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  • 51. Hyvärinen, Marjukka
    et al.
    Tuomilehto, Jaakko
    Laatikainen, Tiina
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nilsson, Peter
    Qiao, Qing
    The impact of diabetes on coronary heart disease differs from that on ischaemic stroke with regard to the gender.2009In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 8, no 17Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To study the diabetes related CVD risk between men and women of different ages. METHODS: Hazards ratios (HRs) (95%CI) for acute CHD and ischaemic stroke events were estimated based on data of Finnish and Swedish cohorts of 5111 women and 4167 men. RESULTS: 182 (3.6%) women and 348 (8.4%) men had CHD and 129 (2.5%) women and 137 (3.3%) men ischaemic stroke events. The multivariate adjusted HRs for acute CHD at age groups of 40-49, 50-59 and 60-69 years were 1.00 (1.94), 1.78 (4.23), 3.75 (8.40) in women (men) without diabetes and 4.35 (5.40), 5.49 (9.54) and 8.84 (13.76) in women (men) with diabetes. The corresponding HRs for ischaemic stroke were 1.00 (1.26), 2.48 (2.83) and 5.17 (5.11) in women (men) without diabetes and 4.14 (4.91), 3.32 (6.75) and 13.91 (18.06) in women (men) with diabetes, respectively. CONCLUSION: CHD risk was higher in men than in women but difference reduced in diabetic population. Diabetes, however, increased stroke risk more in men than in women.

  • 52.
    Isaksson, Rose-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Medicine, Sunderby Hospital, Luleå.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Zingmark, Karin
    FoU enheten, Luleå, Norrbottens läns landsting.
    Older women's prehospital experiences of their first myocardial infarction: a qualitative analysis from the Northern Sweden MONICA Study2013In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 28, no 4, p. 360-369Article in journal (Refereed)
    Abstract [en]

    Background: Few qualitative studies have been conducted on older women’s experiences of myocardial infarction (MI) and, in particular, the time before they seek medical care.

    Objective: The aim of this study was to explore older women’s prehospital experiences of their first MI.

    Methods: Qualitative content analysis was performed on data from individual interviews with 20 women, aged 65 to 80 years (mean, 73.0 years). The participants were interviewed 3 days after admission to a hospital for a confirmed first MI.

    Results: The women perceived their symptoms as a strange and unfamiliar development from indistinct physical sensations to persistent and overwhelming chest pain. Throughout the prehospital phase, they used different strategies such as downplaying and neglecting the symptoms. The symptoms were seen as intrusions in their daily lives, against which the participants defended themselves to remain in control and to maintain social responsibilities. As their symptoms evolved into constant chest pain, the women began to realize the seriousness of their symptoms. When the pain became unbearable, the women took the decision to seek medical care.

    Conclusion: Understanding the complex experiences of older women in the prehospital phase is essential to reducing their patient decision times. The findings of this study should be incorporated into the education of professionals involved in the care of cardiac patients, including those who answer informational and emergency telephone lines.

  • 53.
    Isaksson, Rose-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Zingmark, Karin
    Prehospital experiences of older men with a first myocardial infarction: a qualitative analysis within the Northern Sweden MONICA Study2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 4, p. 787-797Article in journal (Refereed)
    Abstract [en]

    Aim:  To explore older men's prehospital experiences of their first myocardial infarction (MI). Background:  The delay between the onset of symptoms to the initiation of medical care is a major determinant of prognosis in MI. The majority of people experiencing MI are men. But few studies have been conducted solely on men's experiences before seeking medical care for MI. The objective of this study was to explore older men's experiences of symptoms and their reasoning during the prehospital phase of their first MI. Method:  Data collection was carried out through individual interviews with 20 men representing the age range 65-80 (mean 71) years. The participants were interviewed 3 days after admission for a confirmed first MI. The interviews were designed to prompt the men to describe their symptoms and their reasoning up to the decision to seek care. A qualitative content analysis was used to analyse the interviews. Findings:  The prehospital phase in older men was found to be a complex and extended journey. The symptoms were perceived from diffuse ill-being to a cluster of alarming symptoms. The participants dealt with conceptions about MI symptoms. They were unsure about the cause of their symptoms, which did not correspond to their expectations about an MI, and whether they should seek medical care. They had difficulty making the final decision to seek care and strived to maintain a normal life. They initially tried to understand, reduce or treat the symptoms by themselves. The decision to seek medical care preceded a movement from uncertainty to conviction. Conclusions:  Understanding older men's prehospital experiences of MI is essential to reduce their patient decision times. This requires knowledge about the complexity and dynamic evolvement of symptoms, beliefs and strategies to maintain an ordinary life.

  • 54.
    Isaksson, Rose-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Zingmark, Karin
    FoU enheten, Luleå, Norrbottens läns landsting.
    Prehospital experiences of older men with a first myocardial infarction: a qualitative analysis within the Northern Sweden MONICA StudyManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: To explore older men’s prehospital experiences of their first MI.

    Background:  The delay between the onset of symptoms to the initiation of medical care is a major determinant of prognosis in myocardial infarction (MI).  The largest single component of the delay is the time it takes the person to respond to the symptoms by seeking care. The majority of people experiencing MI are men. But few studies have been conducted solely on men’s experiences before seeking medical care for MI. The objective of this study was to explore older men’s experiences of symptoms and their reasoning during the prehospital phase of their first MI.

    Method: Data collection was carried out through individual interviews with 20 men representing the age range 65–80 (mean 71) years. The participants were interviewed three days after admission for a confirmed first MI (with or without ST elevation). The interviews were designed to prompt the men to describe their symptoms and their reasoning up to the decision to seek care. A qualitative content analysis was used to analyse the interviews.        

    Findings: The prehospital phase in older men was found to be a complex and extended journey. The symptoms were perceived from diffuse ill-being to a cluster of alarming symptoms. During this journey the participants dealt with conceptions about MI symptoms. They were unsure both about the cause of their symptoms, which did not correspond to their expectations about an MI, and about whether they should seek medical care. They had difficulty making the final decision to seek care and strived to maintain a normal life. They initially tried to understand, reduce, or treat the symptoms by themselves. The decision to seek medical care preceded a movement from uncertainty to conviction.

    Conclusions:Understanding older men’s prehospital experiences of MI is essential to reduce their patient decision times. This requires knowledge about the complexity and dynamic evolvement of symptoms, beliefs and strategies to maintain an ordinary life.

  • 55.
    Isaksson, Rose-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Holmgren, Lars
    Lundblad, Dan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Time trends in symptoms and prehospital delay time in women vs. men with myocardial infarction over a 15-year period. The Northern Sweden MONICA Study.2007In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 2, p. 152-158Article in journal (Refereed)
    Abstract [en]

    Background

    Few studies have examined the time between onset of myocardial infarction (MI) symptoms and arrival at hospital (prehospital delay time) and symptoms in men vs. women.

    Aims

    To describe prehospital delay time and symptoms in men vs. women with MI and to analyse trends over time and according to age.

    Methods

    The Northern Sweden MONICA myocardial infarction registry, 1989–2003, included 5072 men and 1470 women with a confirmed MI.

    Results

    Typical pain was present in 86% of the men and 81% of the women. The proportion with typical symptoms decreased over time for men and increased for women. Typical symptoms were more common among younger persons than older persons. Insufficiently reported symptoms was unchanged in men over time and decreased among women. Up to the age of 65, no gender differences were seen in the prehospital delay. In the oldest age group (65–74 years) time to hospital was longer than among the younger groups, especially among women.

    Conclusion

    There were no major gender differences in prehospital delay or type of symptoms. However, over time the proportion with typical symptoms decreased in men and increased in women. Older patients had longer prehospital delay and less typical symptoms.

  • 56.
    Isaksson, Rose-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lundblad, Dan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Zingmark, Karin
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Better long-term survival in young and middle-aged women than in men after a first myocardial infarction between 1985 and 2006. An analysis of 8630 patients in the Northern Sweden MONICA Study.2011In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 11, p. 1-Article in journal (Refereed)
    Abstract [en]

    Age-adjusted survival was higher among women than men after a first MI and has improved markedly and equally in both men and women over a 23-year period. This difference was due to lower risk for women to die before reaching hospital.

  • 57.
    Johansson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Bylesjö, Ingemar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Nilsson, Torbjörn K
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Eliasson, Mats
    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.
    Lind, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Factor XII as a Risk Marker for Hemorrhagic Stroke: A Prospective Cohort Study2017In: Cerebrovascular diseases extra, ISSN 1664-5456, Vol. 7, no 1, p. 84-94Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Coagulation factor XII (FXII) is involved in pathological thrombus formation and is a suggested target of anticoagulants. It is unclear whether FXII levels are correlated with cardiovascular risk factors and whether they are associated with myocardial infarction or ischemic or hemorrhagic stroke. The aim of this study was to investigate the correlation between FXII and cardiovascular risk factors in the general population. We also aimed to study the associations between FXII levels and future myocardial infarction and ischemic and hemorrhagic stroke.

