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  • 1.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lundblad, Dan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Escher, Stefan A
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Diabetes mellitus, high BMI and low education level predict sudden cardiac death within 24 hours of incident myocardial infarction2016Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, nr 17, s. 1814-1820Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: More than half of cardiovascular mortality occurs outside the hospital, mainly due to consistently low survival rates from out-of-hospital cardiac arrest.

    METHODS: This is a prospective, nested, case-control study derived from the Västerbotten Intervention Programme and the World Health Organization's Multinational Monitoring of Trends and Determinants in Cardiovascular Disease study in northern Sweden (1986-2006). To determine predictors for sudden cardiac death risk factors for cardiovascular disease were compared between incident myocardial infarction with sudden cardiac death (n = 363) and survivors of incident myocardial infarction (n = 1998) using multivariate logistic regression analysis.

    RESULTS: Diabetes had the strongest association with sudden cardiac death out of all evaluated risk factors (odds ratio (OR) 1.83, 95% confidence interval (CI) 1.30-2.59), followed by low education (OR 1.55, 95% CI 1.19-2.01), high body mass index (OR 1.05, 95% CI 1.02-1.08) and male sex (OR 1.42, 95% CI 1.001-2.01).

    CONCLUSIONS: The pattern of risk factors for incident myocardial infarction is different among survivors and those who die within 24 hours. The risk factors that contribute the most to death within 24 hours are diabetes mellitus, high body mass index and low education level, and can be addressed at both the public health level and by general practitioners.

  • 2.
    Eliasson, Mats
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Eriksson, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Lundqvist, Robert
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Comparison of trends in cardiovascular risk factors between two regions with and without a community and primary care prevention programme2018Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 25, nr 6, s. 1765-1772Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The effect of primary prevention of cardiovascular disease is debated. The Västerbotten Intervention Programme (VIP) is an individual and community-based public health programme that comprises the whole county of Västerbotten (VB). In the neighbouring county of Norrbotten (NB), no programmes have been implemented.

    Method Between 1994 and 2014, five surveys were performed in the two counties on persons aged 40 to 75 years within the Northern Sweden MONICA Study. The number of subjects participating was 6600 (75.4%). We compared time trends in risk factors between the two counties using regression models including age, county and year of survey. To test whether time trends differed between counties, the interaction between county and year was included in the models.

    Results Systolic blood pressure declined in both counties, and the decline was faster in Västerbotten than in Norrbotten ( p = 0.043 for interaction county*year). Diastolic blood pressure declined in VB but increased in NB ( p < 0.001). Cholesterol levels declined at a similar rate in both counties whereas body mass index increased in both counties. Fasting glucose decreased in VB ( p = 0.003) and increased in NB. The prevalence of regular smokers decreased faster in VB than in NB ( p = 0.01). Trend in waist and hip circumference, known diabetes, having an academic degree, being physically inactive or 10 year cardiovascular mortality according to SCORE did not differ.

    Conclusion Blood pressure, glucose and smoking improved at a faster rate in the county with a community and primary care-based intervention than in the county without such an intervention.

  • 3.
    Eriksson, Marie
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Pennlert, Johanna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Eliasson, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Time trends and socioeconomic differences in blood pressure levels: the Northern Sweden MONICA study 1994-20142017Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, nr 14, s. 1473-1481Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: People with low socioeconomic status have higher blood pressure (BP), increasing their risk of myocardial infarction and stroke. We hypothesized that the gap in systolic (SBP) and diastolic (DBP) BP, according to educational level, has decreased over time but, that economical vulnerability would confer higher BP.

    Methods: A total of 4564 women and 4363 men aged 25-74 years participated in five population-based surveys in the Northern Sweden MONICA study between 1994 and 2014 (participation rate 76.8-62.5%).

