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Sökning: WFRF:(Løchen Maja Lisa)

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  • Camen, Stephan, et al. (författare)
  • Temporal relations between atrial fibrillation and ischaemic stroke and their prognostic impact on mortality
  • 2020
  • Ingår i: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 22:4, s. 522-529
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims Limited evidence is available on the temporal relationship between atrial fibrillation (AF) and ischaemic stroke and their impact on mortality in the community. We sought to understand the temporal relationship of AF and ischaemic stroke and to determine the sequence of disease onset in relation to mortality. Methods and results Across five prospective community cohorts of the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project we assessed baseline cardiovascular risk factors in 100 132 individuals, median age 46.1 (25th-75th percentile 35.8-57.5) years, 48.4% men. We followed them for incident ischaemic stroke and AF and determined the relation of subsequent disease diagnosis with overall mortality. Over a median follow-up of 16.1 years, N = 4555 individuals were diagnosed solely with AF, N = 2269 had an ischaemic stroke but no AF diagnosed, and N = 898 developed both, ischaemic stroke and AF. Temporal relationships showed a clustering of diagnosis of both diseases within the years around the diagnosis of the other disease. In multivariable-adjusted Cox regression analyses with time-dependent covariates subsequent diagnosis of AF after ischaemic stroke was associated with increased mortality [hazard ratio (HR) 4.05, 95% confidence interval (CI) 2.17-7.54; P < 0.001] which was also apparent when ischaemic stroke followed after the diagnosis of AF (HR 3.08, 95% CI 1.90-5.00; P < 0.001). Conclusion The temporal relations of ischaemic stroke and AF appear to be bidirectional. Ischaemic stroke may precede detection of AF by years. The subsequent diagnosis of both diseases significantly increases mortality risk. Future research needs to investigate the common underlying systemic disease processes.
  • Csengeri, Dora, et al. (författare)
  • Alcohol consumption, cardiac biomarkers, and risk of atrial fibrillation and adverse outcomes
  • 2021
  • Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 42:12, s. 1170-1177
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: There is inconsistent evidence on the relation of alcohol intake with incident atrial fibrillation (AF), in particular at lower doses. We assessed the association between alcohol consumption, biomarkers, and incident AF across the spectrum of alcohol intake in European cohorts.METHODS AND RESULTS: In a community-based pooled cohort, we followed 107 845 individuals for the association between alcohol consumption, including types of alcohol and drinking patterns, and incident AF. We collected information on classical cardiovascular risk factors and incident heart failure (HF) and measured the biomarkers N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin I. The median age of individuals was 47.8 years, 48.3% were men. The median alcohol consumption was 3 g/day. N = 5854 individuals developed AF (median follow-up time: 13.9 years). In a sex- and cohort-stratified Cox regression analysis alcohol consumption was non-linearly and positively associated with incident AF. The hazard ratio for one drink (12 g) per day was 1.16, 95% CI 1.11-1.22, P < 0.001. Associations were similar across types of alcohol. In contrast, alcohol consumption at lower doses was associated with reduced risk of incident HF. The association between alcohol consumption and incident AF was neither fully explained by cardiac biomarker concentrations nor by the occurrence of HF.CONCLUSIONS: In contrast to other cardiovascular diseases such as HF, even modest habitual alcohol intake of 1.2 drinks/day was associated with an increased risk of AF, which needs to be considered in AF prevention.