    METHODS: This prospective cohort study measured FXII levels in 1,852 randomly selected participants in a health survey performed in northern Sweden in 1994. Participants were followed until myocardial infarction, stroke, death, or until December 31, 2011.

    RESULTS: During the median follow-up of 17.9 years, 165 individuals were diagnosed with myocardial infarction, 108 with ischemic stroke, and 30 with hemorrhagic stroke. There were weak correlations between FXII and body mass index, cholesterol, and hypertension. There was no association between FXII and myocardial infarction or ischemic stroke, neither in univariable Cox regression analysis nor after adjustment for age, sex, smoking, body mass index, cholesterol, hypertension, and diabetes. In univariable Cox regression analysis, the hazard ratio for the association between FXII levels and hemorrhagic stroke was 1.42 per SD (95% confidence interval: 0.99-2.05). In the multivariable model, higher levels of FXII were associated with increased risk of hemorrhagic stroke (hazard ratio 1.51 per SD; 95% confidence interval: 1.03-2.21).

    CONCLUSION: We found an independent association between FXII levels and the risk of hemorrhagic stroke, but not between FXII levels and ischemic stroke or myocardial infarction.

  • 58.
    Karjalainen, Tina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Adiels, Martin
    Björck, Lena
    Cooney, Marie-Therèse
    Graham, Ian
    Perk, Joep
    Rosengren, Annika
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    An evaluation of the performance of SCORE Sweden 2015 in estimating cardiovascular risk: The Northern Sweden MONICA Study 1999-20142017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 1, p. 103-110Article in journal (Refereed)
    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.

  • 59. Keindl, M.
    et al.
    Fedotkina, A.
    du Plessis, E.
    Jain, R.
    Bergum, B.
    Falhammar, H.
    Nyström, T.
    Catrina, S. -B
    Groop, L.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Eliasson, B.
    Nilsson, P. M.
    Berg, T. J.
    Appel, S.
    Lyssenko, V.
    sIL-2R plasma levels as a potential marker for progression to vascular complications in patients with type 1 diabetes2019In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 62, p. S36-S36Article in journal (Other academic)
  • 60.
    Krachler, Benno
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Trends in food intakes in Swedish adults 1986-1999: findings from the Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) Study.2005In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 8, no 6, p. 628-635Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine changes in reported food frequency in adults between 1986 and 1999. DESIGN: Four consecutive cross-sectional surveys. SETTING: Counties of Norrbotten and Västerbotten, Northern Sweden. SUBJECTS: The Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) population, four independent cross-sectional surveys in 1986, 1990, 1994 and 1999. Randomly selected age-stratified samples of the population aged 25-64 years. Analysis is based on 2982 males and 3087 females who completed an 84-item food-frequency questionnaire. RESULTS: Between 1986 and 1999, average reported consumption of 3%-fat milk decreased from 42 to 7 intakes month(-1) in men and from 28 to 4 intakes month(-1) in women. Reported use of 1.5%-fat milk increased from 6 to 27 intakes month(-1) in men and from 6 to 24 in women. Monthly intakes of potatoes and root vegetables decreased from 38 to 27 in men and from 39 to 32 in women. Consumption of pasta increased from 4 to 7 intakes month(-1) in both sexes. Intakes of solid fats with 80% fat content dropped from 92 to 62 per month in men and from 78 to 52 per month in women, whereas use of 40%-fat spread increased from 12 to 22 intakes month(-1) in men and from 5 to 26 in women. Monthly intakes of vegetable oil increased from 3 to 12 in men and from 3 to 15 in women. The percentage of overweight or obese individuals (body mass index >25 kg m(-2)) increased from 52 to 65% in men and from 41 to 52% in women (P for linear trend in all these changes, <0.001). CONCLUSIONS: Our data indicate reduced consumption of foods with a high content of saturated fats. In spite of that, there is an unbroken trend towards increased obesity.

  • 61.
    Krachler, Benno
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Population-wide changes in reported lifestyle are associated with redistribution of adipose tissue.2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 5, p. 545-553Article in journal (Refereed)
  • 62.
    Krachler, Benno
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Reported food intake and distribution of body fat: a repeated cross-sectional study2006In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 22, no 5, p. 34-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Body mass, as well as distribution of body fat, are predictors of both diabetes and cardiovascular disease. In Northern Sweden, despite a marked increase in average body mass, prevalence of diabetes was stagnant and myocardial infarctions decreased. A more favourable distribution of body fat is a possible contributing factor.This study investigates the relative importance of individual food items for time trends in waist circumference (WC) and hip circumference (HC) on a population level. METHODS: Independent cross-sectional surveys conducted in 1986, 1990, 1994 and 1999 in the two northernmost counties of Sweden with a common population of 250,000. Randomly selected age stratified samples, altogether 2982 men and 3087 women aged 25-64 years. Questionnaires were completed and anthropometric measurements taken. For each food item, associations between frequency of consumption and waist and hip circumferences were estimated. Partial regression coefficients for every level of reported intake were multiplied with differences in proportion of the population reporting the corresponding levels of intake in 1986 and 1999. The sum of these product terms for every food item was the respective estimated impact on mean circumference. RESULTS: Time trends in reported food consumption associated with the more favourable gynoid distribution of adipose tissue were increased use of vegetable oil, pasta and 1.5% fat milk. Trends associated with abdominal obesity were increased consumption of beer in men and higher intake of hamburgers and French fried potatoes in women. CONCLUSION: Food trends as markers of time trends in body fat distribution have been identified. The method is a complement to conventional approaches to establish associations between food intake and disease risk on a population level.

  • 63. Lee, Crystal Man Ying
    et al.
    Woodward, Mark
    Pandeya, Nirmala
    Adams, Robert
    Barrett-Connor, Elizabeth
    Boyko, Edward J.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Franco, Laercio J.
    Fujimoto, Wilfred Y.
    Gonzalez, Clicerio
    Howard, Barbara V.
    Jacobs, David R., Jr.
    Keinanen-Kiukaanniemi, Sirkka
    Magliano, Dianna
    Schreiner, Pamela
    Shaw, Jonathan E.
    Stevens, June
    Taylor, Anne
    Tuomilehto, Jaakko
    Wagenknecht, Lynne
    Huxley, Rachel R.
    Comparison of relationships between four common anthropometric measures and incident diabetes2017In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 132, p. 36-44Article in journal (Refereed)
    Abstract [en]

    Aims: First, to conduct a detailed exploration of the prospective relations between four commonly used anthropometric measures with incident diabetes and to examine their consistency across different population subgroups. Second, to compare the ability of each of the measures to predict five-year risk of diabetes. Methods: We conducted a meta- analysis of individual participant data on body mass index (BMI), waist circumference (WC), waist- hip and waist- height ratio (WHtR) from the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox proportional hazard models were used to estimate the association between a one standard deviation increment in each anthropometric measure and incident diabetes. Harrell's concordance statistic was used to test the predictive accuracy of each measure for diabetes risk at five years. Results: Twenty- one studies with 154,998 participants and 9342 cases of incident diabetes were available. Each of the measures had a positive association with incident diabetes. A one standard deviation increment in each of the measures was associated with 64- 80% higher diabetes risk. WC and WHtR more strongly associated with risk than BMI (ratio of hazard ratios: 0.95 [0.92,0.99] - 0.97 [0.95,0.98]) but there was no appreciable difference between the four measures in the predictive accuracy for diabetes at five years. Conclusions: Despite suggestions that abdominal measures of obesity have stronger associations with incident diabetes and better predictive accuracy than BMI, we found no overall advantage in any one measure at discriminating the risk of developing diabetes. Any of these measures would suffice to assist in primary diabetes prevention efforts.

  • 64.
    Lieber, Ingrid
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit, Luleå, Sweden.
    Ott, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Öhlund, Louise
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lundqvist, Robert
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Sunderby Research Unit, Luleå, Sweden.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit, Luleå, Sweden.
    Lithium-associated hypothyroidism and potential for reversibility after lithium discontinuation: Findings from the LiSIE retrospective cohort study2019In: Journal of Psychopharmacology, ISSN 0269-8811, E-ISSN 1461-7285, article id UNSP 0269881119882858Article in journal (Refereed)
    Abstract [en]

    Background: The association between lithium and thyroid dysfunction has long been known. However, it remains unknown if lithium-associated hypothyroidism is reversible once lithium treatment has been stopped.

    Aims: To determine whether lithium-associated hypothyroidism was reversible in patients who subsequently discontinued lithium.

    Methods: A retrospective cohort study in the Swedish region of Norrbotten into the effects and side- effects of lithium treatment and other drugs for relapse prevention (Lithium – Study into Effects and Side Effects). For this particular study, we reviewed medical records between 1997 and 2015 of patients with lithium-associated hypothyroidism who had discontinued lithium.