    Results: SBP decreased by 10 mmHg in women and 4 mmHg in men, while DBP was unchanged. Treatment with antihypertensives increased in all but the youngest men. The prevalence of BP control in the population (<140/90 mmHg) increased and in 2014 reached 75% among women and 70% among men. The decrease in SBP was more pronounced in people without university education than in people with university education and DBP showed the same pattern, regardless of education. After adjustment for confounding factors, age, male sex, higher body mass index, and being born in a Nordic country were related to higher SBP and DBP. University education was related to lower SBP, while variables mirroring economic vulnerability were not associated with BP levels.

    Conclusions: BP levels as well as the socioeconomic gap in BP has decreased in Sweden but people with a lower level of education still have higher SBP. Lacking economic resources is not associated with high BP.

  • 4. Faggiano, Pompilio
    et al.
    Dasseni, Nicolo
    Gaibazzi, Nicola
    Rossi, Andrea
    Henein, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. St George University, London, UK; Brunel University, London, UK.
    Pressman, Gregg
    Cardiac calcification as a marker of subclinical atherosclerosis and predictor of cardiovascular events: A review of the evidence2019Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 26, nr 11, s. 1191-1204Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Risk prediction of future atherothrombotic cardiovascular events is currently based on conventional risk factor assessment and the use of validated algorithms, such as the Framingham Risk Score, the Pooled Cohort Equations, and the European SCORE Risk Charts. However, the identification of subclinical organ damage has emerged as a potentially more accurate predictor of individual risk. Several imaging modalities have been proposed for identification of preclinical atherosclerosis. Coronary artery calcification scanning performed using cardiac computed tomography and calculation of the Agatston score is the most commonly used technique in clinical practice for detection of subclinical disease, prognostic stratification of asymptomatic individuals and implementation of preventive strategies. Furthermore, conventional echocardiographic examination may offer an assessment of cardiac calcifications at different sites, such as the mitral apparatus (including annulus, leaflets and papillary muscles), aortic valve and ascending aorta, that are associated with the clinical manifestation of atherosclerotic disease and are predictive of future cardiovascular events. The aim of this paper is to summarize available evidence on the clinical use of cardiac calcification, review the pathogenetic mechanisms involved, including similarities with atherosclerosis, and evaluate its potential for risk stratification and prevention of clinical events in the primary prevention setting.

  • 5. Faggiano, Pompilio
    et al.
    Dasseni, Nicolò
    Henein, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. St George University London, London, UK; Brunel University, London, UK.
    Imaging subclinical atherosclerosis promises better cardiovascular primary prevention2019Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 26, nr 12, s. 1310-1312Artikel i tidskrift (Övrigt vetenskapligt)
  • 6. Fransson, Eleonor I.
    et al.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Magnusson Hanson, Linda L.
    Westerlund, Hugo
    Job strain and atrial fibrillation: results from the Swedish Longitudinal Occupational Survey of Health and meta-analysis of three studies2018Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 25, nr 11, s. 1142-1149Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Knowledge about the impact of occupational exposures, such as work stress, on the risk of atrial fibrillation is limited. The present study aims to investigate the association between job strain, a measure of work stress, and atrial fibrillation.

    Design: Prospective cohort study design and fixed-effect meta-analysis.

    Methods: Data from the Swedish Longitudinal Occupational Survey of Health (SLOSH) was utilised for the main analysis, combining self-reported data on work stress at baseline with follow-up data on atrial fibrillation from nationwide registers. Cox proportional hazard regression analyses were used to estimate hazard ratios and 95% confidence intervals (CIs). A fixed-effect meta-analysis was conducted to pool the results from the present study with results from two similar previously published studies.

    Results: Based on SLOSH data, job strain was associated with an almost 50% increased risk of atrial fibrillation (hazard ratio 1.48, 95% CI 1.00-2.18) after adjustment for age, sex and education. Further adjustment for smoking, physical activity, body mass index and hypertension did not alter the estimated risk. The meta-analysis of the present and two previously published studies showed a consistent pattern, with job strain being associated with increased risk of atrial fibrillation in all three studies. The estimated pooled hazard ratio was 1.37 (95% CI 1.13-1.67).

