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  • 1. Almroth, Henrik
    et al.
    Höglund, Niklas
    Department of Cardiology, Heart Centre, University Hospital, S-901 85 Umeå, Sweden.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Englund, Anders
    Jensen, Steen
    Department of Cardiology, Heart Centre, University Hospital, S-901 85 Umeå, Sweden.
    Kjellman, Björn
    Tornvall, Per
    Rosenqvist, Mårten
    Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebo-controlled multicentre study2009In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 30, no 7, p. 827-833Article in journal (Refereed)
    Abstract [en]

    AIMS: To evaluate the effect of atorvastatin in achieving stable sinus rhythm (SR) 30 days after electrical cardioversion (CV) in patients with persistent atrial fibrillation (AF). METHODS AND RESULTS: The study included 234 patients. The patients were randomized to treatment with atorvastatin 80 mg daily (n = 118) or placebo (n = 116) in a prospective, double-blinded fashion. Treatment was initiated 14 days before CV and was continued 30 days after CV. The two groups were well-balanced with respect to baseline characteristics. Mean age was 65 +/- 10 years, 76% of the patients were male and 4% had ischaemic heart disease. Study medication was well-tolerated in all patients but one. Before primary endpoint 12 patients were excluded. In the atorvastatin group 99 patients (89%) converted to SR at electrical CV compared with 95 (86%) in the placebo group (P = 0.42). An intention-to-treat analysis with the available data, by randomization group, showed that 57 (51%) in the atorvastatin group and 47 (42%) in the placebo group were in SR 30 days after CV (OR 1.44, 95%CI 0.85-2.44, P = 0.18). CONCLUSION: Atorvastatin was not statistically superior to placebo with regards to maintaining SR 30 days after CV in patients with persistent AF.

  • 2.
    Andersson, T. A.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Larsen, F.
    Karolinska Inst, Stockholm, Sweden.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Pulmonary embolism in Sweden, a national cohort and survival analysis2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no suppl. 1, p. 29-29Article in journal (Other academic)
  • 3. Ashar, Foram N.
    et al.
    Mitchell, Rebecca N.
    Albert, Christine M.
    Newton-Cheh, Christopher
    Brody, Jennifer A.
    Mueller-Nurasyid, Martina
    Moes, Anna
    Meitinger, Thomas
    Mak, Angel
    Huikuri, Heikki
    Junttila, M. Juhani
    Goyette, Philippe
    Pulit, Sara L.
    Pazoki, Raha
    Tanck, MichaelW.
    Blom, Marieke T.
    Zhao, XiaoQing
    Havulinna, Aki S.
    Jabbari, Reza
    Glinge, Charlotte
    Tragante, Vinicius
    Escher, Stefan A.
    Chakravarti, Aravinda
    Ehret, Georg
    Coresh, Josef
    Li, Man
    Prineas, Ronald J.
    Franco, Oscar H.
    Kwok, Pui-Yan
    Lumley, Thomas
    Dumas, Florence
    McKnight, Barbara
    Rotter, Jerome I.
    Lemaitre, Rozenn N.
    Heckbert, Susan R.
    O'Donnell, Christopher J.
    Hwang, Shih-Jen
    Tardif, Jean-Claude
    VanDenburgh, Martin
    Uitterlinden, Andre G.
    Hofman, Albert
    Stricker, Bruno H. C.
    de Bakker, Paul I. W.
    Franks, Paul W.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Asselbergs, Folkert W.
    Halushka, Marc K.
    Maleszewski, Joseph J.
    Tfelt-Hansen, Jacob
    Engstrom, Thomas
    Salomaa, Veikko
    Virmani, Renu
    Kolodgie, Frank
    Wilde, Arthur A. M.
    Tan, Hanno L.
    Bezzina, Connie R.
    Eijgelsheim, Mark
    Rioux, John D.
    Jouven, Xavier
    Kääb, Stefan
    Psaty, Bruce M.
    Siscovick, David S.
    Arking, Dan E.
    Sotoodehnia, Nona
    A comprehensive evaluation of the genetic architecture of sudden cardiac arrest2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 44, p. 3961-+Article in journal (Refereed)
    Abstract [en]

    Aims: Sudden cardiac arrest (SCA) accounts for 10% of adult mortality in Western populations. We aim to identify potential loci associated with SCA and to identify risk factors causally associated with SCA.

    Methods and results: We carried out a large genome-wide association study (GWAS) for SCA (n = 3939 cases, 25 989 non-cases) to examine common variation genome-wide and in candidate arrhythmia genes. We also exploited Mendelian randomization (MR) methods using cross-trait multi-variant genetic risk score associations (GRSA) to assess causal relationships of 18 risk factors with SCA. No variants were associated with SCA at genome-wide significance, nor were common variants in candidate arrhythmia genes associated with SCA at nominal significance. Using cross-trait GRSA, we established genetic correlation between SCA and (i) coronary artery disease (CAD) and traditional CAD risk factors (blood pressure, lipids, and diabetes), (ii) height and BMI, and (iii) electrical instability traits (QT and atrial fibrillation), suggesting aetiologic roles for these traits in SCA risk.

    Conclusions: Our findings show that a comprehensive approach to the genetic architecture of SCA can shed light on the determinants of a complex life-threatening condition with multiple influencing factors in the general population. The results of this genetic analysis, both positive and negative findings, have implications for evaluating the genetic architecture of patients with a family history of SCA, and for efforts to prevent SCA in high-risk populations and the general community.

  • 4. Axelsson, J. M.
    et al.
    Burup-Kristensen, C.
    Kesaniemi, A.
    Rossebo, A. B.
    Pedersen, T. R.
    Nienaber, C. A.
    Gohlke-Barwolf, C.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Willenheimer, R.
    Wachtell, K.
    Incidence and predictors of infective endocarditis in asymptomatic patients with mild-to-moderate aortic stenosis2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P4316, p. 758-758Article in journal (Other academic)
  • 5.
    Bajraktari, Gani
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Batalli, A.
    Poniku, A.
    Ahmeti, A.
    Olloni, R.
    Hyseni, V.
    Vela, Z.
    Morina, B.
    Tafarshiku, R.
    Henein, Michael Y.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Left ventricular dyssynchrony predicts limited exercise capacity in heart failure irrespective of ejection fraction2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no Suppl. 1, p. 34-34Article in journal (Other academic)
  • 6.
    Bajraktari, Gani
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Berisha, G.
    Bytyci, I.
    Haliti, E.
    Ibrahimi, Pranvera
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ahmeti, A.
    Poniku, A.
    Henein, Michael Y.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    The presence of metabolic syndrome predicts long-term outcome in heart failure patients2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, p. 831-831Article in journal (Other academic)
  • 7.
    Bajraktari, Gani
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Bytyci, I.
    Ahmeti, A.
    Ibrahimi, Pranvera
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Poniku, A.
    Haliti, E.
    Batalli, A.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Left atrial emptying function predicts long-term outcome in HFpEF patients2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, p. 1183-1183Article in journal (Other academic)
  • 8.
    Bajraktari, Gani
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Bytyci, I.
    Ibrahimi, Pranvera
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Hyseni, V.
    Berisha, G.
    Rexhepaj, N.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    The relationship between left atrial emptying function and exercise capacity in heart failure2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P2776, p. 510-510Article in journal (Other academic)
  • 9.
    Bajraktari, Gani
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Jashari, Haki
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ibrahimi, Pranvera
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Jashari, Fisnik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Elezi, S.
    Ndrepepa, G.
    Henein, Michael Y.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Comparison of drug-eluting balloon versus drug-eluting stent treatment of DES in-stent restenosis: a meta-analysis of randomized and observational studies2016In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, p. 670-670Article in journal (Other academic)
  • 10.
    Bajraktari, Gani
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Total isovolumic time correlates with limited exercise capacity in HFpEF - its shortening with stress suggests significant rise of filling pressure2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P6544, p. 1179-1179Article in journal (Other academic)
  • 11.
    Bay, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Berghammer, M.
    Lämås, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandberg, Camilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Facilitators and barriers for physical activity in adults with congenital heart disease2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 1120-1121Article in journal (Other academic)
    Abstract [en]

    Background: A majority of adults with congenital heart disease (CHD) have reduced exercise capacity and do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and counteract acquired cardiovascular disease. This study illuminates aspects that may be relevant for performing physical activity.

