| 1. |
- Wallenfeldt, Karin, 1960, et al.
(författare)
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Apolipoprotein B/apolipoprotein A-I in relation to the metabolic syndrome and change in carotid artery intima-media thickness during 3 years in middle-aged men
- 2004
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Ingår i: Stroke. - 1524-4628. ; 35:10, s. 2248-52
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The apolipoprotein B (apoB)/apolipoprotein A-I (apoA-I) ratio is a measure of the relationship between different lipoprotein particles and a powerful predictor of coronary death. The aim was to examine whether apoB/apoA-I was associated with the metabolic syndrome (MetS) at baseline and also with the future change in carotid artery intima-media thickness (IMT). METHODS: In 313 58-year-old men, carotid artery IMT was measured bilaterally by high-resolution B-mode ultrasound at baseline and after 3 years of follow-up. Serum apolipoprotein concentrations and the components of MetS were measured at study entry. RESULTS: ApoB/apoA-I showed statistically significant associations with body mass index, waist-to-hip ratio, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein (LDL) particle size, insulin, and diastolic blood pressure. Two thirds of the patients with MetS had high apoB/apoA-I ratios (>0.90) compared with one third of those without the syndrome (P<0.001). The IMT change was associated with apoB, total cholesterol, LDL cholesterol, triglycerides, and inversely with HDL cholesterol and LDL particle size at entry, and there was a strong colinearity between these variables. The subjects with apoB/apoA-I above the first tertile (0.74) had a 20-microm-higher (95% CI, 7 to 33) annual increase in IMT compared with those below this level after adjustment for blood pressure and smoking. CONCLUSIONS: The apoB/apoA-I ratio was strongly associated with MetS and its components at baseline. ApoB/apoA-I at baseline was related to the change in carotid artery IMT during 3 years of follow-up. There was a strong colinearity between apoB/apoA and the atherogenic lipids.
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| 2. |
- Agewall, S, et al.
(författare)
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Insulin sensitivity and hemostatic factors in clinically healthy 58-year-old men.
- 2000
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Ingår i: Thrombosis and haemostasis. - 0340-6245. ; 84:4, s. 571-5
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this cross-sectional study was to investigate the relationship between factors of the coagulation- and fibrinolysis systems and insulin sensitivity in 104 clinically healthy, 58-years-old men. Insulin sensitivity (hyperinsulinemic euglycemic clamp) adjusted for lean body mass, the metabolic syndrome according to a suggested definition, and different factors in the coagulation- and fibrinolysis system were determined. Subjects with the metabolic syndrome were characterised by increases in PAI-1 activity, tPA antigen, protein C and protein S and low concentrations of tPA activity. Insulin sensitivity was independently and reversibly associated with PAI-1 (p = 0.014) and directly with tPA activity (p = 0.001). Insulin sensitivity was also significantly negatively associated with protein S and protein C and several components in the metabolic syndrome, however not remaining significant in multivariate analyses. Protein C and protein S were significantly associated with PAI-1 activity, tPA activity (negatively), tPA antigen and antithrombin III. In conclusion, the data indicated that insulin resistance and several of the clustering components in the metabolic syndrome are accompanied by increased plasma concentrations of the anticoagulatory proteins C and S which may represent a mechanism which counteracts the concomitantly occurring hypofibrinolysis.
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| 3. |
- Bokemark, Lena, 1960
(författare)
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Atherosclerosis and Insulin Resistance AIR A cross-sectional study of 58-year old men
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main aim of the study was to test the hypothesis that insulin resistance is associated with atherosclerotic disease in the carotid and femoral arteries as measured using the ultrasound technique in clinically healthy 58-year old men with varying degrees of obesity and insulin resistance. The subjects were recruited from the general population and were free from clinical cardiovascular disease, diabetes mellitus and treatment with antihypertensive, lipid-lowering and anti-diabetic drugs (n=818). The study group (n=391) was based on a stratified sampling of all subjects in the lowest and highest quintiles of an estimate of insulin sensitivity and a random selection (1/5) of those in quintiles 2-4 (n=391). Insulin sensitivity was measured in a randomly selected subgroup (n=104) by the euglycemic hyperinsulinemic clamp technique which is considered to be the "gold standard" method. A reproducibility study which was performed in 32 men showed that glucose infusion rate (GIR) for the final 60 minutes adjusted for fat free mass (DEXA) was the most accurate way to measure insulin sensitivity. There was a negative univariate correlation between insulin sensitivity (GIR) and common carotid IMT, but no association with the carotid bulb or common femoral artery IMT. Plasma concentrations of C-peptide, proinsulin, split proinsulin and insulin measured with cross-reacting RIA, but not intact insulin, were univariately associated with common carotid IMT. Intact insulin and C-peptide were associated with common femoral artery IMT. None of the insulin peptides were associated to carotid bulb IMT. There were numerically similar univariate correlations between risk factors which constitute the metabolic syndrome (waist-hip-ratio, triglycerides, HDL cholesterol), and other risk factors such as serum cholesterol, apoB and smoking with common carotid artery, carotid bulb and femoral artery IMT. Plasma insulin measured with cross-reacting RIA and proinsulin were independently related to insulin sensitivity (GIR). There were also an independent association between plasma insulin (RIA) and common carotid IMT. No independent association between common carotid artery IMT and insulin sensitivity or proinsulin was found in this study. In the studied population, the clustering of risk factors which constitute the metabolic syndrome showed a relation to small LDL particles, common carotid, carotid bulb and common femoral IMT. Small LDL particles were also related to common carotid, carotid bulb and common femoral IMT and plaques in the carotid and femoral artery. The conclusion is that in contrast to well-established cardiovascular risk factors such as blood pressure or smoking, insulin sensitivity and hyperinsulinemia were only weakly and inconsistently associated with IMT in the examined arterial beds. The study did not show any independent relationship between proinsulin and IMT. However, there was a consistent association between the metabolic syndrome and common carotid, carotid bulb and femoral artery IMT. Further, small LDL particles were related to the factors in the metabolic syndrome and IMT and plaque in the carotid and femoral arteries.