    Conclusion: The results highlight that occupational exposures, such as work stress, may be important risk factors for incident atrial fibrillation.

  • 7.
    Johansson, Magdalena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Skellefteå Research Unit.
    Johansson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Skellefteå Research Unit.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lind, Marcus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Skellefteå Research Unit.
    Physical activity and risk of first-time venous thromboembolism2019Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 26, nr 11, s. 1181-1187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Physical activity may have a protective effect against venous thromboembolism (VTE). The aim of this study was to investigate the association between leisure time physical activity, occupational physical activity, and the risk of VTE in men and women separately.

    Methods: The population-based, prospective Venous thromboEmbolism In Northern Sweden (VEINS) cohort study included 108,025 participants of health examinations between 1985 and 2014. Physical activity data were collected by questionnaire. Participants were followed from health examination to first-time VTE event, death, emigration or the end of the study. All VTE events were validated by reviewing medical records and radiology reports.

    Results: During 1,496,669 person-years, 2054 participants experienced VTE. Women who performed leisure time physical activity at least once a week had a lower risk of first-time VTE (hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.71–0.98 after adjustments) compared with women with less or no physical activity. Furthermore, women with high occupational physical activity also had a lower risk of VTE (HR 0.85; 95% CI 0.74–0.98). In men, there was no consistent association between either measure of physical activity and the risk of VTE.

    Conclusion: We found an association between increased physical activity and a lower risk of first-time VTE in women.

  • 8.
    Karjalainen, Tina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Adiels, Martin
    Björck, Lena
    Cooney, Marie-Therèse
    Graham, Ian
    Perk, Joep
    Rosengren, Annika
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Eliasson, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    An evaluation of the performance of SCORE Sweden 2015 in estimating cardiovascular risk: The Northern Sweden MONICA Study 1999-20142017Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, nr 1, s. 103-110Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Risk prediction models for cardiovascular death are important for providing advice on lifestyle and in decision-making regarding primary preventive drug treatment. The latest Swedish version of the Systematic COronary Risk Evaluation (SCORE 2015) has yet not been tested in the population.

    OBJECTIVE: The objective of this study was to estimate the prevalence of high and very high risk of fatal cardiovascular disease (CVD) of the current population according to 2015 SCORE Sweden and to evaluate the predictive accuracy of the 2003 Swedish version of SCORE (2003 SCORE Sweden) and 2015 SCORE Sweden in a population with declining CVD mortality.

    METHODS: We estimated the high and very high risk group for cardiovascular death for individuals 40-65 years of age in the 2014 Northern Sweden MONICA population survey excluding subjects with known diabetes or previous CVD (n = 813). Using the 1999 MONICA survey (n = 3347) followed up for 10 years for CVD mortality, we assessed the calibration of both 2003 and 2015 SCORE Sweden.

    RESULTS: In 2014 2.6% of the population was considered at high or very high risk for fatal CVD, 95% were men and 76% were in the age group 60-65 years. Including subjects with a single markedly elevated risk factor, known diabetes or CVD, 12% of the population was at high or very high risk. During 10 years of follow-up of the 1999 cohort, 34 CVD deaths (24 men and 10 women) occurred. The 2003 SCORE overestimated the risk of death from CVD (ratio predicted/observed 2.3, P < 0.001) whereas the 2015 SCORE slightly overestimated the number of deaths (predicted/observed 1.3, P = 0.12). The 2015 SCORE predicted more accurately than the 2003 SCORE the number of deaths in the different risk and age categories.

    CONCLUSION: The 2015 SCORE Sweden more adequately than 2003 SCORE Sweden predicts the number of deaths. In 2014, the proportion of high-risk individuals is small in northern Sweden. The main use of 2015 SCORE Sweden would therefore be as an educational tool between the physician and people without diabetes or CVD in a consultation regarding cardiovascular risk.

