| 1. |
- Lindberg, Gunnar, et al.
(författare)
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Serum sialic acid and its correlates in community samples from Akita, Japan and Minneapolis, USA
- 1997
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Ingår i: International Journal of Epidemiology. - 1464-3685. ; 26:1, s. 58-63
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The concentration of serum total sialic acid (S-TSA) is one recently investigated risk marker for cardiovascular mortality and atherosclerosis. Since the mortality from coronary heart disease is higher in the United States than in Japan, one could expect the S-TSA to be higher among Caucasian US citizens than among Japanese citizens, a hypothesis that is tested in this study. DESIGN: Cross-sectional study of population-based samples of Japanese and US Caucasian men and women. SETTING: The rural community Akita, Japan, and the suburbs of Minneapolis, Minnesota. SUBJECTS: These were 75 consecutive men and women from Akita and Minneapolis respectively aged 47-69 years in 1990. People who had smoked cigarettes during the past 5 years; who had a history of diabetes mellitus, liver disease, coronary heart disease, or stroke; or who were taking anticoagulants were excluded. OUTCOME MEASURES: Serum total sialic acid levels in male and female Japanese and US Caucasian subjects with adjustment for age, systolic blood pressure, fibrinogen, triglycerides and in women also for menopausal status. Race and sex-specific correlations with serum total sialic acid for selected cardiovascular risk markers. RESULTS: The entire sialic acid distributions were shifted to the right in Caucasian men and women compared to Japanese men and women. The mean +/- standard deviation concentrations of S-TSA were 54.1 +/- 5.3 mg/dl in Japanese men and 58.7 +/- 5.6 mg/dl in Caucasian men (P < 0.001). In women, the concentrations were 54.8 +/- 5.1 and 63.1 +/- 6.0 mg/dl respectively (P < 0.001). S-TSA level correlated significantly and positively with fibrinogen levels in Caucasian and Japanese men and women and with triglyceride levels in Caucasian and Japanese men and in Caucasian women but not in Japanese women. After adjustment for age, systolic blood pressure, fibrinogen, triglycerides and menopausal status, the sialic acid levels were 2.2 (P = 0.009) and 6.2 (P < 0.001) mg/dl higher in Caucasian compared to Japanese men and women respectively. CONCLUSIONS: Higher S-TSA levels in Caucasians living in Minneapolis compared to Japanese living in Akita, Japan is in concordance with the higher cardiovascular mortality in the US. Differences in S-TSA levels may reflect international differences in the prevalence of atherosclerosis.
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| 2. |
- Lindberg, Gunnar, et al.
(författare)
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Serum sialic acid and sialoglycoproteins in asymptomatic carotid artery atherosclerosis. ARIC Investigators. Atherosclerosis Risk in Communities
- 1999
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Ingår i: Atherosclerosis. - 1879-1484. ; 146:1, s. 65-69
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Tidskriftsartikel (refereegranskat)abstract
- Serum total sialic acid (S-TSA) is a recently identified risk marker for atherosclerosis and cardiovascular mortality. The purpose of this study was to evaluate the influence of three sialic acid rich glycoproteins (orosomucoid, haptoglobin, and alpha1-antitrypsin) on the relationship between S-TSA and carotid atherosclerosis. The mean S-TSA was 0.045 g/l higher among cases than controls (P<0.001) in 310 45-64 year-old male and female pairs of carotid atherosclerosis cases and disease-free controls from the Atherosclerosis Risk in Communities (ARIC) Study. Also mean serum levels of the glycoproteins were significantly higher in cases compared to controls. In a conditional multiple logistic regression model with the glycoproteins as independent variables, orosomucoid was correlated most strongly with case control status. However, when incorporated into the mathematical model, S-TSA not only contributed additional information as to the risk of atherosclerosis; none of the three glycoproteins contributed further once S-TSA had been accounted for. Thus, some other source of serum sialic acid or variations in the degree of sialylation of glycoproteins may be essential for understanding the relation between S-TSA and atherosclerosis.
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| 3. |
- Lindberg, Gunnar, et al.
(författare)
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The association between serum sialic acid and asymptomatic carotid atherosclerosis is not related to antibodies to herpes type viruses or Chlamydia pneumoniae. The Atherosclerosis Risk in Communities (ARIC) Study Investigators
- 1997
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Ingår i: International Journal of Epidemiology. - 1464-3685. ; 26:6, s. 1386-1391
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Total serum sialic acid is a recently investigated marker for cardiovascular mortality and carotid atherosclerosis. This study tested the hypothesis that past infection by Herpes simplex type 1 or type 2 viruses or Cytomegalovirus or Chlamydia pneumoniae accounts for the association between serum total sialic acid and atherosclerosis. METHODS: Population-based samples of men and women living in four US communities were used in a cross-sectional study. Cases and matched controls were defined by B-mode ultrasound measurements of carotid and popliteal arterial wall thickness. In all, there were 267 case control pairs with information about antibody titres to viruses and 256 pairs with information about antibody titres to Chlamydia pneumoniae. RESULTS: Serum total sialic acid (S-TSA) level was significantly higher in cases with carotid atherosclerosis compared to their controls. The odds ratio for carotid atherosclerosis associated with sialic acid level above 75th percentile was 1.73 (95% confidence interval [CI]: 1.02-2.95) in the sample with information about antibodies to viruses and 1.70 (95% CI: 1.00-2.93) in the sample with information about antibodies to C. pneumoniae. Adjustment for titres of antibodies to viruses and C. pneumoniae had no impact on the relation between sialic acid and carotid atherosclerosis. CONCLUSIONS: From these results, it seems unlikely that previous infection by any of these micro-organisms accounts for the relation between S-TSA level and carotid atherosclerosis.
