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Sökning: WFRF:(Boström Kristina Bengtsson)

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  • Pikkemaat, Miriam, et al. (författare)
  • C-peptide predicts all-cause and cardiovascular death in a cohort of individuals with newly diagnosed type 2 diabetes. The Skaraborg diabetes register
  • 2019
  • Ingår i: Diabetes Research and Clinical Practice. - Elsevier. - 0168-8227. ; 150, s. 174-183
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To study the association between baseline level of C-peptide and all-cause death, cardiovascular death and cardiovascular complications among persons with newly diagnosed type 2 diabetes. Methods: The Skaraborg Diabetes Register contains data on baseline C-peptide concentrations among 398 persons <65 years with newly diagnosed type 2 diabetes 1996–1998. National registries were used to determine all-cause death, cardiovascular death and incidence of myocardial infarction and ischemic stroke until 31 December 2014. The association between baseline C-peptide and outcomes were evaluated with adjustment for multiple confounders by Cox regression analysis. Missing data were handled by multiple imputation. Results: In the imputed and fully adjusted model there was a significant association between 1 nmol/l increase in C-peptide concentration and all-cause death (HR 2.20, 95% CI 1.49–3.25, p < 0.001, number of events = 104), underlying cardiovascular death (HR 2.69, 1.49–4.85, p = 0.001, n = 35) and the composite outcome of underlying cardiovascular death, myocardial infarction or ischemic stroke (HR 1.61, 1.06–2.45, p = 0.027, n = 90). Conclusions: Elevated C-peptide levels at baseline in persons with newly diagnosed type 2 diabetes are associated with increased risk of all-cause and cardiovascular mortality. C-peptide might be used to identify persons at high risk of cardiovascular complications and premature death.
  • Dalemo, Sofia, et al. (författare)
  • Variation in plasma calcium analysis in primary care in Sweden - a multilevel analysis
  • 2010
  • Ingår i: BMC Family Practice. - BioMed Central. - 1471-2296. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Primary hyperparathyroidism (pHPT) is a common disease that often remains undetected and causes severe disturbance especially in postmenopausal women. Therefore, national recommendations promoting early pHPT detection by plasma calcium (P-Ca) have been issued in Sweden. In this study we aimed to investigate variation of P-Ca analysis between physicians and health care centres (HCCs) in primary care in county of Skaraborg, Sweden. Methods: In this cross sectional study of patients' records during 2005 we analysed records from 154 629 patients attending 457 physicians at 24 HCCs. We used multilevel logistic regression analysis (MLRA) and adjusted for patient, physician and HCC characteristics. Differences were expressed as median odds ratio (MOR). Results: There was a substantial variation in number of P-Ca analyses between both HCCs (MORHCC 1.65 [1.44-2.07]) and physicians (MORphysician 1.95 [1.85-2.08]). The odds for a P-Ca analysis were lower for male patients (OR 0.80 [0.77-0.83]) and increased with the number of diagnoses (OR 25.8 [23.5-28.5]). Sex of the physician had no influence on P-Ca test ordering (OR 0.93 [0.78-1.09]). Physicians under education ordered most P-Ca analyses (OR 1.69 [1.35-2.24]) and locum least (OR 0.73 [0.57-0.94]). More of the variance was attributed to the physician level than the HCC level. Different mix of patients did not explain this variance between physicians. Theoretically, if a patient were able to change both GP and HCC, the odds of a P-Ca analysis would in median increase by 2.45. Including characteristics of the patients, physicians and HCCs in the MLRA model did not explain the variance. Conclusions: The physician level was more important than the HCC level for the variation in P-Ca analysis, but further exploration of unidentified contextual factors is crucial for future monitoring of practice variation.
  • Bengtsson Boström, Kristina, et al. (författare)
  • Interaction between the angiotensin-converting enzyme gene insertion/deletion polymorphism and obstructive sleep apnoea as a mechanism for hypertension.
  • 2007
  • Ingår i: Journal of Hypertension. - Lippincott Williams & Wilkins. - 1473-5598. ; 25:4, s. 779-783
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective Obstructive sleep apnoea (OSA) confers a risk of hypertension and cardiovascular complications. Both the renin-angiotensin-aldosterone system and OSA are important determinants of blood pressure, but it is not fully known how they interact. The aim of this study was to explore the interaction between the angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and OSA in the association with hypertension. Design A community-based, case-control design with hypertensive patients in primary care (n =157) and normotensive population controls (n =181). Methods All subjects underwent ambulatory polysomnography during one night. OSA was defined by a minimum of 10 apnoea/hypopnoea events per hour. Office blood pressure was measured and hypertension status was assessed. The genotypes were determined using polymerase chain reaction. Results An interaction analysis including sex, ACE I/D polymorphism (DD and ID versus II), and OSA identified a significant interaction between OSA and the ACE I/D f polymorphism: odds ratio (OR) 6.3, 95% confidence interval (Cl) 1.8-22.5, P= 0.004 as well as between OSA and sex: OR 3.3, 95% Cl 1.1-9.6, P= 0.033. OSA was significantly associated with hypertension in men but not in women. Conclusion The interaction between the ACE gene I/D polymorphism and OSA appears to be an important mechanism in the development of hypertension, particularly in men.