  • 9.
    Krachler, Benno
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Kuopio Research Institute of Exercise Medicine, Finland.
    Savonen, Kai
    Komulainen, Pirjo
    Hassinen, Maija
    Lakka, Timo A.
    Rauramaa, Rainer
    Cardiopulmonary fitness is a function of lean mass, not total body weight: The DR's EXTRA study2015Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, nr 9, s. 1171-1179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Division by total body weight is the usual way to standardise peak oxygen uptake (peak VO2) for body size. However, this method systematically underestimates cardiopulmonary fitness in obese individuals. Our aim was to analyse whether lean-mass is a better base for a body mass-independent standard of cardiopulmonary fitness. Methods: A population based sample of 578 men (body mass index (BMI) 19-47kg/m(2)) and 592 women (BMI 16-49kg/m(2)) 57-78 years of age. Peak VO2 was assessed by respiratory gas analysis during a maximal exercise test on a cycle ergometer. We studied the validity of the weight-ratio and the lean mass-ratio standards in a linear regression model. Results: The weight-ratio standard implies an increase of peak VO2 per additional kg body weight with 20.7ml/min (95% confidence interval (CI): 20.3-21.1) in women and 26.9ml/min (95% CI: 26.4-27.5) in men. The observed increase per kg is only 8.5ml/min (95% CI: 6.5-10.5) in men and 10.4ml/min (95% CI: 7.5-13.4) in women. For the lean mass-ratio standard expected and observed increases in peak VO2 per kg lean mass were 32.3 (95% CI: 31.8-32.9) and 34.6 (95% CI: 30.0-39.1) ml/min for women and 36.2 (95% CI: 35.6-36.8) and 37.3 (95% CI: 32.1-42.4) ml/min in men. The lean mass-ratio standard is a body mass-independent measure of cardiopulmonary fitness in 100% of women and 58% of men; corresponding values for the weight-ratio standard were 11% and 16%. Conclusions: For comparisons of cardiopulmonary fitness across different categories of body mass, the lean mass-ratio standard should be used.

  • 10.
    Krachler, Benno
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stovitz, Steven D.
    Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA..
    How body composition may confound effect estimates of cardiorespiratory fitness2018Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 26, nr 2, s. 196-198Artikel i tidskrift (Refereegranskat)
  • 11. Peters, Sanne A. E.
    et al.
    van der Schouw, Yvonne T.
    Wood, Angela M.
    Sweeting, Michael J.
    Moons, Karel G. M.
    Weiderpass, Elisabete
    Arriola, Larraitz
    Benetou, Vassiliki
    Boeing, Heiner
    Bonnet, Fabrice
    Butt, Salma T.
    Clavel-Chapelon, Francoise
    Drake, Isabel
    Gavrila, Diana
    Key, Timothy J.
    Klinaki, Eleni
    Krogh, Vittorio
    Kuehn, Tilman
    Lassale, Camille
    Masala, Giovanna
    Matullo, Giuseppe
    Merritt, Melissa
    Molina-Portillo, Elena
    Moreno-Iribas, Conchi
    Nost, Therese H.
    Olsen, Anja
    Onland-Moret, N. Charlotte
    Overvad, Kim
    Panico, Salvatore
    Redondo, M. Luisa
    Tjonneland, Anne
    Trichopoulou, Antonia
    Tumino, Rosario
    Turzanski-Fortner, Renee
    Tzoulaki, Ioanna
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Winkvist, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Thompson, Simon G.
    Di Angelantonio, Emanuele
    Riboli, Elio
    Wareham, Nicholas J.
    Danesh, John
    Butterworth, Adam S.
    Parity, breastfeeding and risk of coronary heart disease: A pan-European case-cohort study2016Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, nr 16, s. 1755-1765Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective There is uncertainty about the direction and magnitude of the associations between parity, breastfeeding and the risk of coronary heart disease (CHD). We examined the separate and combined associations of parity and breastfeeding practices with the incidence of CHD later in life among women in a large, pan-European cohort study. Methods Data were used from European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD, a case-cohort study nested within the EPIC prospective study of 520,000 participants from 10 countries. Information on reproductive history was available for 14,917 women, including 5138 incident cases of CHD. Using Prentice-weighted Cox regression separately for each country followed by a random-effects meta-analysis, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD, after adjustment for age, study centre and several socioeconomic and biological risk factors. Results Compared with nulliparous women, the adjusted HR was 1.19 (95% CI: 1.01-1.41) among parous women; HRs were higher among women with more children (e.g., adjusted HR: 1.95 (95% CI: 1.19-3.20) for women with five or more children). Compared with women who did not breastfeed, the adjusted HR was 0.71 (95% CI: 0.52-0.98) among women who breastfed. For childbearing women who never breastfed, the adjusted HR was 1.58 (95% CI: 1.09-2.30) compared with nulliparous women, whereas for childbearing women who breastfed, the adjusted HR was 1.19 (95% CI: 0.99-1.43). Conclusion Having more children was associated with a higher risk of CHD later in life, whereas breastfeeding was associated with a lower CHD risk. Women who both had children and breastfed did have a non-significantly higher risk of CHD.

