| 1. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Secular trends in cardiovascular risk factors with a 36-year perspective: observations from 38- and 50-year-olds in the Population Study of women in Gothenburg
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 26:3, s. 140-6
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Tidskriftsartikel (refereegranskat)abstract
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Sweden. cecilia.bjorkelund@allmed.gu.se OBJECTIVES: To study secular trends in cardiovascular risk factors in four different cohorts of women examined in 1968-1969, 1980-1981, 1992-1993 and 2004-2005. DESIGN: Comparison of four representative cohorts of 38- and 50-year-old women over a period of 36 years. SETTING: Gothenburg, Sweden with approximately 450,000 inhabitants. SUBJECTS: Four representative samples of 38- and 50-year-old women were invited to free health examinations (participation rate 59-90%, n =1901). MAIN OUTCOME MEASURES: Body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), leisure time exercise, use of antihypertensive medication, smoking, levels of haemoglobin, b-glucose, s-cholesterol, s-triglycerides and HDL-cholesterol. RESULTS: There was no significant difference in mean BMI from 1968-1969 versus 2004-2005. Mean leisure time exercise was significantly higher in later born cohorts; in 1968, around 15% were physically active compared with 40% in 2004. SBP and DBP, mean s-cholesterol and s-triglyceride levels were significantly lower in both 38- and 50-year-old cohorts in 2004-2005 versus 1968-1969. HDL-cholesterol (not measured until 1992-1993), showed a significantly higher mean level in 2004-2005. Reduction of risk factors was apparent in women with a high as well as low level of physical activity. Smoking declined most in women with high levels of physical activity. CONCLUSIONS: Several cardiovascular risk factors related to lifestyle have improved in middle-aged women from the 1960s until today. Most of the positive trends are observed in women with both low and high physical activity.
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| 2. |
- Leong, Tora, et al.
(författare)
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Asymmetric dimethylarginine independently predicts fatal and non-fatal myocardial infarction and stroke in women : 24 year follow up of the Population Study of Women in Gothenburg
- 2008
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Ingår i: Arteriosclerosis, thrombosis, and vascular biology. - 1079-5642. ; 28:5, s. 961-967
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Asymmetrical dimethylarginine (ADMA) reduces nitric oxide by inhibiting nitric oxide synthase is associated with cardiovascular disease (CVD). Our study examined the association of ADMA with CVD prospectively in a healthy population-based cohort of women. METHODS AND RESULTS: We measured baseline ADMA of 880 women in the Population Study of Women in Gothenburg using high-performance liquid chromatography. After adjustment for traditional risk factors, creatinine clearance, and homocysteine using Cox models, the HR (95% CI in parentheses) of CVD end points at 24 years for a 0.15 micromol/L (1 SD) increase in ADMA were: all-cause mortality 1.12 (0.96, 1.32), fatal CVD 1.30 (1.04, 1.62), total CVD events 1.29 (1.09, 1.53). The top quintile (ADMA >or=0.71 micromol/L) compared with the bottom four-fifths, conferred a cumulative risk 22 versus 14%, relative risk 1.75 (95% CI 1.18, 2.59) and population attributable risk 12.7% of total CVD events, and further identified individuals who are at higher than expected risk based on the SCORE and Framingham systems. CONCLUSIONS: A 0.15 mumol/L increase in baseline ADMA levels is associated with approximately 30% increase in incident cardiovascular risk at 24 years in women after adjustment. ADMA levels >or=0.71 micromol/L enhances CVD risk assessment in women.
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| 3. |
- Lissner, Lauren, 1956, et al.
