| 31. |
- Emerging Risk Factors, Collaboration, et al.
(författare)
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The Emerging Risk Factors Collaboration: analysis of individual data on lipid, inflammatory and other markers in over 1.1 million participants in 104 prospective studies of cardiovascular diseases
- 2007
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Ingår i: Eur J Epidemiol. - 0393-2990. ; 22:12, s. 839-69
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Tidskriftsartikel (refereegranskat)abstract
- Many long-term prospective studies have reported on associations of cardiovascular diseases with circulating lipid markers and/or inflammatory markers. Studies have not, however, generally been designed to provide reliable estimates under different circumstances and to correct for within-person variability. The Emerging Risk Factors Collaboration has established a central database on over 1.1 million participants from 104 prospective population-based studies, in which subsets have information on lipid and inflammatory markers, other characteristics, as well as major cardiovascular morbidity and cause-specific mortality. Information on repeat measurements on relevant characteristics has been collected in approximately 340,000 participants to enable estimation of and correction for within-person variability. Re-analysis of individual data will yield up to approximately 69,000 incident fatal or nonfatal first ever major cardiovascular outcomes recorded during about 11.7 million person years at risk. The primary analyses will involve age-specific regression models in people without known baseline cardiovascular disease in relation to fatal or nonfatal first ever coronary heart disease outcomes. This initiative will characterize more precisely and in greater detail than has previously been possible the shape and strength of the age- and sex-specific associations of several lipid and inflammatory markers with incident coronary heart disease outcomes (and, secondarily, with other incident cardiovascular outcomes) under a wide range of circumstances. It will, therefore, help to determine to what extent such associations are independent from possible confounding factors and to what extent such markers (separately and in combination) provide incremental predictive value.
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| 32. |
- Eriksson, Peter J, 1959, et al.
(författare)
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Bundle-branch block in middle-aged men: risk of complications and death over 28 years. The Primary Prevention Study in Goteborg, Sweden
- 2005
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Ingår i: Eur Heart J. - : Oxford University Press (OUP). - 0195-668X. ; 26:21, s. 2300-6
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To investigate the long-term fate of men with bundle-branch block (BBB) from a general population sample. METHODS AND RESULTS: Data were derived from 7392 men without a history of myocardial infarction or stroke, born between 1915 and 1925 and investigated between 1970 and 1973. All participants were followed from the date of their baseline examination until 1998. We identified 70 men with right-BBB and 46 men with left-BBB at baseline. In men with right-BBB, there was no increased risk of myocardial infarction, coronary death, heart failure, or all-cause mortality during follow-up. The multiple-adjusted hazard ratio for progression to high-degree atrioventricular block was 3.64 (99% confidence interval 0.79-16.72). In men with left-BBB, the hazard ratio for high-degree atrioventricular block was 12.89 (4.13-40.24). However, hazard ratio for all-cause mortality was 1.85 (1.15-2.97) when compared with men without BBB, mostly due to outside hospital coronary deaths, whose hazard ratio was 4.22 (1.90-9.34). CONCLUSION: The presence of BBB was strongly associated with future high-degree atrioventricular block that was more pronounced for left-BBB. Men with left-BBB have a substantially increased risk of coronary death, mainly due to sudden death outside the hospital setting.
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| 33. |
- Fibrinogen Studies, Collaboration, et al.
(författare)
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Associations of plasma fibrinogen levels with established cardiovascular disease risk factors, inflammatory markers, and other characteristics: individual participant meta-analysis of 154,211 adults in 31 prospective studies: the fibrinogen studies collaboration.