    Results: Of 1340 patients screened, 90 were included. Of these, 27% had overt hypothyroidism at the start of thyroid replacement therapy. The mean delay from starting lithium to starting thyroid replacement therapy was 2.3 years (SD 4.7). In total, 50% of patients received thyroid replacement therapy within 10 months of starting lithium. Of 85 patients available for follow-up, 41% stopped thyroid replacement therapy after lithium discontinuation. Only six patients reinstated thyroid replacement therapy subsequently. Of these, only one had overt hypothyroidism.

    Conclusions: Lithium-associated hypothyroidism seems reversible in most patients once lithium has been discontinued. In such cases, thyroid replacement therapy discontinuation could be attempted much more often than currently done. Based on the limited evidence of our study, we can expect hypothyroidism to recur early after thyroid replacement therapy discontinuation, if at all.

  • 65.
    Lilja, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eriksson, Marie
    Umeå University, Faculty of Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    A right-hand shift of the distribution of fasting and post load glucose in northern Sweden between 1990 and 2009, and its predictorsManuscript (preprint) (Other academic)
    Abstract [en]

    Background Recent Swedish studies have shown stable diabetes prevalence despite increasing obesity, but glucose levels may shift upwards below the diagnostic threshold for diabetes. Determinants for this shift are not consistently described, and may include obesity and obesity related factors such as the adipokine leptin.

    Aims To explore secular trends in diabetes prevalence, glucose concentrations and glucose intolerance in northern Sweden, to evaluate if these trends are uniformly distributed throughout the spectrum of glucose concentrations, and to relate trends in glucose concentrations to  traditional risk factors and leptin.

    Methods Four cross-sectional population surveys between 1990 and 2009 with 7069 participants aged 25-64 years with an overall participation rate of 74.4%. Tukey mean-difference plot were used to examine changes in glucose distribution together with trend analyses in each decile of glucose distribution. Linear regression was used to estimate changes in glucose levels in relation to survey year and risk factors including leptin.

    Results Fasting and post load glucose in women (all p<0.001) and post load glucose in men (p=0.004) increased, and the increase was seen in almost all deciles of glucose concentrations, but more pronounced in the upper deciles. In men, fasting glucose remained unchanged, though with an increase in lower deciles. The prevalence of impaired glucose tolerance rose in women from 7.8 to 14.5% and in men from 3.5 to 10.1% (all p=0.004), and the prevalence of impaired fasting glucose rose in women from 4.5 to 7.7% (p<0.001), but was unchanged in men.  The prevalence of diabetes did not change and was 2009 in men 6.4%, and in women 6.5%.  Leptin could, on top of traditional risk factors, in men partly explain the variance in fasting (p=0.008) and post load (p<0.001) glucose. 

    Conclusion The prevalence of diabetes did not increase in northern Sweden between 1986 and 2009, despite increasing fasting and post load glucose levels seen in most deciles of glucose distribution. Leptin is significantly associated with changes in fasting and post load glucose in men.

  • 66.
    Lilja, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Public Health and Clinical Medicine, Sunderby Unit, Umeå University, Umeå, Sweden.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    A rightward shift of the distribution of fasting and post-load glucose in northern Sweden between 1990 and 2009 and its predictors. Data from the Northern Sweden MONICA study2013In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 30, no 9, p. 1054-1062Article in journal (Refereed)
    Abstract [en]

    Aims

    Most Swedish studies show stable diabetes prevalence despite increasing obesity, but glucose levels may shift upwards below the diagnostic threshold for diabetes. Our aim was to explore trends in glucose distribution in northern Sweden; whether these trends were uniformly distributed throughout the spectrum of glucose concentrations; and to relate trends to traditional risk factors and the obesity-related adipokine leptin.

    Methods

    The project consisted of four cross-sectional surveys between 1990 and 2009, with 7069 participants aged 25–64 years. The overall participation rate was 74.4%. Trend analyses of glucose concentrations along the entire distribution and linear regression in relation to survey years and risk markers were used.

    Results

    Fasting and post-load glucose increased in women (both P < 0.001) and post-load glucose in men (P = 0.004). The increase was seen in most deciles of glucose concentrations. The prevalence of impaired glucose tolerance doubled in women to 14.5% and tripled in men to 10.1% (both P = 0.004). The prevalence of impaired fasting glucose rose in women from 4.5 to 7.7% (P < 0.001). The prevalence of diabetes was unchanged—6.4% in 2009. In men, leptin, together with traditional risk factors, explained 7.8 and 10.8% of the variance in fasting (P = 0.008) and post-load (P < 0.001) glucose, respectively.

    Conclusions

    Increasing fasting and post-load glucose concentrations were seen in most deciles of the glucose distribution, indicating a shift in the entire population. Leptin was significantly associated with fasting and post-load glucose in men.

  • 67.
    Lilja, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Olsson, Tommy
    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, Medicine.
    Trends in obesity and its distribution: data from the Northern Sweden MONICA survey, 1986–20042008In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 16, no 5, p. 1120-1128Article in journal (Refereed)
    Abstract [en]

    Objective: Obesity, especially abdominal, is a risk factor for many diseases. This study explored trends in theprevalence of general and abdominal obesity, 1986–2004, in northern Sweden.

    Methods and Procedures: Cross-sectional population surveys were performed in 1986, 1990, 1994, 1999, and 2004;250 men and 250 women aged 25−34, 35−44, 45−54, and 55−64 years (from 1994, also 65−74 years) were randomlyselected; the overall participation rate was 77%. Anthropometric data were used.

    Results: Weight and BMI increased in all men, most significantly in men aged 25−64 years (P < 0.0005). Weightincreased in women aged 25−64 years (P < 0.005) and BMI in women aged 25−44 years (P < 0.005). Prevalence ofobesity (BMI≥ 30) increased significantly in men aged 25−44 and 55−74 years (P < 0.005; for men 65−74 years old,P< 0.05) and in women aged 25−44 years (P < 0.005). Waist circumference decreased significantly between 1986and 1990 in all women (P < 0.005) and in men aged 55−64 years (P < 0.05). After 1990 waist circumference increased, most markedly so in women; by 2004 circumference measurements for women, and for men aged 55−64 years, were equal to those of 1986, while for men aged 25−54 years they were higher. Prevalence of abdominal obesity has increased since 1990, most markedly so in women aged 45−64 years (P < 0.0005).

    Discussion: The rapid increase in both general and central obesity raises concern for the future; increasing abdominalobesity in women is particularly alarming.

  • 68. Lindholm, Asa
    et al.
    Bixo, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology. Obstetrik och gynekologi.
    Björn, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Wölner-Hanssen, Pål
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Larsson, Anders
    Johnson, Owe
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Poromaa, Inger Sundström
    Effect of sibutramine on weight reduction in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial.2007In: Fertil Steril, ISSN 1556-5653Article in journal (Refereed)
  • 69.
    Lindholm, Åsa
    et al.
    Department of Obstetrics and Gynecology, Sunderby Hospital, Luleå, Sweden.
    Andersson, Liselott
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Bixo, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Sundström-Poromaa, Inger
    Department of Women's and Children's Health, Uppsala University, Sweden.
    Prevalence of symptoms associated with polycystic ovary syndrome2008In: International Journal of Gynaecology and Obstetrics, ISSN 0020-7292, Vol. 102, no 1, p. 39-43Article in journal (Other academic)
    Abstract [en]

    Objective: To establish the prevalence of symptoms associated with polycystic ovary syndrome (PCOS) in a population-based sample of women from Northern Sweden, and to relate symptoms of PCOS to features of metabolic syndrome.

    Methods: A population-based survey of 147 women under 40 years of age sampled from 267 eligible women from the Northern Sweden component of the World Health Organization's MONICA study. The study involved questionnaires, physical examination, and assays of testosterone and sex hormone-binding globulin.

    Results: The estimated prevalence of symptoms associated with PCOS was 4.8% in the study population. Features of metabolic syndrome were more common in women with signs of hyperandrogenism than in healthy controls.

    Conclusion: The estimated prevalence of PCOS in Northern Sweden corresponds with other prevalence studies. A simple questionnaire and analysis of the free androgen index are sufficient to detect the subgroup with the highest risk for metabolic syndrome.

  • 70.
    Lindholm, Åsa
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Bixo, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Hudecova, Miriam
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Arnadottir, Ragnheidur
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Holte, Jan
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Poromaa, Inger Sundström
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Tissue plasminogen activator and plasminogen activator inhibitor 1 in obese and lean patients with polycystic ovary syndrome2010In: Gynecological Endocrinology, ISSN 0951-3590, E-ISSN 1473-0766, Vol. 26, no 10, p. 743-748Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Disturbances in the fibrinolytic system are predictors of future cardiovascular events. The aim of this study was to compare plasminogen activator inhibitor 1 (PAI-1) activity and tissue plasminogen activator (tPA) mass concentration between patients with polycystic ovary syndrome (PCOS) and control subjects.