    Purpose: To describe facilitators and barriers for physical activity in adults with CHD.

    Methods: Semi-structured interviews were performed individually with fourteen adults (age 19–68 years, women=7) with complex CHD. The interviews were analyzed using qualitative content analysis.

    Results: Aspects that may enable or inhibit physical activity were found in two domains; Facilitators and Barriers, which both consisted of four categories physical, psychological, psychosocial and environmental aspects (Table 1).

    This can be exemplified by the category physical aspects; where persons expressed being limited by the CHD to perform physical activity, but also that improved aerobic fitness allows for being more active, and in the category psychosocial aspects; the person's previous negative experiences and lack of support constituted barriers while encouragement from others and being active as a child facilitated an active lifestyle in adult age.

    Conclusion: The present study identifies barriers and facilitators for being physically active in adults living with CHD. It is essential to identify prerequisites for supporting and promoting physical activity and thereby hopefully prevent long-term adverse outcomes. Barriers can potentially be transformed to facilitators through increased knowledge in both the adult with CHD and the healthcare provider.

  • 12.
    Bay, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Sandberg, Camilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Thilen, U.
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Exercise self-efficacy (ESE) in adults with congential heart disease2017In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no Suppl. 1, article id ehx501.P618Article in journal (Refereed)
    Abstract [en]

    Background: Many adults with congenital heart disease (CHD) have reduced aerobic exercise capacity and impaired muscle function. However, it is largely unknown which factors have influence on the confidence to perform exercise training, i.e. Exercise Self-Efficacy (ESE).

    Aims: To identify factors related to low ESE, and thus identify potential targets for rehabilitation and thereby enhance the potential for being physically active.

    Methods: Seventy-nine adults with CHD; simple lesions n=38 (women n=16), complex lesions n=41 (women n=17) (mean age 36.7±14.6 years) and 42 age and sex matched controls were recruited. All participants completed questionnaires on ESE, quality of life (EQ-5D), and physical activity (international physical activity questionnaire, IPAQ), and performed muscle endurance tests.

    Results: ESE was categorised into low (<26 points, n=24) and high (≥26 points, n=55). Patients with low ESE were older (45.2±15.4 vs. 32.6±12.5 years, p=0.002), more often had prescribed medication (67% vs. 44%, p=0.06), higher New York Heart Association functional class (NYHA) (≥ III) (25% vs. 7%, p=0.03) and performed fewer shoulder flexions (30.9±16.1 vs. 45.9±23.9, p=0.01) compared with those with high ESE. In the high ESE group, ESE did not differ from controls (33.8±3.9 vs. 33.4±6.1, p=0.74). In linear multivariate analysis age (B;-0.18, 95% CI -0.28- -0.08), smoking (B;-3.73, 95% CI -7.17- -0.28), EQ-5Dindex <1 (B;-3.33, 95% CI -6.08- -0.57) and number of shoulder flexions (B; 0.09, 95% CI 0.03–0.16) were independently associated with ESE.

    Conclusion: Many adults with CHD have low ESE. Rehabilitation targeting quality of life, smoking cessation and muscle training may improve ESE, and thus enhance the potential for being physically active in this population.

  • 13. Berghammer, M.
    et al.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Mattson, E.
    Moons, P.
    Dellborg, M.
    Exploration of disagreement between the patient's self reported limitations and limitations assessed by caregivers in adults with congenital heart disease2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 468-468Article in journal (Other academic)
    Abstract [en]

    Background: The New York Heart Association (NYHA) classification is applied in a wide spectrum of heart diseases including adult patients with congenital heart disease (ACHD). The NYHA-class assessment is often based on the evaluation by the caregiver, but to what extent it correlates with the patient's view of their function is not fully known.

    Purpose: To investigate the relation between the patient's self-reported physical limitations, symptoms, other heart defect related factors and NYHA-class assessed by the caregiver.

    Methods: Eligible patients (n=333, age 39.2±13.6 years) were identified and randomly selected from the national registry for CHD. All of the patients completed a standardized questionnaire measuring different PRO-domains. By combing self-reported data with registry data including NYHA-class, analyses of agreement of physical limitations were performed.

    Results: Almost 30% of the patients rated their limitations higher compared to the NYHA-class estimated by the caregiver. Patients with self-reported limitations and their NYHA-class underestimated by caregivers, more often reported symptoms, anxiety, lower health and worked fewer hours/week compared to other patients with CHD. There were no differences regarding sex, type of symptoms, prescribed medications, or complexity of cardiac lesion. In patients without self-reported limitations agreement with NYHA-class estimated by caregivers was 97%.

    Conclusion: Adult patients with CHD and self-reported limitations may not be correctly identified by the care-giver. Instruments for patient reported outcomes might improve the assessment of physical limitations and could further improve the correctness in evaluating the patient's status.

  • 14. Blomström-Lundqvist, Carina
    et al.
    Johansson, Birgitta
    Berglin, Eva
    Avd för molekylär och klinisk medicin, Institutionen för medicin vid Sahlgrenska akademin.
    Nilsson, Leif
    Jensen, Steen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Thelin, Stefan
    Holmgren, Anders
    Edvardsson, Nils
    Källner, Göran
    Blomström, Per
    A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF).2007In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 28, no 23, p. 2902-2908Article in journal (Refereed)
  • 15.
    Boles, Usama
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    David, S.
    Pinto, Rui C.
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Abdullah, S.
    Henein, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University Hospital.
    Disturbed fatty acids metabolism in coronary artery ectasia: an extended lipidomic analysis2016In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, p. 1099-1099Article in journal (Other academic)
  • 16. Burup-Kristensen, C.
    et al.
    Axelsson, J. M.
    Kesaniemi, A.
    Rossebo, A. B.
    Pedersen, T. R.
    Nienaber, C. A.
    Gohlke-Barwolf, C.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Willenheimer, R.
    Wachtell, K.
    Advancing age and differences in outcomes in patients with asymptomatic mild to moderate aortic stenosis2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P2389, p. 418-419Article in journal (Other academic)
  • 17. Bytyci, I.
    et al.
    Ibrahmi, P.
    Batalli, A.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Bajraktari, G.
    Left atrial changes in early stage of heart failure with preserved ejection fraction2016In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, p. 1112-1112Article in journal (Other academic)
  • 18. Bytyci, I.
    et al.
    Tishukaj, A.
    Poniku, A.
    Henein, Michael Y.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Bajraktari, G.
    Left atrial compliance predicts limited exercise in patients with HFpEF and right ventricular dysfunction2016In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, p. 126-126Article in journal (Other academic)
  • 19.
    Bytyci, Ibadete
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Bajraktari, G.
    Henein, Michael Y.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Left atrial strain increases in CRT responders: a systematic review and meta-analysis2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 422-422Article in journal (Other academic)
    Abstract [en]

    Background and aim: Impaired left atrial (LA) strain is associated with myocardial fibrosis and carries poor prognosis, especially arrhythmia. Cardiac resynchronization therapy (CRT) is associated with reserved LA remodeling and reduced arrhythmia. The aim of this meta-analysis was to assess the relationship between CRT and LA function improvement.

    Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to February 2018 in order to select clinical trials and observational studies, which assessed the predictive value of LA strain of CRT response. The left ventricular end-systolic volume (LVESV) reduction ≥15 ml and/or LV ejection fraction (EF) increase ≥10% were the documented criteria for assessment of CRT response.

    Results: A total of 299 patients (181 responders and 118 non-responders to CRT) from 5 observational studies, with mean follow-up period of 6 months were included in this meta-analysis. The pooled analysis showed no difference between baseline LA strain in the two groups with weighted mean difference (WMD) 1.07% [95% CI -2.37 to 4.51, P=0.54, Figure 1]. After the follow-up period, LA strain in the CRT responders significantly increased, WMD 27.7% [95% CI 23.1 to 32.6, P<0.001, Figure 2, a)], but not in the non-responders, WMD -34.5 [95% CI -38.4 to -30.6, p<0.001, Figure 2, b)].

    Conclusions: Improvement of LA strain in CRT responders reflects LA reserve remodeling. These results support the importance of LA function in patients treated by CRT for heart failure.

  • 20. Cameli, M.
    et al.
    Lisi, M.
    Reccia, R.
    Bigio, E.
    Bennati, E.
    Malandrino, A.
    Maccherini, M.
    Chiavarelli, M.
    Henein, Michael Y.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Mondillo, S.
    Left atrial strain predicts postoperative atrial fibrillation in patients waiting for aortic valve replacement for aortic stenosis2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no Suppl. 1, p. 826-826Article in journal (Other academic)
  • 21. Cameli, M.
    et al.
    Mondillo, S.
    Righini, F. M.
    Lisi, M.
    Sparla, S.
    Di Tommaso, C.
    Marino, F.
    Tsioulpas, C.
    Maccherini, M.
    Henein, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Left ventricular deformation accurately predicts the extent of myocardial fibrosis in patients with advanced heart failure requiring transplantation2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no Suppl 1, p. 835-835Article in journal (Other academic)
  • 22. Cameli, M.
    et al.
    Righini, F. M.
    Lisi, M.
    Di Tommaso, C.
    Curci, V.
    Navarri, R.
    Lunghetti, S.
    Focardi, M.
    Henein, Mark
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Mondillo, S.
    Left atrial strain for prognisis prediction of patients with moderate mitral valve regurgitation2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P1380, p. 243-243Article in journal (Other academic)
  • 23.
    Cameli, Matteo
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Focardi, M.
    Bennati, E.
    Massoni, A.
    Loffreno, A.
    Carbone, S.
    Galderisi, M.
    Henein, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Mondillo, S.
    Patients with suspicion of myocarditis and normal ejection fraction: role of speckle tracking echocardiography2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P5212, p. 919-920Article in journal (Other academic)
  • 24.
    Cameli, Matteo
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Sparla, S.
    Fineschi, M.
    Favilli, R.
    Pierli, C.
    Henein, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Mondillo, S.
    Left atrial strain as independent parameter to predict left ventricular end diastolic pressure2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P1531, p. 278-279Article in journal (Other academic)
  • 25. Camen, S.
    et al.
    Ojeda, F. M.
    Niiranen, T.
    Gianfagna, F.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lochen, M. L.
    Kee, F.
    Blankenberg, S.
    Jørgensen, T.
    Zeller, T.
    Kuulasmaa, K.
    Linneberg, A.
    Salomaa, V.
    Iacoviello, L.
    Schnabel, R.
    Temporal relations between atrial fibrillation and ischemic stroke and their prognostic impact on mortality2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 204-205Article in journal (Other academic)
    Abstract [en]

    Introduction: Atrial fibrillation (AF) and stroke are common diseases and AF is a well-established risk factor for stroke. The physiological mechanism of atrial dysfunction, disturbed hemodynamics and arterial thromboembolism links the pathologies. However, limited evidence is available on the temporal relationship between stroke and AF and the impact of subsequent disease onset on mortality in the community.

    Methods and results: Across five prospective community cohorts (DanMONICA, FINRISK, Moli-Sani project, Northern Sweden MONICA study, The Tromsø Study) of the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE)-project we assessed baseline cardiovascular risk factors in 101164 individuals, median age 46.1 (25th, 75th percentile 35.8, 57.6) years, 48.4% men. We followed them for incident stroke and AF and determined the relation of subsequent disease diagnosis with overall mortality. Follow-up (FU) for stroke and AF was based upon linkage with national hospitalization registries or administrative registries for ambulatory visits to specialized hospitals.

    Over a median FU of 16.1 years N=4556 individuals were diagnosed solely with AF, N=2269 had a stroke but no AF diagnosed, and N=898 developed both stroke and AF during FU. Participants who developed either AF or stroke as the index event revealed a similar baseline risk factor profile. Temporal relations showed a peak of the diagnosis of both diseases within the years around the diagnosis of the other disease. The highest incidence rates of stroke were observed within a five-year interval prior to AF diagnosis. Cox regression showed an association of baseline stroke with diagnosis of AF during FU (hazard ratio (HR) 1.29; 95% confidence interval (CI) 1.11–1.50; p<0.001).

    In multivariable-adjusted Cox regression analyses with time-dependent covariates excluding individuals with diagnosis of both AF and stroke or death within 30 days, subsequent diagnosis of AF after stroke was associated with a higher overall mortality (HR, 3.51; 95% CI 1.87–6.59; p<0.001); subsequent stroke after the diagnosis of AF was associated with a HR of 2.39 (95% CI 1.59–3.60; p<0.001).

    Conclusions: Stroke and AF are common comorbidities in older adults with an overlapping risk factor profile. The temporal relations appear to be bidirectional, although uncertainty regarding disease onset remains due to the often paroxysmal and asymptomatic nature of AF. Stroke may precede detection of AF by years. The subsequent diagnosis of both diseases significantly increases mortality risk. Whether targeting modifiable risk factors or improved screening for AF after stroke would improve survival needs to be determined.

  • 26. Crowe, Francesca L
    et al.
    Roddam, Andrew W
    Key, Timothy J
    Appleby, Paul N
    Overvad, Kim
    Jakobsen, Marianne U
    Tjønneland, Anne
    Hansen, Louise
    Boeing, Heiner
    Weikert, Cornelia
    Linseisen, Jakob
    Kaaks, Rudolf
    Trichopoulou, Antonia
    Misirli, Gesthimani
    Lagiou, Pagona
    Sacerdote, Carlotta
    Pala, Valeria
    Palli, Domenico
    Tumino, Rosario
    Panico, Salvatore
    Bueno-de-Mesquita, H Bas
    Boer, Jolanda
    van Gils, Carla H
    Beulens, Joline W J
    Barricarte, Aurelio
    Rodríguez, Laudina
    Larrañaga, Nerea
    Sánchez, Maria-José
    Tormo, María-José
    Buckland, Genevieve
    Lund, Eiliv
    Hedblad, Bo
    Melander, Olle
    Jansson, Jan-Håkan
    Department of Medicine, Skellefteå County Hospital, Skellefteå, Sweden .
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wareham, Nicholas J
    Slimani, Nadia
    Romieu, Isabelle
    Jenab, Mazda
    Danesh, John
    Gallo, Valentina
    Norat, Teresa
    Riboli, Elio
    Fruit and vegetable intake and mortality from ischaemic heart disease: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study.2011In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 32, no 10, p. 1235-1243Article in journal (Refereed)
    Abstract [en]

    AIMS: A higher intake of fruits and vegetables has been associated with a lower risk of ischaemic heart disease (IHD), but there is some uncertainty about the interpretation of this association. The objective was to assess the relation between fruit and vegetable intake and risk of mortality from IHD in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study.

