| 1. |
- Ahmad Kiadaliri, Aliasghar, et al.
(författare)
-
Predicting Changes in Cardiovascular Risk Factors in Type 2 Diabetes in the Post-UKPDS Era: Longitudinal Analysis of the Swedish National Diabetes Register
- 2013
-
Ingår i: Journal of Diabetes Research. - : Hindawi Limited. - 2314-6745 .- 2314-6753. ; 2013
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of the current study was to provide updated time-path equations for risk factors of type-2-diabetes-related cardiovascular complications for application in risk calculators and health economic models. Observational data from the Swedish National Diabetes Register were analysed using Generalized Method of Moments estimation for dynamic panel models ( , aged 25–70 years at diagnosis in 2001–2004). Validation was performed using persons diagnosed in 2005 ( ). Results were compared with the UKPDS outcome model. The value of the risk factor in the previous year was the main predictor of the current value of the risk factor. People with high (low) values of risk factor in the year of diagnosis experienced a decreasing (increasing) trend over time. BMI was associated with elevations in all risk factors, while older age at diagnosis and being female generally corresponded to lower levels of risk factors. Updated time-path equations predicted risk factors more precisely than UKPDS outcome model equations in a Swedish population. Findings indicate new time paths for cardiovascular risk factors in the post-UKPDS era. The validation analysis confirmed the importance of updating the equations as new data become available; otherwise, the results of health economic analyses may be biased.
|
|
| 2. |
- Ahmad Kiadaliri, Aliasghar, et al.
(författare)
-
Towards Renewed Health Economic Simulation of Type 2 Diabetes: Risk Equations for First and Second Cardiovascular Events from Swedish Register Data
- 2013
-
Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 8:5
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Predicting the risk of future events is an essential part of health economic simulation models. In pursuit of this goal, the current study aims to predict the risk of developing first and second acute myocardial infarction, heart failure, non-acute ischaemic heart disease, and stroke after diagnosis in patients with type 2 diabetes, using data from the Swedish National Diabetes Register. Material and Methods Register data on 29,034 patients with type 2 diabetes were analysed over five years of follow up (baseline 2003). To develop and validate the risk equations, the sample was randomly divided into training (75%) and test (25%) subsamples. The Weibull proportional hazard model was used to estimate the coefficients of the risk equations, and these were validated in both the training and the test samples. Results In total, 4,547 first and 2,418 second events were observed during the five years of follow up. Experiencing a first event substantially elevated the risk of subsequent events. There were heterogeneities in the effects of covariates within as well as between events; for example, while for females the hazard ratio of having a first acute myocardial infarction was 0.79 (0.70–0.90), the hazard ratio of a second was 1.21 (0.98–1.48). The hazards of second events decreased as the time since first events elapsed. The equations showed adequate calibration and discrimination (C statistics range: 0.70–0.84 in test samples). Conclusion The accuracy of health economic simulation models of type 2 diabetes can be improved by ensuring that they account for the heterogeneous effects of covariates on the risk of first and second cardiovascular events. Thus it is important to extend such models by including risk equations for second cardiovascular events.
|
|
| 3. |
- Andersson, Ulrika, et al.
(författare)
-
Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study
- 2024
-
Ingår i: SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 42:3, s. 415-423
-
Tidskriftsartikel (refereegranskat)abstract
- Objective To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures Association between self-reported BP and 10 self-report lifestyle-related variables. Results Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.
|
|
| 4. |
- Andersson, Ulrika, et al.