    DESIGN: One hundred thirty-five patients with PCOS (lean and obese) and 81 healthy controls were recruited for the study. Blood samples for PAI-1 activity and tPA mass were collected together with anthropometric measures.

    RESULTS: Obese patients with PCOS displayed increased tPA mass concentration in comparison with controls (p <0.05), and this finding was consistent regardless of whether patients displayed signs of hyperandrogenism or not. When hyperandrogenism was introduced as a prerequisite for the PCOS diagnosis, obese patients with PCOS displayed increased PAI-1 activity as well, p <0.05. Lean patients with PCOS did not differ in terms of PAI-1 activity or tPA mass concentration in comparison to controls.

    CONCLUSION: Obese women with PCOS have impaired fibrinolysis, in particular if they also display objective biochemical markers of hyperandrogenism.

  • 71.
    Lindroth, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umea Univ, Dept Publ Hlth & Clin Med, Sunderby Res Unit, Umea, Sweden.
    Lundqvist, Robert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umea Univ, Dept Publ Hlth & Clin Med, Sunderby Res Unit, Umea, Sweden.
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umea Univ, Dept Publ Hlth & Clin Med, Östersund Res Unit, Umea, Sweden.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Cardiovascular risk factors differ between rural and urban Sweden: the 2009 Northern Sweden MONICA cohort2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 825-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Rural communities have a higher burden of cardiovascular risk factors than urban communities. In Sweden, socioeconomic transition and urbanization have led to decreased populations in rural areas and changing characteristics of the remaining inhabitants. We investigated the risk factors in urban and rural populations in Northern Sweden.

    METHODS: The 2009 Northern Sweden MONICA Study invited a random sample of 2,500 people, 25 to 74 years and 69.2% participated. Community size was classified as rural = <1,000 inhabitants, town = 1,000-15,000, or urban/city= >15,000. We adjusted our analysis for age, gender and education.

    RESULTS: The rural population was older and the proportion of men was higher than in the urban areas. Having only primary education was more common in rural areas than in urban areas (26.2% vs. 12.3%). Waist and hip circumference, body mass index (BMI), and total cholesterol levels were higher in rural areas than in urban areas, even after adjusting for differences in age and gender. The largest differences between rural and urban dwellers were seen in waist circumference of women (4.8 cm), BMI of women (1.8 units) and cholesterol of men (0.37 mmol/l). Blood pressure was higher in rural areas, but not after adjusting for age and gender.Participants in rural areas were more often treated for hypertension and hyperlipidaemia, hospitalized for myocardial infarction and diagnosed with diabetes. However, after adjusting for age and gender, there were no differences. The odds ratio for being physically active comparing rural areas to urban areas was 0.73 (95% CI 0.53; 1.01). Smoking, snuff use and the prevalence of pathological glucose tolerance did not differ between community sizes. Middle-sized communities often had values in between those found in rural and urban communities, but overall they were more similar to the rural population. Further adjustment for education did not change the results for any variable.

    CONCLUSIONS: In 2009 the rural population in northern Sweden was older, with less education, higher BMI, more sedentary lifestyle, and had higher cholesterol levels than the urban population. The rural population should be considered targets for focused preventive interventions, but with due consideration of the socioeconomic and cultural context.

  • 72. Lindstedt, Göran
    et al.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    [Insufficient evidence for the need of screening and treatment of subclinical thyroid function disorders. Evidence-based analysis]2005In: Lakartidningen, ISSN 0023-7205, Vol. 102, no 1-2, p. 30-2, 35Article in journal (Refereed)
  • 73. Lindstedt, Göran
    et al.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    [New guidelines for better documentation of survey methodology and results]2005In: Lakartidningen, ISSN 0023-7205, Vol. 102, no 10, p. 748, 750, 752-3Article in journal (Refereed)
  • 74.
    Lundblad, Dan
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Internal Medicine, Sunderby Hospital, Luleå.
    Dinesen, B
    Rautio, Aslak
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Internal Medicine, Sunderby Hospital, Luleå.
    Roder, M E
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Internal Medicine, Sunderby Hospital, Luleå.
    Low level of tissue plasminogen activator activity innon-diabetic patients with a first myocardial infarction2005In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 258, no 1, p. 13-20Article in journal (Refereed)
    Abstract [en]

    Objective. To explore the role of tissue plasminogen activator (tPA) activity and plasminogen activator inhibitor type 1 (PAI-1) in survivors of a first myocardial infarction (MI). Insulin and proinsulin were analysed as potential risk factors. Design. Case-control study in northern Sweden. Subjects. A total of 115 patients under 65 years of age with a first MI were enrolled and recalled for further examination 3 months later. Twenty-seven patients were excluded, 17 with known diabetes and 10 who did not come to the follow-up, giving a final number of 88 patients, 73 men and 15 women. Patients were age- and sex matched with control subjects drawn from the local cohort in the MONICA population survey 1994. Main outcome measures. We compared MI patients and controls using univariate and multiple regression analyses including odds ratios (OR). Results. PAI-1 activity, fibrinogen, postload insulin and -proinsulin were significantly higher and tPA activity significantly lower in MI patients in the univariate analysis. In a multiple regression analysis, including also age, sex and cardiovascular risk factors, these parameters were divided in quartiles. The lowest quartile of tPA activity was significantly associated with MI (OR = 19.1; CI 3.0-123) together with the highest quartiles of fibrinogen (OR = 25; CI 5.2-120) but other variables were not. Conclusion. Low tPA activity, i.e. low fibrinolytic activity, characterized nondiabetic subjects after a first MI which is not explained by concomitant disturbances in metabolic and anthropometric variables

  • 75.
    Lundblad, Dan
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Holmgren, Lars
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gender differences in trends of acute myocardial infarction events: the Northern Sweden MONICA study 1985 - 2004.2008In: BMC cardiovascular disorders, ISSN 1471-2261, Vol. 8, p. 17-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The registration of non-fatal and fatal MI events initiated 1985 in the WHO MONICA project has been ongoing in northern Sweden since the end of the WHO project in 1995. The purpose of the present study was to analyze gender differences in first and recurrent events, case fatality and mortality in myocardial infarction (MI) in Northern Sweden during the 20-year period 1985 - 2004. METHODS: Diagnosed MI events in subjects aged 25-64 years in the Counties of Norrbotten and Västerbotten were validated according to the MONICA protocol. The total number of events registered up to January 1, 2005 was 11,763: 9,387 in men and 2,376 in women. RESULTS: The proportion of male/female events has decreased from 5.5:1 to 3:1. For males the reductions were 30% and 70% for first and recurrent MI, respectively, and for women 0% and 40% in the 55-64 year group. For both sexes a 50% reduction in 28-day case fatality was seen in the 25-64 year-group. Mortality was reduced by 69% and 45% in men and women, respectively. CONCLUSION: First and recurrent events of myocardial infarction was markedly reduced in men over the 20-year observation period, but for women the reduction was seen only for recurrent infarctions. Case fatality, on the other hand, was markedly reduced for both sexes. As a result of the positive effects on incidence and case fatality a substantial reduction was seen in total mortality, most pronounced for men.

  • 76. Lyssenko, V.
    et al.
    Moller, C.
    Storm, P.
    Poon, W.
    Vikman, P.
    Groop, L.
    Rossing, P.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, B.
    Brismar, K.
    Nilsson, P. M.
    How to survive type 1 diabetes: the prolong study2014In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 57, no S1, p. S146-S146Article in journal (Other academic)
  • 77.
    Mattsson, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rask, Eva
    Carlström, Kjell
    Andersson, Jonas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ahrén, Bo
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gender-specific links between hepatic 11beta reduction of cortisone and adipokines2007In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 15, no 4, p. 887-894Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Reduction of cortisone to cortisol is mediated by 11beta-hydroxysteroid dehydrogenase type 1 (11betaHSD1), a putative key enzyme in obesity-related complications. Experimental studies suggest that adipokines, notably leptin and tumor necrosis factor-alpha (TNF-alpha), are of importance for 11betaHSD1 activity. We hypothesized that the regulation of hepatic preceptor glucocorticoid metabolism is gender-specific and associated with circulating levels of leptin and TNF-alpha receptors and/or sex hormones. RESEARCH METHODS AND PROCEDURES: A total of 34 males and 38 women (14 premenopausal and 22 postmenopausal) underwent physical examination and fasting blood sampling. Insulin sensitivity was tested by euglycemic hyperinsulinemic clamps, and hepatic 11betaHSD1 enzyme activity was estimated by the conversion of orally-ingested cortisone to cortisol. RESULTS: Hepatic 11betaHSD1 activity was negatively associated with leptin and soluble TNF (sTNF) r1 and sTNFr2 in males. These correlations remained significant after adjustment for age and insulin sensitivity, and for sTNF-alpha receptors also after adjustment of BMI and waist circumference. In contrast, 11beta reduction of cortisone was positively associated to leptin in females after adjustment for BMI and waist circumference. DISCUSSION: Hepatic 11beta reduction shows different links to circulating adipocyte-derived hormones in males and females. This emphasizes the need for further studies on tissue-specific regulation of 11betaHSD1 in both genders.