  • 12.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Engström, Karl Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dellborg, Mikael
    Thilén, Ulf
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Heart Centre, Umeå.
    The level of physical exercise is associated with self-reported health status (EQ-5D) in adults with congenital heart disease2015Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, nr 2, s. 240-248Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The prognosis in adults with congenital aortic valve disease is usually favourable; nevertheless, a number of medical and social factors might hamper long-term prognosis and quality of life. With a focus on physical exercise level, data from the Swedish National Registry on Congenital Heart Disease (SWEDCON) were analysed and variables associated with health-related quality of life in adults with congenital aortic valve disease were identified.

    METHODS: In this registry study, SWEDCON was searched for adult patients with isolated congenital aortic valve disease and valid EuroQol-5Dimensions health questionnaire (EQ-5D) data.

    RESULTS: This study identified 315 patients. The majority (n = 202, 64%) reported best possible health status (EQ-5Dindex = 1) whereas 113 (35%) reported some impairment (EQ-5Dindex < 1) with mean EQ-5Dindex 0.73 ± 0.17. In a multivariate logistic regression model, self-reported physical exercise > 3 h/week was independently associated with best possible health status (EQ-5Dindex = 1; p = 0.013). Moreover presence of cardiovascular symptoms (p < 0.001), active smoking (p = 0.002), history of valve surgery (p = 0.017), low educational level (p = 0.022), and higher systolic blood pressure (p = 0.029) were independently associated with impaired health status (EQ-5Dindex < 1).

    CONCLUSIONS: Physical exercise >3 h/week was, as a single variable, associated with best possible health status in adults with congenital aortic valve disease. In contrast, a number of medical and social factors are associated with worse self-reported health status. Among these, symptoms, smoking, and educational level are potential targets for modification and intervention. There is a need for studies investigating the effect of increased level of physical exercise in patients with congenital aortic valve disease.