- 2007
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Ingår i: American journal of epidemiology. - : Oxford University Press (OUP). - 0002-9262 .- 1476-6256. ; 166:8, s. 867-79
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Tidskriftsartikel (refereegranskat)abstract
- Long-term increases in plasma fibrinogen levels of 1 g/liter are associated with an approximate doubling of risk of major cardiovascular disease outcomes, but causality remains uncertain. To quantify cross-sectional associations of fibrinogen levels with established risk factors and other characteristics, the investigators combined individual data on 154,211 apparently healthy adults from 31 prospective studies conducted between 1967 and 2003, using a linear mixed model that included random effects at the cohort level. Fibrinogen levels increased with age and showed continuous, approximately linear relations with several risk markers and slightly curvilinear associations with log triglycerides, albumin, and tobacco and alcohol consumption. Female sex, Black ethnicity, lower socioeconomic status, and alcohol abstinence were each associated with modestly higher fibrinogen levels. Approximately one third of the variation in fibrinogen levels was explained by cohort, age, and sex. An additional 7% was explained by established risk factors (notably, positive associations with smoking and body mass index and an inverse association with high density lipoprotein cholesterol), and a further 10% was explained by inflammatory markers (notably, a positive association with C-reactive protein). The association with body mass index was twice as strong in women as in men, whereas the association with smoking was much stronger in men. These findings substantially advance understanding of the correlates and possible determinants of fibrinogen levels.
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| 34. |
- Fibrinogen Studies, Collaboration, et al.
(författare)
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Systematically missing confounders in individual participant data meta-analysis of observational cohort studies.
- 2009
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Ingår i: Statistics in medicine. - : Wiley. - 0277-6715 .- 1097-0258. ; 28:8, s. 1218-37
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Tidskriftsartikel (refereegranskat)abstract
- One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an exposure and disease either are restricted to cohorts with full confounder information, or use all cohorts but do not fully adjust for confounding. We propose using a bivariate random-effects meta-analysis model to use information from all available cohorts while still adjusting for all the potential confounders. Our method uses both the fully adjusted and the partially adjusted estimated effects in the cohorts with full confounder information, together with an estimate of their within-cohort correlation. The method is applied to estimate the association between fibrinogen level and coronary heart disease incidence using data from 154,012 participants in 31 cohorts
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| 35. |
- Giang, Kok Wai, 1984, et al.
(författare)
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Long-term risk of stroke and myocardial infarction in middle-aged men with a hypertensive response to exercise : a 44-year follow-up study
- 2021
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Ingår i: Journal of Hypertension. - : Wolters Kluwer. - 0263-6352 .- 1473-5598. ; 39:3, s. 503-510
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Data on the prognostic value of hypertensive response to exercise in cardiovascular disease are limited. The aim was to determine whether SBP reactions during exercise have any prognostic value in relation to the long-term risk of stroke and myocardial infarction (MI).Patients and methods: A representative cohort of men from Gothenburg, Sweden, born in 1913, who performed a maximum exercise test at age 54 years, (n = 604), was followed-up for a maximum of 44 years with regard to stroke and MI. Results: Among the 604 men, the mean resting and maximum SBP was 141.5 (SD 18.8) and 212.1 (SD 24.6) mmHg, respectively. For maximum SBP, the risk of stroke increased by 34% (hazard ratio 1.34, 95% confidence interval 1.11-1.61) per 1-SD increase, while no risk increase was observed for MI. The highest risk of stroke among blood pressure groups was observed among men with a resting SBP of at least 140 mmHg and a maximum SBP of at least 210 mmHg with an hazard ratio of 2.09 (95% confidence interval 1.29-3.40), compared with men with a resting SBP of less than 140 mmHg and a maximum SBP of less than 210 mmHg, independent of smoking, blood glucose, cholesterol and BMI.Conclusion: Among middle-aged men with high resting and maximum blood pressure during maximum exercise workload, an increased risk of stroke was observed but not for MI. Further studies with larger sample sizes are needed to investigate the underlying mechanisms of the increased risk of stroke among individuals with hypertensive response to exercise.
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| 36. |
- Giang, Kok Wai, 1984, et al.