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| 4. |
- Lindberg, Gunnar, et al.
(författare)
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Use of calcium channel blockers and risk of suicide: ecological findings confirmed in population based cohort study
- 1998
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Ingår i: BMJ. - 0959-8138. ; 316:7133, s. 741-745
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate possible associations between use of cardiovascular drugs and suicide. DESIGN: Cross sectional ecological study based on rates of use of eight cardiovascular drug groups by outpatients. A population based cohort study including users of drugs to control hypertension. SUBJECTS: The ecological study included 152 of Sweden's 284 municipalities. The cohort study included all inhabitants of one Swedish municipality who during 1988 or 1989 had purchased cardiovascular agents from pharmacies within the municipality. Six hundred and seventeen subjects (18.2%) were classified as users of calcium channel blockers and 2780 (81.8%) as non-users. MAIN OUTCOME MEASURES: Partial correlations (least squares method) between rates of use of cardiovascular drugs and age standardised mortality from suicide in Swedish municipalities. Hazard ratios for risk of suicide with adjustments for difference in age and sex in users of calcium channel blockers compared with users of other hypertensive drugs. RESULTS: Among the Swedish municipalities the use of each cardiovascular drug group except angiotensin converting enzyme inhibitors correlated significantly and positively with suicide rates. After adjustment for the use of other cardiovascular drug groups, as a substitute for the prevalence of cardiovascular morbidity, only the correlation with calcium channel blockers remained significant (r = 0.29, P < 0.001). In the cohort study, five users and four non-users of calcium channel blockers committed suicide during the follow up until the end of 1994. The absolute risk associated with use of calcium channel blockers was 1.1 suicides per 1000 person years. The relative risk, adjusted for differences in age and sex, among users versus non-users was 5.4 (95% confidence interval 1.4 to 20.5). CONCLUSIONS: Use of calcium channel blockers may increase the risk of suicide.
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| 5. |
- Lindberg, Gunnar, et al.
(författare)
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Use of calcium channel blockers as antihypertensives in relation to mortality and cancer incidence: a population-based observational study
- 2002
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Ingår i: Pharmacoepidemiology and Drug Safety. - : Wiley. - 1053-8569. ; 11:6, s. 493-497
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose Treatment with blood pressure lowering drugs may reduce morbidity and mortality. However, the efficacy and effectiveness may differ between antihypertensive agents. The current investigation aimed to compare mortality and cancer incidence in hypertensive patients treated with calcium channel blockers (CCB) or with other antihypertensive drugs (AHD). Methods All patients in two outpatient clinics treated with AHD who underwent an annual check-up during 1989 or 1990 were selected. Fatal events were identified through 1997 and incident cancers through 1998. Results Two hundred and fourteen patients on CCB and 1029 on other AHD were identified. Overall mortality and the combined mortality from myocardial infarction and stroke were higher in CCB users; hazard ratios adjusted for sex, age, co-morbidity and other and risk factors were 1.84 (95% CI 1.25-2.72) and 2.37 (95% CI 1.27-4.44), respectively. The risk estimates for cancer mortality and for cancer incidence did not differ significantly. Conclusions Results from clinical trials as well as observational studies, including the present one, indicate a higher mortality risk and a higher cardiovascular morbidity risk associated with use of CCB. Accordingly, CCB should not be regarded as first line drugs in hypertension.
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| 6. |
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| 7. |
- Merlo, Juan, et al.
