| 1. |
- Carlsson, Axel C., et al.
(författare)
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Effects of prescribed antihypertensives and other cardiovascular drugs on mortality in patients with atrial fibrillation and hypertension : a cohort study from Sweden
- 2014
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Ingår i: Hypertension Research. - : Springer Science and Business Media LLC. - 0916-9636 .- 1348-4214. ; 37:6, s. 553-559
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Tidskriftsartikel (refereegranskat)abstract
- Although antihypertensive drugs are known to reduce mortality in individuals with hypertension, the effects of different cardiovascular pharmacotherapies on mortality among patients with hypertension and atrial fibrillation (AF) have been less thoroughly explored. To study mortality rates in men and women separately with hypertension and AF prescribed different cardiovascular pharmacotherapies. A cohort of men (n = 2809) and women (n = 2793) aged > 45 years diagnosed with hypertension and AF were selected using patient records. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox regression, with all-cause mortality as the outcome. Analysis was performed on the whole population and after stratification by age and sex. Independent factors were prescribed pharmacotherapies. Adjustments were made for a propensity score comprising age, comorbidities, education and marital status. The higher the number of antihypertensive drugs prescribed, the lower the mortality rate (P-value for trend 0.005). Individuals prescribed 4-5 antihypertensive drugs had a lower risk of mortality than those prescribed 0-1 drugs (HR: 0.62; 95% CI: 0.45-0.86). The HRs for the following drug classes were: loop diuretics 1.39 (95% CI: 1.08-1.78), non-selective beta-blockers 0.68 (95% CI: 0.53-0.88), angiotensin receptor blockers 0.75 (95% CI: 0.56-0.99) and statins 0.68 (95% CI: 0.53-0.88). AF patients with hypertension prescribed statins, non-selective b-blockers and angiotensin receptor blockers had low relative mortality risks, suggesting that these prescribed pharmacotherapies were beneficial. This needs to be further explored in other clinical settings.
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| 2. |
- Wandell, Per, et al.
(författare)
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Effect of cardiovascular drugs on mortality in atrial fibrillation and chronic heart failure
- 2014
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 48:5, s. 291-298
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To study mortality rates among men and women with atrial fibrillation (AF) and concomitant chronic heart failure (CHF) prescribed different classes of cardiovascular drugs in primary health care. Design. A cohort of men (n = 1159) and women (n = 1155) aged 45 years or above and diagnosed with both AF and CHF from patient records from 75 primary care centers in Sweden were included in the study. Regression models with mortality as the outcome were used, with adjustment for a propensity score comprising age, cardiovascular co-morbidities, education, marital status, and pharmacotherapy. We analysed using Cox regression with hazard ratio (HR), and Laplace regression with years until 10% of the patients had died, with 95% confi dence intervals (95% CI). Independent variables were prescribed cardiovascular drugs. Results. Individuals prescribed anticoagulants versus no treatment gained 1.95 years (95% CI 0.47-3.43), anticoagulants versus antiplatelets 1.26 years (95% CI 0.42-2.10), calcium channel blockers 1.17 years (95% CI 0.21-2.14), and statins 1.49 years (95% CI 0.39-2.59). Among patients 80 years or above no significant effect by anticoagulants was seen, HR 0.73 (95% CI 0.43-1.23). Conclusions. Our findings suggest that life may be prolonged in patients with AF and concomitant CHF in primary care prescribed anticoagulants, calcium channel blockers, and statins.
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| 3. |
- Wändell, Per, et al.
