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- Hjemdahl, P., et al.
(författare)
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Favourable long term prognosis in stable angina pectoris : an extended follow up of the angina prognosis study in Stockholm (APSIS)
- 2006
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Ingår i: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 92:2, s. 177-182
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the long term prognosis of patients with stable angina pectoris. Design: Registry based follow up ( median 9.1 years) of patients participating in the APSIS ( angina prognosis study in Stockholm), which was a double blind, single centre trial of antianginal drug treatment. Patients: 809 patients (31% women) with stable angina pectoris < 70 ( mean (SD) 59 (7) years at inclusion) and an age and sex matched reference population from the same catchment area. Interventions: Double blind treatment with metoprolol or verapamil during 3.4 years ( median), followed by referral for usual care with open treatment. Main outcome measures: Cardiovascular ( CV) death and non-fatal myocardial infarction (MI) in the APSIS cohort and total mortality in comparison with reference subjects. Results: 123 patients died ( 41 MI, 36 other CV causes) and 72 had non-fatal MI. Mortality (19% v 6%, p< 0.001) and fatal MI (6.6% v 1.6%, p< 0.001) were increased among male compared with female patients. Diabetes, previous MI, hypertension, and male sex independently predicted CV mortality ( p, 0.001). Diabetes greatly increased the risk in a small subgroup of female patients. Male patients had higher mortality than men in the reference population during the first three years ( cumulative absolute difference 3.8%) but apparently not thereafter. Female patients had similar mortality to women in the reference population throughout the 9.1 years of observation. Conclusions: Female patients with stable angina had similar mortality to matched female reference subjects but male patients had an increased risk. Diabetes, previous MI, hypertension, and male sex were strong risk factors for CV death or MI. Objective: To evaluate the long term prognosis of patients with stable angina pectoris. Design: Registry based follow up ( median 9.1 years) of patients participating in the APSIS ( angina prognosis study in Stockholm), which was a double blind, single centre trial of antianginal drug treatment. Patients: 809 patients (31% women) with stable angina pectoris < 70 ( mean (SD) 59 (7) years at inclusion) and an age and sex matched reference population from the same catchment area. Interventions: Double blind treatment with metoprolol or verapamil during 3.4 years ( median), followed by referral for usual care with open treatment. Main outcome measures: Cardiovascular ( CV) death and non-fatal myocardial infarction (MI) in the APSIS cohort and total mortality in comparison with reference subjects. Results: 123 patients died ( 41 MI, 36 other CV causes) and 72 had non-fatal MI. Mortality (19% v 6%, p< 0.001) and fatal MI (6.6% v 1.6%, p< 0.001) were increased among male compared with female patients. Diabetes, previous MI, hypertension, and male sex independently predicted CV mortality ( p, 0.001). Diabetes greatly increased the risk in a small subgroup of female patients. Male patients had higher mortality than men in the reference population during the first three years ( cumulative absolute difference 3.8%) but apparently not thereafter. Female patients had similar mortality to women in the reference population throughout the 9.1 years of observation. Conclusions: Female patients with stable angina had similar mortality to matched female reference subjects but male patients had an increased risk. Diabetes, previous MI, hypertension, and male sex were strong risk factors for CV death or MI.
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- Rathnayake, N, et al.
(författare)
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Saliva and plasma levels of cardiac-related biomarkers in post-myocardial infarction patients.
- 2017
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Ingår i: Journal of Clinical Periodontology. - : Blackwell. - 0303-6979 .- 1600-051X. ; 44:7, s. 692-699
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To relate cardiac biomarkers, such as cystatin C and growth differentiation factor-15 (GDF-15) in saliva to myocardial infarction (MI) and to periodontal status, and to investigate the relation between salivary and plasma cardiac biomarkers. Materials and Methods: Two hundred patients with MI admitted to coronary care units and 200 matched controls without MI were included. Dental examination and collection of blood and saliva samples was performed 6–10 weeks after the MI for patients and in close proximity thereafter for controls. Analysing methods: ARCHITECT i4000SR, Immulite 2000 XPi or ELISA. Results: The mean age was 62 ± 8 years and 84% were male. Total probing pocket depth, fibrinogen, white blood cell counts and HbA1c were higher in patients than controls. GDF-15 levels correlated with most of the included clinical variables in both study groups. No correlation was found between plasma and saliva levels of cystatin C or GDF-15. Conclusion: Salivary cystatin C and GDF-15 could not differentiate between MI patients and controls.