  • Ostberg, Anna-Lena, et al. (författare)
  • Group treatment of obesity in primary care practice : A qualitative study of patients' perspectives
  • 2011
  • Ingår i: Scandinavian Journal of Public Health. - Sage Publications. - 1403-4948. ; 39:1, s. 98-105
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To explore patients' experiences of very low calorie diet (VLCD) and subsequent corset treatment of obesity in a primary care setting, and to explore their perceptions of factors influencing weight control. Methods: In western Sweden, five focus group sessions were carried out. The main themes for the discussions were the informants' perceptions of the treatment they had received and their experiences of living with obesity. The analysis was based on the Grounded Theory methodology. Results: The outcomes reflect obese individuals' struggle to handle the demands of their life situation and to recognize their own resources. The core category generated was labelled "Achieving a balance in life and adjusting one's identity". Three categories related to the process of weight reduction were identified: living with obesity, reducing weight and developing self-management. The group treatment with VLCD was positively perceived by the participants, but the corset treatment was considered to be of less value. Conclusions: Maintenance after weight reduction was demanding and the findings indicate a need for extended support. For some individuals the corset treatment could be a psychological support. Follow-up after weight reduction programmes should focus on long-term self-help strategies.
  • Andersson, Tobias, 1976-, et al. (författare)
  • Mortality trends and cause of death in patients with new-onset type 2 diabetes and controls: A 24-year follow-up prospective cohort study.
  • 2018
  • Ingår i: Diabetes research and clinical practice. - 1872-8227. ; 138, s. 81-89
  • Tidskriftsartikel (refereegranskat)abstract
    • Our aim was to assess causes of death and temporal changes in excess mortality among patients with new-onset type 2 diabetes in Skaraborg, Sweden.Patients from the Skaraborg Diabetes Register with prospectively registered new-onset type 2 diabetes 1991-2004 were included. Five individual controls matched for sex, age, geographical area and calendar year of study entry were selected using population records. Causes of deaths until 31 December 2014 were retrieved from the Cause of Death Register. Adjusted excess mortality among patients and temporal changes of excess mortality were calculated using Poisson models. Cumulative incidences of cause-specific mortality were calculated by competing risk regression.During 24 years of follow-up 4364 deaths occurred among 7461 patients in 90,529 person-years (48.2/1000 person-years, 95% CI 46.8-49.7), and 18,541 deaths in 479,428 person-years among 37,271 controls (38.7/1000 person-years, 38.1-39.2). The overall adjusted mortality hazard ratio was 1.47 (p < .0001) among patients diagnosed at study start 1991 and decreased by 2% (p < .0001) per increase in calendar year of diagnosis until 2004. Excess mortality was mainly attributed to endocrine and cardiovascular cause of death with crude subdistributional hazard ratios of 5.06 (p < .001) and 1.22 (p < .001).Excess mortality for patients with new-onset type 2 diabetes was mainly attributed to deaths related to diabetes and the cardiovascular system, and decreased with increasing year of diagnosis 1991-2004. Possible explanations could be temporal trends of earlier diagnosis due to lowered diagnostic thresholds and intensified diagnostic activities, as well as improved treatment.