  • 13.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Thilén, Ulf
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Adults with complex congenital heart disease have impaired skeletal muscle function and reduced confidence in performing exercise training2015Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, nr 12, s. 1523-1530Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Adults with congenital heart disease (ACHD) usually have reduced aerobic exercise capacity compared with controls. However, their skeletal muscle function is less studied. Material and methods In this cross-sectional study, unilateral isotonic shoulder flexion, unilateral isotonic heel-lift, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were tested in 85 patients with ACHD (35 women, mean age 36.814.8 years), classed as either complex' (n=43) or simple' (n=42), and 42 age and gender matched controls (16 women, mean age 36.914.9). Maximum number of shoulder flexions and heel-lifts were measured. MIP/MEP was tested using a handheld respiratory pressure meter. Exercise self-efficacy, measuring confidence in performing exercise training, was evaluated. Results Adults with complex lesions performed fewer shoulder flexions compared with controls and patients with simple lesions (28.2 +/- 11.1 vs. 63.6 +/- 40.4, p<0.001 and 28.2 +/- 11.1 vs. 54.9 +/- 24.9, p<0.001), as well as fewer heel-lifts compared with controls and patients with simple lesions (17.6 +/- 7.7 vs. 26.3 +/- 12.8, p<0.001 and 17.6 +/- 7.7 vs. 23.2 +/- 7.0, p=0.024), lower MIP than controls (80.7 +/- 26.7 vs. 111.1 +/- 29.9cm H2O, p<0.001) and lower MEP compared with controls (110.8 +/- 39.9 vs. 141.8 +/- 39.5, p<0.001). Their exercise self-efficacy was lower than controls (28.0 +/- 8.3 vs. 33.4 +/- 6.1, p=0.002). In a linear regression model complex heart lesions were independently associated with impaired limb muscle function. Conclusion Adults with complex congenital heart disease have impaired skeletal muscle function compared with patients with simple lesions and healthy controls. They also had lower confidence in performing exercise training. Thus, this population might have a potential for rehabilitation focusing on improving muscle function and confidence in performing exercise training.

  • 14. Smink, P. A.
    et al.
    Hoekman, J.
    Grobbee, D. E.
    Eijkemans, M. J. C.
    Parving, H-H
    Persson, F.
    Ibsen, H.
    Lindholm, Lars H.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Wachtell, K.
    de Zeeuw, D.
    Heerspink, H. J. Lambers
    A prediction of the renal and cardiovascular efficacy of aliskiren in ALTITUDE using short-term changes in multiple risk markers2014Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 21, nr 4, s. 434-441Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction We recently developed and validated in existing trials a novel algorithm (PRE score) to predict long-term drug efficacy based on short-term (month-6) drug-induced changes in multiple risk markers. To show the value of the PRE score for ongoing and planned clinical trials, we here report the predicted long-term cardio-renal efficacy of aliskiren in type 2 diabetes, which was investigated in the ALTITUDE trial, but unknown at the time this study was conducted. Methods We established the relation between multiple risk markers and cardio-renal endpoints (as defined in ALTITUDE) using a background database from past clinical trials. The short-term effect of aliskiren on multiple risk markers was taken from the AVOID trial. A PRE score was developed by multivariate Cox analysis in the background population and was then applied to the baseline and month-6 measurements of the aliskiren treatment arm of the AVOID trial to predict cardio-renal risk. The net risk difference at these time-points, after correction for placebo effects, was taken to indicate the estimated long-term cardio-renal risk change. Results Based on the PRE score, we predicted that aliskiren treatment in ALTITUDE would confer a relative risk change of -7.9% (95% CI -2.5 to -13.4) for the cardio-renal endpoint, a risk change of -5.1% (-1.2 to -9.0) for the CV endpoint and a non-significant risk change of -19.9% (-42.1 to +2.1) for the renal endpoint. Conclusions PRE score estimations suggested that aliskiren has only a marginal additive protective effect on cardio-renal endpoints. These predictions were validated by the results of the ALTITUDE trial, confirming the potential of the PRE score to prospectively predict drug efficacy on cardio-renal outcomes.

  • 15.
    Ulvenstam, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Unit of Research, Education and Development, Östersund Hospital, Sweden.
    Henriksson, Robin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Söderström, Lars
    Mooe, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Ischemic stroke rates decrease with increased ticagrelor use after acute myocardial infarction in patients treated with percutaneous coronary intervention2018Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 25, nr 11, s. 1219-1230Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: It is unknown whether dual antiplatelet therapy with ticagrelor instead of clopidogrel reduces the risk of ischaemic stroke in acute myocardial infarction patients that undergo percutaneous coronary intervention. This study investigated whether the introduction of dual antiplatelet therapy with ticagrelor was associated with reduced ischaemic stroke risk in a real-world population.