(författare)
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Participation bias in longitudinal studies: experience from the Population Study of Women in Gothenburg, Sweden
- 2003
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Ingår i: Scandinavian Journal of Primary Health Care. ; 21, s. 242-247
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Tidskriftsartikel (refereegranskat)abstract
- Department of Primary Health Care, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. lauren.lissner@medfak.gu.se OBJECTIVE: To describe a cohort study of women receiving a series of comprehensive health examinations over 32 years. DESIGN: Longitudinal population study based on a randomised sample of the female population from defined age cohorts. SETTING: City of Göteborg, Sweden. SUBJECTS: Subjects were 38, 46, 50, 54 or 60 years old at the start of the study in 1968. Re-examinations were performed in 1974, 1982 and 1992. Non-participants in the most recent examination, initiated in 2000, were offered home visits. MAIN OUTCOME MEASURES: Participation, anthropometric and blood pressure changes. RESULTS: At the end of the 32-year follow-up, 64% of the original participants were alive, and low participation among survivors was a problem. An acceptable participation rate (71% of those alive) was obtained after home visits were offered. Surviving non-participants already had elevated cardiovascular risk factors at onset of the study in 1968, along with lower educational level and lower socioeconomic status. Home visited subjects were similar to non-participants with regard to anthropometry and blood pressure, but did not differ from participants with regard to social indicators. Thirty-two-year longitudinal data demonstrate clear ageing effects for several important variables, which should, however, be considered in the context of documented differences with non-participants at the baseline examination. CONCLUSIONS: Longitudinal studies in elderly populations provide important data on changes during the ageing process. However, participation rates decline for a number of reasons and generalisations should be made with care. Moreover, including home visits in the protocol can both increase participation and reduce participation bias in elderly cohorts. PMID: 14695076 [PubMed - indexed for MEDLINE]
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| 4. |
- Zylberstein, Dimitri, 1951
(författare)
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Homocysteine and vascular morbidity and dementia in women. A prospective population study
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Homocysteine and cardiovascular morbidity and dementia in women - A prospective population study Dimitri Edin Zylberstein Institute of Medicine, The Sahlgrenska Academy, Department of Public Health and Community Medicine, Section of Primary Health Care, University of Gothenburg Abstract Purpose. The purpose of this thesis was to study cardiovascular morbidity and dementia in relation to homocysteine levels in women in a longitudinal, prospective population study over several decades. We also studied associations between methylenetetrahydrofolate reductase (MTHFR) genotypes and dementia. Methods. The Prospective Population Study of Women in Gothenburg started 1968/1969. A representative cohort of female population aged 38 to 60 years in Gothenburg was selected with assistance from the census register and invited. Of all invited 90.1% agreed to participate (1462). Blood and serum samples were drawn at baseline examination and at subsequent examinations. A fraction of blood and serum were stored at -200C. This thesis is based on 1368 women with available homocysteine data at baseline. Follow-up examinations were performed 1974/75, 1981/82, 1992/93 and 2000/01 (-03). The studied endpoints were myocardial infarctions (MI), lacunar infarcts in brain, white matter lesions in brain and dementia. The follow-up time was 24 years for myocardial infarctions, lacunar infarcts and white matter lesions. Follow-up time for dementia was 35 years. Homocysteine was analysed using stored samples from baseline examination. MTHFR genes were analysed in 2000/2001 Results. Belonging to the highest quintile of total homocysteine (tHcy) was associated with two-fold risk for developing MI and five-fold risk for dying due to MI, compared to the four lowest quintiles pooled, during 24 years of follow-up. HR=1.9 (95% CI 1.1-3.3) respective 5.1 (95% CI 2.2-11.9). The effect of elevated tHcy on MI was demonstrable after 15 years of follow-up. Belonging to the highest tertile of tHcy was associated with almost three-fold risk for developing lacunar brain infarcts after 24 years of follow-up. OR=2.82 (95% CI 1.34-5.93). Belonging to the highest tertile of tHcy was associated with risk for developing all dementia and especially Alzheimer’s Disease without cerebrovascular disease. HR=1.67 (95% CI 1.10-2.57) respective 2.43 (95% CI 1.25-4.71). The effect could not be seen until 22 years of follow-up. The C allele of MTHFR 1298A>C single nucleotide polymorphism is protective against all dementia and Alzheimer disease. HR=0.59 (95% CI 0.39-0.90) respective HR=0.56 (95% CI 0.33-0.93) Conclusions. Elevated midlife homocysteine is a risk factor for cardiovascular morbidity and dementia in women in extended time perspective. MTHFR 1298C allele is protective against all dementia and Alzheimer’s disease Keywords: Women, population study, dementia, Homocysteine, MTHFR, myocardial infarctions, lacunar infarcts, epidemiology ISBN 978-91-628-7879-5 Gothenburg 2009
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| 5. |
- Zylberstein, Dimitri, 1951, et al.
(författare)
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Homocysteine levels and lacunar brain infarcts in elderly women: the prospective population study of women in Gothenburg.