    METHODS AND RESULTS: After an average of 8.4 years of follow-up, there were 1636 deaths from IHD among 313 074 men and women without previous myocardial infarction or stroke from eight European countries. Participants consuming at least eight portions (80 g each) of fruits and vegetables a day had a 22% lower risk of fatal IHD [relative risk (RR) = 0.78, 95% confidence interval (CI): 0.65-0.95] compared with those consuming fewer than three portions a day. After calibration of fruit and vegetable intake to account for differences in dietary assessment between the participating centres, a one portion (80 g) increment in fruit and vegetable intake was associated with a 4% lower risk of fatal IHD (RR = 0.96, 95% CI: 0.92-1.00, P for trend = 0.033).

    CONCLUSION: Results from this large observational study suggest that a higher intake of fruits and vegetables is associated with a reduced risk of IHD mortality. Whether this association is causal and, if so, the biological mechanism(s) by which fruits and vegetables operate to lower IHD risks remains unclear.

  • 27. Csengeri, D.
    et al.
    Spruenker, N. A.
    Di Castelnuovo, A.
    Niiranen, T.
    Söderberg, Stefan
    Umeå University Hospital.
    Magnussen, C.
    Lochen, M. J.
    Kee, F.
    Blankenberg, S.
    Jørgensen, T.
    Kuulasmaa, K.
    Zeller, T.
    Salomaa, V.
    Iacoviello, L.
    Schnabel, R.
    Alcohol consumption and risk of atrial fibrillation - results from the BiomarCaRE Consortium2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 902-903Article in journal (Other academic)
    Abstract [en]

    Background: Atrial fibrillation (AF) is an arrhythmia with high impact on public health. Among modifiable risk factors for the disease the role of alcohol consumption (AC) has remained inconsistent.

    Purpose: To assess the association between AC and incident AF across European cohorts.

    Methods: To study the association between self-reported AC and incident AF in N=107,845 community-based individuals from the BiomarCaRE consortium, 106,915 individuals free of AF at baseline were followed up for AF and stroke after AF. We assessed AC using validated questionnaires. Biomarkers N-terminal pro B-type natriuretic peptide (Nt-proBNP) and high sensitivity troponin I (hsTnI) were measured.

    Results: The median age of individuals was 47.8 years, 48.3% were men. The median of right-winsorized AC was 3 g/day. N=6,055 individuals developed AF (median follow-up time: 13.9 years). In a linear multivariable-adjusted Cox regression analyses, AC was linearly and positively associated with incident AF (Figure), hazard ratio (HR) per g/day 1.009, 95% confidence interval (CI) 1.007- 1.012, P<0.001. For one drink (12g) per day the HR was 1.15, CI 1.12–1.18, P<0.001. There was a high heterogeneity in associations across cohorts.

    No significant interactions of the association by Nt-proBNP and hsTnI were observed. AC was positively related to stroke risk after diagnosis of AF (HR 1.18, 95% CI 1.04–1.34, P=0.012).

    Conclusions: In contrast to other cardiovascular diseases, we did not observe a U-shaped association of alcohol with incident AF in the community, but a rather linearly increasing relation.

  • 28. D'Ascenzi, F.
    et al.
    Cameli, M.
    Iadanza, A.
    Reccia, R.
    Lisi, M.
    Curci, V.
    Sinicropi, G.
    Henein, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Pierli, C.
    Mondillo, S.
    Left atrial remodeling in patients undergoing transcatheter aortic valve implantation: a speckle tracking prospective study2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no Supplement: 1, p. 338-338Article in journal (Other academic)
    Abstract [en]

    Background: Aortic Stenosis (AS) results in several Left Ventricular (LV) disturbances as well as progressive Left Atrial (LA) enlargement and dysfunction. Transcatheter Aortic Valve Implantation (TAVI) reverses LV remodelling and improves overall systolic function but its effect on LA function remains undetermined. The aim of this prospective study was toinvestigate the effects of TAVI on LA structure and function.

    Material and methods: We studied thirty-two patients with severe symptomatic AS and high surgical risk who underwent TAVI, using standard and 2-dimensional speckle-tracking echocardiography before, at 40-day and at 3-month follow-up.

    Results: Following TAVI, mean transvalvular gradient reduced (p<0.001). Both LA mean area index and LA mean volume index decreased at 40-day (16.2±6.4 vs. 12.5±2.9 cm2/m2, and 47.3±12.0 vs. 42.8±12.5 mL/m2, respectively, p<0.05) and values remained unchanged at 3 months. The reduction of LA size was accompanied by a significant increase in global PALS (14.4±3.9% vs. 19.1±4.7%, p<0.001) and global PACS (8.4±2.5% vs. 11.0±4.1%, p<0.05) at 3-month. After the procedure, LA stiffness measurements decreased and became significant at 3-month follow up (p<0.001). Pre-procedural trans-aortic mean gradient and pre-procedural LA volume were identified as predictors of global PALSincrease (p<0.0001) while the delta drop in trans-aortic mean gradient as predictors of LA volume index reduction 3 months after TAVI (p<0.0001).

    Conclusion: TAVI is associated with significant recovery of LA structure and function suggesting a reverse cavity remodelling. Such functional recovery is determined by the severity of pre-procedural valve stenosis.

  • 29. Drager, Luciano F.
    et al.
    Li, Jianguo
    Shin, Mi-Kyung
    Reinke, Christian
    Aggarwal, Neil R.
    Jun, Jonathan C.
    Bevans-Fonti, Shannon
    Sztalryd, Carole
    OByrne, Sheila M.
    Kroupa, Olessia
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Olivecrona, Gunilla
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Blaner, William S.
    Polotsky, Vsevolod Y.
    Intermittent hypoxia inhibits clearance of triglyceride-rich lipoproteins and inactivates adipose lipoprotein lipase in a mouse model of sleep apnoea2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no 6, p. 783-U33Article in journal (Refereed)
    Abstract [en]

    Delayed lipoprotein clearance is associated with atherosclerosis. This study examined whether chronic intermittent hypoxia (CIH), a hallmark of obstructive sleep apnoea (OSA), can lead to hyperlipidaemia by inhibiting clearance of triglyceride rich lipoproteins (TRLP). Male C57BL/6J mice on high-cholesterol diet were exposed to 4 weeks of CIH or chronic intermittent air (control). FIO2 was decreased to 6.5 once per minute during the 12 h light phase in the CIH group. After the exposure, we measured fasting lipid profile. TRLP clearance was assessed by oral gavage of retinyl palmitate followed by serum retinyl esters (REs) measurements at 0, 1, 2, 4, 10, and 24 h. Activity of lipoprotein lipase (LpL), a key enzyme of lipoprotein clearance, and levels of angiopoietin-like protein 4 (Angptl4), a potent inhibitor of the LpL activity, were determined in the epididymal fat pads, skeletal muscles, and heart. Chronic intermittent hypoxia induced significant increases in levels of total cholesterol and triglycerides, which occurred in TRLP and LDL fractions (P 0.05 for each comparison). Compared with control mice, animals exposed to CIH showed increases in REs throughout first 10 h after oral gavage of retinyl palmitate (P 0.05), indicating that CIH inhibited TRLP clearance. CIH induced a 5-fold decrease in LpL activity (P 0.01) and an 80 increase in Angptl4 mRNA and protein levels in the epididymal fat, but not in the skeletal muscle or heart. CIH decreases TRLP clearance and inhibits LpL activity in adipose tissue, which may contribute to atherogenesis observed in OSA.

