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- Khalili, Payam, et al.
(författare)
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Smoking as a modifier of the systolic blood pressure-induced risk of cardiovascular events and mortality : a population-based prospective study of middle-aged men
- 2002
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Ingår i: Journal of Hypertension. - : Ovid Technologies (Wolters Kluwer Health). - 0263-6352 .- 1473-5598. ; 20:9, s. 1759-1764
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Tidskriftsartikel (refereegranskat)abstract
- Objective To examine to what degree smoking habits modulate the relationship between systolic blood pressure (SBP) and risk for cardiovascular morbidity (first event) and mortality in middle-aged men. Design and methods In all, 22 444 middle-aged men were recruited from a population-based screening study (mean attendance rate 71%). Risk factor intervention was offered to about 20% of participants. Subjects were followed in local and national registers for cardiovascular morbidity and mortality during more than 17 years of follow-up. Lifestyle variables were investigated at baseline, including smoking habits. Event rates were calculated in relation to quintiles (Q1-Q5) of baseline SBP in untreated subjects, subdivided into categories of smoking habits, but also for 915 previously known, treated hypertensive (tHT) patients at baseline. Results We found an increasing incidence of first cardiovascular event (CE) with increasing SBP levels, ranging from 63.5 CE/10 000 person-years (Q1) to 62.3, 70.5,82.3 and 115.1 CE/10 000 person-years (Q2-Q5). The corresponding figure in tHTs; was 153 CE/10 000 person-years. If further subdivided into smokers/ex-smokers/non-smokers, the relative risks (RR) of smokers were 1.9 [95% confidence interval (Cl): 1.5-2.4], 2.1 (1.8-2.5), 2.3 (1.8-2.9), 1.8 (1.5-2.1), and 1.7 (1.5-2.0) compared to present non-smokers, in relation to SBP (Q1-Q5). In tHTs; the RR was 1.4 (1.1-1.8). Cardiovascular mortality rates differed in relation to SBP and smoking habits, from 40.3 (present non-smokers) and 70.7 (smokers) deaths/10 000 person-years in Q1, to 54.2 and 134.0 deaths/10 000 person-years in Q5. In tHTs the corresponding figures were 81.6 and 149.4 deaths/10 000 person-years, respectively. No difference in risk was found for never-smokers compared to ex-smokers in relation to SBP. The risk in moderate/heavy smokers (> 10 cigarettes/day) compared to other smokers (less than or equal to 10 cigarettes/day) was significantly (P < 0.005) increased only in Q5. Conclusion Increasing systolic blood pressure levels in middle-aged men is associated with an increasing risk of future cardiovascular events and mortality, an association modified by smoking habits. Patients with treated hypertension in the 1970-1980s were also at an increased risk in spite of healthcare efforts. This calls for a more comprehensive multiple risk factor approach for the management and reduction of cardiovascular risk in these patients. (C) 2002 Lippincott Williams Wilkins.
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- Fava, Cristiano, et al.
(författare)
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The common functional polymorphism -50G>T of the CYP2J2 gene is not associated with ischemic coronary and cerebrovascular events in an urban-based sample of Swedes.
- 2010
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Ingår i: Journal of Hypertension. - 1473-5598. ; 28:2, s. 294-299
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: CYP2J2 is responsible for the production of 5,6 8,9 11,12 and 14,15-epoxyeicosatrienoic acids, vasodilator and anti-inflammatory substances. It is abundantly expressed in human heart and also present in kidney and vasculature. Carriers of a common polymorphism, the CYP2J2-50G>T, rs890293, have reduced expression of CYP2J2 mRNA level in the heart putatively through the interference with a binding site for a transcription factor with consequently reduced circulating levels of CYP2J2 epoxygenase metabolites in vivo. AIM: The aim of the present study was to evaluate the effect of this functional polymorphism on blood pressure (BP) levels, hypertension prevalence, and risk of incident cardiovascular events in middle-aged Swedes. METHODS: The CYP2J2 polymorphism was genotyped in 5740 participants of the cardiovascular cohort of the 'Malmö Diet and Cancer' study. The incidence of cardiovascular events (coronary events, n = 261; ischemic stroke, n = 185) was monitored over 10 years of follow-up. RESULTS: In the whole population the polymorphism had no effect on BP and hypertension prevalence and no interaction was found between the polymorphism and sex, age or body mass index. Before and after adjustment for major cardiovascular risk factors, the hazard ratio for incident ischemic stroke and coronary events was not significantly different in carriers of different genotypes. CONCLUSIONS: Our data do not support a major role for the CYP2J2-50G>T variant in determining BP level and incident ischemic events. Other studies are needed to elucidate if other polymorphisms in the same gene could have a role in BP homeostasis or incidence of cardiovascular events.
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| 7. |
- Fava, Cristiano, et al.
(författare)
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The functional variant of the CLC-Kb channel T481S is not associated with blood pressure or hypertension in Swedes.