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| 4. |
- Herlitz, Hans, 1946, et al.
(författare)
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Erythrocyte sodium/lithium countertransport is associated with thrombotic and fibrinolytic factors in 58-year-old men
- 2004
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Ingår i: Thromb Haemost. - 0340-6245. ; 91:6, s. 1152-7
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Tidskriftsartikel (refereegranskat)abstract
- The metabolic syndrome, in which insulin resistance is the core feature, is associated both with dysregulation of thrombosis/fibrinolysis and erythrocyte sodium/lithium countertransport (SLC). To investigate this further we designed a cross-sectional study to examine whether factors involved in coagulation- and fibrinolysis systems were associated with SLC independently of insulin resistance in 93 58-year-old men. SLC was in univariate analysis positively correlated with PAI-1 activity (r = 0.35, p <0.01), tPA antigen (r = 0.38, p <0.01), von Willebrand factor (r = 0.25, p <0.05), protein S (r = 0.26, p <0.05), and C (r = 0.30, p <0.01), and negatively associated with tPA activity(r = -0.28, p <0.01). Since these correlations could be influenced by the components of the metabolic syndrome itself, a separate analysis with adjustment for glucose infusion rate (GIR), plasma insulin, body fat, sagittal diameter of the abdomen (SD) and log serum triglyceride concentration (TG) was conducted. Then SLC was associated with tPA antigen independent of GIR, plasma insulin, body fat, SD and TG. SLC was also associated with protein C independent of GIR, insulin, body fat and SD but not TG. In conclusion, we found a relationship between SLC and the fibrinolytic system that was not related to the metabolic syndrome.
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| 5. |
- Hjalmarsson, Clara, 1969, et al.
(författare)
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Can prolonged QTc and cTNT level predict the acute and long-term prognosis of stroke?
- 2011
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 155:3, s. 414-417
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies in patients with stroke indicate that QTc prolongation and elevated cTNT are related to increased risk of all-cause and cardiovascular mortality. METHODS: We analysed the importance of electrocardiographic (ECG) abnormalities and elevated serum cardiac troponin (cTNT)-at baseline examination-as potential predictors for acute and long-term mortalities after stroke in a follow-up of 478 patients with a mean age of 78years. RESULTS: In a multivariate analysis, strong predictors for poor prognosis during the acute phase were: elevated cTNT (p=0.001); stroke severity (p=0.004); ischemia on ECG (p=0.044); and age (p=0.050). Prolonged QTc interval was on the limit to statistical significance (p=0.050) when using multivariate analysis, while clearly significant in a Cox-regression (when corrected for missing cTNT values). One year after stroke, when adjusted for covariates (gender, diabetes mellitus, hypertension, and ischemic heart disease), elevated cTNT (p=0.001), stroke severity (p=0.014), and age (p=0.031) retained a significant relation with mortality. Moreover, atrial fibrillation was strongly correlated with poor survival (p=0.009). Cox regression confirmed the predictive value of QTc, cTNT, age, and stroke severity, as markers of acute mortality in relation to stroke. CONCLUSION: Prolonged repolarization time independently predicts poor prognosis during the acute phase, but not one year after stroke. In the absence of acute myocardial infarction, elevated initial cTNT is strongly related to poor outcome, both during the acute phase and one year after stroke.
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| 6. |
- Hjalmarsson, Clara, 1969, et al.
(författare)
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Electrocardiographic Abnormalities and Elevated cTNT at Admission for Intracerebral Hemorrhage: Predictors for Survival?
- 2013
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Ingår i: Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. - : Wiley. - 1542-474X. ; 18:5, s. 441-9
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Tidskriftsartikel (refereegranskat)abstract
- Cerebrovascular lesions are often associated with electrocardiographic (ECG) abnormalities. The main purpose of this work was to investigate the prognostic value of ECG abnormalities and/or elevated cardiac troponin (cTNT) on admission in patients with nontraumatic intracerebral hemorrhage (ICH).
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| 7. |
- Hjalmarsson, Clara, 1969, et al.
