Subclinical Cardiovascular Disease, Vascular Health and Markers of Risk

Cardiovascular diseases are a leading cause of morbidity and mortality. To facilitate early treatment and prevention, the relationship between risk markers and measures of subclinical disease should be determined. This dissertation examines how putative markers of risk, including traditional cardiovascular risk factors, rheumatoid arthritis and negative affect, are associated with measures of subclinical cardiovascular disease and vascular health. First, the relationship of traditional risk factors with carotid artery intima-media thickness (IMT) is evaluated in 453 healthy middle-aged women. It is unknown whether segment-specific associations exist when accounting for the interdependence across IMT locations. Results show unique positive associations between common carotid IMT and weight, bifurcation IMT and smoking and systolic blood pressure, and internal carotid IMT and apoprotein B.Second, it is postulated that the evaluation of carotid diameters augments knowledge of associations between rheumatoid arthritis and IMT and plaque. In 93 middle-aged patients, diagnosis of rheumatoid arthritis is associated with larger lumen and interadventitial diameters compared to 93 matched healthy women; whereas plaque prevalence is not statistically different and carotid IMT is similar, showing potential influences of vascular adaptation. Positive associations are demonstrated between carotid measures and rheumatoid arthritis medications, hypothyroidism and inflammatory markers. Third, associations between negative psychosocial indices and brachial artery flow-mediated dilation (FMD) are examined in 332 healthy older men and women. It is not known whether a link exists when considering multiple measures of negative affect in a large sample of both sexes. After controlling for traditional cardiovascular risk factors, FMD is inversely associated with hostility and general anger scores for men, and anger suppression in women. As demonstrated in this dissertation, associations between cardiovascular health and risk markers are evident early in the disease process. When evaluating cardiovascular disease risk, including co-morbid conditions and psychosocial symptoms along with traditional risk factors is of public health relevance. Additionally, the implications of appropriate statistical methods, the effects of vascular adaptation, and the importance of including women in epidemiologic research are illustrated.In conclusion, evaluating associations between markers of risk and subclinical cardiovascular disease and vascular health provides insight into the broader epidemic of cardiovascular disease