- 2007
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Ingår i: Journal of Hypertension. - 1473-5598. ; 25:1, s. 111-116
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Tidskriftsartikel (refereegranskat)abstract
- Objective A common threonine481serine polymorphism (T481S) has been shown in vitro to strongly activate the chloride channel Kb (CLC-Kb) expressed in the kidney, and the 481S allele has been associated with human hypertension. The study aim was to evaluate the association of the T481 S polymorphism with blood pressure (BP) levels and the BP progression rate in Swedes. Design and methods The cardiovascular cohort of the Malmo Diet and Cancer (MDC) study is a population surveyed in 1991-1996 (n = 6103, DNA available on n = 6055), 53% of whom had also been examined 11 +/- 4.4 years earlier in the Malmo preventive Project (MPP) Hypertension was defined as having BP above 140/90 mmHg or being on antihypertensive therapy (AHT). Carriers of one or two copies of the 481S allele were compared with T481T homozygotes (noncarriers). Results Among individuals without AHT in the MIX study (n = 4988) there was no difference between carriers (n = 1164, 23%) and noricarriers (n = 3824, 77%) in systolic BP (139.3 +/- 8.3 vs 139.2 +/- 8.3 mmHg, P=0.82) or diastolic BP (86.0 +/- 9.1 vs 86.0 +/- 9.2 mmHg, P = 0.95). In subjects free from AHT at the Ill and Ill studies (n = 2627) there was no difference between carriers (n = 607, 23%) and noricarriers (n = 2020, 77%) in progression of systolic BP (2.1 +/- 2.6 vs 2.0 +/- 2.8 mmHg/year, P = 0.72) or diastolic BP (0.57 +/- 1.4 vs 0.58 +/- 1.6 mmHg/year, P = 0.85) from Ill to Ill Multivariate analysis gave no support of interaction between the CLC-Kb 481S polymorphism, gender, age or body mass index regarding their effect on BP. Conclusion Our data do not support a role of the CLC-Kb T481S polymorphism in BP regulation in Swedes.
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- Fedorowski, Artur, et al.
(författare)
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Consequences of orthostatic blood pressure variability in middle-aged men (The Malmö Preventive Project).
- 2010
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Ingår i: Journal of Hypertension. - 1473-5598. ; 28:3, s. 551-559
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the determinants and consequences of orthostatic hypotension in the middle-aged segment of the general population. METHODS: A population of 5722 men aged 52.6 +/- 3.6 years, previously included in the Malmö Preventive Project (n = 22 444 men), was re-screened after 5.6 +/- 1.0 years and thereafter followed up over a period of 19.6 +/- 5.3 years. RESULTS: At re-screening, 566 (9.9%) participants were found to have orthostatic hypotension according to international consensus criteria, of these 365 (64.5%) demonstrated systolic impairment only. In a multivariate adjusted logistic regression model, age, low BMI, hypertension, increased heart rate, antihypertensive treatment, diabetes and current smoking independently determined orthostatic hypotension, but systolic impairment also showed association with higher pulse pressure and reduced glomerular filtration rate. In a multivariate adjusted Cox proportional hazard model, men with orthostatic hypotension demonstrated a higher risk of incident coronary event, stroke and all-cause mortality than men without orthostatic hypotension. Systolic impairment was a better predictor of all studied endpoints than were the combined criteria of orthostatic hypotension. Moreover, participants with orthostatic hypotension at both baseline and re-screening showed the highest risk of any adverse event (hazard risk 1.76, 95% confidence interval 1.28-2.43, P = 0.001), exceeding the risk predicted by orthostatic hypotension at re-screening only (hazard risk 1.22, 95% confidence interval 1.07-1.38, P = 0.003). CONCLUSION: Orthostatic hypotension may be found in up to 10% of middle-aged men and correlates with well known cardiovascular risk factors such as hypertension, smoking, diabetes and kidney failure. Orthostatic impairment seems to constitute an independent cardiovascular risk factor and may be practically estimated by systolic reaction only. As orthostatic reaction may vary over time, repeated measurements or more accurate diagnostic methods are recommended to identify high-risk patients with persistent orthostatic hypotension.
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- Öhlin, Bertil, et al.
(författare)
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Job strain, decision latitude and alpha2B-adrenergic receptor polymorphism significantly interact, and associate with higher blood pressures in men.
- 2007
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Ingår i: Journal of Hypertension. - 1473-5598. ; 25:8, s. 1613-1619
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Tidskriftsartikel (refereegranskat)abstract
- Background Job strain (high demands and low decision latitude) and the DID genotype of an I/D polymorphism in the adrenergic alpha(2B)-receptor have been associated with hypertension, respectively. We hypothesized that the I/D polymorphism interacts with external stress, such as job strain, in the development of hypertension. Methods A sample of 3045 employed men and women from the population cohort of Malmo Diet and Cancer Study, n = 28 098, with baseline data regarding work characteristics and cardiovascular risk factors, were genotyped for the adrenergic alpha(2B)-receptor I/D polymorphism. This was possible in 1302 men and 1662 women, and these individuals formed the study group. Results The age-adjusted systolic blood pressure (SBP) for men with the DD polymorphism and job strain (n = 26) was 147.0 +/- 3.4 mmHg, whereas for men with the DD polymorphism but without job strain (n = 184), the SBP was 138.2 +/- 1.4 mmHg (P = 0.018). Similar findings were made regarding diastolic blood pressures (DBP) in men. Job strain and the I/D polymorphism in the adrenergic alpha(2B)-receptor gene significantly interacted in men [P = 0.008 for SBP, P = 0.03 for DBP, adjusted for age, body mass index, occupational status and nationality (Model 1)]. Increasing latitude score was inversely correlated with SBP (beta -0.17, P = 0.03, Model 1) in DD men, but not in men with the I-allele; interaction significance for genotype X latitude score, P = 0.02 for SBP (Model 1). In women, there were no significant interactions between genotype and work characteristics (P = 0.32 for SBP, and P = 0.60 for DBP). Conclusion For the first time, a significant interaction between a genetic factor and work environment, resulting in elevated blood pressures, has been described.
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