- 2008
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Ingår i: Journal of the American Geriatrics Society. - : Wiley. - 1532-5415 .- 0002-8614. ; 56:6, s. 1087-91
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine whether total serum homocysteine (tHcy) in a population-based sample of middle-aged women is an independent risk factor for presence of lacunar infarcts (LIs) 24 years later. DESIGN: Prospective population study, follow-up time 24 years. SETTING: Gothenburg, an urban area in western Sweden. PARTICIPANTS: Five hundred twenty-six women, 89.6% of the original study sample of the Population Study of Women in Gothenburg, aged 46 to 60 at baseline in 1968/69 and re-examined at age 70 to 84. MEASUREMENTS: After 24 years of follow-up, all subjects underwent a psychiatric examination, and 277 computerized tomography (CT) scans of the brain were performed. Two radiologists assessed LIs and white matter lesions (WMLs). Baseline serum tHcy was analyzed from frozen stored serum samples. Logistic regression analyses were performed controlling for potential confounders such as age and selected cardiovascular risk factors. RESULTS: Thirty-four subjects had LIs in 1992 (12.3%). In the full multivariate-adjusted stepwise model, LIs were associated with elevated tHcy (odds ratio (OR)=1.09, 95% confidence interval (CI)=1.01-1.17 per micromol/L of tHcy increment). Women with tHcy values in the highest tertile were almost three times as likely to have LIs (OR=2.82, 95% CI=1.34-5.93) as were those in the lowest tertile. tHcy was not related to WMLs. Subjects who did not undergo a CT scan did not differ from those who did regarding tHcy or any of the covariates studied. CONCLUSION: tHcy in middle-aged women is an independent risk factor for LIs, but not WMLs, as observed using CT later in life.
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| 6. |
- Zylberstein, Dimitri, 1951, et al.
(författare)
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Midlife homocysteine and late-life dementia in women. A prospective population study.
- 2011
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Ingår i: Neurobiology of aging. - : Elsevier BV. - 1558-1497 .- 0197-4580. ; 32:3, s. 380-6
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Tidskriftsartikel (refereegranskat)abstract
- Elevated serum total homocysteine (tHcy) is an established risk factor for cardiovascular disease. Its role in dementia is still controversial, and no study has examined the role of midlife tHcy, or reports longer than 8 years of follow-up. We examined the relation between midlife tHcy and late-life dementia in women followed for 35 years. The Prospective Population Study of Women in Gothenburg began in 1968-1969, comprising a representative population of women aged 38-60 years. Four extensive follow-ups were conducted by 2003. Serum samples from 1968 to 1969 were analysed for tHcy in 1368 women. In total, 151 women developed dementia. The highest tHcy tertile was related to a hazard ratio of 1.7 (95% CI 1.1-2.6) for developing any dementia, 2.1 (95% CI 1.2-3.7, n=100) for AD and 2.4 (95% CI 1.3-4.7, n=68) for AD without cerebrovascular disease. Kaplan-Meier plots showed divergence with respect to dementia after 22 years of follow-up. In conclusion, high homocysteine in midlife is an independent risk factor for the development of late-life Alzheimer dementia in women.
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| 7. |
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| 8. |
- Zylberstein, Dimitri, 1951, et al.
(författare)
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Serum homocysteine in relation to mortality and morbidity from coronary heart disease - a 24 year follow-up of the Population Study of Women in Gothenburg
- 2004
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Ingår i: Circulation. ; 109 (5):Feb 10, s. 601-606
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Tidskriftsartikel (refereegranskat)abstract
- Department of Primary Health Care, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. dimitri.zylberstein@allmed.gu.se BACKGROUND: Elevated serum total homocysteine (tHcy) is an established risk factor for cardiovascular disease (CVD), especially in men. However, there are few prospective population studies on female cohorts, and none of these has been longer than 13 years. METHODS AND RESULTS: The Population Study of Women in Gothenburg began in 1968/1969, at which time a representative population-based cohort of women aged 38, 46, 50, 54, and 60 years was recruited. The present cohort is a prospective follow-up of 1368 women in the original cohort for whom blood samples were stored and who were free of previous acute myocardial infarction (AMI) at the 1968/1969 baseline. Homocysteine was analyzed in 2001 with frozen serum from the baseline study and related to AMI incidence and mortality during 24 years of follow-up. Cox regression analyses were used with adjustment for age, traditional risk factors, and tHcy modifiers. For the fifth tHcy quintile, relative risk was 1.86 (95% CI 1.06 to 3.26) for AMI and 5.14 (95% CI 2.22 to 11.92) for death due to AMI. Age-standardized Kaplan-Meier plots for the fifth tHcy quintile versus others showed significant differences both for AMI and for death due to AMI that were apparent after 15 years of follow-up. CONCLUSIONS: Homocysteine in middle-aged women is an independent risk factor for myocardial infarction and in particular mortality due to myocardial infarction. The study illustrates that long-term prospective studies might be necessary to show effects of homocysteine levels on AMI morbidity and mortality in women. PMID: 14769681 [PubMed - indexed for MEDLINE]
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