  • 30.
    Eliasson, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Lundqvist, R.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Comparison of trends in cardiovascular risk factors between two regions with and without a community and primary care prevention programme2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 76-76Article in journal (Other academic)
  • 31. Ericsson, M.
    et al.
    Hellström Ängerud, Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Nursing.
    Sederholm Lawesson, S.
    Swahn, E.
    Stromberg, A.
    Isaksson, R. M.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    First medical contact in the pre-hospital phase of a myocardial infarction, the interaction between callers and tele-nurses impacts action and level of care2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 1120-1120Article in journal (Other academic)
    Abstract [en]

    Background: Pre-hospital delay in myocardial infarction (MI) patients' is of great concern. The total ischemic time, i.e., between symptom onset and reperfusion therapy is the most important factor to achieve best possible outcome. One reason for patient delay is choice of first medical Contact (FMC), still not everyone contact the emergency medical services. A previous Swedish cross-sectional multicentre study found that every fifth patient with an evolving ST elevated MI (STEMI) contacted an advisement tele-nurse intended for non-life-threatening situations as FMC. This caused a median difference in delay of 38 min from symptom onset to diagnosis. Advisement tele-nursing is an expanding actor in the Swedish healthcare system, as in some other Western nations.

    Purpose: The aim was to explore the communication between tele-nurses and callers when MI patients called a national health advisement number as FMC.

    Method: This study had a qualitative approach. We received access to 30 authentic calls. The recordings lasted between 0:39 minutes to 16:44 minutes, transcribed verbatim and analysed with content analysis. The following questions were applied to the transcript: (1) How do the callers communicate their symptom and context (2) How do the tele-nurses respond and which level of care was directed (3) Do the callers get an advice and what action do they take.

    Result: One third of the callers were female, aged 46–89 years, six were diagnosed with NSTEMI and 24 with STEMI. All tele-nurses were females. The calls followed a structure of three phases, opening-, orienting- and end-phase. The first phase was non-interfered, where the caller communicated their context and/or symptoms and tele-nurses adopt an active listening position, followed by two interactive phases. Four categories defined the interaction in the communication, indecisive, irrational, distinct or reasoning. The different interactions illustrated how tele-nurses and callers assessed and elaborated upon symptom, context and furthermore expressed the process in the dialogue. Type of interaction was pivotal for progress in the call and had impact on the communicative process either sufficient in reaching a mutual understanding or not. An indecisive or irrational interaction could increase risk of acute care not being recommended. A non explicit explanation, why it is of importance to seek acute care could lead caller to ignore the advice.

    Conclusion: Both communicative and medical skills are needed to identify level of urgency. Our study suggests that the interaction in the communication categorised in four types, indecisive, irrational or distinct or reasoning can mislead level of care directed as well as a disability to express the need of acute care. This knowledge adds new perspective and hopefully will our findings be useful to deepen our knowledge in identifying MI patients and in a broader sense improve educational efforts and diminsh delay.

  • 32.
    Ericsson, M.
    et al.
    Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden.
    Sederholm-Lawesson, S.
    Linkoping Univ, Dept Cardiol Med & Hlth Sci, Linkoping, Sweden.
    Isaksson, R. M.
    Norrbotten Cty Council, Dept Res, Lulea, Sweden.
    Hellström Ängerud, Karin
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Logander, E.
    Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden.
    Swahn, E.
    Linkoping Univ, Dept Cardiol Med & Hlth Sci, Linkoping, Sweden.
    Thylen, I.
    Linkoping Univ, Div Nursing Sci, Dept Med & Hlth Sci, Linkoping, Sweden.
    Differences in symptom presentation in STEMI patients, with or without a previous history of hypertension: a survey report from the SymTime study group2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P5161, p. 908-908Article in journal (Other academic)
  • 33.
    Eriksson, Marie
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Forslund, Ann-Sofi
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Greater decreases in cholesterol levels among individuals with high cardiovascular risk than among the general population: the northern Sweden MONICA study 1994 to 20142016In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, no 25, p. 1985-1992Article in journal (Refereed)
    Abstract [en]

    AIM: Decreasing cholesterol levels in Western populations is the main reason for decreasing mortality due to coronary heart disease. Our aim was to analyze trends in cholesterol levels in the population during a period of 20 years in relation to previous cardiovascular disease (CVD), other cardiovascular risk factors, and socioeconomic status.

    METHODS AND RESULTS: A total of 4546 women and 4349 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%). Total cholesterol levels decreased from 6.2 mmol/L (95% confidence interval, CI, 6.1-6.2) in 1994 to 5.5 mmol/L (CI 5.4-5.5) in 2014. The decrease was more pronounced in elderly vs. younger participants (1.0 vs. 0.5 mmol/L). In 2014, participants with previous CVD, diabetes, or hypertension had lower cholesterol levels than the general population, whereas their levels were higher or similar to the general population in 1994. The use of lipid-lowering drugs increased markedly and was used by 14.3% in 2014. Previously described differences in cholesterol levels between participants with obesity and normal weight, and between those with and without university education, diminished, or vanished over time.

    CONCLUSION: Cholesterol levels decreased by 0.7 mmol/L over 20 years with no sign of abating. The improvement occurred in all age and gender groups but more prominently among those at high risk of ischaemic heart disease.

  • 34.
    Eriksson, Peter
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Long-term clopidogrel therapy after percutaneous coronary intervention in PCI-CURE and CREDO: the2004In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 25, no 9, p. 720-722Article in journal (Refereed)
  • 35. Friedrich, Felix W
    et al.
    Bausero, Pedro
    Sun, Yuli
    Treszl, Andras
    Krämer, Elisabeth
    Juhr, Denise
    Richard, Pascale
    Wegscheider, Karl
    Schwartz, Ketty
    Brito, Dulce
    Arbustini, Eloisa
    Waldenström, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Isnard, Richard
    Komajda, Michel
    Eschenhagen, Thomas
    Carrier, Lucie
    A new polymorphism in human calmodulin III gene promoter is a potential modifier gene for familial hypertrophic cardiomyopathy.2009In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 30, no 13, p. 1648-1655Article in journal (Refereed)
    Abstract [en]