(författare)
-
PERson-centredness in Hypertension management using Information Technology: a randomized controlled trial in primary care
- 2023
-
Ingår i: Journal of hypertension. - : LIPPINCOTT WILLIAMS & WILKINS. - 1473-5598 .- 0263-6352. ; 41:2, s. 246-253
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To increase the proportion of individuals with hypertension obtaining a blood pressure (BP) of less than 140/90mmHg by improving the management of hypertension in daily life from a person-centred perspective. METHODS: In this unblinded randomized controlled trial, we tested an interactive web-based self-management system for hypertension. A total of 949 patients with hypertension from 31 primary healthcare centres (PHCCs) in Sweden were randomized 1:1 to either the intervention or usual care group. The intervention included daily measurement - via the participant's mobile phone - of BP and pulse and reports of well being, symptoms, lifestyle, medication intake and side effects for eight consecutive weeks. It also included reminders and optional motivational messages. The primary outcome was the proportion of participants obtaining BP of less than 140/90mmHg at 8 weeks and 12months. Significance was tested by Pearson's chi 2 -test. RESULTS: A total of 862 patients completed the trial, 442 in the intervention group and 420 in the control group. The primary outcome (BP <140/90mmHg) at 8 weeks was achieved by 48.8% in the intervention group and 39.9% in the control group ( P =0.006). At 12months, 47.1% (intervention) and 41.0% (control group) had a BP less than 140/90mmHg ( P =0.071). CONCLUSION: The proportion of participants with a controlled BP of less than 140/90mmHg increased after using the interactive system for self-management of hypertension for 8 weeks compared with usual care. Although the trend continued, there was no significant difference after 12months. The results indicate that the effect of the intervention is significant, but the long-term effect is uncertain. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (NCT03554382).
|
|
| 5. |
- Andersson, Ulrika, et al.
(författare)
-
Variability in home blood pressure and its association with renal function and pulse pressure in patients with treated hypertension in primary care
- 2023
-
Ingår i: Journal of Human Hypertension. - : SPRINGERNATURE. - 0950-9240 .- 1476-5527.
-
Tidskriftsartikel (refereegranskat)abstract
- Blood pressure variability (BPV) represents a cardiovascular risk factor, regardless of mean level of blood pressure (BP). In this post-hoc analysis from the PERson-centredness in Hypertension management using Information Technology (PERHIT) study, we aimed to explore BPV in daily home measurements in hypertensive patients from primary care, to identify factors associated with high BPV and to investigate whether estimated glomerular filtration rate (eGFR) and pulse pressure, as markers of target organ damage (TOD), are associated with BPV. For eight consecutive weeks, 454 participants reported their daily BP and heart rate in their mobile phone, along with reports of lifestyle and hypertension-related factors. Systolic BP (SBP) values were used to calculate BPV with coefficient of variation (CV) as primary estimate. Background characteristics and self-reports were tested between fifths of CV in a linear regression model, adjusted for age and sex. Associations between BPV and eGFR and pulse pressure were tested with linear and logistic regression models. Higher home BPV was associated with higher age, BP, heart rate, and smoking. BPV was lower for participants with low alcohol consumption and treatment with calcium channel blockers. There was a significant association between BPV and pulse pressure (P = 0.015), and between BPV and eGFR (P = 0.049). Participants with high BPV reported more dizziness and palpitations. In conclusion, pulse pressure and eGFR were significantly associated with home BPV. Older age, high BP, heart rate, and smoking were associated with high BPV, but treatment with calcium channel blockers and low alcohol consumption was associated with low BPV. Trial registration: The study was registered with ClinicalTrials.gov [NCT03554382].
|
|
| 6. |
- Avdic, Tarik, et al.
(författare)
-
Reduced Long-Term Risk of Aortic Aneurysm and Aortic Dissection Among Individuals With Type 2 Diabetes Mellitus: A Nationwide Observational Study.
- 2018
-
Ingår i: Journal of the American Heart Association. - 2047-9980. ; 7:3
-
Tidskriftsartikel (refereegranskat)abstract
- No studies have examined long-term risks for aortic aneurysm (AA) and aortic dissection (AD) or mortality after AA or AD hospitalization among patients with type 2 diabetes mellitus (T2DM).In this observational cohort study, we linked data for patients with T2DM in the Swedish National Diabetes Register, and 5 individually matched population-based control subjects (CSs) without diabetes mellitus (on the basis of sex, age, and county), to other national databases to capture hospitalizations and death. We examined the risk of hospitalization for AA and AD, as well as mortality risk after AA and AD using Kaplan-Meier curves and Cox regression hazards models. Data on 448319 patients with T2DM and 2251015 CSs were obtained between 1998 and 2015. Mean follow-up time was 7.0years for the T2DM group and 7.2years for the CS group. Patients with T2DM had a relative risk reduction of 28% (hazard ratio, 0.72; 95% confidence interval, 0.68-0.76; P<0.0001) for AA and a 47% relative risk reduction (hazard ratio, 0.53; 95% confidence interval, 0.42-0.65; P<0.0001) for AD compared with CSs. Patients with T2DM had a relative risk reduction of 12% (hazard ratio, 0.88; 95% confidence interval, 0.82-0.94; P<0.0001) for mortality after hospitalization for AA, and unaltered risk (hazard ratio, 1.07; 95% confidence interval, 0.85-1.34; P=0.5859) for mortality after AD, up to 2years compared with CSs.Patients with T2DM had significantly reduced risks of AA and AD as well as reduced risk of mortality after hospitalization for AA, compared to CS. Data suggest that glycated cross-links in aortic tissue may play a protective role in the progression of aortic diseases among patients with T2DM.