  • Eriksson, Charli, 1948-, et al. (författare)
  • The Swedish Think Tank Tobaksfakta : An Assessment of Relevance and Quality
  • 2014
  • Rapport (övrigt vetenskapligt)abstract
    • Think tanks are non-governmental institutions – intellectually, organizationally and financially autonomous of government, political parties and organized interests – that are set up with the aim of influencing policy. The Swedish think tank Tobaksfakta, as a nonprofit organization, was formed by Health Professionals against Tobacco in October 2010, and has a number of member organizations. It is a national independent player focusing on measures to reduce tobacco use. The goal is that Tobaksfakta contributes continuously to reducing tobacco use toward a society free of tobacco.A quality evaluation has been conducted by an external panel in five phases: (1) Planning and selection of approach, (2) Collection of data on Tobaksfakta, (3) Self-evaluations, (4) External assessment by a panel of independent experts, and (5) Measures and follow-up.As background to the evaluation, there is a short review of what a think tank is. Then, the scene for tobacco prevention in Sweden is set by giving data on tobacco consumption, an overall Swedish map of tobacco prevention, and a presentation of some controversial issues. The WHO Framework Convention on Tobacco Control sets the global agenda and also the framework for the activities of Tobaksfakta.A SWOT analysis provides an overall assessment of Tobaksfakta. Its strengths include competence, having an effective organization and member organizations, and being a strong provider of information and opinion leaders. Weaknesses include limited economic and human resources, low involvement in activities by member organizations, too broad a focus, and a limited impact on decision-making. Threats include poor economic resources, the perception that tobacco is no longer an issue, and weakness in national tobacco prevention efforts. Among the opportunities available is a new three-year business plan, strengthening of communicative work, networking and extended cooperation, the Tobacco End Game, and new efforts at national and international levels.The evaluation considered organizational structure and resources, goal structure and work processes (monitoring, investigations, knowledge materials, website, press activities, twitter and social media, dissemination of knowledge, and European and international tobacco prevention work). The panel assessed the information and communication work of Tobaksfakta as of high quality, relevant, and timely.The Tobacco Industry Project has functioned as an important vehicle for the overall efforts made by Tobaksfakta The project has performed impressive work in relation to relatively limited economic resources. Although time has run out for the project, the need for its activities will continue for so long as the activities pursued by the tobacco industry continue. Therefore, it is recommended that Tobaksfakta continues to act as a watchdog on the tobacco industry.The Tobacco End Game is a challenging and future-oriented project that has a great potential. Tobaksfakta wants a Swedish government that, after the 2014 elections, reaches a decision on a plan to phase out smoking by 2025. The idea is that such a decision shall be achieved by advocacy at all levels of society. Further development of the Tobacco End Game is recommended as a key developmental effort.Overall assessments and recommendations are: Tobaksfakta is a classic think tank but needs independent financing. It shall continue with intellectual argument not covert lobbying. Tobaksfakta is one of the key actors on the landscape of tobacco prevention. Focusing on structural issues gives added value. The think tank is an efficient and professional organization. Tobaksfakta has an international role to play.
  • Morseth, Bente, et al. (författare)
  • Age-specific atrial fibrillation incidence, attributable risk factors and risk of stroke and mortality : Results from the MORGAM Consortium
  • 2021
  • Ingår i: Open heart. - : BMJ Publishing Group Ltd. - 2053-3624. ; 8:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Background The main aim was to examine age-specific risk factor associations with incident atrial fibrillation (AF) and their attributable fraction in a large European cohort. Additionally, we aimed to examine risk of stroke and mortality in relation to new-onset AF across age.Methods We used individual-level data (n=66 951, 49.1% men, age range 40-98 years at baseline) from five European cohorts of the MOnica Risk, Genetics, Archiving and Monograph Consortium. The participants were followed for incident AF for up to 10 years and the association with modifiable risk factors from the baseline examinations (body mass index (BMI), hypertension, diabetes, daily smoking, alcohol consumption and history of stroke and myocardial infarction (MI)) was examined. Additionally, the participants were followed up for incident stroke and all-cause mortality after new-onset AF.Results AF incidence increased from 0.9 per 1000 person-years at baseline age 40-49 years, to 17.7 at baseline age ≥70 years. Multivariable-adjusted Cox models showed that higher BMI, hypertension, high alcohol consumption and a history of stroke or MI were associated with increased risk of AF across age groups (p<0.05). Between 30% and 40% of the AF risk could be attributed to BMI, hypertension and a history of stroke or MI. New-onset AF was associated with a twofold increase in risk of stroke and death at ages≥70 years (p≤0.001).Conclusion In this large European cohort aged 40 years and above, risk of AF was largely attributed to BMI, high alcohol consumption and a history MI or stroke from middle age. Thus, preventive measures for AF should target risk factors such as obesity and hypertension from early age and continue throughout life.
  • Schnabel, Renate B., et al. (författare)
  • Searching for Atrial Fibrillation Poststroke : A White Paper of the AF-SCREEN International Collaboration
  • 2019
  • Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 1524-4539. ; 140:22, s. 1834-1850
  • Tidskriftsartikel (refereegranskat)abstract
    • Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive/prolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non-vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non-vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated.
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