    AIMS: Familial hypertrophic cardiomyopathy (FHC) is caused by mutations in genes encoding sarcomeric proteins. Incomplete penetrance suggests the existence of modifier genes. Calmodulin (CaM) could be of importance given the key role of Ca(2+) for cardiac contractile function and growth. Any variant that affects CaM expression and/or function may impact on FHC clinical expression. METHODS AND RESULTS: We screened the promoter region of human calmodulin III gene (CALM3) and identified a new -34T>A polymorphism with a T-allele frequency of 0.70. The distribution of CALM3 genotypes differed in 180 unrelated FHC patients carrying a known FHC mutation compared with 134 controls, with higher TT-genotype frequency (0.73 vs. 0.51) and lower frequencies of AT- (0.24 vs. 0.37) and AA genotypes (0.03 vs. 0.11; P = 0.0005). To study whether the -34T>A polymorphism could play a modifier role, patients' relatives including both affected and healthy carriers were added. Affected carriers had a 0.56 times higher odds of carrying a T allele than healthy carriers (P = 0.053). We then investigated whether the -34T>A polymorphism affects the promoter activity using luciferase reporter vectors containing either CALM3-T or CALM3-A promoters. The activity of CALM3-T was lower than CALM3-A in HEK293 cells (1.00 +/- 0.19 vs. 2.31 +/- 0.13, P = 0.00001) and in cardiomyocytes (0.96 +/- 0.10 vs. 1.33 +/- 0.08, P = 0.00727). CONCLUSION: These data suggest that the -34T>A CALM3 polymorphism is a modifier gene for FHC, potentially by affecting expression level of CALM3 and therefore Ca(2+)-handling and development of hypertrophy.

  • 36. Glader, C A
    et al.
    Birgander, L S
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ildgruben, H P
    Saikku, P
    Waldenström, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Dahlén, G H
    Lipoprotein(a), Chlamydia pneumoniae, leptin and tissue plasminogen activator as risk markers for valvular aortic stenosis.2003In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 24, no 2, p. 198-208Article in journal (Refereed)
    Abstract [en]

    AIMS: The aim of the present study was to identify risk markers for the development of valvular aortic stenosis (AS). Lipoprotein(a) (Lp(a)) and Chlamydia pneumoniae IgG antibody titres in plasma and in circulating immune complexes as well as leptin and tissue plasminogen activator (t-PA) in plasma were studied.

    METHODS AND RESULTS: One hundred and one patients (41 women and 60 men, mean age 71+/-8 years) with significant AS and 101 age- and sex-matched controls were included in this study. All patients underwent aortic valve replacement at the University Hospital in Umeå, Sweden. The controls had no symptoms of cardiovascular disease and they were examined echocardiographically. An Lp(a) level >or=480 mg x l(-1), a C. pneumoniae-specific IgG titre >or=1/128, a high leptin level and a high t-PA mass concentration in plasma were identified as risk markers for AS. A strong synergism between Lp(a) and C. pneumoniae IgG antibodies in circulating immune complexes was found.

    CONCLUSION: Our data indicate that a chronic C. pneumoniae infection and a high plasma Lp(a) level might influence and aggravate aortic heart valve sclerosis via the formation of circulating immune complexes. The present study also strongly suggests an association between high plasma leptin, t-PA mass concentration and AS.

  • 37. Greve, A.
    et al.
    Gohlke-Baerwolf, C.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Egstrup, K.
    Kesianemi, Y. A.
    Ray, S.
    Pedersen, T.
    Best, P.
    Rajamannan, N.
    Wachtell, K.
    The low-density lipoprotein-density-pressure theory identifies asymptomatic aortic stenosis patients benefiting from cholesterol lowering therapy: the seas study2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P2392, p. 419-420Article in journal (Other academic)
  • 38.
    Gustafsson, Sandra
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Granåsen, Gabriel
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Grönlund, Christer
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Suhr, Ole B.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Discriminating hereditary transthyretin cardiomyopathy from hypertrophic cardiomyopathy using an echocardiographic and ECG based classification tree2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P5254, p. 929-929Article in journal (Other academic)
  • 39.
    Gustafsson, Sandra
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå Heart Centre.
    Grönlund, Christer
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Mörner, Stellan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå Heart Centre.
    Suhr, Ole
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology. Umeå Heart Centre.
    Can echocardiography differentiate hereditary transthyretin amyloidosis from hypertrophic cardiomyopathy?2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no Supplement: 1, p. 213-213Article in journal (Other academic)
    Abstract [en]

    Purpose: Hereditary transthyretin amyloidosis (ATTR) andhypertrophic cardiomyopathy (HCM) have many phenotypic similarities when examined by echocardiography. As the two conditions have different treatment strategies it is of importance to accurately diagnose these patients early in the disease. This study aimed to identify the most accurate echocardiographic method in differentiating these two conditions by using traditional and speckle tracking echocardiographyas well as myocardial texture analysis.

    Methods: We investigated 40 healthy controls, 33 patients with biopsy proven ATTR and 20 with HCM. All patients had septal thickness >12 mm. We measured left ventricular (LV) global strain as intrinsic systolic function and LV E/e' to estimate filling pressures. We also tested septal cyclic integrated backscatter (cIBS) and septal entropy as both being measures for myocardial highly reflection pattern whereas cIBS showing motion of highly reflective echoes and entropy the distribution of highly reflective echoes.

    Results: LV global strain, cIBS and E/e' were not useful in differentiating ATTR from HCM. However, septal entropy was found to be significantly different and showed an area under the curve from ROC analysis of 0.66 separating ATTR from HCM.

    Conclusion: After using detailed analysis of different aspects of LV morphology and function we found that myocardial texture behavior from entropy analysis was the only method useful in differentiating patients with ATTR fromHCM.

  • 40. Haas, Jan
    et al.
    Frese, Karen S
    Peil, Barbara
    Kloos, Wanda
    Keller, Andreas
    Nietsch, Rouven
    Feng, Zhu
    Müller, Sabine
    Kayvanpour, Elham
    Vogel, Britta
    Sedaghat-Hamedani, Farbod
    Lim, Wei-Keat
    Zhao, Xiaohong
    Fradkin, Dmitriy
    Köhler, Doreen
    Fischer, Simon
    Franke, Jennifer
    Marquart, Sabine
    Barb, Ioana
    Li, Daniel Tian
    Amr, Ali
    Ehlermann, Philipp
    Mereles, Derliz
    Weis, Tanja
    Hassel, Sarah
    Kremer, Andreas
    King, Vanessa
    Wirsz, Emil
    Isnard, Richard
    Komajda, Michel
    Serio, Alessandra
    Grasso, Maurizia
    Syrris, Petros
    Wicks, Eleanor
    Plagnol, Vincent
    Lopes, Luis
    Gadgaard, Tenna
    Eiskjær, Hans
    Jørgensen, Mads
    Garcia-Giustiniani, Diego
    Ortiz-Genga, Martin
    Crespo-Leiro, Maria G
    Deprez, Rondal H Lekanne Dit
    Christiaans, Imke
    van Rijsingen, Ingrid A
    Wilde, Arthur A.
    Waldenström, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Bolognesi, Martino
    Bellazzi, Riccardo
    Mörner, Stellan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Bermejo, Justo Lorenzo
    Monserrat, Lorenzo
    Villard, Eric
    Mogensen, Jens
    Pinto, Yigal M
    Charron, Philippe
    Elliott, Perry
    Arbustini, Eloisa
    Katus, Hugo A
    Meder, Benjamin
    Atlas of the clinical genetics of human dilated cardiomyopathy2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 18, p. 1123-U43Article in journal (Refereed)
    Abstract [en]