(författare)
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Incidence of myocardial infarction in elderly men being treated with antihypertensive drugs: population based cohort study
- 1996
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Ingår i: BMJ. - 0959-8138. ; 313:7055, s. 457-461
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyse the association between use of antihypertensive treatment, diastolic blood pressure, and long term incidence of ischaemic cardiac events in elderly men. DESIGN: Population based cohort study. Baseline examination in 1982-3 and follow up for up to 10 years. SETTING: Malmo, Sweden. SUBJECTS: 484 randomly selected men born in 1914 and living in Malmo during 1982. MAIN OUTCOME MEASURES: Observational comparisons of incidence rates and rate and hazard ratios of ischaemic cardiac events (myocardial infarction or death due to chronic ischaemic cardiac disease). RESULTS: The crude incidence rate of ischaemic cardiac events was higher in those subjects who were taking antihypertensive drugs than in those who were not (rate ratio 2.6 (95% confidence interval 1.7 to 3.9)). After adjustment for potential confounders (differences in baseline smoking habits, blood pressure, time since diagnosis of hypertension, ischaemic or other cardiovascular disease, hypercholesterolaemia, hypertriglyceridaemia, diabetes mellitus, obesity, and raised serum creatinine concentration) this rate was reduced but still raised (hazard ratio 1.9 (1.0 to 3.7)). In men with diastolic blood pressure > 90 mm Hg, antihypertensive treatment was associated with a twofold increase in the incidence of ischaemic cardiac events (rate ratio 2.0 (1.1 to 3.6)), which vanished after adjustment for potential confounders (hazard ratio 1.1 (0.5 to 2.6)). In those subjects with diastolic blood pressure < or = 90 mm Hg, antihypertensive treatment was associated with fourfold increase in incidence (rate ratio 3.9 (2.1 to 7.1)), which remained after adjustment for potential confounders (hazard ratio 3.8 (1.3 to 11.0)). CONCLUSION: Antihypertensive treatment may increase the risk of myocardial infarction in elderly men with treated diastolic blood pressures < or = 90 mm Hg.
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| 8. |
- Merlo, Juan, et al.
(författare)
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Utilization of cardiovascular drugs (blood pressure lowering drugs, lipid lowering drugs and nitrates) and mortality from ischaemic heart disease and stroke. An ecological analysis based on Sweden's municipalities
- 1999
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 55:1, s. 69-76
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To perform an ecological study in an effort to generate questions concerning the preventive impact of various cardiovascular drugs on mortality from stroke and ischaemic heart disease (IHD) in the community, and to explore the association between sales of nitrates and mortality from stroke and IHD. METHODS: Out-patient drug utilization (sales) of blood pressure lowering drugs, lipid lowering drugs and nitrates were categorized in four groups of equal size by quartiles and compared with mortality from IHD and stroke, using the group of municipalities with the lowest utilization as reference, from 1989 to 1993 in 283 of Sweden's 288 municipalities, by Poisson regression. Adjustments were made for population size, age and gender proportions, the utilization rate of cardiovascular drugs other than the tested drug group and location of the municipality. RESULTS: Compared with the group of municipalities with the lowest sales and adjusting only for population size, mortality from IHD and stroke increased with the extent of utilization of blood pressure lowering drugs and nitrates. In contrast, mortality decreased with increased utilization of lipid lowering drugs. After further adjustments by percentage of men, age structure, geographical location (mid-points) of the municipalities, and, as a proxy for cardiovascular disease, the sales of cardiovascular drugs other than the tested drug group, the increased risk associated with blood pressure lowering drugs disappeared, and there was a dose-response association between sales of diuretics and old antihypertensives and decreasing mortality, sales of nitrates continued to be associated with an increased risk, and the low mortality risk associated with sales of lipid lowering drugs persisted. CONCLUSION: Lipid lowering drugs may have a preventive impact in the general population, but the preventive impact of blood pressure lowering drugs, with the exception of diuretics and old antihypertensives, may be low in many municipalities. The safety of nitrates needs more investigation at the individual level.
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| 9. |
- Råstam, Lennart, et al.
(författare)
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Association between serum sialic acid concentration and carotid atherosclerosis measured by B-mode ultrasound. The ARIC Investigators. Atherosclerosis Risk in Communities Study
- 1996
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 1464-3685 .- 0300-5771. ; 25:5, s. 953-958
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies have shown that the serum level of sialic acid is associated positively with mortality from coronary disease and stroke. In this study its relation with carotid atherosclerosis was evaluated. METHODS: From the Atherosclerosis Risk in Communities (ARIC) Study, 323 cases with carotid intima-media wall thickness above the 90th percentile (measured with B-mode ultrasound) were matched 1:1 with controls without atherosclerosis. Serum sialic acid, plasma LDL and HDL cholesterol, serum insulin concentrations, blood pressure, antihypertensive medication use, and smoking status were used to assess the independent contribution of the sialic acid level to carotid atherosclerosis. RESULTS: The mean (SD) serum sialic acid concentration was 75.0 (9.7) mg/dl in cases and 70.7 (8.9) mg/dl in controls (P = 0.0001). In a conditional logistic model with adjustment for age, LDL-cholesterol, HDL-cholesterol, serum insulin, smoking and hypertension, the odds ratio associated with sialic acid above the 75th percentile (> or = 78.3 mg/dl) versus below was 1.65 with a 95% confidence interval of 1.01-2.70. CONCLUSION: The sialic acid level is correlated with the presence of carotid atherosclerosis, independently of major cardiovascular disease risk factors. The biological mechanism behind this association is not resolved.
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