umu.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Näslund, Ulf
Alternative names
Publications (10 of 75) Show all publications
Gustafsson, N., Ahlqvist, J., Näslund, U., Buhlin, K., Gustafsson, A., Kjellström, B., . . . Levring Jäghagen, E. (2019). Associations among Periodontitis, Calcified Carotid Artery Atheromas, and Risk of Myocardial Infarction. Journal of Dental Research, Article ID UNSP 0022034519885362.
Open this publication in new window or tab >>Associations among Periodontitis, Calcified Carotid Artery Atheromas, and Risk of Myocardial Infarction
Show others...
2019 (English)In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, article id UNSP 0022034519885362Article in journal (Refereed) Epub ahead of print
Abstract [en]

Cardiovascular disease is a common cause of morbidity and premature mortality. Cardiovascular disease can be prevented when risk factors are identified early. Calcified carotid artery atheromas (CCAAs), detected in panoramic radiographs, and periodontitis have both been associated with increased risk of cardiovascular disease. This case-control study aimed to 1) investigate associations between periodontitis and CCAA detected in panoramic radiographs and 2) determine the risk of future myocardial infarctions due to CCAA combined with periodontitis. We evaluated 1,482 participants (738 cases and 744 controls) with periodontitis and CCAAs recruited from the PAROKRANK study (Periodontitis and Its Relation to Coronary Artery Disease). Participants were examined with panoramic radiographs, including the carotid regions. Associations between myocardial infarction and periodontitis combined with CCAA were evaluated in 696 cases and 696 age-, sex-, and residential area-matched controls. Periodontitis was evaluated radiographically (as degree of bone loss) and with a clinical periodontal disease index score (from clinical and radiographic assessments). We found associations between CCAA and clinical periodontal disease index score among cases (odds ratio [OR], 1.51; 95% CI, 1.09 to 2.10; P = 0.02) and controls (OR, 1.70; 95% CI, 1.22 to 2.38; P < 0.01), although not between CCAA and the degree of bone loss. In a multivariable model, myocardial infarction was associated with CCAA combined with periodontitis, as assessed by degree of bone loss (OR, 1.75; 95% CI, 1.11 to 2.74; P = 0.01). When the cohort was stratified by sex, only men showed a significant association between myocardial infarction and CCAA combined with periodontitis. Participants with clinically diagnosed periodontitis exhibited CCAA in panoramic radiographs more often than those without periodontitis, irrespective of the presence of a recent myocardial infarction. Participants with combined periodontitis and CCAA had a higher risk of having had myocardial infarction as compared with participants with either condition alone. These findings implied that patients in dental care might benefit from dentists assessing panoramic radiographs for CCAA-particularly, patients with periodontitis who have not received any preventive measures for cardiovascular disease.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
carotid artery atherosclerosis, cardiovascular disease(s), inflammation, radiography, risk factor(s), gender differences
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-165744 (URN)10.1177/0022034519885362 (DOI)000497086100001 ()31702950 (PubMedID)
Funder
The Kempe FoundationsVästerbotten County Council
Available from: 2019-12-10 Created: 2019-12-10 Last updated: 2019-12-10
Lindahl, B., Norberg, M., Johansson, H., Lindvall, K., Ng, N., Nordin, M., . . . Schulz, P. J. (2019). Health literacy is independently and inversely associated with carotid artery plaques and cardiovascular risk. European Journal of Preventive Cardiology
Open this publication in new window or tab >>Health literacy is independently and inversely associated with carotid artery plaques and cardiovascular risk
Show others...
2019 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims: Health literacy, the degree to which individuals understand and act upon health information, may have a pivotal role in the prevention of cardiovascular disease (CVD), with low health literacy potentially explaining poorer adherence to prevention guidelines. We investigated the associations between health literacy, ultrasound-detected carotid atherosclerosis and cardiovascular risk factors.

Methods: Baseline data (cross-sectional analysis) from a randomized controlled trial, integrated within the Västerbotten Intervention Program, Northern Sweden, was used. We included 3459 individuals, aged 40 or 50 years with ≥1 conventional risk factor or aged 60 years old. The participants underwent clinical examination, blood sampling, carotid ultrasound assessment of intima-media wall thickness (CIMT) and plaque formation, and answered a questionnaire on health literacy – the Brief Health Literacy Screen. The European Systematic Coronary Risk Evaluation and Framingham Risk Score were calculated.