(författare)
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Effects of prescribed antithrombotics and other cardiovascular pharmacotherapies on all-cause mortality in patients with diabetes and atrial fibrillation - a cohort study from Sweden using propensity score analyses
- 2014
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Ingår i: Diabetology & Metabolic Syndrome. - : Springer Science and Business Media LLC. - 1758-5996. ; 6, s. 2-
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Tidskriftsartikel (refereegranskat)abstract
- AimsTo study mortality rates among patients with diabetes and concomitant atrial fibrillation (AF), prescribed different cardiovascular drugs in primary health care.MethodsStudy population consisted of men (n = 1319) and women (n = 1094) aged = >= 45 years from a database including 75 primary care centres in Sweden. Cox regression analysis, with hazard ratios (HRs), 95% confidence interval (95% CIs) and mortality (years to death) as outcome, and Laplace regression, with difference in time to first 10% mortality (with 95% CI), were performed. Independent variables were prescribed cardiovascular drugs. Regression models were adjusted for a propensity score calculated separately for each prescribed drug class (comprising age, cardiovascular co-morbidities, education, marital status and pharmacotherapy).ResultsOverall mortality was lower in the whole sample for anticoagulants vs no treatment (HR 0.45; 95% CI 0.26-0.77); and among patients < 80 years for anticoagulants vs. antiplatelets (HR 0.44; 95% CI 0.25-0.78); while among individuals aged >= 80 years, antiplatelets (HR 0.47; 95% CI 0.26-0.87) and anticoagulants (HR 0.49; 95% CI 0.24-1.00) vs. no treatment were equally effective. Statins were associated with lower mortality among those < 80 years (HR 0.45; 95% CI 0.29-0.71). Laplace regression models in the whole sample, with years to first 10% of total mortality as outcome, were significant for: among patients < 80 years anticoagulants vs. no treatment 2.70 years (95% CI 0.04-5.37), anticoagulants vs. antiplatelets 2.31 years (95% CI 0.84-3.79), and those >= 80 antiplatelets vs. no treatment 1.78 years (95% CI 1.04-2.52).ConclusionsOur findings suggest that antiplatelets could exert a beneficial effect among those above 80 years.
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| 4. |
- Wandell, Per, et al.
(författare)
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Effect of cardiovascular drug classes on all-cause mortality among atrial fibrillation patients treated in primary care in Sweden: a cohort study
- 2013
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 69:2, s. 279-287
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Tidskriftsartikel (refereegranskat)abstract
- Risk factors for stroke are well known in atrial fibrillation (AF) patients, while less is known on the effect of these factors on total mortality. Our aim was to study the impact of cardiovascular drug classes on mortality in AF patients treated in primary care. The study population was chosen based on patient data from 75 primary care centres in Sweden compiled in a database. Individuals diagnosed with AF who were older than 45 years were enrolled (n = 12,302, of whom 6,660 were men). Cox regression analysis with mortality (years to death) as outcome was conducted in the men and women separately, as well in the age categories < 80 and a parts per thousand yen80 years, with cardiovascular drugs as independent factors, and age, cardiovascular diagnoses and educational level as covariates. Lower mortality was shown for anticoagulant treatment among men, both younger (< 80 years) [adjusted hazard ratio (HR) 0.43, 95 % confidence interval (CI) 0.31-0.61] and older (a parts per thousand yen80 years) (adjusted HR 0.47, 95 % CI 0.32-0.69), and among younger women (adjusted HR 0.46, 95 % CI 0.29-0.74), and for antiplatelet treatment in older men (adjusted HR 0.51, 95 % CI 0.35-0.74). Treatment with thiazides was associated with lower mortality among younger men (adjusted HR 0.68, 95 % CI 0.48-0.96), older men (adjusted HR 0.67, 95 % CI 0.46-0.98) and older women (adjusted HR 0.70, 95 % CI 0.52-0.94). Statins were associated with lower mortality among younger patients, in both men (adjusted HR 0.47, 95 % CI 0.32-0.68) and women (adjusted HR 0.54, 95 % CI 0.35-0.82). The differences in age and gender patterns need further exploration.
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| 5. |
- Hemminki, Kari, et al.
