Umeå University's logo

umu.sePublications
Change search
Link to record
Permanent link

Direct link
Lindholm, Lars H
Alternative names
Publications (10 of 98) Show all publications
Brunström, M., Ng, N., Dahlström, J., Lindholm, L. H., Norberg, M., Nyström, L., . . . Carlberg, B. (2022). Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease. Blood Pressure, 31(1), 31-39
Open this publication in new window or tab >>Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease
Show others...
2022 (English)In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 31, no 1, p. 31-39Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. MATERIALS AND METHODS: Individuals ≥18 years with a blood pressure (BP) recording in Västerbotten or Södermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Västerbotten County (intervention) compared with Södermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. RESULTS: A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. CONCLUSIONS: This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2022
Keywords
antihypertensive treatment, continuous medical education, Hypertension, implementation science, primary care
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-192773 (URN)10.1080/08037051.2022.2041393 (DOI)000757622100001 ()35179089 (PubMedID)2-s2.0-85124775764 (Scopus ID)
Funder
Swedish Research Council, K2007-70X-20515-01-2Swedish Research Council, K2009-69X-20515-04-2Swedish Research Council, 2017-02246Västerbotten County CouncilSwedish Society for Medical Research (SSMF)
Available from: 2022-03-09 Created: 2022-03-09 Last updated: 2023-05-22Bibliographically approved
Kohler, S., Annerstedt, K. S., Diwan, V., Lindholm, L. H., Randive, B., Vora, K. & De Costa, A. (2018). Postpartum quality of life in Indian women after vaginal birth and cesarean section: a pilot study using the EQ-5D-5L descriptive system. BMC Pregnancy and Childbirth, 18, Article ID 427.
Open this publication in new window or tab >>Postpartum quality of life in Indian women after vaginal birth and cesarean section: a pilot study using the EQ-5D-5L descriptive system
Show others...
2018 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, article id 427Article in journal (Refereed) Published
Abstract [en]

Background: There has been little evaluation of the postpartum quality of life (QOL) of women in India and its association with the mode of birth. This study piloted the use of the generic EQ-5D-5L questionnaire to assess postpartum QOL experienced by rural Indian women.

Methods: A convenience sample of rural women who gave birth in a health facility in Gujarat or Madhya Pradesh was recruited into this pilot study. QOL was measured during three interviews within 30days of birth using the EQ-5D-5L questionnaire. Patient-level quality-adjusted life days (QALDs) were estimated. Multivariate regression was used to adjust for selected baseline characteristics.

Results: Forty-six women with cesarean section and 178 with vaginal birth from 17 public and private health facilities were studied. Postpartum QOL in both groups improved between interviews 1 and 3. Comparing between vaginal and cesarean births indicated that the vaginal birth group had a higher QOL (0-3 days postpartum: 0.28 vs. 0.57, 3-7 days postpartum: 0.59 vs. 0.81; P<0.001) and was more likely to report no or slight problems in 4 of 5 health dimensions (mobility, self-care, usual activities, painordiscomfort; P0.04) during interviews 1 and 2. Postpartum QOL converged, but still differed between groups by the time of interview 3 (21-30 days postpartum: 0.85 vs. 0.93; P<0.001). While most women reported no problems by the end of the first postpartum month, the difference in the ability to perform usual activities persisted (P=0.001). In result, fewer QALDs were attained by women in the cesarean section group between day 1 and day 21 postpartum (13.1 vs. 16.6 QALDs; P<0.001). Subgroup analysis showed that having had an episiotomy during vaginal birth was also associated with reduced QOL postpartum, but to a lesser extent than cesarean section. Similar results were obtained when adjusting for socioeconomic, pregnancy and birth characteristics, but postpartum QOL already ceased to be statistically different between groups before interview 3.

Conclusions: Vaginal births, even with episiotomy, were associated with a higher postpartum QOL than cesarean births among the Indian women in our pilot study. Finding these expected results suggests that the EQ-5D-5L questionnaire is asuitable instrumentto assess postpartum QOL in Indian women.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
India, Quality of life, Postpartum period, Vaginal delivery, Episiotomy, Caesarean section, Pilot study
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-153700 (URN)10.1186/s12884-018-2038-0 (DOI)000448750500001 ()30373545 (PubMedID)2-s2.0-85055618358 (Scopus ID)
Funder
EU, FP7, Seventh Framework Programme, 261304
Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2023-03-24Bibliographically approved
Griffin, S., Lindholm, L. H. & Spencer, S. (2017). Framgång för den nationella forskarskolan i allmänmedicin: nu finns förutsättningar för svensk allmänmedicinsk forskning att bli internationellt konkurrenskraftig: [Success for the national research school in general medicine]. Läkartidningen, 114(35-36), Article ID ER3I.
Open this publication in new window or tab >>Framgång för den nationella forskarskolan i allmänmedicin: nu finns förutsättningar för svensk allmänmedicinsk forskning att bli internationellt konkurrenskraftig: [Success for the national research school in general medicine]
2017 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 35-36, article id ER3IArticle in journal, Editorial material (Other academic) Published
Abstract [sv]

De flesta kontakter inom hälso- och sjukvård sker i primärvården, men huvuddelen av medicinsk forskning sker på sjukhus och laboratorier. Att ta fram evidens som är relevant för primärvård förutsätter en kritisk massa av multidisciplinära forskare med förmåga att samarbeta med nationella och internationella forskningscentrum. År 2009 etablerades den nationella forskarskolan i allmänmedicin i Sverige för att svara mot detta behov. Skolan har hitintills medverkat till 31 doktorsavhandlingar och ett flertal internationella forskningssamarbeten. Samverkande multidisciplinära forskningsmiljöer är en framgångsfaktor för att skapa hållbara och internationellt konkurrenskraftiga forskningsprogram i primärvård.