  • 78.
    Mayans, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Lackovic, Kurt
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Lindgren, Petter
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Ruikka, Karin
    Department of Medicine, Sunderby Hospital, Luleå.
    Ågren, Åsa
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Medicine, Sunderby Hospital, Luleå.
    Holmberg, Dan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics. Umeå University, Faculty of Medicine, Umeå Centre for Molecular Medicine (UCMM).
    TCF7L2 polymorphisms are associated with type 2 diabetes in northern Sweden2007In: European Journal of Human Genetics, ISSN 1018-4813, E-ISSN 1476-5438, Vol. 15, no 3, p. 342-346Article in journal (Refereed)
    Abstract [en]

    A recent study found association of one microsatellite and five single nucleotide polymorphisms (SNPs) in intron 3 of the TCF7L2 gene with type 2 diabetes (T2D) in the Icelandic, Danish and American populations. The aim of the present study was to investigate if those SNPs were associated to T2D in two (family- and population-based) cohorts from northern Sweden. We genotyped four of the associated SNPs in a case-control cohort consisting of 872 T2D cases and 857 controls matched with respect to age, sex and geographical origin and in a sample of 59 extended families (148 affected and 83 unaffected individuals). Here, we report replication of association between T2D and three SNPs in the case-control (rs7901695, P=0.003; rs7901346, P=0.00002; and rs12255372, P=0.000004) and two SNPs in the family-based (rs7901695, P=0.01 and rs7901346, P=0.04) samples from northern Sweden. This replication strengthens the evidence for involvement of TCF7L2 in T2D.

  • 79.
    Mayans, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics. Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Lackovic, Kurt
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Nyholm, Caroline
    Lindgren, Petter
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Ruikka, Karin
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Cilio, Corrado M
    Holmberg, Dan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    CT60 genotype does not affect CTLA-4 isoform expression despite association to T1D and AITD in northern Sweden2007In: BMC Medical Genetics, ISSN 1471-2350, E-ISSN 1471-2350, Vol. 8, article id 3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Polymorphisms in and around the CTLA-4 gene have previously been associated to T1D and AITD in several populations. One such single nucleotide polymorphism (SNP), CT60, has been reported to affect the expression level ratio of the soluble (sCTLA-4) to full length CTLA-4 (flCTLA-4) isoforms. The aims of our study were to replicate the association previously published by Ueda et al. of polymorphisms in the CTLA-4 region to T1D and AITD and to determine whether the CT60 polymorphism affects the expression level ratio of sCTLA-4/flCTLA-4 in our population.

    METHODS: Three SNPs were genotyped in 253 cases (104 AITD cases and 149 T1D cases) and 865 ethnically matched controls. Blood from 23 healthy individuals was used to quantify mRNA expression of CTLA-4 isoforms in CD4+ cells using real-time PCR. Serum from 102 cases and 59 healthy individuals was used to determine the level of sCTLA-4 protein.

    RESULTS: Here we show association of the MH30, CT60 and JO31 polymorphisms to T1D and AITD in northern Sweden. We also observed a higher frequency of the CT60 disease susceptible allele in our controls compared to the British, Italian and Dutch populations, which might contribute to the high frequency of T1D in Sweden. In contrast to previously published findings, however, we were unable to find differences in the sCTLA-4/flCTLA-4 expression ratio based on the CT60 genotype in 23 healthy volunteers, also from northern Sweden. Analysis of sCTLA-4 protein levels in serum showed no correlation between sCTLA-4 protein levels and disease status or CT60 genotype.

    CONCLUSION: Association was found between T1D/AITD and all three polymorphisms investigated. However, in contrast to previous investigations, sCTLA-4 RNA and protein expression levels did not differ based on CT60 genotype. Our results do not rule out the CT60 SNP as an important polymorphism in the development of T1D or AITD, but suggest that further investigations are necessary to elucidate the effect of the CTLA-4 region on the development of T1D and AITD.

  • 80.
    Mohlin, Eric
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Filipsson Nyström, Helena
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Long-term prognosis after medical treatment of Graves' disease in a northern Swedish population 2000-20102014In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 170, no 3, p. 419-427Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the long-term prognosis of patients with Graves' disease (GD) after antithyroid drug (ATD) treatment and follow-up outside of highly specialised care. Design and methods: Medical records of all patients diagnosed with first-time GD in 2000-2010 with at least 6 months ATD treatment at a central hospital and follow-up in primary health care in the county of Norrbotten in northern Sweden were retrospectively reviewed. Patients were followed for relapse until 31st December 2012. We included 219 patients (mean age 46 years, 82.5% women) with follow-up of maximum 10 years and 829 observed patient years. Data were analysed using Kaplan-Meier estimates and log-rank test. Results: During the observation period, 43.5% of the patients had relapsed into active GD. The cumulative relapse rates were 22.6, 30.2, 36.9 and 41.5% after 6 months, 1, 3 and 5 years respectively. The presence of goitre (P=0.014) predicted relapse. Previous smoking was protective against relapse (P=0.003). The levels of free thyroxine or free tri-iodothyronine, age, gender, current smoking and ophthalmopathy did not predict relapse. Agranulocytosis was found in 1.7% (95% CI 0.7-4.0%). Conclusion: A long-term remission of 56.5%, in an iodine-sufficient area where ATD is offered to most patients in the real world of central and district hospitals, is higher than in most studies. Relapse was most common during the first year, and prognosis was excellent after 4 years without relapse. The protective effect of previous smoking merits further research.

  • 81.
    Nilsson, Lena Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Medicine, Skellefteå Hospital.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Sunderby Hospital, Luleå.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Medicine, Skellefteå Hospital.
    Van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Consumption of filtered and boiled coffee and the risk of fist acute myocardial infarction: a nested case/referent study2010In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 20, no 7, p. 527-535Article in journal (Refereed)
    Abstract [en]

    Background and aim

    In northern Sweden, consumption of both filtered and boiled coffee is common. Boiled coffee, especially popular in rural areas, is known to raise blood lipids, a risk factor for acute myocardial infarction (MI). To our knowledge, only one epidemiological study, a case-control study from Sweden, has investigated boiled coffee in MI, noting an increased risk at high consumption levels in men, and no association in women. The aim of the present nested case-referent study was to relate consumption of filtered and boiled coffee to the risk of first MI.

    Methods and results

    The study subjects were 375 cases (303 men, 72 women) and 1293 matched referents from the population-based Northern Sweden Health and Disease Study. Coffee consumption was assessed by food frequency questionnaire. Risk estimates were calculated by conditional logistic regression. A statistically significant positive association was found between consumption of filtered coffee and MI risk in men [odds ratio for consumption ≥4 times/day versus ≤1 time/day 1.73 (95% CI 1.05–2.84)]. In women, a similar association was observed, but for boiled coffee [odds ratio 2.51 (95% CI 1.08–5.86)]. After adjustment for current smoking, postsecondary education, hypertension, and sedentary lifestyle, the results for women were no longer statistically significant.

    Conclusion

    Consumption of filtered coffee was positively associated with the risk of a first MI in men. A similar tendency was observed for boiled coffee in women, but the result was not statistically significant in multivariate analysis. Further investigation in a larger study is warranted.

  • 82.
    Nilsson, Lena Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Winkvist, Anna
    Göteborgs universitet.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lenner, Per
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Low-carbohydrate, high-protein score and mortality in a northern Swedish population2012In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 66, no 6, p. 694-700Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVE: Long-term effects of carbohydrate-restricted diets are unclear. We examined a low-carbohydrate, high-protein (LCHP) score in relation to mortality.

    SUBJECTS/METHODS: This is a population-based cohort study on adults in the northern Swedish county of Vasterbotten. In 37 639 men (1460 deaths) and 39 680 women (923 deaths) from the population-based Vasterbotten Intervention Program, deciles of energy-adjusted carbohydrate (descending) and protein (ascending) intake were added to create an LCHP score (2-20 points). Sex-specific hazard ratios (HR) were calculated by Cox regression.

    RESULTS: Median intakes of carbohydrates, protein and fat in subjects with LCHP scores 2-20 ranged from 61.0% to 38.6%, 11.3% to 19.2% and 26.6% to 41.5% of total energy intake, respectively. High LCHP score (14-20 points) did not predict all-cause mortality compared with low LCHP score (2-8 points), after accounting for saturated fat intake and established risk factors (men: HR for high vs low 1.03 (95% confidence interval (CI) 0.88-1.20), P for continuous 0.721; women: HR for high vs low 1.10 (95% CI 0.91-1.32), P for continuous 0.229). For cancer and cardiovascular disease, no clear associations were found. Carbohydrate intake was inversely associated with all-cause mortality, though only statistically significant in women (multivariate HR per decile increase 0.95 (95% CI 0.91-0.99), P = 0.010).