(författare)
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Neuronal and glia-related biomarkers in cerebrospinal fluid of patients with acute ischemic stroke
- 2014
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Ingår i: Journal of Central Nervous System Disease. - 1179-5735. ; 19:6, s. 51-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cerebral ischemia promotes morphological reactions of the neurons, astrocytes, oligodendrocytes, and microglia in experimental studies. Our aim was to examine the profile of CSF (cerebrospinal fluid) biomarkers and their relation to stroke severity and degree of white matter lesions (WML). METHODS: A total of 20 patients (mean age 76 years) were included within 5-10 days after acute ischemic stroke (AIS) onset. Stroke severity was assessed using NIHSS (National Institute of Health stroke scale). The age-related white matter changes (ARWMC) scale was used to evaluate the extent of WML on CT-scans. The concentrations of specific CSF biomarkers were analyzed. RESULTS: Patients with AIS had significantly higher levels of NFL (neurofilament, light), T-tau, myelin basic protein (MBP), YKL-40, and glial fibrillary acidic protein (GFAP) compared with controls; T-Tau, MBP, GFAP, and YKL-40 correlated with clinical stroke severity, whereas NFL correlated with severity of WML (tested by Mann-Whitney test). CONCLUSIONS: Several CSF biomarkers increase in AIS, and they correlate to clinical stroke severity. However, only NFL was found to be a marker of degree of WML.
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| 8. |
- Hjalmarsson, Clara, 1969, et al.
(författare)
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The effect of statins on acute and long-term outcome after ischemic stroke in the elderly.
- 2012
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Ingår i: The American journal of geriatric pharmacotherapy. - : Elsevier BV. - 1876-7761 .- 1543-5946. ; 10:5, s. 313-22
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Tidskriftsartikel (refereegranskat)abstract
- Although treatment with statins has produced beneficial effects when used as secondary prevention, its primary protective role is still somewhat controversial. Moreover, few studies have evaluated the effect of statins in older patients with stroke.
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| 9. |
- Hjalmarsson, Clara, 1969, et al.
(författare)
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The role of prestroke glycemic control on severity and outcome of acute ischemic stroke.
- 2014
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Ingår i: Stroke Research and Treatment. - : Hindawi Limited. - 2042-0056 .- 2090-8105. ; 2014
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim. Relatively few studies have investigated the association of prestroke glycemic control and clinical outcome in acute ischemic stroke (IS) patients, regardless of presence of diabetes mellitus (DM). The aim of this study was to investigate the importance of prestroke glycemic control on survival, stroke severity, and functional outcome of patients with acute IS. Methods. We performed a retrospective survival analysis of 501 patients with IS admitted to Sahlgrenska University Hospital from February 15, 2005, through May 31, 2009. The outcomes of interest were acute and long-term survival; the stroke severity (NIHSS) and the functional outcome, mRS, at 12 months. Results. HbA1c was a good predictor of acute (HR 1.45; CI, 1.09 to 1.93, P = 0.011) and long-term mortality (HR 1.29; CI 1.03 to 1.62; P = 0.029). Furthermore, HbA1c >6% was significantly correlated with acute stroke severity (OR 1.29; CI 1.01 to 1.67; P = 0.042) and predicted worse functional outcome at 12 months (OR 2.68; CI 1.14 to 6.03; P = 0.024). Conclusions. Our study suggests that poor glycemic control (baseline HbA1c) prior to IS is an independent risk factor for poor survival and a marker for increased stroke severity and unfavorable long-term functional outcome.
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| 10. |
- Holmström, Alexandra, et al.
(författare)
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Heart dysfunction in patients with acute ischemic stroke or TIA does not predict all-cause mortality at long-term follow-up
- 2013
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Ingår i: Bmc Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite heart failure being a substantial risk factor for stroke, few studies have evaluated the predictive value of heart dysfunction for all-cause mortality in patients with acute ischemic stroke, in particular in the elderly. The aim of this study was to investigate whether impaired heart function in elderly patients can predict all-cause mortality after acute ischemic stroke or transient ischemic attack (TIA). Methods: A prospective long-term follow-up analysis was performed on a hospital cohort consisting of n = 132 patients with mean age 73 +/- 9 years, presenting with acute ischemic stroke or transient ischemic attack, without atrial fibrillation. All patients were examined by echocardiography during the hospital stay. Data about all-cause mortality were collected at the end of the follow-up period. The mean follow-up period was 56 +/- 22 months. Results: In this cohort, 58% of patients with acute ischemic stroke or TIA had heart dysfunction. Survival analysis showed that heart dysfunction did not predict all-cause mortality in this cohort. Furthermore, in multivariate regression analysis age (HR 5.401, Cl 1.97-14.78, p < 0.01), smoking (HR 3.181, Cl 1.36-7.47, p < 0.01), myocardial infarction (HR 2.826, Cl 1.17-6.83, p < 0.05) were independent predictors of all-cause mortality. Conclusion: In this population with acute ischemic stroke or TIA and without non-valvular atrial fibrillation, impaired heart function does not seem to be a significant predictor of all-cause mortality at long-term follow-up.
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