    Aim: We were able to show that targeted Next-Generation Sequencing is well suited to be applied in clinical routine diagnostics, substantiating the ongoing paradigm shift from low- to high-throughput genomics in medicine. By means of our atlas of the genetics of human DCM, we aspire to soon be able to apply our findings to the individual patient with cardiomyopathy in daily clinical practice. Numerous genes are known to cause dilated cardiomyopathy (DCM). However, until now technological limitations have hindered elucidation of the contribution of all clinically relevant disease genes to DCM phenotypes in larger cohorts. We now utilized next-generation sequencing to overcome these limitations and screened all DCM disease genes in a large cohort. Methods and results: In this multi-centre, multi-national study, we have enrolled 639 patients with sporadic or familial DCM. To all samples, we applied a standardized protocol for ultra-high coverage next-generation sequencing of 84 genes, leading to 99.1% coverage of the target region with at least 50-fold and a mean read depth of 2415. In this well characterized cohort, we find the highest number of known cardiomyopathy mutations in plakophilin-2, myosin-binding protein C-3, and desmoplakin. When we include yet unknown but predicted disease variants, we find titin, plakophilin-2, myosin-binding protein-C 3, desmoplakin, ryanodine receptor 2, desmocollin-2, desmoglein-2, and SCN5A variants among the most commonly mutated genes. The overlap between DCM, hypertrophic cardiomyopathy (HCM), and channelopathy causing mutations is considerably high. Of note, we find that >38% of patients have compound or combined mutations and 12.8% have three or even more mutations. When comparing patients recruited in the eight participating European countries we find remarkably little differences in mutation frequencies and affected genes. Conclusion: This is to our knowledge, the first study that comprehensively investigated the genetics of DCM in a large-scale cohort and across a broad gene panel of the known DCM genes. Our results underline the high analytical quality and feasibility of Next-Generation Sequencing in clinical genetic diagnostics and provide a sound database of the genetic causes of DCM.

  • 41.
    Hellström Ängerud, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Nursing.
    Ericsson, M.
    Isaksson, R. M.
    Sederholm Lawesson, S.
    Thylen, I.
    Swahn, E.
    Differences in symptoms in relation to myocardial infarction type2016In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, p. 730-730Article in journal (Other academic)
  • 42.
    Hellström Ängerud, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sederholm Lawesson, S
    Linköping Univ Hosp, Dept Cardiol, S-58185 Linköping, Sweden.
    Swahn, E
    Linköping Univ Hosp, Dept Cardiol, S-58185 Linköping, Sweden.
    Thylén, I
    Linköping Univ Hosp, Dept Cardiol, S-58185 Linköping, Sweden.
    Isaksson, R. M
    Norrbotten City Council, Sunderby Hosp, Dept Res, Luleå, Sweden.
    Ericsson, M
    Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Symptoms in MI in patients with and without diabetes: a survey report from the SymTime study group2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P6111, p. 1076-1076Article in journal (Other academic)
  • 43.
    Henein, Michael
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Nicoll, Rachel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Schmermund, A.
    Diederichsen, A. C. P.
    Mickley, H.
    Zamorano, P.
    Gueret, P.
    Budoff, M. J.
    European Calcific Coronary Artery Disease (Euro-CCAD) study: the additional value of coronary calcification, to angiography, in investigating angina patients2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no Supplement: 1, p. 177-177Article in journal (Other academic)
    Abstract [en]

    Background and aim: This study is a part of the Euro-CCAD (CalcificCoronary Artery Disease) project, investigating the geographic prevalence of a coronary artery calcium (CAC) score of >400 in patients with no flow-limiting lesions (FLL) as a potential cause for stable angina. With the development of computerized tomographic coronaryangiography (CTCA), assessment of CAC has become less fashionable, although CTCA often fails to determine the exact cause of symptoms in the absence of FLLs.

    Methods: Data from consecutive symptomatic intermediate risk patients (as defined by guidelines), who had both CA and calcium scoring, were compared between USA and Europe as well as between Europeancountries (Denmark, Germany, France and Spain). No patient had a priorcoronary event, intervention, valve disease or kidney failure.

    Results: The inclusion criteria were fulfilled in 4,444 patients, (60% males), mean age 59.3 years (SD 11.3 years). The prevalence of FLL was higher in the USA at 53% (983/1851) than in Europe at 34% (870/2593) as a whole, (p<0.001). The FLL prevalence was also different (p<0.001) within Europe: Denmark 16%, Germany 35%, France 46% and Spain 89%. In patients with no FLL, 9% had CAC >400, with no difference in prevalence between the USA and Europe, irrespective of age and gender. However, within Europe the prevalence of patients without FLL and with a CAC score >400 differed: Spain 22%, Germany 13%, France 10% and Denmark 7%. Within the total patient population 22% of those with CAC score >400 had no FLL.

    Conclusion: Despite the known variability in the current management of symptomatic angina patients at intermediate risk between the USA andEuropean countries, a consistent proportion (nearly 10%) exhibits severe CAC in the absence of flow limiting lesions. The presence of severe CAC could explain their symptoms through compromised coronary flow reserve. These results highlight the potential value of obtaining additional anatomical information by using CAC assessment in symptomatic patients.

  • 44.
    Henein, Michael Y.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Nicoll, Rachel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Schmermund, A.
    Diederichsen, A. C. P.
    Mickley, H.
    Zamorano, P.
    Gueret, P.
    Budoff, M. J.
    European Calcific Coronary Artery Disease (Euro-CCAD) study: the relationship between coronary calcification and flow limiting lesion in symptomatic patients2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no Supplement: 1, p. 723-723Article in journal (Other academic)
    Abstract [en]

    Background and aim: This study is a part of the Euro-CCAD (CalcificCoronary Artery Disease) project, investigating the geographic prevalence of a coronary artery calcium (CAC) score of >400 in patients with no flow-limiting lesions (FLL) as a potential cause for stable angina. With the development of computerized tomographic coronaryangiography (CTCA), assessment of CAC has become less fashionable, although CTCA often fails to determine the exact cause of symptoms in the absence of FLLs.

    Methods: Data from consecutive symptomatic intermediate risk patients (as defined by guidelines), who had both CA and calcium scoring, were compared between USA and Europe as well as between Europeancountries (Denmark, Germany, France and Spain). No patient had a priorcoronary event, intervention, valve disease or kidney failure.

    Results: The inclusion criteria were fulfilled in 4,444 patients, (60% males), mean age 59.3 years (SD 11.3 years). The prevalence of FLL was higher in the USA at 53% (983/1851) than in Europe at 34% (870/2593) as a whole, (p<0.001). The FLL prevalence was also different (p<0.001) within Europe: Denmark 16%, Germany 35%, France 46% and Spain 89%. In patients with no FLL, 9% had CAC >400, with no difference in prevalence between the USA and Europe, irrespective of age and gender. However, within Europe the prevalence of patients without FLL and with a CAC score >400 differed: Spain 22%, Germany 13%, France 10% and Denmark 7%. Within the total patient population 22% of those with CAC score >400 had no FLL.

    Conclusion: Despite the known variability in the current management of symptomatic angina patients at intermediate risk between the USA andEuropean countries, a consistent proportion (nearly 10%) exhibits severe CAC in the absence of flow limiting lesions. The presence of severe CAC could explain their symptoms through compromised coronary flow reserve. These results highlight the potential value of obtaining additional anatomical information by using CAC assessment in symptomatic patients.

