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| 2. |
- Byberg, Liisa, et al.
(författare)
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Total mortality after changes in leisure time physical activity in 50 year old men : 35 year follow-up of population based cohort
- 2009
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Ingår i: British Journal of Sports Medicine. - : BMJ Publishing Group Ltd. - 0306-3674 .- 1473-0480. ; 338, s. b688-
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine how change in level of physical activity after middle age influences mortality and to compare it with the effect of smoking cessation.Design: Population based cohort study with follow-up over 35 years.Setting: Municipality of Uppsala, Sweden.Participants: 2205 men aged 50 in 1970-3 who were reexamined at ages 60, 70, 77, and 82 years.Main Outcome Measure: Total (all cause) mortality.Results: The absolute mortality rate was 27.1, 23.6, and 18.4 per 1000 person years in the groups with low, medium, and high physical activity, respectively. The relative rate reduction attributable to high physical activity was 32% for low and 22% for medium physical activity. Men who increased their physical activity level between the ages of 50 and 60 continued to have a higher mortality rate during the first five years of follow-up (adjusted hazard ratio 2.64, 95% confidence interval 1.32 to 5.27, compared with unchanged high physical activity). After 10 years of follow-up their increased physical activity was associated with reduced mortality to the level of men with unchanged high physical activity (1.10, 0.87 to 1.38). The reduction in mortality associated with increased physical activity (0.51, 0.26 to 0.97, compared with unchanged low physical activity) was similar to that associated with smoking cessation (0.64, 0.53 to 0.78, compared with continued smoking).Conclusions: Increased physical activity in middle age is eventually followed by a reduction in mortality to the same level as seen among men with constantly high physical activity. This reduction is comparable with that associated with smoking cessation
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| 3. |
- Carlsson, Sofia, et al.
(författare)
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Genetic effects on physical activity : results from the Swedish Twin Registry
- 2006
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Ingår i: Medicine & Science in Sports & Exercise. - : Ovid Technologies (Wolters Kluwer Health). - 0195-9131 .- 1530-0315. ; 38:8, s. 1396-1401
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to investigate the genetic effects on leisure-time physical activity using data from the Swedish Twin Registry. METHODS: We investigated 13,362 twin pairs (5334 monozygotic and 8028 dizygotic pairs) aged 14-46 yr. Information on leisure-time physical activity was obtained by questionnaire. Correlations and odds ratios of physical activity were calculated for males, females, and monozygotic and dizygotic twins, respectively. Structural equation modeling was used to estimate the contribution of genetic effects as well as common and nonshared environmental factors on leisure-time physical activity. RESULTS: About one third of the twins reported that they exercised regularly (26% in females and 39% in males). The correlations of physical activity were twice as high in monozygotic compared with dizygotic twins, suggesting the presence of genetic effects. The variation in physical activity due to heritage was 57% (95% confidence interval (CI) = 0.49-0.63) in males and 50% (95% CI = 0.49-0.55) in females. The common environmental influence on physical activity was very small compared with the influence from environmental factors unique to the individual. CONCLUSIONS: Our study establishes heredity as an important component behind individual differences in physical activity in adult men and women. This may be one reason behind difficulties in convincing people to adopt an active lifestyle. Still, this study shows that there is a substantial influence on physical activity from environmental factors unique to the individual.
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| 4. |
- Carlsson, Sofia, et al.
(författare)
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Low physical activity and mortality in women : Baseline lifestyle and health as alternative explanations
- 2006
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Ingår i: Scandinavian Journal of Public Health. - Karolinska Inst, Div Epidemiol & Social Med, Stockholm Ctr Publ Hlth, Stockholm, Sweden. Karolinska Inst, Dept Epidemiol, Inst Environm Med, Stockholm, Sweden. Karolinska Inst, Dept Nutr Epidemiol, Inst Environm Med, Stockholm, Sweden. : SAGE PUBLICATIONS LTD. - 1403-4948 .- 1651-1905. ; 34:5, s. 480-487
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of this study was to investigate the association between physical activity and mortality in post-menopausal women. In addition, the authors wanted to investigate to what extent this association could be attributed to confounding from other lifestyle factors, and to reverse causation due to a number of common health problems that may inhibit the ability to exercise. Methods: A total of 27,734 women aged 51-83 years from the Swedish Mammography Cohort were investigated. In 1997 they responded to a detailed questionnaire including questions on physical activity, diet, alcohol intake, smoking, and medical problems. During follow-up in 1999-2004, 1,232 deaths were identified by linkage to the National Population Register. Results: Women with low physical activity (<= 35 MET*h/day) had a 3.22 times increased mortality (95% confidence interval (CI)=2.35-4.43) compared with the most active women (> 50 MET*h/day). No increased risk was seen in women with moderate compared with high physical activity. Sedentary women tended to have a less healthy lifestyle and more health problems at baseline, e. g. almost 30% of them reported high blood pressure compared with less than 20% of active women. Baseline medical problems and lifestyle factors such as smoking, diet, and education accounted for 30% of the excess risk seen in sedentary women (24% and 6% respectively). Conclusions: This study indicates that even fairly small amounts of activity will reduce mortality in older women. However, sedentary women seemed to be a selected group with more medical problems and a less healthy lifestyle. The findings indicate that the association between physical inactivity and mortality will be overestimated if this is not taken into account.