Place, publisher, year, edition, pages
Läkartidningen förlag AB, 2017
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-211427 (URN)2-s2.0-85028629487 (Scopus ID)
Available from: 2023-07-11 Created: 2023-07-11 Last updated: 2023-07-11Bibliographically approved
Brunström, M., Dahlström, J., Lindholm, L. H., Lönnberg, G., Hallström, S., Norberg, M., . . . Carlberg, B. (2016). From efficacy in trials to effectiveness in clinical practice: The Swedish Stroke Prevention Study. Blood Pressure, 25(4), 206-211
Open this publication in new window or tab >>From efficacy in trials to effectiveness in clinical practice: The Swedish Stroke Prevention Study
Show others...
2016 (English)In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 25, no 4, p. 206-211Article in journal (Refereed) Published
Abstract [en]

Blood pressure treatment has shown great efficacy in reducing cardiovascular events in randomized controlled trials. If this is effective in reducing cardiovascular disease in the general population, is less studied. Between 2001 and 2009 we performed an intervention to improve blood pressure control in the county of Vasterbotten, using Sodermanland County as a control. The intervention was directed towards primary care physicians and included lectures on blood pressure treatment, a computerized decision support system with treatment recommendations, and yearly feed back on hypertension control. Each county had approximately 255000 inhabitants. Differences in age and incidence of cardiovascular disease were small. During follow-up, more than 400000 patients had their blood pressure recorded. The mean number of measurements was eight per patient, yielding a total of 3.4 million blood pressure recordings. The effect of the intervention will be estimated combining the blood pressure data collected from the electronic medical records, with data on stroke, myocardial infarction and mortality from Swedish health registers. Additional variables, from health registers and Statistics Sweden, will be collected to address for confounders. The blood pressure data collected within this study will be an important asset for future epidemiological studies within the field of hypertension.

Keywords
Blood pressure, clinical trials, hypertension, intervention
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-124833 (URN)10.3109/08037051.2015.1127556 (DOI)000380053800002 ()26854107 (PubMedID)2-s2.0-84958044727 (Scopus ID)
Available from: 2016-10-03 Created: 2016-08-26 Last updated: 2023-03-23Bibliographically approved
Vishram, J. K. .., Dahlöf, B., Devereux, R. B., Ibsen, H., Kjeldsen, S. E., Lindholm, L. H., . . . Olsen, M. H. (2015). Blood pressure variability predicts cardiovascular events independently of traditional cardiovascular risk factors and target organ damage: a LIFE substudy. Journal of Hypertension, 33(12), 2422-2430
Open this publication in new window or tab >>Blood pressure variability predicts cardiovascular events independently of traditional cardiovascular risk factors and target organ damage: a LIFE substudy
Show others...
2015 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 33, no 12, p. 2422-2430Article in journal (Refereed) Published
Abstract [en]

Background: Assessment of antihypertensive treatment is normally based on the mean value of a number of blood pressure (BP) measurements. However, it is uncertain whether high in-treatment visit-to-visit BP variability may be harmful in hypertensive patients with left ventricular hypertrophy (LVH).

Methods: In 8505 patients randomized to losartan vs. atenolol-based treatment in the LIFE study, we tested whether BP variability assessed as SD and range for BP6-24months measured at 6, 12, 18 and 24 months of treatment was associated with target organ damage (TOD) defined by LVH on ECG and urine albumin/creatinine ratio at 24 months, and predicted the composite endpoint (CEP) of cardiovascular death, nonfatal myocardial infarction (MI) or stroke occurring after 24 months (CEP=630 events).

Results: In multiple regression models adjusted for mean BP6-24months and treatment allocation, neither high BP6-24months SD nor wide range were related to TOD at 24 months, except for a weak association between Sokolow-Lyon voltage and DBP6-24months SD and range (both b=0.04, P<0.01). Independently of mean BP6-24months, treatment allocation, TOD and baseline characteristics in Cox regression models, CEP after 24 months was associated with DBP6-24months SD [hazard ratio per 1mmHg increase1.04, 95% confidence interval (95% CI) 1.01-1.06, P=0.005], range (hazard ratio 1.02, 95% CI 1.01-1.03, P=0.004), SBP6-24months SD (hazard ratio 1.01, 95% CI 0.99-1.02, P=0.07) and range (hazard ratio 1.006, 95% CI 1.001-1.01, P=0.04). Adjusted for the same factors, stroke was associated with DBP6-24months SD (hazard ratio 1.06, 95% CI 1.02-1.10, P=0.001), range (hazard ratio 1.03, 95% CI 1.01-1.04, P=0.001), SBP6-24months SD (hazard ratio 1.02, 95% CI 1.002-1.04, P=0.04) and range (hazard ratio 1.008, 95% CI 1.001-1.02, P=0.05), but MI was not.