    CONCLUSION: Our results do not support a clear, general association between LCHP score and mortality. Studies encompassing a wider range of macronutrient consumption may be necessary to detect such an association.

  • 83.
    Nordfjäll, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology. Patologi.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Melander, Olle
    Nilsson, Peter
    Roos, Göran
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology. Patologi.
    Telomere Length Is Associated With Obesity Parameters but With a Gender Difference.2008In: Obesity (Silver Spring), ISSN 1930-7381, Vol. 16, no 12, p. 2682-2689Article in journal (Refereed)
  • 84.
    Nordfjäll, Kathrine
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology. Patologi.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lundin, S
    Roos, Göran
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology. Patologi.
    Nilsson, P M
    Increased abdominal obesity, adverse psychosocial factors and shorter telomere length in subjects reporting early ageing; the MONICA Northern Sweden Study.2008In: Scand J Public Health, ISSN 1403-4948, Vol. 36, no 7, p. 744-752Article in journal (Other academic)
  • 85. Nyman, Ulf
    et al.
    Mare, Klas
    Eriksson, Henry
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Bergqvist, David
    [Diagnosis of acute pulmonary embolism. Simplified strategy based on clinical probability, D-dimer and computer tomography]2006In: Lakartidningen, ISSN 0023-7205, Vol. 103, no 34, p. 2380-1Article in journal (Refereed)
  • 86. Qiao, Qing
    et al.
    Laatikainen, Tiina
    Zethelius, Björn
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jousilahti, Pekka
    Tuomilehto, Jaakko
    Comparison of definitions of metabolic syndrome in relation to the risk of developing stroke and coronary heart disease in Finnish and Swedish cohorts2009In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 40, no 2, p. 337-343Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: The purpose of this study was to compare definitions of metabolic syndrome with regard to their prediction of stroke and coronary heart disease incidence. METHODS: The study comprises 4041 men and 3812 women of 6 Finnish and Swedish cohorts aged 25 to 74 years at baseline. Hazard ratio was estimated applying Cox regression analyses adjusting for cohort, cholesterol, and smoking and using age as a time scale. A paired homogeneity test was performed to compare the differences. RESULTS: A total of 113 (47) ischemic and 43 (15) hemorrhagic stroke and 235 (50) coronary heart disease events were accumulated in men (women). Hazard ratios (95% CIs) for ischemic stroke in men were 1.59 (1.09 to 2.32), 1.52 (1.01 to 2.28), 1.16 (0.77 to 1.74), and 1.27 (0.87 to 1.86), respectively, for the World Health Organization, National Cholesterol Education Program, National Cholesterol Education Program revised, and the International Diabetes Federation definitions of metabolic syndrome, and in women 2.20 (1.15 to 4.19), 2.68 (1.47 to 4.87), 2.31 (1.27 to 4.20), and 1.91 (1.05 to 3.49), respectively. The corresponding hazard ratios (95% CIs) for coronary heart disease were 1.57 (1.21 to 2.04), 1.51 (1.15 to 1.99), 1.63 (1.25 to 2.13), and 1.46 (1.12 to 1.89) in men and 1.32 (0.69 to 2.51), 1.54 (0.85 to 2.79), 1.81 (1.02 to 3.21), and 2.47 (1.37 to 4.45) in women. None of the definitions of metabolic syndrome predicted hemorrhagic stroke. There was no difference between definitions of metabolic syndrome and between a full definition and its individual components. CONCLUSIONS: Metabolic syndrome as well as its individual components predicted the incidence of the ischemic stroke and the coronary heart disease equally well and should be treated equally as well.

  • 87.
    Ramnemark, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pettersson-Kymmer, Ulrika
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Adequate vitamin D levels in a Swedish population living above latitude 63°N: The 2009 Northern Sweden MONICA study2015In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 74, no 1, article id 27963Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Even though vitamin D is mainly produced by exposure to sunlight, little is known regarding vitamin D levels in populations living in sub-Arctic areas with little or no daylight during winter.

    OBJECTIVE: We describe distributions of vitamin D3 and the prevalence of adequate levels in a population living above 63°N.

    DESIGN: We sampled 1,622 randomly selected subjects, aged 25-74 years, between January and May, 2009, as part of the Northern Sweden MONICA study (69.2% participation rate). By using HPLC, 25(OH) vitamin D3 was analysed. Levels used for definitions were deficient, D3<25 nmol/l (<10 ng/ml); insufficient, D3 25-49.9 nmol/l (10-20 ng/ml); and adequate, D3≥50 nmol/l (20 ng/ml).

    RESULTS: Mean (median) level of vitamin D3 was 65.2 (63.6) nmol/l in men and 71.0 (67.7) nmol/l in women. Adequate levels were found in 79.2%, more often in women (82.7%) than in men (75.6%). Only 0.7% of the population were vitamin D3-deficient but 23.1% of men and 17.1% of women had insufficient levels. Levels of vitamin D3 increased with age and insufficient status was most common among those aged 25-34 years, 41.0% in men and 22.3% in women. If subjects using vitamin D-supplementation are excluded, the population level of D3 is 1-2 nmol/l lower than in the general population across sex- and age groups. There were no differences between the northern or the southern parts, between urban or rural living or according to educational attainment. Those subjects born outside of Sweden or Finland had lower levels.

    CONCLUSION: The large majority living close to the Arctic Circle in Sweden have adequate D3 levels even during the second half of the dark winter. Subjects with D3 deficiency were uncommon but insufficient levels were often found among young men.

  • 88. Rask, Eva
    et al.
    Walker, Brian R
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Livingstone, Dawn E W
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johnson, Owe
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Andrew, Ruth
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Tissue-specific changes in peripheral cortisol metabolism in obese women: increased adipose 11beta-hydroxysteroid dehydrogenase type 1 activity.2002In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 87, no 7, p. 3330-3336Article in journal (Refereed)
    Abstract [en]

    Cushing's syndrome and the metabolic syndrome share clinical similarities. Reports of alterations in the hypothalamic-pituitary-adrenal (HPA) axis are inconsistent, however, in the metabolic syndrome. Recent data highlight the importance of adipose 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1), which regenerates cortisol from cortisone and, when overexpressed in fat, produces central obesity and glucose intolerance. Here we assessed the HPA axis and 11beta-HSD1 activity in women with moderate obesity and insulin resistance. Forty women were divided into tertiles according to body mass index (BMI; median, 22.0, 27.5, and 31.4, respectively). Serum cortisol levels were measured after iv CRH, low dose dexamethasone suppression, and oral cortisone administration. Urinary cortisol metabolites were measured in a 24-h sample. A sc abdominal fat biopsy was obtained in 14 participants for determination of 11beta-HSD type 1 activity in vitro. Higher BMI was associated with higher total cortisol metabolite excretion (r = 0.49; P < 0.01), mainly due to increased 5alpha- and, to a lesser extent, 5beta-tetrahydrocortisol excretion, but no difference in plasma cortisol basally, after dexamethasone, or after CRH, and only a small increase in the ACTH response to CRH. Hepatic 11beta-HSD1 conversion of oral cortisone to cortisol was impaired in obese women (area under the curve, 147,736 +/- 28,528, 115,903 +/- 26,032, and 90,460 +/- 18,590 nmol/liter.min; P < 0.001). However, 11beta-HSD activity in adipose tissue was positively correlated with BMI (r = 0.55; P < 0.05). In obese females increased reactivation of glucocorticoids in fat may contribute to the characteristics of the metabolic syndrome. Increased inactivation of cortisol in liver may be responsible for compensatory activation of the HPA axis. These alterations in cortisol metabolism may be a basis for novel therapeutic strategies to reduce obesity-related complications.

  • 89.
    Rautio, Aslak
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. NLL.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Sunderby Hosp, Dept Med, Luleå, Sweden.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Favorable Trends in the Incidence and Outcome in Stroke in Nondiabetic and Diabetic Subjects Findings From the Northern Sweden MONICA Stroke Registry in 1985 to 20032008In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 39, no 12, p. 3137-3144Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Several studies indicate a declining case-fatality and mortality in stroke. Little is known about time trends in stroke for subjects with diabetes. The purpose of this study was to compare time trends in incidence, case-fatality and mortality for stroke patients with or without diabetes. METHODS: This study was based on the Northern Sweden MONICA Project Stroke registry during 1985 to 2003. 15 382 patients, aged 35 to 74 years, were included in the study. 11 605 had a first-ever stroke and 3777 had a recurrent stroke. In both men and women previously diagnosed diabetes was found in 22.8%. RESULTS: The incidence of stroke was 5 and 8 times higher in diabetic subjects than in nondiabetics, in men and women, respectively. Incidence of first-ever stroke decreased for nondiabetic men, probability value <0.001, and for diabetic women, probability value=0.012. Recurrent stroke incidence declined highly significant, probability value <0.001, in all but diabetic men. For diabetic women, the decrease in incidence in first and recurrent stroke was significantly greater than in nondiabetic women. Case-fatality and mortality in stroke declined for all groups except diabetic women with first-ever stroke. The time trends in case fatality and mortality did not differ significantly between nondiabetic and diabetic patients. CONCLUSIONS: The incidence of stroke declined in both nondiabetic and diabetic subjects except for diabetic men and for nondiabetic women with first-ever stroke. Case-fatality in first-ever stroke declined for all but diabetic women. This led to a decreased mortality over the 19-year period for both groups. This is the first time that the decline in stroke incidence is reported in this MONICA population.