(författare)
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Stroke and coronary heart disease: predictive power of standard risk factors into old age-long-term cumulative risk study among men in Gothenburg, Sweden
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 34:14, s. 1068-1074
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Tidskriftsartikel (refereegranskat)abstract
- Aims The aim of this study was to examine the short-term and long-term cumulative risk of coronary heart disease (CHD) and stroke separately based on age, sex, smoking status, systolic blood pressure, and total serum cholesterol. Methods and results The Primary Prevention Study comprising 7174 men aged between 47 and 55 free from a previous history of CHD, stroke, and diabetes at baseline examination (1970–73) was followed up for 35 years. To estimate the cumulative effect of CHD and stroke, all participants were stratified into one of five risk groups, defined by their number of risk factors. The estimated 10-year risk for high-risk individuals when adjusted for age and competing risk was 18.1% for CHD and 3.2% for stroke which increased to 47.8 and 19.6%, respectively, after 35 years. The estimates based on risk factors performed well throughout the period for CHD but less well for stroke. Conclusion The prediction of traditional risk factors (systolic blood pressure, total serum cholesterol, and smoking status) on short-term risk (0–10 years) and long-term risk (0–35 years) of CHD of stroke differs substantially. This indicates that the cumulative risk in middle-aged men based on these traditional risk factors can effectively be used to predict CHD but not stroke to the same extent.
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| 37. |
- Halford, Christina, et al.
(författare)
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Effects of self-rated health on sick leave, disability pension, hospital admissions and mortality. A population-based longitudinal study of nearly 15,000 observations among Swedish women and men.
- 2012
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Ingår i: BMC public health. - : Springer Science and Business Media LLC. - 1471-2458. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Simple global self-ratings of health (SRH) have become increasingly used in national and international public health monitoring, and in recent decades recommended as a standard part of health surveys. Monitoring developments in population health requires identification and use of health measures, valid in relation to targets for population health. The aim of the present study was to investigate associations between SRH and sick leave, disability pension, hospital admissions, and mortality, adjusted for effects of significant covariates, in a large population-based cohort. The analyses were based on screening data from eight population-based cohorts in southern and central Sweden, and on official register data regarding sick-leave, disability pension, hospital admissions, and death, with little or no data loss. Sampling was performed 1973-2003. The study population consisted of 11,880 women and men, age 25-99 years, providing 14,470 observations. Information on SRH, socio-demographic data, lifestyle variables and somatic and psychological symptoms were obtained from questionnaires. There was a significant negative association between SRH and sick leave (Beta -13.2, p<0.0001, and -9.5, p<0.01, in women and men, respectively), disability pension (Hazard ratio 0.77, p<0.0001 and 0.76, p<0.0001, in women and men, respectively), and mortality, adjusted for covariates. SRH was also significantly associated with hospital admissions in men (Hazard ratio 0.87, p<0.0001), but not in women (Hazard ratio 0.96, p0.20). Associations between SRH on the one hand, and sick leave, disability pension, hospital admission, and mortality, on the other, were robust during the follow-up period. SRH had strong predictive validity in relation to use of social insurance facilities and health care services, and to mortality. Associations were strong and robust during follow-up.
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| 38. |
- Harmsen, P., et al.
(författare)
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Long-term risk factors for stroke: twenty-eight years of follow-up of 7457 middle-aged men in Goteborg, Sweden
- 2006
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Ingår i: Stroke. - 1524-4628. ; 37:7, s. 1663-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: To estimate the predictive value of risk factors for stroke measured in midlife over follow-up extending through 28 years. METHODS: A cohort of 7457 men 47 to 55 years of age and free of stroke at baseline year 1970 were examined. Risk of stroke was analyzed for the entire period and for 0 to 15, 16 to 21, and 22 to 28 years of follow-up using age-adjusted and multiple Cox regression analyses. RESULTS: Age, diabetes, and high blood pressure were independently associated with increased risk of stroke for the entire 28 years and for each of the periods. Previous transient ischemic attacks, atrial fibrillation, history of chest pain, smoking, and psychological stress were independently related to stroke for the entire follow-up period and also during the first 1 or 2 successive periods. Family history of stroke or of coronary disease carried no independent prognostic information, nor did serum cholesterol. Elevated body mass index predicted stroke during the later part of the follow-up and so did (almost) low physical activity during leisure time, together with antihypertensive medication at baseline. CONCLUSIONS: High blood pressure and diabetes retain their importance as stroke risk factors also over an extended follow-up into old age. A family history of cardiovascular disease was not significantly related to outcome. Transient ischemic attacks, atrial fibrillation, stress, smoking, and a history of chest pain were associated with outcome only for the first or the first 2 periods. High body mass index and antihypertensive medication at baseline emerged as risk factors in the second and third decades.