  • 45.
    Henriksson, Robin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ulvenstam, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Graipe, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Mooe, Thomas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ticagrelor reduces the risk of ischemic stroke after acute myocardial infarction compared with clopidogrel2016In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, p. 636-636Article in journal (Other academic)
  • 46. Hjortshøj, Cristel M Sørensen
    et al.
    Kempny, Aleksander
    Jensen, Annette Schophuus
    Sørensen, Keld
    Nagy, Edit
    Dellborg, Mikael
    Johansson, Bengt
    Rudiene, Virginija
    Hong, Gu
    Opotowsky, Alexander R
    Budts, Werner
    Mulder, Barbara J
    Tomkiewicz-Pajak, Lidia
    D'Alto, Michele
    Prokšelj, Katja
    Diller, Gerhard-Paul
    Dimopoulos, Konstantinos
    Estensen, Mette-Elise
    Holmstrøm, Henrik
    Turanlahti, Maila
    Thilén, Ulf
    Gatzoulis, Michael A
    Søndergaard, Lars
    Past and current cause-specific mortality in Eisenmenger syndrome.2017In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 26, p. 2060-2067Article in journal (Refereed)
    Abstract [en]

    Aims: Eisenmenger syndrome (ES) is associated with considerable morbidity and mortality. Therapeutic strategies have changed during the 2000s in conjunction with an emphasis on specialist follow-up. The aim of this study was to determine the cause-specific mortality in ES and evaluate any relevant changes between 1977 and 2015.

    Methods and results: This is a retrospective, descriptive multicentre study. A total of 1546 patients (mean age 38.7 ± 15.4 years; 36% male) from 13 countries were included. Cause-specific mortality was examined before and after July 2006, 'early' and 'late', respectively. Over a median follow-up of 6.1 years (interquartile range 2.1-21.5 years) 558 deaths were recorded; cause-specific mortality was identified in 411 (74%) cases. Leading causes of death were heart failure (34%), infection (26%), sudden cardiac death (10%), thromboembolism (8%), haemorrhage (7%), and peri-procedural (7%). Heart failure deaths increased in the 'late' relative to the 'early' era (P = 0.032), whereas death from thromboembolic events and death in relation to cardiac and non-cardiac procedures decreased (P = 0.014, P = 0.014, P = 0.004, respectively). There was an increase in longevity in the 'late' vs. 'early' era (median survival 52.3 vs. 35.2 years, P < 0.001).

    Conclusion: The study shows that despite changes in therapy, care, and follow-up of ES in tertiary care centres, all-cause mortality including cardiac remains high. Patients from the 'late' era, however, die later and from chronic rather than acute cardiac causes, primarily heart failure, whereas peri-procedural and deaths due to haemoptysis have become less common. Lifelong vigilance in tertiary centres and further research for ES are clearly needed.

  • 47.
    Huber, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Henriksson, Robin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Jakobsson, Stina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Mooe, Thomas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Nurse-led telephone-based follow-up of secondary prevention after acute myocardial infarction: one-year results from the randomized controlled NAILED-ACS trial2016In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, p. 337-338Article in journal (Other academic)
  • 48.
    Huber, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Section of Cardiology, Dept of Internal Medicine, Östersund Hospital, Östersund Sweden, Östersund, Sweden.
    Wiken, C.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Section of Cardiology, Dept of Internal Medicine, Östersund Hospital, Östersund Sweden, Östersund, Sweden.
    Henriksson, Robin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Mooe, Thomas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Section of Cardiology, Dept of Internal Medicine, Östersund Hospital, Östersund Sweden, Östersund, Sweden.
    Statin treatment after acute coronary syndrome: long-term persistence and reasons for non-persistence2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 1102-1103Article in journal (Other academic)
    Abstract [en]

    Background: Secondary prevention after acute coronary syndrome (ACS) is crucial to prevent recurrent events. Multiple studies however show that patients often end treatments and for reasons unknown. Our aims in this study were to perform a prospective follow-up of persistence to statin treatment in a population based patient cohort after ACS, to explore the reasons for discontinuation, and to determine whether a nurse-based follow-up could improve persistence.

    Methods: We studied patients recruited between 2010–2014 in the ongoing randomised controlled NAILED-ACS trial. All patients admitted with ACS at our County Hospital were eligible and exclusion criteria limited to inability to adhere to the study concept or participation in another trial. We randomised participants either to an intervention group with nurse-based telephone follow-up or to a control group with follow-up by a general practitioner (usual care). All participants were interviewed and screened yearly for blood pressure and blood lipids. The intervention group also got yearly counselling on healthy living and individualised titration of medicines to reach target values for blood pressure and blood lipids. We forwarded the measurements for the control group to the general practitioner for assessment. We collected information on adherence to statin treatment at the yearly interview and by review of medical records. Each reason for treatment discontinuation were recorded and classified as temporary or permanent.

    Results: Out of 963 patients, 89.3% (n=434) in the intervention and 82.0% (n=391) in the control group were persistent to statin treatment after a median of 3.9 years of follow-up (p=0.001). The most prevalent reason for permanent discontinuation in the intervention group was advanced disease (27.5%, n=14) while in the control group it was side effects without a compelling relation to treatment (32.8%, n=22). A total of 27.8% (n=135) of the patients in the intervention group and 20.5% (n=98) in the control group discontinued treatment at some point during the period (p=0.009). The most common reasons for a first discontinuation were in both arms side effects without a compelling relation to treatment and lack of treatment motivation.

    Conclusion: A nurse-based, long-term follow-up by telephone after an ACS with individualised medical adjustments results in a higher persistence to statin treatment than usual care.

  • 49.
    Högström, Gabriel
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    High aerobic fitness in late adolescence is associated with a reduced risk of myocardial infarction later in life: a nationwide cohort study in men2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no 44, p. 3133-3140Article in journal (Refereed)
    Abstract [en]

    AIMS: Cardiovascular disease is the leading cause of morbidity and mortality worldwide, and signs of atherosclerosis are present in all large arteries already in adolescence. We investigated the association between high physical fitness in late adolescence and myocardial infarction (MI) later in life.

    METHODS AND RESULTS: The study cohort comprised 743 498 Swedish men examined at the age of 18 years during conscription 1969-84. Aerobic fitness (Wmax) and muscle strength at conscription were measured using standardized methods. Myocardial infarctions occurring in the cohort were tracked through national registers. During a median follow-up period of 34 years, 11 526 MIs were registered in the cohort. After adjusting for age, body mass index (BMI), diseases, education, blood pressure, and socio-economic factors, one standard deviation increase in the level of physical fitness (Wmax) was associated with an 18% decreased risk of later MI [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.80-0.85]. The beneficial effects of Wmax were significant across all recognized BMI groups, ranging from lean (BMI < 18.5) to obese (BMI > 30) (P < 0.05 for all). However, obese men (BMI > 30) in the highest fourth of Wmax had a higher risk of MI than did lean men (BMI < 18.5) in the highest (HR 4.6, 95% CI 1.9-11.2), and lowest (HR 1.7, 95% CI 1.2-2.6) fourth of Wmax.

    CONCLUSIONS: We report a significant graded association between aerobic fitness in late adolescence and MI later in life in men. However, obese men with a high aerobic fitness had a higher risk of MI than lean men with a low aerobic fitness.

  • 50.
    Ibrahimi, Pranvera
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Jashari, Fisnik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Arnerlöv, Conny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Garoff, Maria
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Carotid ultrasound accurately detects arterial calcification quantified by cone beam computed tomography2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P3519, p. 636-636Article in journal (Other academic)
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