate that 20% to 25% of all future events occur in individuals with only one of these factors (Ridker et al., 2004). With evolving understanding of the pathophysiology of CVD, it is more than likely that other risk factors may greatly influence an individual’s overall risk burden (Hemann et al., 2007). As a result, a series of biomarkers such as Hcy and CRP reflecting inflammation, hemostasis, thrombosis, and oxidative stress have been evaluated as potential clinical tools in an effort to improve risk prediction (Ridker et al., 2004).
The close association between traditional risk factors, atherosclerotic burden, and risk for clinical CVD has allowed multivariate risk prediction equations to be developed to better estimate CVDrisk. The Framingham Risk Score calculates the absolute risk of CVD events for patients with no known previous history of CVD, stroke, or peripheral vascular disease (Sheridan et al., 2003). What is apparent is that the Framingham equation may not accurately estimate the risk of vascular disease in some ethnic groups (Cappuccio et al., 2002). However, given the lack of prospective data in large ethnically mixed populations including Nigeria, these risk equations are the best available tools to guide the decision making process of prevention in general practice.
1.3 Justification for the study
There is a dramatic increase in incidence of CVD in the developing world as earlier predicted by World Health Organization (Murray and Lopez, 1996). It is increasingly recognized that developing countries are undergoing an epidemiologic transition, accompanied by an increasing burden of CVD linked to urbanization and lifestyle modifications (Dominguez et al., 2006). The health transition is occurring at an increased pace in urban societies widely exposed to lifestyle modernization, sedentary occupation, and to lipid- and sugar-rich foods often poor in fiber and micronutrients.
In Nigeria the extent of most CVD’s and risk factors at population level remains largely unknown. For the past 25 years, high blood pressure has become established in Nigeria. This has been attributed to consumption of sodium salt and alcohol, psychological stress, obesity, physical inactivity and other dietary factors (Trowell, 1980; Lowe, 1993). Although the exact genetic markers of CVD remain unknown in Nigeria, different environmental mediators contribute to the development of this disease. It therefore essential to identify the risk factors involved in order to develop preventive strategies.
To understand who is at risk and what risk actually means to an individual, one first needs to understand how diseases of the heart and circulatory system—particularly heart attacks-develop (Münzel et al., 2010). However, the present state of knowledge on such dependence is still not complete (Münzel et al., 2010): while numerous discrepancies have been observed in studies and no unequivocal answer has been reached on the appropriate cluster of thesefactors for the incidence of metabolic syndrome among Nigerians. Furthermore, the impact of occupational demand on civil servant in Nigeria has not received much attention. In addition, that the incidence of CVD is related to antioxidant potential is an issue of current debate in literature, and information on Nigerian population is especially limited. This underscores the following aim and objectives of this study.
1.4 Objectives of the Study
The overall aim of this study is to assess the cardiovascular and antioxidant status of some working class women in Ambrose Alli University, Ekpoma; with major focus on the effect of the activity patterns.
1.4.1 Specific Objectives
- To obtain data on the prevalence of dyslipidemia.
- To obtain data on the prevalence of obesity.
- To obtain data on the prevalence of diabetes.
- To obtain data on the prevalence of hypertension.
- To obtain data on prevalence of oxidative stress.
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