Results: About 20% of the participants had low health literacy. Low health literacy was independently associated with the presence of ultrasound-detected carotid artery plaques after adjustment for age and education, odds ratio (95% confidence interval) 1.54 (1.28–1.85), demonstrating a similar level of risk as for smoking. Health literacy was associated with CIMT in men. Low health literacy was associated with higher CVD risk scores. Sensitivity analyses with low health literacy set to 9% or 30% of the study sample, respectively, yielded essentially the same results.

Conclusions: Low health literacy was independently associated with carotid artery plaques and a high level of CVD risk scores. Presenting health information in a fashion that is understood by all patients may improve preventive efforts.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Health literacy, cardiovascular risk scores, carotid artery plaque, ultrasound
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-165791 (URN)10.1177/2047487319882821 (DOI)000491457000001 ()31615294 (PubMedID)2-s2.0-85074364646 (Scopus ID)
Available from: 2019-12-03 Created: 2019-12-03 Last updated: 2019-12-04
Olsson, K., Näslund, U., Nilsson, J. & Hörnsten, Å. (2019). Hope and despair: patients' experiences of being ineligible for transcatheter aortic valve implantation. European Journal of Cardiovascular Nursing, 18(7), 593-600
Open this publication in new window or tab >>Hope and despair: patients' experiences of being ineligible for transcatheter aortic valve implantation
2019 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 7, p. 593-600Article in journal (Refereed) Published
Abstract [en]

Background: Transcatheter aortic valve implantation may be indicated for patients with aortic stenosis and high risk of postoperative mortality. The assessment of suitability for transcatheter aortic valve implantation requires consensus agreement of a team of cardiologists and cardiac surgeons. The burden of comorbidities, frailty and cognitive impairment are factors included when risks for transcatheter aortic valve implantation are balanced against the expected benefits. Although transcatheter aortic valve implantation is a possibility for many, there are still ineligible patients. Knowledge of their experiences of being deemed ineligible are lacking. Aim: The aim of this study was to explore patients' experiences of being considered for transcatheter aortic valve implantation but judged ineligible. Methods: Individual in-depth interviews were performed with eight persons, and qualitative content analysis was used for the analysis. Results: Being ineligible for transcatheter aortic valve implantation may induce both hope and despair. Hope was linked to experiences of acceptance, relief of symptoms, support and control; despair was associated with feelings of being missed and abandoned, and of grief and insecurity. Some expressed great anxiety, since their incurable heart disease meant an imminent death. Others were more concerned over practical problems that affected everyday life. Conclusion: Being ineligible for transcatheter aortic valve implantation does not necessarily lead to despair. Hope is built through relationships, continuity and support. A combination of person-centred care and palliative care during the end-of-life phase should be offered to patients in order to help clients re-conceptualise hope during this stage of their illness. Cardiovascular nurses in the transcatheter aortic valve implantation team are suitable to facilitate continued care based on the patient's needs, desires and local conditions.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Aortic stenosis, transcatheter aortic valve implantation, incurable, hope, person-centred care
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:umu:diva-164036 (URN)10.1177/1474515119852209 (DOI)000487801400010 ()31113221 (PubMedID)
Available from: 2019-10-16 Created: 2019-10-16 Last updated: 2019-10-16Bibliographically approved
Nyman, E., Vanoli, D., Näslund, U. & Grönlund, C. (2019). Inter-sonographer reproducibility of carotid ultrasound plaque detection using Mannheim consensus in subclinical atherosclerosis. Clinical Physiology and Functional Imaging
Open this publication in new window or tab >>Inter-sonographer reproducibility of carotid ultrasound plaque detection using Mannheim consensus in subclinical atherosclerosis
2019 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097XArticle in journal (Refereed) Published
Abstract [en]

Aims: To determine the inter-sonographer reproducibility of carotid ultrasound plaque detection using Mannheim consensus in a subclinical population and evaluate associations related to the reproducibility.

Methods and results: Bilateral ultrasound screening for carotid plaques defined by Mannheim consensus was performed on 106 subclinical participants. Two different sonographers scanned the same participant, and reproducibility of plaque detection was measured by Cohens kappa. Associations with reproducibility were evaluated by comparing wall, and plaque characteristics between subjects with plaques identified in one and both scans. In general, the inter-sonographer reproducibility of plaque detection was substantial with a kappa value of 0 center dot 70 (95% CI 0 center dot 60-0 center dot 80). Plaques detected in only one scan had significantly lower plaque area and plaque thickness (6 center dot 82 mm(2) and 1 center dot 45 mm) as compared to plaques detected in both scans (11 center dot 65 mm(2) and 1 center dot 96 mm, P<0 center dot 001).