Conclusion: In LIFE patients, higher in-treatment BP6-24months variability was independently of mean BP6-24months associated with later CEP and stroke, but not with MI or TOD after 24 months.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2015
Keywords
blood pressure variability, cardiovascular risk, epidemiology, target organ damage
National Category
General Practice Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-199963 (URN)10.1097/HJH.0000000000000739 (DOI)000368458700010 ()26378687 (PubMedID)2-s2.0-84947020304 (Scopus ID)
Available from: 2022-10-04 Created: 2022-10-04 Last updated: 2024-03-21Bibliographically approved
Smink, P. A., Hoekman, J., Grobbee, D. E., Eijkemans, M. J., Parving, H.-H., Persson, F., . . . Heerspink, H. J. (2014). A prediction of the renal and cardiovascular efficacy of aliskiren in ALTITUDE using short-term changes in multiple risk markers. European Journal of Preventive Cardiology, 21(4), 434-441
Open this publication in new window or tab >>A prediction of the renal and cardiovascular efficacy of aliskiren in ALTITUDE using short-term changes in multiple risk markers
Show others...
2014 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 21, no 4, p. 434-441Article in journal (Refereed) Published
Abstract [en]

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

Keywords
direct renin inhibition, biomarkers, Type 2 diabetes, nephropathy, cardiovascular disease
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-88318 (URN)10.1177/2047487313481754 (DOI)000332971800004 ()2-s2.0-84896465696 (Scopus ID)
Available from: 2014-06-17 Created: 2014-04-30 Last updated: 2023-03-23Bibliographically approved
Weber, M. A., Schiffrin, E. L., White, W. B., Mann, S., Lindholm, L. H., Kenerson, J. G., . . . Harrap, S. B. (2014). Clinical Practice Guidelines for the Management of Hypertension in the Community A Statement by the American Society of Hypertension and the International Society of Hypertension. Journal of Hypertension, 32(1), 3-15
Open this publication in new window or tab >>Clinical Practice Guidelines for the Management of Hypertension in the Community A Statement by the American Society of Hypertension and the International Society of Hypertension
Show others...
2014 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 32, no 1, p. 3-15Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-84769 (URN)10.1097/HJH.0000000000000065 (DOI)000328743500002 ()2-s2.0-84891560610 (Scopus ID)
Available from: 2014-02-10 Created: 2014-01-20 Last updated: 2023-03-23Bibliographically approved
Weber, M. A., Schiffrin, E. L., White, W. B., Mann, S., Lindholm, L. H., Kenerson, J. G., . . . Harrap, S. B. (2014). Clinical practice guidelines for the management of hypertension in the community a statement by the American society of hypertension and the International society of hypertension. The Journal of Clinical Hypertension, 16(1), 14-26
Open this publication in new window or tab >>Clinical practice guidelines for the management of hypertension in the community a statement by the American society of hypertension and the International society of hypertension
Show others...
2014 (English)In: The Journal of Clinical Hypertension, ISSN 1524-6175, E-ISSN 1751-7176, Vol. 16, no 1, p. 14-26Article in journal (Refereed) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2014
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-85707 (URN)10.1111/jch.12237 (DOI)000329487800010 ()24341872 (PubMedID)2-s2.0-84892367290 (Scopus ID)
Available from: 2014-02-19 Created: 2014-02-10 Last updated: 2023-07-31Bibliographically approved
Lindholm, L. H. & Spencer, S. (2014). Nationell forskarskola har global räckvidd: både vetenskapligt och geografiskt når doktoranderna långt. Läkartidningen, 111(15), Article ID CT67.
Open this publication in new window or tab >>Nationell forskarskola har global räckvidd: både vetenskapligt och geografiskt når doktoranderna långt
2014 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 15, article id CT67Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Sveriges läkarförbund, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-213941 (URN)2-s2.0-84939191029 (Scopus ID)
Note

Lakartidningen.se 2014-04-15

Available from: 2023-09-01 Created: 2023-09-01 Last updated: 2023-09-01Bibliographically approved
Lindholm, L. H. & Carlberg, B. (2014). The new Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2014): a giant undertaking. Hypertension Research, 37(4), 391-392
Open this publication in new window or tab >>The new Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2014): a giant undertaking
2014 (English)In: Hypertension Research, ISSN 0916-9636, E-ISSN 1348-4214, Vol. 37, no 4, p. 391-392Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Nature Publishing Group, 2014
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-89233 (URN)10.1038/hr.2014.21 (DOI)000334342400003 ()2-s2.0-84898741470 (Scopus ID)
Available from: 2014-05-26 Created: 2014-05-26 Last updated: 2023-03-23Bibliographically approved
Organisations

Search in DiVA

Show all publications