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Toss, Fredrik
Publications (10 of 10) Show all publications
Toss, F., Edgren, G., Berlin, G., Stegmayr, B. & Witt, V. (2018). Does prophylactic calcium in apheresis cause more harm than good?: Centre heterogeneity within the World Apheresis Association Register prevents firm conclusions. Vox Sanguinis, 113(7), 632-638
Open this publication in new window or tab >>Does prophylactic calcium in apheresis cause more harm than good?: Centre heterogeneity within the World Apheresis Association Register prevents firm conclusions
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2018 (English)In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 113, no 7, p. 632-638Article in journal (Refereed) Published
Abstract [en]

Background and objectives: Symptomatic hypocalcaemia is common during apheresis procedures based on citrate‐based anticoagulants. As a consequence, patients often receive prophylactic calcium treatment. However, a recent publication based on the World Apheresis Association (WAA) register suggested harmful effects of such prophylactic calcium use. Recognizing possible limitations in the previous WAA register analyses, we critically re‐evaluate the data, to test whether a change in prophylactic calcium usage may be warranted.

Materials and methods: Using the WAA register, we reanalysed previous data by means of centre and treatment type stratification, to explore the role of prophylactic calcium as a risk factor for adverse events.

Results: There was large variability in adverse event rates dependent on the centre performing the apheresis procedure and dependent on the type of procedure. When this variability was accounted for, there was no clear effect of calcium administration on risk of adverse effects.

Conclusion: Shortcomings in the previous WAA register analyses may have failed to account for important confounding factors resulting in a substantial overestimation of the risk attributable to calcium usage. Overall our findings do not support a negative effect of prophylactic calcium administration in the apheresis setting.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
blood component removal, plasmapheresis, plasma exchange, cytapheresis, adverse events, calcium
National Category
Hematology
Identifiers
urn:nbn:se:umu:diva-153132 (URN)10.1111/vox.12698 (DOI)000447492200003 ()30079964 (PubMedID)
Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2018-11-09Bibliographically approved
Toss, F., Nordström, A. & Nordström, P. (2013). Association between hematocrit in late adolescence and subsequent myocardial infarction in Swedish men. International Journal of Cardiology, 168(4), 3588-3593
Open this publication in new window or tab >>Association between hematocrit in late adolescence and subsequent myocardial infarction in Swedish men
2013 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, no 4, p. 3588-3593Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hematocrit is an independent predictor of cardiovascular risk in middle and old age, but whether hematocrit is also a predictor at younger ages is presently not known. In this study, we examined whether hematocrit measured in adolescence was associated with the risk of myocardial infarction later in life. METHODS: During Swedish national conscription tests conducted between 1969 and 1978, the hematocrit was measured in 417,099 young Swedish men. The cohort was followed for subsequent myocardial infarction events through December 2010. Associations between hematocrit and myocardial infarction were accessed using Cox regression models. RESULTS: During a median follow-up period of 36years, 9322 first-time myocardial infarctions occurred within the study cohort. After adjusting for relevant confounders and potential risk factors for myocardial infarction, men with a hematocrit≥49% had a 1.4-fold increased risk of myocardial infarction compared with men with a hematocrit≤44%. This relationship was dose dependent (p<0.001 for trend) and remained consistent throughout the follow-up period. CONCLUSIONS: In this cohort of young Swedish men, hematocrit was associated with the risk of myocardial infarction later in life after controlling for other coronary risk factors. The study findings indicate that hematocrit may aid future risk assessments in young individuals.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Hematocrit, Blood rheology, Erythrocyte sedimentation rate, Risk factor, Adolescence, Myocardial infarction
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-79213 (URN)10.1016/j.ijcard.2013.05.065 (DOI)23735337 (PubMedID)
Available from: 2013-08-13 Created: 2013-08-13 Last updated: 2018-06-08Bibliographically approved
Toss, F., Nordström, A. & Nordström, P. (2013). Inflammation in young adulthood is associated with myocardial infarction later in life. American Heart Journal, 165(2), 164-169
Open this publication in new window or tab >>Inflammation in young adulthood is associated with myocardial infarction later in life
2013 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 165, no 2, p. 164-169Article in journal (Refereed) Published
Abstract [en]