|
|
| 7. |
- Bennet, Louise, et al.
(författare)
-
Dubbelt så hög risk för diabetes typ 2 hos svenskar födda i Irak
- 2015
-
Ingår i: Läkartidningen. - 0023-7205. ; 112:16, s. 1-4
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The MEDIM study reports that Immigrants from the Middle East to Sweden – independently of other diabetes related risk factors – have a twice as high type 2 diabetes risk as compared to non-immigrated Swedes. Diabetes onset occurs 6 years earlier in this group and is partly explained by family history and/or obesity. But the MEDIM study has identified that Middle Eastern background per se is an independent risk factor for earlier disease onset. Immigrants from the Middle East free of diabetes have a more pronounced insulin resistance and worse glycaemic control than non-immigrated Swedes independently of age, obesity or other risk factors for diabetes. To be able to reduce the risk of diabetes and offer an equal health care, glucose/HbA1c should be controlled on wide indications, and risk evaluation and preventive actions provided earlier for this population at high risk for type 2 diabetes. © 2015, Swedish Medical Association. All rights reserved.
|
|
| 8. |
|
|
| 9. |
- Cederholm, Jan, et al.
(författare)
-
Blood pressure and risk of cardiovascular diseases in type 2 diabetes : further findings from the Swedish National Diabetes Register (NDR-BP II)
- 2012
-
Ingår i: Journal of Hypertension. - 0263-6352 .- 1473-5598. ; 30:10, s. 2020-2030
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: Estimate risks of coronary heart disease (CHD), stroke and cardiovascular disease (CVD) with updated mean systolic (SBP) and diastolic (DBP) blood pressure in an observational study of patients with type 2 diabetes. Methods: Thirty-five thousand and forty-one patients treated with antihypertensive drugs, and 18 512 untreated patients, aged 30-75 years, without previous heart failure, followed for 6 years until 2009. Results: In treated patients, nonlinear splines for 6-year risk of fatal/nonfatal CHD, stroke and CVD by BP as a continuous variable showed a progressive increase with higher SBP from 140 mmHg and higher, and with DBP from 80 mmHg, with a J-shaped risk curve at lowest SBP levels, but not obviously at lowest DBP levels. Analysing intervals of SBP with 130-134 mmHg as reference at Cox regression, adjusted hazard ratios (HR) for fatal/nonfatal CHD, stroke and CVD with at least 140 mmHg were 1.22 [95% confidence interval (CI): 1.08-1.39], 1,43 (1.18-1.72), 1.26 (1.13-1.41), all P<0.001. HR with 115-129 and 135-139 mmHg were nonsignificant, whereas increased with 100-114 mmHg, 1.96 (P<0.001), 1.75 (P=0.02), 2.08 (P < 0.001), respectively. With DBP 75-79 mmHg as reference, adjusted HR for fatal/nonfatal CHD, stroke and CVD with DBP 80-84 mmHg were 1.42 (1.26-1.59), 1.46 (1.24-1.72), 1.39 (1.26-1.53), all P< 0.001. Corresponding HR with DBP at least 85 mmHg were 1.70 (1.50-1.92), 2.35 (1.99-2.77), 1..87 (1.69-2.07), all P < 0.001. Corresponding HR with DBP 60-69 and 70-74 mmHg were nonsignificant. The picture was similar in 7059 patients with previous CVD and in untreated patients. Conclusion: BP around 130-135/75-79 mmHg showed lower risks of cardiovascular diseases in patients with type 2 diabetes.
|
|
| 10. |
|
|