  • 90.
    Rautio, Aslak
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Medicine, Sunderby Hospital, Luleå.
    Lundberg, Vivan
    Messner, Torbjörn
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Medicine, Kiruna Hospital, Kiruna, Sweden.
    Nasic, Salmir
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Medicine, Sunderby Hospital, Luleå.
    Favourable trends in the incidence and outcome ofmyocardial infarction in nondiabetic, but not in diabetic, subjects: findings from the MONICA myocardial infarctionregistry in northern Sweden in 1989–20002005In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 258, no 4, p. 369-377Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to comparetime trends in incidence, case fatality and mortalitydue to myocardial infarction (MI) in patients with orwithout diabetes.Methods: This study was based on the Northe rnSweden MONICA Project MI registry with a targetpopulation of about 200 000 inhabitants in the agegroup 35–64 years in the two northernmostcounties of Sweden. During 1989–2000, 6254patients who had had an MI according to MONICAcriteria were included in this study: 4569 patientshad a first MI and 1685 had a recurrent MI. Sixteenper cent of the men and 20% of the women had haddiabetes mellitus diagnosed prior the MI.Results: Over the 12-year period, there was adeclining trend in incidence and case fatality infirst MI. Also, the event rates (first ever andrecurrent MI) decline d in men without diabetes. Inwomen without diabetes favourable time trendswere seen in first ever MI, recurrent MI and in casefatality. There were no favourable time trends forany of these outcomes in patients with diabetes.Conclusion: In nondiabetic subjects belo w the age of65, the inc idence of, and case-fatality in, MIdeclined. This led to a decreased mortality over the12-year period. These favourable trends over timewere not observed in diabetic subjects.Keywords: acute myocardial infarction, diabetesmellitus, incidence, mortali ty, time trends

  • 91. Ringbäck Weitoft, Gunilla
    et al.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rosén, Måns
    Underweight, overweight and obesity as risk factors for mortality and hospitalization.2008In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, no 2, p. 169-76Article in journal (Refereed)
    Abstract [en]

    AIMS: The prevalence of overweight and obesity is increasing in many countries. We aimed to investigate differences in mortality and severe morbidity between underweight people (body mass index (BMI)<18.5), overweight people (BMI 25 to <30), obese people (BMI> or =30), and those with normal weights (BMI 18.5 to <25). METHODS: Random samples of the Swedish population aged 16-74 years in 1980-81 and 1988-89 were followed for 12 years with regard to all-cause mortality and mortality from circulatory diseases, all inpatient care, and inpatient care for circulatory and musculoskeletal diseases. Relative risks (RRs) for different levels of BMI were adjusted for age, longstanding illness, smoking, and educational level at baseline. In addition, analyses were made with delayed entry until the fourth-year after interview. RESULTS: Obesity and underweight, but not overweight, was associated with higher all-cause mortality. Among underweight men, the adjusted RR for all-cause mortality was 2.4 (95% confidence interval 1.6-3.6), and among underweight women it was 2.0 (1.5-2.7), but population attributable risks (PARs) were small, at 1.2% and 2.7%, respectively. Overweight was associated with increased risks for inpatient care for circulatory diseases, with PARs being 13.4% among men and 8.1% among women, and musculoskeletal diseases (PARs were 12.7% and 12.9%, respectively). Obese men and women had about 50% higher risks of all-cause mortality than normal-weight people, PARs being 3.2% and 3.8% respectively. CONCLUSIONS: This study supports the findings of other studies, in that overweight seems to be an exaggerated risk factor for all-cause mortality, but is related to other chronic disease. Underweight and obesity generally implies greater increases of RRs, but avoidance of overweight may have greater effect on the population level with regard to reduced cardiovascular and locomotor disease.

  • 92. Rodu, Brad
    et al.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    The low prevalence of smoking in the Northern Sweden MONICA study, 20092013In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 8, p. 808-811Article in journal (Refereed)
    Abstract [en]

    Aims: The purpose of this study was to describe tobacco use in the 2009 Northern Sweden cohort of the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases (MONICA) study. Methods: Subjects (N = 1698) were randomly selected from population registers, stratified for age (25-74 years old) and gender, in the two northernmost Swedish counties of Norrbotten and Västerbotten. Responses from tobacco-related questions were used to develop three mutually exclusive categories of snus use: past, current, or never use; and three comparable categories of smoking that were consistent with previous studies. Results: Among men, the prevalence of smoking (9%) and dual use (2%) remain unchanged from 2004, although the prevalence of snus use declined from 27% in 2004 to 24% in 2009. Among women, the prevalence of all forms of tobacco use declined between 2004 and 2009; smoking dropped from 16% to 11%, dual use from 2% to less than 1%, and snus use from 9% to 8%. Although overall prevalence of tobacco use was similar for younger versus older men and younger versus older women, there were notable differences in specific snus and smoking rates. Conclusions: This study confirms that use of snus was a significant factor in the low prevalence of smoking, especially among younger men and women in Northern Sweden. Furthermore, it documents that tobacco harm reduction is entirely compatible with a population-level decline in overall tobacco use.

  • 93. Saha, Sanjib
    et al.
    Carlsson, Katarina Steen
    Gerdtham, Ulf-G
    Eriksson, Margareta K.
    Hagberg, Lars
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johansson, Pia
    Are Lifestyle Interventions in Primary Care Cost-Effective?: An Analysis Based on a Markov Model, Differences-In-Differences Approach and the Swedish Björknäs Study2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 11, p. e80672-Article in journal (Refereed)
    Abstract [en]

    Background: Lifestyle interventions affect patients' risk factors for metabolic syndrome (MeSy), a pre-stage to cardiovascular diseases, diabetes and related complications. An effective lifestyle intervention is the Swedish Bjorknas intervention, a 3-year randomized controlled trial in primary care for MeSy patients. To include future disease-related cost and health consequences in a cost-effectiveness analysis, a simulation model was used to estimate the short-term (3-year) and long-term (lifelong) cost-effectiveness of the Bjorknas study.

    Methodology/Principal Findings: A Markov micro-simulation model was used to predict the cost and quality-adjusted life years (QALYs) for MeSy-related diseases based on ten risk factors. Model inputs were levels of individual risk factors at baseline and at the third year. The model estimated short-term and long-term costs and QALYs for the intervention and control groups. The cost-effectiveness of the intervention was assessed using differences-in-differences approach to compare the changes between the groups in the health care and societal perspectives, using a 3% discount rate. A 95% confidence interval (CI), based on bootstrapping, and sensitivity analyses describe the uncertainty in the estimates. In the short-term, costs are predicted to increase over time in both groups, but less in the intervention group, resulting in an average cost saving/reduction of US$-700 (in 2012, US $ 1= six point five seven SEK) and US$-500, in the societal and health care perspectives. The long-term estimate also predicts increased costs, but considerably less in the intervention group: US$-7,300 (95% CI: US$-19,700 to US $-1,000) in the societal, and US$-1,500 (95% CI: US$-5,400 to US$ 2,650) in the health care perspective. As intervention costs were US$ 211 per participant, the intervention would result in cost saving. Furthermore, in the long-term an estimated 0.46 QALYs (95% CI: 0.12 to 0.69) per participant would be gained.

    Conclusions/Significance: The Swedish Bjorknas study appears to reduce demands on societal and health care resources and increase health-related quality of life.

  • 94.
    Sahli, David
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Eliasson, Björn
    Svensson, Maria
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Blohmé, Göran
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Samuelsson, Pär
    Öjbrandt, Kristina
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Eriksson, Jan
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Assessment of toe blood pressure is an effective screening method to identify diabetes patients with lower extremity arterial disease2004In: Angiology, ISSN 0003-3197, E-ISSN 1940-1574, Vol. 55, no 6, p. 641-651Article in journal (Refereed)
  • 95.
    Segerstedt, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lundqvist, Robert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Patients with type 1 diabetes in Sweden experience more fatigue than the general population2015In: Journal of Clinical and Translational Endocrinology, ISSN 2214-6237, Vol. 2, p. 105-109Article in journal (Refereed)
    Abstract [en]

    Aims: Type 2 diabetes has been linked to fatigue, but results on type 1 diabetes are ambiguous. Our aim was to determine if type 1 diabetes is associated with fatigue and whether the fatigue is due to complications or to the disease itself.