Background There is evidence that atherosclerosis begins in childhood. There is also evidence that inflammatory markers measured in middle and old age predict risks of cardiovascular disease. In this report, we test whether an inflammatory marker measured in young adult men is associated with risk of myocardial infarction in middle age. Methods During Swedish national conscription tests from 1969 through 1978, the erythrocyte sedimentation rate, as a measure of inflammation, was measured in 433,577 young Swedish men. The cohort was observed for subsequent myocardial infarction events through December 2009. Results During an average follow-up time of 35 years, a total of 8,081 first-time myocardial infarctions occurred within the cohort. After adjustments for potential confounders and known risk factors for myocardial infarction, men with an elevated erythrocyte sedimentation rate (>= 15 mm/h) had a 1.7 times increased risk of myocardial infarction during follow-up (95% CI 1.4-2.1) compared with men with an erythrocyte sedimentation rate of 1 mm/h. This relationship was dose dependent for each unit increase in erythrocyte sedimentation rate (P for trend < .001). Conclusions In this cohort of young Swedish men, the erythrocyte sedimentation rate was associated with risk of myocardial infarction 35 years later after control of the available data on other coronary risk factors. These data add important relevant information to the existing evidence that atherosclerosis begins in childhood.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-66633 (URN)10.1016/j.ahj.2012.10.030 (DOI)000314112300009 ()
Available from: 2013-03-05 Created: 2013-02-26 Last updated: 2018-06-08Bibliographically approved
Toss, F., Wiklund, P., Nordström, P. & Nordström, A. (2012). Body composition and mortality risk in later life. Age and Ageing, 41(5), 677-681
Open this publication in new window or tab >>Body composition and mortality risk in later life
2012 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 41, no 5, p. 677-681Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: body mass index is used widely to define overweight and obesity. Both high and low body mass indices are associated with increased mortality risk during middle age, but the relationship is less clear in later life. Thus, studies on the relationships between other aspects of body composition and mortality among older subjects are needed.

OBJECTIVE: to investigate associations between different aspects of body composition and mortality in older people.

METHODS: the study population comprised 921 participants aged ≥65 years who underwent dual-energy X-ray (DXA) absorptiometric examination at the Sports Medicine Unit, Umeå University. The main reason for admission was clinical suspicion of osteoporosis. Total, abdominal and gynoid fat masses and lean body mass were measured by DXA absorptiometry at baseline, and the cohort was followed (mean duration, 9.2 years) for mortality events.

RESULTS: during follow-up, 397 participants died. Lean mass was associated negatively with mortality in men and women (P < 0.001). Total fat mass showed a U-shaped association with mortality in men (P < 0.01) and a negative association in women (P < 0.01). A higher ratio of abdominal to gynoid fat mass increased mortality risk in women (P = 0.04), but not in men (P = 0.91).

CONCLUSIONS: lean mass is associated strongly with survival in older subjects. Greater fat mass is protective in older women, whereas very low or very high fat mass increases the risk of death in men. Further research is needed to better understand the mechanisms underlying these associations.

Place, publisher, year, edition, pages
Oxford University Press, 2012
Keywords
Fat mass, fat distribution, lean mass, mortality, dual energy x-ray absorptiometry, dual energy x-ray absorptiometry (DXA), older people
National Category
Geriatrics
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-49831 (URN)10.1093/ageing/afs087 (DOI)22820447 (PubMedID)
Available from: 2011-11-21 Created: 2011-11-21 Last updated: 2018-06-08Bibliographically approved
Toss, F., Wiklund, P., Franks, P. W., Eriksson, M., Gustafson, Y., Hallmans, G., . . . Nordström, A. (2011). Abdominal and gynoid adiposity and the risk of stroke. International Journal of Obesity, 35(11), 1427-1432
Open this publication in new window or tab >>Abdominal and gynoid adiposity and the risk of stroke
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2011 (English)In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 35, no 11, p. 1427-1432Article in journal (Refereed) Published
Abstract [en]

Background: Previous studies have indicated that fat distribution is important in the development of cardiovascular disease (CVD). We investigated the association between fat distribution, as measured by dual energy X-ray absorptiometry (DXA), and the incidence of stroke.

Methods: A cohort of 2751 men and women aged 40 years was recruited. Baseline levels of abdominal, gynoid and total body fat were measured by DXA. Body mass index (BMI, kg m(-2)) was calculated. Stroke incidence was recorded using the regional stroke registry until subjects reached 75 years of age.

Results: During a mean follow-up time of 8 years and 9 months, 91 strokes occurred. Of the adiposity indices accessed abdominal fat mass was the best predictor of stroke in women (hazard ratio (HR)=1.66, 95% confidence interval (CI)=1.23-2.24 per standard deviation increase), whereas the ratio of gynoid fat to total fat mass was associated with a decreased risk of stroke (HR=0.72, 95% CI=0.54-0.96). Abdominal fat mass was the only of the adiposity indices assessed that was found to be a significant predictor of stroke in men (HR=1.49, 95% CI=1.06-2.09). The associations between abdominal fat mass and stroke remained significant in both women and men after adjustment for BMI (HR=1.80, 95% CI=1.06-3.07; HR=1.71, 95% CI=1.13-2.59, respectively). However, in a subgroup analyses abdominal fat was not a significant predictor after further adjustment for diabetes, smoking and hypertension.