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| 5. |
- Carlsson, Sofia, et al.
(författare)
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Physical activity and mortality : is the association explained by genetic selection?
- 2007
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Ingår i: American Journal of Epidemiology. - : Oxford University Press (OUP). - 0002-9262 .- 1476-6256. ; 166:3, s. 255-259
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Tidskriftsartikel (refereegranskat)abstract
- Public health recommendations promote physical activity to improve health and longevity. Recent data suggest that the association between physical activity and mortality may be due to genetic selection. Using data on twins, the authors investigated whether genetic selection explains the association between physical activity and mortality. Data were based on a postal questionnaire answered by 13,109 Swedish twin pairs in 1972. The national Cause of Death Register was used for information about all-cause mortality (n=1,800) and cardiovascular disease mortality (n=638) during 1975-2004. The risk of death was reduced by 34% for men (relative risk=0.64, 95% confidence interval: 0.50, 0.83) and by 25% for women (relative risk=0.75, 95% confidence interval: 0.50, 1.14) reporting high physical activity levels. Within-pair comparisons of monozygotic twins showed that, compared with their less active co-twin, the more active twin had a 20% (odds ratio=0.80, 95% confidence interval: 0.65, 0.99) reduced risk of all-cause mortality and a 32% (odds ratio=0.68, 95% confidence interval: 0.49, 0.95) reduced risk of cardiovascular disease mortality. Results indicate that physical activity is associated with a reduced risk of mortality not due to genetic selection. This finding supports a causal link between physical activity and mortality.
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| 6. |
- Farahmand, Bahman Y., et al.
(författare)
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Survival after hip fracture
- 2005
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 16:12, s. 1583-90
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Tidskriftsartikel (refereegranskat)abstract
- Although it is known that overall mortality is increased after hip fracture, the influence of hip fracture risk factors on the subsequent mortality and cause of death has not been well studied. The objective of this study was to establish the survival after hip fracture in women and to assess the impact of comorbidity on mortality. We identified a complete population-based set of 2,245 incident hip fracture cases and 4,035 randomly selected population-based controls among women 50-81 years old in Sweden and followed these subjects for an average of 5 years through the Swedish National Inpatient and Cause-of-Death Registers. Information on factors related to hip fracture was obtained through linkage to hospital discharge data and through a mailed questionnaire. We studied excess mortality of hip fracture patients compared to controls using survival curves and proportional hazard regression models. During follow-up, 896 hip fracture patients (40%) and 516 (13%) controls died. The relative risk (RR) of death, adjusted for age and previous hospitalization for serious disease, was 2.3 (95% CI 2.0-2.5). Although the highest mortality risks were in the 1st 6 months post-fracture, RRs for fractures versus controls were increased for at least 6 years. Increased mortality was apparent both in those with evidence of comorbidity and those without. Hip fracture patients have a substantially increased risk of death that persists for at least 6 years post-fracture. The relative excess mortality is independent of comorbidity and known hip fracture risk factors.
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| 8. |
- Janszky, Imre, et al.
(författare)
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Hospitalization for depression is associated with an increased risk for myocardial infarction not explained by lifestyle, lipids, coagulation, and inflammation : The SHEEP study
- 2007
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Ingår i: Biological Psychiatry. - : Elsevier BV. - 0006-3223 .- 1873-2402. ; 62:1, s. 25-32
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDepression is considered a risk factor for coronary heart disease (CHD) in initially CHD-free populations. Subclinical CHD or other somatic causes of depressive symptoms might account for the association, however.MethodsIn this case–control study, patients had had their first acute myocardial infarction (AMI). The study included 1799 cases, aged 45–70 years, and 2339, age-, gender-, and hospital-catchment-area-matched control subjects. We calculated odds ratios (OR) with 95% confidence intervals (CI) by multivariate logistic regressions to assess the AMI risk associated with a hospitalization for depression.ResultsForty-seven cases and 22 control subjects had been hospitalized for depression. After adjustment for matching criteria and socioeconomic status, the OR for AMI was 2.9 (1.8–4.9) for ever hospitalized for depression. Patients hospitalized for depression before or after the median time, 15 years and 2 months, between the first hospitalization for depression and AMI, were at similar risk. Adjustment for lifestyle, lipid profile, coagulation, inflammation, prior cardiovascular events, and comorbidity only partly decreased the observed association.ConclusionsDepression was associated with increased risk for AMI. Subclinical CHD or other somatic causes are unlikely to account for our findings, which also appear not to be explained by established risk factors for AMI.