    Methods: The Multidimensional Fatigue Inventory (MFI-20), was submitted to all 435 adult patients with type 1 diabetes in the National Diabetes Register at the Sunderby Hospital clinic and to a control group of 2500 persons. The participation rate was 62% in both groups.

    Results: Type 1 diabetes was associated with greater fatigue, with a 1.4-point difference (0.9–1.9, 95% CI) in general fatigue on a scale of 4–20. Type 1 diabetes was an independent predictor of fatigue, as were cardiovascular and cerebrovascular disease. Women with long diabetes duration but without complications experienced more fatigue than women in the general population (difference in general fatigue = 2.5, p = 0.021), whereas men showed no significant difference.

    Conclusions: Type 1 diabetes is associated with greater fatigue, partly ascribed to vascular disease. Type 1 diabetes of long duration might be associated with fatigue regardless of classical complications, but further research is needed to confirm results.

  • 96. Song, Huan
    et al.
    Held, Maria
    Sandin, Sven
    Rautelin, Hilpi
    Eliasson, Mats
    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.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Engstrand, Lars
    Nyrén, Olof
    Ye, Weimin
    Increase in the Prevalence of Atrophic Gastritis Among Adults Age 35 to 44 Years Old in Northern Sweden Between 1990 and 20092015In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 13, no 9, p. 1592-1600Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Atrophic corpus gastritis (ACG) is believed to be an early precursor of gastric adenocarcinoma. We aimed to investigate trends of ACG in Northern Sweden, from 1990 through 2009, and to identify possible risk factors.

    METHODS: We randomly selected serum samples collected from 5284 participants in 1990, 1994, 1999, 2004, and 2009, as part of the population-based, cross-sectional Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease study (ages 35-64 y). Information was collected on sociodemographic, anthropometric, lifestyle, and medical factors using questionnaires. Serum samples were analyzed for levels of pepsinogen I, to identify participants with functional ACG; data from participants with ACG were compared with those from frequency-matched individuals without ACG (controls). Blood samples were analyzed for antibodies against H pylori and CagA. Associations were estimated with unconditional logistic regression models.

    RESULTS: Overall, 305 subjects tested positive for functional ACG, based on level of pepsinogen I. The prevalence of ACG in participants 55-64 y old decreased, from 124/1000 to 49/1000 individuals, between 1990 and 2009. However, the prevalence of ACG increased, from 22/1000 to 64/1000 individuals among participants 35-44 y old during this time period. CagA seropositivity was associated with risk for ACG (odds ratio, 2.29; 95% confidence interval, 1.69-3.12). Other risk factors included diabetes, low level of education, and high body mass index. The association between body mass index and ACG was confined to individuals 35-44 y old; in this group, overweight and obesity were associated with a 2.8-fold and 4.7-fold increased risk of ACG, respectively.

    CONCLUSIONS: Among residents of Northern Sweden, the prevalence of ACG increased from 1990 through 2009 specifically among adults 35-44 y old. The stabilizing seroprevalence of H pylori and increasing prevalence of overweight and obesity might contribute to this unexpected trend; studies are needed to determine whether these changes have affected the incidence of gastric cancer.

  • 97.
    Stegmayr, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Rodu, Brad
    The decline of smoking in northern Sweden.2005In: Scand J Public Health, ISSN 1403-4948, Vol. 33, no 4, p. 321-4; discussion 243Article in journal (Refereed)
  • 98.
    Söderberg, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ahrén, B
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Dinesen, B
    Brismar, K
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Circulating IGF binding protein-1 is inversely associated with leptin in non-obese men and obese postmenopausal women.2001In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 144, no 3, p. 283-290Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Hyperleptinaemia and hyperinsulinaemia interrelate to insulin-like growth factor binding protein 1 (IGFBP-1), and disturbances in the growth hormone-IGF-I axis are linked to obesity and cardiovascular diseases. However, whether the association between leptin and the GH-IGF-I axis is altered with increasing obesity is not known. We therefore examined the relationship between leptin, IGF-I, IGFBP-1, insulin and proinsulin in men and women with or without obesity in a population study.

    DESIGN AND SUBJECTS: Healthy subjects (n=158; 85 men and 73 pre- and postmenopausal women) from the Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) population were studied with a cross-sectional design.

    METHODS: Anthropometric measurements (body mass index (BMI) and waist circumference) and oral glucose tolerance tests were performed. Radioimmunoassays were used for the analyses of leptin, IGF-I and IGFBP-1, and ELISAs for specific insulin and proinsulin.

    RESULTS: Leptin inversely correlated to IGFBP-1 in non-obese men (P<0.05) and obese postmenopausal women (P<0.05). In contrast, leptin did not correlate to IGF-I. IGFBP-1 was also significantly associated with proinsulin in non-obese men (P<0.01) and non-obese premenopausal women (P<0.05). The association between leptin and IGFBP-1 was lost after adjustment for insulin. In multivariate analyses taking measures of adiposity into account, low proinsulin, and IGF-I in combination with old age, but not leptin, predicted high IGFBP-1 levels.

    CONCLUSIONS: Leptin was inversely associated with IGFBP-1 in non-obese men and obese postmenopausal women, and proinsulin was inversely associated with IGFBP-1 in non-obese men and premenopausal women. However, these associations were lost with increasing central obesity in men and premenopausal women and after control for insulin. Therefore, this study suggests (i) that leptin is of minor importance for regulation of IGFBP-1 levels and (ii) that the insulin resistance syndrome is characterised by an altered relationship between leptin, IGFBP-1 and insulin.

  • 99.
    Söderberg, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ahrén, B
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Dinesen, B
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    The association between leptin and proinsulin is lost with central obesity.2002In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 252, no 2, p. 140-148Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Hyperproinsulinaemia and hyperleptinaemia are interrelated features of the insulin resistance syndrome that are linked to the prospective risk of cardiovascular diseases. Whether the association between leptin and proinsulin is different between groups displaying different degrees of risk for cardiovascular diseases is not known. We therefore examined this association in men versus women and in pre- versus postmenopausal women from a population-based sample.

    DESIGN AND SUBJECTS: Healthy subjects (n = 158; 85 men and 73 pre- and postmenopausal women) from the Northern Sweden Monitoring of Trends and Determinants in Cardiovascular Disease population were studied with a cross-sectional design.

    METHODS: Anthropometric measurements (body mass index and waist circumference) and oral glucose tolerance tests were performed. Enzyme-linked immunosorbent assays were used for the analyses of specific insulin and proinsulin, and radioimmunoassay for leptin. Insulin resistance and beta-cell function were calculated according to the homeostasis assessment model. Partial correlation coefficients adjusted for age and measures of adiposity were calculated and multiple linear regression analyses were performed with leptin as dependent variable.

    RESULTS: In nonobese men and premenopausal women and in obese postmenopausal women, leptin was significantly associated with proinsulin after stratification for waist circumference. Furthermore, a multivariate analyses taking age and measures of adiposity into account, showed that high fasting proinsulin was a significant predictor of high leptin in these groups. In contrast, this association was lost with increasing central obesity in men and premenopausal women.

    CONCLUSIONS: This study shows that both the degree of adiposity and the hormonal milieu influence the association between circulating leptin and proinsulin in a normal population. Therefore, the insulin resistance syndrome seems to be characterized by lost association between leptin and proinsulin, which may be explained by dysfunction in the adipoinsular axis.

  • 100.
    Söderberg, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johnson, Owe
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ahrén, B
    Plasma leptin levels are associated with abnormal fibrinolysis in men and postmenopausal women.1999In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 245, no 5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Leptin is a crucial mediator of satiety signals and energy balance, and its circulating levels are increased in obesity. It has recently been shown that plasma leptin levels in humans correlate with circulating insulin and to insulin secretion. This indicates that leptin may be an important link in metabolic consequences of the insulin resistance syndrome. Whether this includes abnormalities in fibrinolysis has not been studied.

    METHODS AND RESULTS: Healthy subjects (n = 165; 85 men and 80 women) from the Northern Sweden MONICA population were investigated. Anthropometric measurements, oral glucose tolerance tests and sampling for plasma leptin, lipids, fibrinogen and fibrinolytic variables were made. Leptin levels were 342% higher in women than in men and were in both sexes strongly correlated to body mass index (BMI). After adjustments for age and BMI, leptin levels correlated significantly to pre/post glucoseload insulin levels in both sexes. After further adjustment for baseline insulin levels, leptin levels were in males significantly associated with increased waist circumference (P<0.001), low HDL cholesterol (P<0.05), low tPA activity (P<0.01) and high PAI-1 activity (P<0.001). In postmenopausal females, a significant association between leptin and low tPA activity/high PAI-1 activity was seen after adjustment for age and BMI (P<0.05). Conclusions. Circulating levels of leptin are associated with components of the insulin resistance syndrome, including defective fibrinolysis, in men and postmenopausal women. This suggests that leptin may be involved in the mediation of consequences of insulin resistance.

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