(författare)
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Familial Association of Inflammatory Bowel Diseases With Other Autoimmune and Related Diseases
- 2010
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Ingår i: American Journal of Gastroenterology. - : Ovid Technologies (Wolters Kluwer Health). - 1572-0241 .- 0002-9270. ; 105:1, s. 139-147
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Familial risk estimates are useful for genetic counseling, etiological understanding, and design of gene identification studies. We wanted to estimate the associations of ulcerative colitis (UC) and Crohn's disease (CD) with 32 autoimmune and related diseases among parents and offspring, singleton siblings, twins, and spouses. METHODS: The Multigeneration Register in Sweden provides reliable access to information on families among 11.5 million individuals throughout the last century. The diseases in individual family members were obtained through linkage to the Hospital Discharge Register. Standardized incidence ratios (SIRs) and 95 % confi dence intervals were calculated as relative risks for UC/CD in family members of patients diagnosed with any of the 34 diseases compared with those lacking affected family members through years 1964-2004. RESULTS: Among a total of 441,642 patients diagnosed with autoimmune and related conditions, 25,846 were diagnosed with UC and 18,885 with CD. Familial cases amounted to 5.4 % of all UC patients and 6.5 % of CD patients. SIR for UC was 3.9 (95% confidence interval 3.5 - 4.3) in offspring of affected parents, 4.6 (3.0-7.4) in siblings, 10.4 (6.5-15.8) in families of affected parents and siblings, and 6.3 (1.9-17.7) for monozygotic twins. The respective SIRs for CD were 6.0 (5.4-6.7), 6.3 (4.1-9.8), 34.0 (24.9-45.3), and 23.4 (10.1-51.1). All discordant associations, i. e., those between CD and other diseases, were also found for UC, including ankylosing spondylitis, asthma, polymyalgia rheumatica, psoriasis, and sarcoidosis. For UC, six additional associations were observed. No correlations between specifi c diseases were found among spouses, but between UC or CD and any disease it was 1.1 (1.0-1.1). CONCLUSIONS: The concordant familial risks for UC and CD were lower than those commonly cited. Both diseases are associated with several autoimmune and related diseases, suggesting genetic sharing. Am J Gastroenterol 2010; 105: 139- 147; doi: 10.1038/ ajg. 2009.496; published online 25 August 2009
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| 6. |
- Hemminki, Kari, et al.
(författare)
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Familial Risks for Type 2 Diabetes in Sweden
- 2010
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 33:2, s. 293-297
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE - Our aim was to characterize familial risks for type 2 diabetes by the type and number of affected family members, including half-siblings, adoptees, and spouses, to quantify risks and estimate the contribution of environmental effect. RESEARCH DESIGN AND METHODS - Families were identified from the Multigeneration Register, and type 2 diabetic patients were obtained from the Hospital Discharge Register. Standardized incidence ratios were calculated for offspring with type 2 diabetes whose family members were hospitalized for type 2 diabetes at ages >39 years compared With those lacking affected family members. RESULTS - The number of hospitalized type 2 diabetic patients was 157,549. Among 27,895 offspring, 27.9% had a parent or sibling also hospitalized for type 2 diabetes. The familial relative risk (RR) ranged from 2.0 to >30, depending on the number and type of probands. The highest RRs of type 2 diabetes were found in individuals who had at least two siblings affected by type 2 diabetes, irrespective of the parental disease. Adoptees showed no risk from adopted parents. CONCLUSIONS - The Study, the largest yet published, showed that familial RRs varied by the number and type Of affected family member. However, much Of the familial clustering remains yet to be genetically explained. The high risk should be recognized in clinical genetic counseling. The data from adoptees confirmed the genetic basis Of the familial associations, but those from half siblings and Spouses Suggested that a smaller part of familial Clustering may be accounted for by environmental factors.
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| 7. |
- Hemminki, Kari, et al.
(författare)
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Familial risks in nervous system tumours: joint Nordic study.