    Methods and results: Patients with ischaemic stroke after acute myocardial infarction from 8 December 2009-31 December 2013 were identified using the Register for Information and Knowledge on Swedish Heart Intensive Care Admissions and the Swedish National Patient Register. The study period was divided into two similar periods using the date of the first prescription of ticagrelor as the cut-off. The risk of ischaemic stroke in percutaneous coronary intervention-treated acute myocardial infarction patients during the first period (100% clopidogrel treatment) versus the second period (60.7% ticagrelor treatment) was assessed using Kaplan-Meier analysis. Variables associated with ischaemic stroke were identified using a multivariable Cox proportional hazards model. There were 686 ischaemic stroke events (2.0%) among 34931 percutaneous coronary intervention-treated acute myocardial infarction patients within one year, 366 (2.2%) during the first period and 320 (1.8%) during the second period (p=0.004). The Cox model showed a 21% relative risk reduction in ischaemic stroke in the second period versus the first one (hazard ratio 0.79, 95% confidence interval, 0.68-0.92; p=0.003). The independent predictors of increased stroke risk were older age, hypertension, diabetes mellitus, atrial fibrillation, heart failure during hospitalization, previous ischaemic stroke, and ST-segment elevation myocardial infarction.

    Conclusion: The risk of ischaemic stroke in percutaneous coronary intervention-treated acute myocardial infarction patients decreased after the introduction of ticagrelor in Sweden.

  • 16. Veronesi, Giovanni
    et al.
    Tunstall-Pedoe, Hugh
    Ferrario, Marco M.
    Kee, Frank
    Kuulasmaa, Kari
    Chambless, Lloyd E.
    Amouyel, Philippe
    Arveiler, Dominique
    Bobak, Martin
    Ferrieres, Jean
    Giampaoli, Simona
    Jorgensen, Torben
    Peters, Annette
    Salomaa, Veikko
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Tamosiunas, Abdonas
    Cesana, Giancarlo
    Combined effect of educational status and cardiovascular risk factors on the incidence of coronary heart disease and stroke in European cohorts: implications for prevention2017Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, nr 4, s. 437-445Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The combined effect of social status and risk factors on the absolute risk of cardiovascular disease has been insufficiently investigated, but results provide guidance on who could benefit most through prevention.

    Methods: We followed 77,918 cardiovascular disease-free individuals aged 35-74 years at baseline, from 38 cohorts covering Nordic and Baltic countries, the UK and Central Europe, for a median of 12 years. Using Fine-Gray models in a competing-risks framework we estimated the effect of the interaction of education with smoking, blood pressure and body weight on the cumulative risk of incident acute coronary heart disease and stroke.

    Results: Compared with more educated smokers, the less educated had an added increase in absolute risk of cardiovascular disease of 3.1% ( 95% confidence interval+0.1%, +6.2%) in men and of 1.5% ( = 1.9%, +5.0%) in women, consistent across smoking categories. Conversely, the interaction was negative for overweight: -2.6% ( 95% CI: -5.6%, +0.3%) and obese: -3.6% ( -7.6%, +0.4%) men, suggesting that the more educated would benefit more from the same reduction in body weight. A weaker interaction was observed for body weight in women, and for blood pressure in both genders. Less educated men and women with a cluster of two or more risk factors had an added cardiovascular disease risk of 3.6% ( +0.1%, +7.0%) and of 2.6% ( - 0.5%, +5.6%), respectively, compared with their more educated counterparts.

    Conclusions: Socially disadvantaged subjects have more to gain from lifestyle and blood pressure modification, hopefully reducing both their risk and also social inequality in disease.