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| 39. |
- Harmsen, Per, et al.
(författare)
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Stroke incidence and mortality rates 1987 to 2006 related to secular trends of cardiovascular risk factors in Gothenburg, Sweden.
- 2009
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Ingår i: Stroke; a journal of cerebral circulation. - 1524-4628. ; 40:8, s. 2691-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Stroke incidence rates were unchanged whereas fatality rates declined during the period 1971 to 1987 in Gothenburg (Göteborg), Sweden. For the period 1987 to 2006, we now report on trends in stroke incidence and mortality with concurrent risk factor trends in the same population. Since 1976 the incidence of myocardial infarction decreased by 50%. METHODS: Through the National Hospital Discharge Register linked with the Cause of Death Register, 12 904 males and 15 250 females with first strokes were detected for the period 1987 to 2006. Cardiovascular risk factor data were available for random population samples of men and women aged 50 years from 1963 to 2003. RESULTS: Incidence and mortality rates for all-stroke were unchanged. Rates for subarachnoid hemorrhage declined for the age group 45 to 54 in men, but not significantly in any other age group of men or women. Mortality rates of intracerebral hemorrhage declined for women aged 65 to 74, with no significant changes in any other age group. Ischemic stroke incidence did not change, but mortality increased for men and women aged 75 and older, whereas mortality declined for the age group 20 to 44 for men. In the general population there were significant reductions in smoking, total cholesterol, and blood pressure levels in both men and women, whereas diabetes prevalence, body weight, and BMI increased among both sexes, and triglycerides increased in men. CONCLUSIONS: Contrary to myocardial infarction, stroke incidence and mortality did not change. Monitoring of cardiovascular risk factors in the community is important.
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| 40. |
- Hedén Ståhl, Christina, 1972, et al.
(författare)
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High-normal blood pressure and long-term risk of type 2 diabetes: 35-year prospective population based cohort study of men
- 2012
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Ingår i: BMC cardiovascular disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: The link between type 2 diabetes and hypertension is well established and the conditions often coexist. High normal blood pressure, defined by WHO-ISH as systolic blood pressure (SBP) 130--139 mm Hg or diastolic blood pressure (DBP) 85--89 mm Hg, has been found to be an independent predictor for type 2 diabetes in studies, although with relatively limited follow-up periods of approximately 10 years. The aim of this study was to investigate whether hypertension, including mildly elevated blood pressure within the normal range, predicted subsequent development of type 2 diabetes in men over an extended follow-up of 35 years. METHODS: Data were derived from the Gothenburg Primary Prevention Study where a random sample of 7 494 men aged 47--55 years underwent a baseline screening investigation in the period 1970--1973. A total of 7 333 men were free from previous history of diabetes at baseline. During a 35-year follow-up diabetes was identified through the Swedish hospital discharge and death registries. The cumulative risk of diabetes adjusted for age and competing risk of death was calculated. Using Cox proportional hazard models we calculated the multiple adjusted hazard ratios (HR) (95% confidence interval (CI)) for diabetes at different blood pressure levels. RESULTS: During a 35-year follow-up, 956 men (13%) were identified with diabetes. The 35-year cumulative risk of diabetes after adjusting for age and competing risk of death in men with SBP levels <130 mm Hg, 130--139 mm Hg, 140--159 mm Hg and >=160 mm Hg were 19%, 30%, 31% and 49%, respectively. The HR for diabetes adjusted for age, body mass index (BMI), cholesterol, antihypertensive treatment, smoking, physical activity and occupation were 1.43 (95% CI 1.12-1.84), 1.43 (95% CI 1.14-1.79) and 1.95 (95% CI 1.55-2.46) for men with SBP 130--139 mm Hg, 140--159 mm Hg, and >= 160 mm Hg, respectively (reference; SBP<130 mm Hg). CONCLUSION: In this population, at mid-life, even high-normal SBP levels were shown to be a significant predictor of type 2 diabetes, independently of BMI and other conventional type 2 diabetes risk factors over an extended follow-up.
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