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| 9. |
- Janszky, Imre, et al.
(författare)
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Increased risk and worse prognosis of myocardial infarction in patients with prior hospitalization for epilepsy : the Stockholm Heart Epidemiology Program
- 2009
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Ingår i: Brain. - : Oxford University Press (OUP). - 0006-8950 .- 1460-2156. ; 132:Pt 10, s. 2798-2804
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Tidskriftsartikel (refereegranskat)abstract
- The association of epilepsy with risk of acute myocardial infarction (AMI) remains uncertain, and its association with myocardial infarction prognosis has not been evaluated. In this study, we performed a population-based case-control study that included 1799 cases with first AMI and 2339 controls, frequency matched by age, sex and hospital catchment area. A history of epilepsy was identified using the Swedish hospital discharge registry. Information on lifestyle and biomarkers was determined from questionnaires and standardized clinic examinations. The cohort of cases was followed for 8 years to evaluate the relationship between epilepsy and post AMI prognosis. A diagnosis of epilepsy was associated with higher risk of incident AMI, with an odds ratio (OR) of 4.92 [95% confidence interval (CI) 2.34-10.31] after adjustment for age, gender, hospital catchment area, and education. There was a graded positive relation between number of hospitalizations for epilepsy and risk of AMI. Adjustment for smoking and levels of tissue plasminogen activator (tPA)/plasminogen activator inhibitor 1 (PAI-1) complex, von Willebrand factor and homocysteine weakened, and adjustment for high-density lipoprotein (HDL) and fibrinogen strengthened, the relationship between epilepsy and AMI. The OR for epilepsy was 4.83 (95% CI 1.62-14.43) when age, gender, hospital catchment area, education and established, clinically relevant AMI risk factors, i.e. diabetes mellitus, smoking, hypertension, physical activity, obesity, high-density lipoprotein, total cholesterol and alcohol consumption were simultaneously controlled for. Epilepsy was also associated with AMI prognosis. Multivariable adjusted hazard ratios for total and cardiac mortality and for a combined outcome of cardiac death and non-fatal reinfarction, heart failure and stroke during follow up, were 1.95 (0.70-5.43), 3.49 (1.05-11.65) and 2.39 (1.16-4.90), respectively. We conclude that epilepsy might be a risk and an adverse prognostic factor for AMI. Smoking and increase in the level of homocysteine, tPA/PAI-1 complex and von Willebrand factor are candidate mechanisms linking epilepsy to increased AMI risk. Physicians should be aware of the potential cardiovascular implications of epilepsy.
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| 10. |
- Janszky, Imre, et al.
(författare)
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Prognostic role of the glucometabolic status assessed in a metabolically stable phase after a first acute myocardial infarction : the SHEEP study
- 2009
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 265:4, s. 465-475
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVESOur objective was to examine fasting glucose and insulin levels in patients surviving 3 months after a first AMI in relation to long-term prognosis.DESIGNA total of 1167 consecutive patients between 45 and 70 years with a first nonfatal AMI underwent a standardized clinical examination and were followed for a mean of 8 years for total and cardiac mortality and hospitalization for nonfatal cardiovascular disease. Impaired fasting glucose (IFG) was defined as fasting glucose between 5.6 and 7 mmol L(-1) and a level >or=7 mmol L(-1) as newly detected diabetes. Patients with a fasting glucose level <5.6 mmol L(-1) and without a history of diabetes were classified as normoglycemic (NG). An estimate of insulin resistance was calculated using the homeostasis model assessment (HOMA).RESULTSWe recorded 219 deaths, 121 deaths from cardiac causes, during the follow-up period. After adjustment for several potential confounders, hazard ratios for total mortality were 1.36 (95% confidence interval 0.93-1.99, P=0.11), 2.27 (1.26-4.09, P=0.006) and 2.15 (1.43-3.21, P<0.001) for patients with IFG, newly detected diabetes and history of diabetes when compared to the NG group. Cardiac mortality, risk of hospitalization for recurrent nonfatal AMI, stroke or heart failure generally showed a similar pattern to that of total mortality. Insulin level and HOMA values were also associated with increased risk for recurrent events.CONCLUSIONSWe confirmed that both known and newly detected diabetes is a strong prognostic factor in AMI. In addition, our findings suggest that glucose levels below the diabetes cut off value might also predict poor long-term prognosis when assessed in a metabolically stable phase.
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