  • Bengtsson Boström, Kristina (författare)
  • Genetic Factors Contributing to Hypertension. With Emphasis on Hypertension in Type 2 Diabetes
  • 2002
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Popular Abstract in Swedish Högt blodtryck (hypertoni) och åldersdiabetes (typ 2 diabetes) är två av västvärldens vanligaste folksjukdomar, i Sverige är förekomsten ca 15% respektive 3,5%. Båda tillstånden ger upphov till hjärta-kärlkomplikationer såsom hjärtinfarkt, hjärtsvikt och stroke och orsakar hög sjuklighet och dödlighet i befolkningen. Kombinationen av hypertoni och typ 2 diabetes ökar ytterligare risken för hjärta-kärlkomplikationer. Den långt övervägande delen av hypertoni och typ 2 diabetes beror på flera miljöfaktorer (bland annat livsstilen) och ärftliga faktorer i kombination och kallas därför multifaktoriella eller komplexa sjukdomar. Det finns dock sällsynta hypertoni- och diabetesformer som orsakas av förändringar i ett enda arvsanlag (en gen). Ärftligheten av hypertoni är hög. Har en eller båda föräldrarna hypertoni löper barnen ca 30% respektive 45% risk att utveckla hypertoni jämfört med ca 3% om föräldrarna har normalt blodtryck. Undersökningar av tvillingpar har visat att 40-60% av blodtrycksvariationen är ärftlig. Studier av arvets betydelse för blodtrycks-variationen eller utvecklingen av hypertoni kan göras med hjälp av kända gener som kodar för äggviteämnen som spelar en viktig roll i regleringen av blodtryck och saltbalans. En gen har två alleler som ärvs från vardera föräldern och de två allelerna utgör en genotyp. Frekvensen alleler eller genotyper av en känd gen (kandidatgen för hypertoni) jämförs mellan hypertoniker och friska individer i så kallade associationsstudier. Om en allel eller genotyp förekommer oftare hos hypertonikerna än hos de friska är allelen eller genotypen associerad med hypertoni. Man kan också i familjer undersöka om en allel nedärvs tillsammans med sjukdomen (kopplings eller linkage-studie) eller om syskon med olika genotyper (genotypdiskordanta syskon) också har olika blodtrycksnivåer (systoliskt och diastoliskt blodtryck). De kandidatgener vi studerat är gener som ingår i renin-angiotensin- aldosteron systemet (RAAS) och det sympatiska nervsystemet. RAAS spelar stor roll i den hormonella regleringen av blodtrycket medan det sympatiska nervsystemet kontrollerar blodtrycket vid snabba förändringar såsom vid akut blodförlust eller ändring av kroppsläge. I våra studier kommer patienterna med hypertoni och typ 2 diabetes samt friska kontroller från Skaraborg Hypertension and Diabetes Projekt och från familjer i Skåne (HYTE project). Från Finland (Botnia Study) har genotypdiskordanta syskon studerats. Målsättningen var att undersöka om angiotensin converting enzyme (ACE) och angiotensinogen (AGT) generna i RAAS är associerade med hypertoni och/eller typ två diabetes (Arbete I). Den sk DD genotypen av I/D variationen (polymorfin) i ACE genen och Thr235Thr genotypen av Met235Thr polymorfin i AGT genen ger ökade nivåer av ACE och AGT hos sina bärare och skulle teoretiskt kunna öka risken för hypertoni. DD genotypen har i de flesta tidigare studier dock inte visat association till hypertoni eller blodtrycksnivåer i motsats till Thr235Thr. Vi kunde visa att ACE genens DD genotyp var associerad till hypertoni i Skara speciellt hos icke överviktiga personer under 70 år med hypertoni kombinerat med typ 2 diabetes. Däremot fann vi att Thr235Thr eller två andra polymorfier i närheten av AGT genen inte var associerade till hypertoni och/eller typ 2 diabetes. I Arbete II visade vi att risken för död var ökad hos män, med DD genotypen (jämfört med II genotypen) och hypertoni i kombination med typ 2 diabetes. I Arbete III beskrivs studier av beta 1 adrenerga receptorn (B1AR) som spelar stor roll för regleringen av hjärtats slagfrekvens och slagkraft, som i sin tur påverkar blodtrycknivån. Betablockerare som blockerar B1AR är ett ofta använt blodtryckssänkande medel. Vi har för första gången kunnat visa att en genotyp, Arg389Arg, i en vanlig polymorfi i B1AR genen, Arg389Gly, var associerad till hypertoni hos svenskar. Hos de finska genotypdiskordanta syskonen hade syskonet med Arg389Arg genotypen högre systoliskt blodtryck och högre hjärtfrekvens än syskonet med Arg389Gly eller Gly389Gly. I Arbete IV beskrivs två vanliga polymorfier, Arg16Gly och Gln27Glu, i beta 2 adrenerga receptorns (B2AR) gen, som påverkar receptorns känslighet efter stimulering och som tidigare visats vara associerade till hypertoni och övervikt. Vi kunde redovisa en svag association mellan hypertoni och Gln27 allelen och Arg16 allelen visade association till hypertoni kombinerad med typ 2 diabetes. Hos de genotypdiskordanta syskonen hade syskonet med en eller två Arg16 alleler högre diastoliskt blodtryck och var tyngre än syskonet med två Gly16 alleler. Sammanfattningsvis har dessa studier visat ACE, B1AR och B2AR genernas betydelse för utvecklingen av hypertoni med och utan typ 2 diabetes. Studier av ärftliga faktorer kan öka förståelsen av de mekanismer som orsakar sjukdomarna och i framtiden leda till effektivare, skräddarsydd behandling med läkemedel och råd angående förebyggande åtgärder till den enskilde individen.