Conclusion: Abdominal fat mass is a risk factor for stroke independent of BMI, but not independent of diabetes, smoking and hypertension. This indicates that the excess in stroke risk associated with abdominal fat mass is at least partially mediated through traditional stroke risk factors.International Journal of Obesity advance online publication, 22 February 2011; doi:10.1038/ijo.2011.9.

Place, publisher, year, edition, pages
Nature Publishing Group, 2011
Keywords
fat mass, fat distribution, abdominal fat, gynoid fat, stroke cox proportional hazard model
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-44034 (URN)10.1038/ijo.2011.9 (DOI)21343905 (PubMedID)
Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2018-06-08Bibliographically approved
Toss, F. (2011). Body fat distribution, inflammation and cardiovascular disease. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Body fat distribution, inflammation and cardiovascular disease
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cardiovascular disease (CVD) is one of the major health issues of our time. The prevalence of CVD is increasing, both in industrialized and in developing countries, and causes suffering and a decreased quality of life for millions of people worldwide. CVD can have multiple etiologies, but the main underlying cause is atherosclerosis, which causes blood clot formation and obstructs vital arteries.

Multiple risk factors of atherosclerosis have been identified, and body fatness is one of the most important ones. 

The main aims of this thesis were to investigate the relation between body fatness and: CVD risk factors (paper I), incident stroke (paper II), and overall mortality (paper III). The results showed that abdominal obesity is strongly associated with both CVD risk factors and stroke incidence (papers I-II). The results also suggested that a substantial part of the association between increased body fat and stroke can be explained by an increase in traditional stroke risk factors associated with increased body fat (paper II). A gynoid fat distribution, with a high share of fat located around the hip, is, on the other hand, associated with lower risk factor levels in both men and women, and with a decreased risk of stroke in women (papers I-II). This illustrates the importance of assessing the overall distribution of body fat rather, than solely focusing on total body fatness.

In elderly women, total body fat was found to be associated with increased survival, while abdominal fat moderately increased mortality risk (paper III). Lean mass (fat-free mass) was strongly associated with increased survival among elderly men and women (paper III).

Erythrocyte sedimentation rate (ESR) is an indicator of inflammation and, possibly, an indicator of atherosclerotic disease. In paper IV, the relationship between ESR in young adulthood and the later risk of myocardial infarction (MI) was studied. Results showed that higher levels of ESR were associated with a higher MI risk, in a dose-responsive manner, and was independent of other well-established risk factors.

In summary, both total and regional fat distribution are associated with CVD risk factors and stroke, but do not seem to correspond to an increase in mortality risk among the elderly. Also, inflammation, detected as an increase in ESR, is associated with long term MI risk in young men. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2011. p. 95
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1451
Keywords
fat mass, lean mass, fat distribution, stroke, myocardial infarction, cardiovascular disease, cardiovascular risk factors, inflammation, dual energy x-ray absorptiometry, mortality, erythrocyte sedimentation rate
National Category
General Practice Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-49833 (URN)978-91-7459-305-1 (ISBN)
Public defence
2011-12-16, Bergasalen, by 27, 90185 Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-11-25 Created: 2011-11-21 Last updated: 2018-06-08Bibliographically approved
Wiklund, P., Toss, F., Jansson, J.-H., Eliasson, M., Hallmans, G., Nordström, A., . . . Nordström, P. (2010). Abdominal and gynoid adipose distribution and incident myocardial infarction in women and men. International Journal of Obesity, 34(12), 1752-1758
Open this publication in new window or tab >>Abdominal and gynoid adipose distribution and incident myocardial infarction in women and men
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2010 (English)In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 34, no 12, p. 1752-1758Article in journal (Refereed) Published
Abstract [en]

In summary, fat distribution was a strong predictor of the risk of MI in women, but not in men. These different results may be explained by the associations found between fat distribution and hypertension, impaired glucose tolerance and hypertriglyceridemia.

Keywords
abdominal fat; myocardial infarction; risk; men; women
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-40854 (URN)10.1038/ijo.2010.102 (DOI)000285242900009 ()20498655 (PubMedID)
Available from: 2011-03-11 Created: 2011-03-11 Last updated: 2018-06-08Bibliographically approved
Wiklund, P., Toss, F., Weinehall, L., Hallmans, G., Franks, P. W., Nordström, A. & Nordström, P. (2008). Abdominal and gynoid fat mass are associated with cardiovascular risk factors in men and women. Journal of Clinical Endocrinology and Metabolism, 93(11), 4360-4366
Open this publication in new window or tab >>Abdominal and gynoid fat mass are associated with cardiovascular risk factors in men and women
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2008 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 93, no 11, p. 4360-4366Article in journal (Refereed) Published
Abstract [en]

CONTEXT: Abdominal obesity is an established risk factor for cardiovascular disease (CVD). However, the correlation of dual-energy x-ray absorptiometry (DEXA) measurements of regional fat mass with CVD risk factors has not been completely investigated.