- 2010
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Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 1532-1827 .- 0007-0920. ; 102, s. 1786-1790
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Tidskriftsartikel (refereegranskat)abstract
- Background:Familial nervous system cancers are rare and limited data on familial aspects are available particularly on site-specific tumours.Methods:Data from five Nordic countries were used to analyse familial risks of nervous system tumours. Standardised incidence ratios (SIRs) were calculated for offspring of affected relatives compared with offspring of non-affected relatives.Results:The total number of patients with nervous system tumour was 63 307, of whom 32 347 belonged to the offspring generation. Of 851 familial patients (2.6%) in the offspring generation, 42 (4.7%) belonged to the families of a parent and at least two siblings affected. The SIR of brain tumours was 1.7 in offspring of affected parents; it was 2.0 in siblings and 9.4 in families with a parent and sibling affected. For spinal tumours, the SIRs were much higher for offspring of early onset tumours, 14.0 for offspring of affected parents and 22.7 for siblings. The SIRs for peripheral nerve tumours were 16.3 in offspring of affected parents, 27.7 in siblings and 943.9 in multiplex families.Conclusion:The results of this population-based study on medically diagnosed tumours show site-, proband- and age-specific risks for familial tumours, with implications for clinical genetic counselling and identification of the underlying genes.British Journal of Cancer advance online publication, 25 May 2010; doi:10.1038/sj.bjc.6605708 www.bjcancer.com.
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| 8. |
- Hemminki, Kari, et al.
(författare)
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Histology-specific risks in testicular cancer in immigrants to Sweden
- 2010
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Ingår i: Endocrine-Related Cancer. - 1479-6821. ; 17:2, s. 329-334
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Tidskriftsartikel (refereegranskat)abstract
- The changes of cancer incidence upon immigration have been used as an estimator of environmental influence on cancer risk. The previous immigrant studies have indicated that the origins of testicular cancer are at an early age in life, probably in the intrauterine period. We wanted to reexamine the critical periods on histology-specific testicular cancer in sons of immigrants to Sweden. We used the nationwide Swedish Family-Cancer Database to calculate standardized incidence ratios (SIRs) for testicular cancer in sons of parents immigrating to Sweden from low-and high-risk countries compared with the native Swedes. Among the large immigrant groups, the SIRs for sons of two Finnish and Asian parents were decreased if the sons were born outside Sweden. The sons of a Danish immigrant couple showed an increased risk of testicular cancer. The changes in SIR were most systematic for seminoma. The present patterns of testicular cancer risk among sons of immigrants point to the early environmental risk factors, which influence the risk probably after the intrauterine period. These factors appear to influence seminoma risk in a more enduring way than they influence non-seminoma. Endocrine-Related Cancer (2010) 17 329-334
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| 9. |
- Hemminki, Kari, et al.
(författare)
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Liver and gallbladder cancer in immigrants to Sweden.
- 2010
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Ingår i: European Journal of Cancer. - : Elsevier BV. - 1879-0852 .- 0959-8049. ; 46, s. 926-931
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The changes of cancer incidence upon immigration can be used as an estimator of environmental influence on cancer risk. We studied site-specific liver and biliary cancers in first-generation immigrants to Sweden with an aim to search for aetiological clues and to find evidence for indigenous incidence rates. MATERIAL AND METHODS: We used the nation-wide Swedish Family-Cancer Database to calculate standardised incidence ratios (SIRs) in immigrants compared to native Swedes. RESULTS: A total of 1428 cancers were identified in immigrants whose median ages (years) at immigration were 27 for men and 26 for women and whose median diagnostic ages were 64 and 66, respectively. The highest SIRs of 6.7 for primary liver cancer were observed for men from East Asia and sub-Saharan Africa. Increased SIRs were recorded for male immigrants from previous Yugoslavia (1.78), Southern Europe (2.91), Turkey (2.15) and Asian Arab countries (2.89). For gallbladder cancer, only women from the Indian subcontinent (3.84) and Chile (2.34) had increased risk while some Northern European immigrants showed decreased risks. CONCLUSIONS: Primary liver cancer was increased in immigrants from endemic regions of hepatitis B virus infection but also from large regions lacking cancer incidence data, North Africa, Asian Arab countries, Turkey and previous Yugoslavia; these are probably intermediary risk regions for this infection. The consideration of these regions as risk areas would justify active diagnostic and vaccination programs. The increase in gallbladder cancer in Chileans and Indians suggests that some persistent damage was inflicted before emigration, characterisation of which will be a challenge for aetiological studies.
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