  • Bengtsson Boström, Kristina, et al. (författare)
  • Polymorphism in the angiotensin converting enzyme but not in the angiotensinogen gene is associated with hypertension and type 2 diabetes: the Skaraborg Hypertension and diabetes project
  • 1999
  • Ingår i: Journal of Hypertension. - Lippincott Williams & Wilkins. - 1473-5598. ; 17:11, s. 1569-1575
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To study the association between polymorphisms in the angiotensin converting enzyme (ACE) gene and angiotensinogen (AGT) gene and hypertension and/or type 2 diabetes in a community population. PATIENTS AND METHODS: The insertion (I)/deletion (D) polymorphism of the ACE gene and the M235T polymorphism of the AGT gene were genotyped in 773 nondiabetic individuals with hypertension, 193 normotensive patients with type 2 diabetes, 243 patients with type 2 diabetes and hypertension, and in 820 normotensive control individuals identified in a community-based study. RESULTS: The DD genotype was associated with hypertension in individuals less than 70 years [odds ratio (OR) = 1.54, confidence interval (CI) = 1.09-2.18] and remained so when patients with type 2 diabetes were excluded from the analysis (OR = 1.45, CI = 1.01-2.09). The strongest association was with the combination of type 2 diabetes and hypertension (OR = 2.19, CI = 1.09-4.38). There was no association with type 2 diabetes without hypertension. No association was observed between the M235T variant or the 3'-microsatellite polymorphism of the AGT gene and hypertension. CONCLUSION: The D-allele of the ACE gene ID polymorphism increases susceptibility to hypertension, particularly when associated with type 2 diabetes. No association was observed between the M235T variant or 3'-microsatellite polymorphism of the AGT gene and hypertension.
  • Bengtsson Boström, Kristina, et al. (författare)
  • Polymorphisms in α- And β-adrenergic receptor genes, hypertension, and obstructive sleep apnea : The skaraborg sleep study
  • 2010
  • Ingår i: International Journal of Hypertension. - Hindawi Publishing Corporation. - 2090-0384. ; 2010
  • Tidskriftsartikel (refereegranskat)abstract
    • The sympathetic nervous system and the adrenergic receptors play an important role in regulation of blood pressure. This study explored the associations between functional polymorphisms of the α 2B -, β 1 -, and β 2 -adrenergic receptor genes and obstructive sleep apnea (OSA) in hypertensive patients and hypertension in patients with OSA in a populationbased sample of 157 hypertensive patients and 181 healthy control subjects. Only the Arg389Gly polymorphism of the β 1 -adrenergic receptor gene was associated with increased risk for mild OSA in hypertensive patients (Arg/Arg versus Gly/Arg/Gly/Gly, 2.1, 95% CI, 1.02-4.7). Hypertensive men carrying the Arg389Arg genotype had higher crude and age-adjusted AHI than carriers of the Arg389Gly/Gly389Gly genotypes. When adjusted also for BMI this difference became borderline significant. This difference was not observed in women. The risk of hypertension in mild OSA was associated with increasing number of Arg-alleles (Arg/Arg OR 5.4, 95 CI 1.4-21.2).
  • Bokrantz, Tove, et al. (författare)
  • Antihypertensive drug classes and the risk of hip fracture: results from the Swedish primary care cardiovascular database.
  • 2020
  • Ingår i: Journal of hypertension. - 1473-5598. ; 38:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Hypertension and fractures related to osteoporosis are major public health problems that often coexist. This study examined the associations between exposure to different antihypertensive drug classes and the risk of hip fracture in hypertensive patients.We included 59 246 individuals, 50 years and older, diagnosed with hypertension during 2001-2008 in the Swedish Primary Care Cardiovascular Database. Patients were followed from 1 January 2006 (or the date of diagnosis of hypertension) until they had their first hip fracture, died, or reached the end of the study on 31 December 2012. Cox proportional hazards models were used to calculate the risk of hip fracture across types of antihypertensive medications, adjusted for age, sex, comorbidity, medications, and socioeconomic factors.In total, 2593 hip fractures occurred. Compared to nonusers, current use of bendroflumethiazide or hydrochlorothiazide was associated with a reduced risk of hip fracture (hazard ratio 0.86; 95% CI 0.75-0.98 and hazard ratio 0.84; 95% CI 0.74-0.96, respectively), as was use of fixed drug combinations containing a thiazide (hazard ratio 0.69; 95% CI 0.57-0.83). Current use of loop diuretics was associated with an increased risk of hip fracture (hazard ratio 1.23; 95% CI 1.11-1.35). No significant associations were found between the risk of hip fracture and current exposure to beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone-receptor blockers or calcium channel blockers.In this large observational study of hypertensive patients, the risk of hip fracture differed across users of different antihypertensive drugs, results that could have practical implications when choosing antihypertensive drug therapy.
  • Bokrantz, Tove, et al. (författare)
  • Reply.
  • 2017
  • Ingår i: Journal of hypertension. - 1473-5598. ; 35:3, s. 646-647
  • Tidskriftsartikel (övrigt vetenskapligt)
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