  • 17. Wallert, John
    et al.
    Held, Claes
    Madison, Guy
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Olsson, Erik J.
    Psycho-affective pathology in adults with congenital heart disease: Important progress is being made within a challenging field2019Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881Artikel i tidskrift (Refereegranskat)
  • 18. Wallert, John
    et al.
    Lissåker, Claudia
    Madison, Guy
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Held, Claes
    Olsson, Erik
    Young adulthood cognitive ability predicts statin adherence in middle-aged men after first myocardial infarction: a Swedish National Registry study2017Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, nr 6, s. 639-646Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Cognitive ability (CA) is positively related to later health, health literacy, health behaviours and longevity. Accordingly, a lower CA is expected to be associated with poorer adherence to medication. We investigated the long-term role of CA in adherence to prescribed statins in male patients after a first myocardial infarction (MI). Methods: CA was estimated at 18-20 years of age from Military Conscript Register data for first MI male patients (<= 60 years) and was related to the one- and two-year post-MI statin adherence on average 30 years later. Background and clinical data were retrieved through register linkage with the unselected national quality register SWEDEHEART for acute coronary events (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) and secondary prevention (Secondary Prevention after Heart Intensive Care Admission). Previous and present statin prescription data were obtained from the Prescribed Drug Register and adherence was calculated as >= 80% of prescribed dispensations assuming standard dosage. Logistic regression was used to estimate crude and adjusted associations. The primary analyses used 2613 complete cases and imputing incomplete cases rendered a sample of 4061 cases for use in secondary (replicated) analyses. Results: One standard deviation increase in CA was positively associated with both one-year (OR 1.15 (CI 1.01-1.31), P< 0.05) and two-year (OR 1.14 (CI 1.02-1.27), P< 0.05) adherence to prescribed statins. Only smoking attenuated the CA-adherence association after adjustment for a range of > 20 covariates. Imputed and complete case analyses yielded very similar results. Conclusions: CA estimated on average 30 years earlier in young adulthood is a risk indicator for statin adherence in first MI male patients aged <= 60 years. Future research should include older and female patients and more socioeconomic variables.

  • 19. Wang, Anne
    et al.
    Arver, Stefan
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Gerstein, Hertzel C.
    Lee, Shun Fu
    Hess, Sibylle
    Ryden, Lars
    Mellbin, Linda G.
    Testosterone, sex hormone-binding globulin and risk of cardiovascular events: A report from the Outcome Reduction with an Initial Glargine Intervention trial2019Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 26, nr 8, s. 847-854Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: Testosterone and its binding protein sex hormone-binding globulin have been associated with cardiovascular disease and dysglycaemia. However, information on the prognostic implication in patients at high cardiovascular risk with dysglycaemia is inconsistent. The study objective was to determine whether testosterone and/or sex hormone-binding globulin predict cardiovascular events or death in dysglycaemic patients.

    Methods: Dysglycaemic males at high cardiovascular risk (n = 5553) who participated in the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial and provided baseline blood samples were studied. Testosterone and sex hormone-binding globulin were measured at baseline and used to estimate free testosterone. Low levels of total and free testosterone were defined as ≤300 ng/dl and ≤7 ng/dl, respectively. Patients were followed for six years for cardiovascular events (defined as the composite of cardiovascular death, non-fatal myocardial infarction or stroke) and all-cause mortality.

    Results: The mean total and free testosterone levels were 416.6 ng/dl and 8.4 ng/dl, and low levels were present in 13% and 37% of the patients. The median sex hormone-binding globulin level was 35 nmol/l. In Cox regression models adjusted for age, previous diseases and pharmacological treatment, neither total nor free testosterone predicted cardiovascular events. However, a one-standard-deviation increase in sex hormone-binding globulin predicted both cardiovascular events (hazard ratio 1.07; 95% confidence interval 1.00–1.14; p = 0.03) and all-cause mortality (hazard ratio 1.13; 95% confidence interval 1.06–1.21; p < 0.01).

    Conclusion: Sex hormone-binding globulin, but not total testosterone, predicts cardiovascular disease and all-cause mortality in dysglycaemic males at high cardiovascular risk.

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