Conclusion: Minor carotid plaques contribute to decreased reproducibility as compared to large plaques when screening for subclinical atherosclerosis using Mannheim consensus. Using an alternative plaque definition based on plaque thickness >1.5 mm and plaque area >10 mm(2) could increase the reproducibility of plaque detection in subclinical atherosclerosis.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
carotid, inter-sonographer, plaque, reproducibility, subclinical, ultrasound
National Category
Physiology
Identifiers
urn:nbn:se:umu:diva-165443 (URN)10.1111/cpf.12602 (DOI)000493037200001 ()31605665 (PubMedID)
Available from: 2019-11-27 Created: 2019-11-27 Last updated: 2019-11-27
Näslund, U., Lundgren, A., Vanoli, D. & Norberg, M. (2019). Is intima-media thickness a predictor for cardiovascular risk?: Authors' reply [Letter to the editor]. The Lancet, 394(10196), 381-381
Open this publication in new window or tab >>Is intima-media thickness a predictor for cardiovascular risk?: Authors' reply
2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 394, no 10196, p. 381-381Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-162305 (URN)10.1016/S0140-6736(19)30343-5 (DOI)000478698300018 ()31379329 (PubMedID)
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2019-08-27Bibliographically approved
Ljungberg, J., Johansson, B., Bergdahl, I., Holmgren, A., Näslund, U., Hultdin, J. & Söderberg, S. (2019). Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk for future surgery for aortic stenosis. Scandinavian Journal of Clinical and Laboratory Investigation, 79(7), 524-530
Open this publication in new window or tab >>Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk for future surgery for aortic stenosis
Show others...
2019 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 79, no 7, p. 524-530Article in journal (Refereed) Published
Abstract [en]

Recently, a new approach was proposed to detect mild impairment in renal function: a reduced ratio between estimated glomerular filtration rate (eGFR) calculated by cystatin C and eGFR calculated by creatinine. We aimed to evaluate if this ratio is associated with aortic stenosis (AS) requiring surgery. We identified 336 patients that first participated in population surveys and later underwent surgery for AS (median age [interquartile range] 59.8 [10.3] years at survey and 68.3 [12.7] at surgery, 48% females). For each patient, two matched referents were allocated. Cystatin C and creatinine were determined in stored plasma. eGFR(cystatin C) and eGFR(creatinine) and their ratio were estimated. Conditional logistic regression analyses were used to estimate the risk (odds ratio (OR) with [95% confidence interval (CI)]) related to one (ln) standard deviation increase in the ratio between eGFR(cystatin C) and eGFR(creatinine). A high ratio was associated with lower risk for AS requiring surgery (OR [95% CI]) (OR 0.84 [0.73-0.97]), especially in women (0.74 [0.60-0.92] vs. 0.93 [0.76-1.13] in men). After further stratification for coronary artery disease (CAD), the association remained in women with CAD but not in women without CAD (0.60 [0.44-0.83] and 0.89 [0.65-1.23], respectively). In conclusion, a high ratio between eGFR(cystatin C) and eGFR(creatinine) was associated with lower risk for surgery for AS, especially in women. Mild impairment of renal function is thus associated with future risk for AS requiring surgery.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Aortic stenosis, valvular replacement, renal insufficiency, creatinine, cystatin C
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-164404 (URN)10.1080/00365513.2019.1664761 (DOI)000486559100001 ()31522562 (PubMedID)
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05Bibliographically approved
Näslund, U., Ng, N., Wennberg, P. & Norberg, M. (2019). Patient-doctor engagement in cardiovascular prevention: Authors' reply [Letter to the editor]. The Lancet, 394(10199), E27-E27
Open this publication in new window or tab >>Patient-doctor engagement in cardiovascular prevention: Authors' reply
2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 394, no 10199, p. E27-E27Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-164539 (URN)10.1016/S0140-6736(19)31335-2 (DOI)000483011200007 ()31448748 (PubMedID)
Available from: 2019-11-14 Created: 2019-11-14 Last updated: 2019-11-14Bibliographically approved
Näslund, U., Ng, N., Lundgren, A., Fhärm, E., Grönlund, C., Johansson, H., . . . Norberg, M. (2019). Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. The Lancet, 393(10167), 133-142
Open this publication in new window or tab >>Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial
Show others...
2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10167, p. 133-142Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.

METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.

FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).

INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-154318 (URN)10.1016/S0140-6736(18)32818-6 (DOI)000455437100026 ()30522919 (PubMedID)
Funder
Västerbotten County Council, Dnr ALFVLL-298001Swedish Research Council, Dnr 521-2013-2708Swedish Research Council, 2016-01891Swedish Heart Lung Foundation, Dnr 20150369Swedish Heart Lung Foundation, 20170481
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-02-22Bibliographically approved
Gustafsson, N., Ahlqvist, J. B., Näslund, U., Wester, P., Buhlin, K., Gustafsson, A. & Levring Jäghagen, E. (2018). Calcified carotid artery atheromas in panoramic radiographs are associated with a first myocardial infarction: a case-control study. Oral surgery, oral medicine, oral pathology and oral radiology, 125(2), 199-205
Open this publication in new window or tab >>Calcified carotid artery atheromas in panoramic radiographs are associated with a first myocardial infarction: a case-control study
Show others...
2018 (English)In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 125, no 2, p. 199-205Article in journal (Refereed) Published
Abstract [en]

Objective. The aim of this case-control study was to investigate whether patients with a first myocardial infarction (MI) had a higher prevalence of calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs) than age-, gender-, and residential area-matched controls without MI. Study Design. Six hundred ninety-six cases with a first MI and 696 controls were included in this substudy of the Swedish multicentre PAROKRANK study. All participants underwent panoramic radiography, and the PRs were evaluated for CCAAs. Results. The prevalence of CCAAs detected by PR was 33.8% (235 of 696) in cases and 27.6% (192 of 696) in controls (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.04-1.44; P = .012). Among males, 32.7% of cases (184 of 562) and 26.5% of controls (149 of 562) displayed CCAAs on PRs (OR 1.24; 95% CI 1.03-1.48; P = .022). Among both genders, bilateral CCAAs were significantly more common among cases than among controls (P = .002). Conclusions. Cases with recent MIs had a significantly higher prevalence of CCAAs on PRs compared with controls without MIs. This difference between groups was more pronounced for bilateral CCAAs. These findings supported the hypothesis that CCAA detection could serve as a risk indicator for future MIs.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2018
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-144341 (URN)10.1016/j.oooo.2017.10.009 (DOI)000422751700018 ()29242130 (PubMedID)
Available from: 2018-02-08 Created: 2018-02-08 Last updated: 2019-05-21Bibliographically approved
Olsson, K., Näslund, U., Nilsson, J. & Hörnsten, Å. (2018). Patients' experiences of the transcatheter aortic valve implantation trajectory: A grounded theory study. Nursing Open, 5(2), 149-157
Open this publication in new window or tab >>Patients' experiences of the transcatheter aortic valve implantation trajectory: A grounded theory study
2018 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 2, p. 149-157Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to explore how patients experienced the recovery process from transcatheter aortic valve implantation. Design: A qualitative approach where in-depth interviews were used. Method: Eleven men and eight women undergoing transcatheter aortic valve implantation were individually interviewed 6 months after transcatheter aortic valve implantation. Grounded theory was used for the analysis. Results: The analysis generated the core concept "A journey of balancing between life-struggle and hope" connected to descriptive, bipolar categories. Before transcatheter aortic valve implantation patients not only felt threatened but also experienced hope. The rehabilitation phase was described as demanding or surprisingly simple. At the 6 months follow-up patients were pleased to return to life, however, still struggling with limitations. To feel hope is essential for transcatheter aortic valve implantation patients' well-being, both before and during the recovery process. It is important that healthcare professionals not only support hopeful thinking but also take time to discuss and prepare patients, talk about concerns and build confidence. Individual plans for rehabilitation should be designed.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
aortic stenosis, coping, hope, qualitative study, recovery, supportive nursing, transcatheter aortic valve implantation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-148639 (URN)10.1002/nop2.124 (DOI)000428455600006 ()29599990 (PubMedID)
Available from: 2018-06-25 Created: 2018-06-25 Last updated: 2018-06-25Bibliographically approved
Organisations

Search in DiVA

Show all publications