OBJECTIVE: The aim of this study was to investigate the association of estimated regional fat mass, measured with DEXA and CVD risk factors.

DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional study of 175 men and 417 women. DEXA measurements of regional fat mass were performed on all subjects, who subsequently participated in a community intervention program.

MAIN OUTCOME MEASURES: Outcome measures included impaired glucose tolerance, hypercholesterolemia, hypertriglyceridemia, and hypertension. RESULTS: We began by assessing the associations of the adipose measures with the cardiovascular outcomes. After adjustment for confounders, a sd unit increase in abdominal fat mass was the strongest predictor of most cardiovascular variables in men [odds ratio (OR)=2.63-3.37; P<0.05], whereas the ratio of abdominal to gynoid fat mass was the strongest predictor in women (OR=1.48-2.19; P<0.05). Gynoid fat mass was positively associated with impaired glucose tolerance, hypertriglyceridemia, and hypertension in men (OR=2.07-2.15; P<0.05), whereas the ratio of gynoid to total fat mass showed a negative association with hypertriglyceridemia and hypertension (OR=0.42-0.62; P<0.005).

CONCLUSIONS: Abdominal fat mass is strongly independently associated with CVD risk factors in the present study. In contrast, gynoid fat mass was positively associated, whereas the ratio of gynoid to total fat mass was negatively associated with risk factors for CVD.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-19088 (URN)10.1210/jc.2008-0804 (DOI)18728169 (PubMedID)
Available from: 2009-03-04 Created: 2009-03-04 Last updated: 2018-06-09Bibliographically approved
Toss, F., Nordström, P. & Nordström, A. Erytrocyte sedimenation rate in young adulthood is associated with myocardial infarction later in life.
Open this publication in new window or tab >>Erytrocyte sedimenation rate in young adulthood is associated with myocardial infarction later in life
(English)Article in journal (Refereed) Submitted
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-49832 (URN)
Available from: 2011-11-21 Created: 2011-11-21 Last updated: 2018-06-08Bibliographically approved
Hult, A., Toss, F., Malm, C. & Oldenborg, P.-A.Phagocytosis of liquid-stored red blood cells in vitro requires serum and macrophage scavenger receptors.
Open this publication in new window or tab >>Phagocytosis of liquid-stored red blood cells in vitro requires serum and macrophage scavenger receptors
(English)Manuscript (preprint) (Other academic)
Abstract [en]

BACKGROUND: Red blood cells (RBCs) undergo structural and metabolic changes with prolonged storage, which ultimately may decrease their survival after transfusion. Although the storage-induced damage to RBCs has been rather well described biochemically, little is known about the mechanisms underlying the recognition and rapid clearance of the damaged cells by macrophages.STUDY DESIGN AND METHODS: We here used a murine model for cold (+4°C) RBC storage and transfusion. Phagocytosis of human or murine RBCs, liquid stored for 6-8 weeks or 10-14 days respectively, was investigated in murine peritoneal macrophages.RESULTS: The effects of storage on murine RBCs resembled that described for stored human RBCs with regard to decreased adenosine triphosphate (ATP) levels, accumulation of microparticles during storage, and RBC recovery kinetics after transfusion. Under serum-free conditions, phagocytosis of stored human or murine RBCs was reduced by 70-75%, as compared with that in the presence of heat-inactivated fetal calf serum (FCS). Human serum promoted phagocytosis of stored human RBCs similar to that seen with FCS. By blocking macrophage class A scavenger receptors with fucoidan or dextran sulphate, phagocytosis of human or murine RBCs was reduced by more than 90%. Phagocytosis of stored human RBCs was also sensitive to inhibition by the phosphatidylinositol 3 kinase-inhibitor LY294002, the ERK1/2-inhibitor PD98059, or the p38 MAPK-inhibitor SB203580.CONCLUSIONS: RBCs damaged during liquid storage may be recognized by macrophage class A scavenger receptors and serum-dependent mechanisms. This species-independent recognition mechanism may help to further understand the rapid clearance of stored RBCs shortly after transfusion.

National Category
Cell and Molecular Biology
Research subject
transfusion medicine
Identifiers
urn:nbn:se:umu:diva-103266 (URN)
Available from: 2015-05-19 Created: 2015-05-19 Last updated: 2018-06-07
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