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- Rathnayake, N, et al.
(författare)
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Salivary Matrix Metalloproteinase-8 and -9 and Myeloperoxidase in Relation to Coronary Heart and Periodontal Diseases: A Subgroup Report from the PAROKRANK Study (Periodontitis and Its Relation to Coronary Artery Disease).
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 10:7
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objective: Matrix metalloproteinase (MMP) -8, -9 and myeloperoxidase (MPO) are inflammatory mediators. The potential associations between MMP-8, -9, MPO and their abilities to reflect cardiovascular risk remains to be evaluated in saliva. The objective of this study was to investigate the levels and associations of salivary MMP-8, -9, MPO and tissue inhibitors of metalloproteinase (TIMP)-1 in myocardial infarction (MI) patients and controls with or without periodontitis. Materials and Methods: 200 patients with a first MI admitted to coronary care units in Sweden from May 2010 to December 2011 and 200 controls matched for age, gender, residential area and without previous MI were included. Dental examination and saliva sample collection was performed 6-10 weeks after the MI in patients and at baseline in controls. The biomarkers MMP -8, -9, MPO and TIMP-1 were analyzed by time-resolved immunofluorescence assay (IFMA), Western blot and Enzyme-Linked ImmunoSorbent Assay (ELISA). Results: After compensation for gingivitis, gingival pockets and smoking, the mean salivary levels of MMP-8 (543 vs 440 ng/mL, p = 0.003) and MPO (1899 vs 1637 ng/mL, p = 0.02) were higher in non-MI subjects compared to MI patients. MMP-8, -9 and MPO correlated positively with clinical signs of gingival/periodontal inflammation while TIMP-1 correlated mainly negatively with these signs. The levels of latent and active forms of MMP-8 did not differ between the MI and non-MI groups. Additionally, MMP-8, MPO levels and MMP-8/TIMP-1 ratio were significantly higher in men compared to women with MI. Conclusions: This study shows that salivary levels of the analyzed biomarkers are associated with periodontal status. However, these biomarkers could not differentiate between patients with or without a MI. These findings illustrate the importance to consider the influence of oral conditions when analyzing levels of inflammatory salivary biomarkers.
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- Rehnqvist, N., et al.
(författare)
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Effects of metoprolol vs verapamil in patients with stable angina pectoris : The Angina Prognosis Study in Stockholm (APSIS)
- 1996
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 17:1, s. 76-81
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Tidskriftsartikel (refereegranskat)abstract
- Objective To study long-term treatment effects of metoprolol or verapamil on combined cardiovascular end points and psychological variables in patients with stable angina pectoris. Design Randomized, double-blind, double-dummy trial. Patients The study included 809 patients under 70 years of age with stable angina pectoris. The mean age of the patients was 59 +/- 7 years and 31% were women. Exclusion criteria were myocardial infarction within the previous 3 years and contraindications to beta-blockers and calcium antagonists. The patients were followed between 6 and 75 months (median 3.4 years and a total of 2887 patient years). Intervention The patients were treated with either metoprolol (Seloken ZOC 200 mg o.d.) or verapamil (Isoptin Retard 240 b.i.d.). Acetylsalicylic acid, ACE inhibitors, lipid lowering drugs and long acting nitrates were allowed in the study. End points Death, non-fatal cardiovascular events including acute myocardial infarction, incapacitating or unstable angina, cerebrovascular or peripheral vascular events. Psychological variables reflecting quality of life i.e. psychosomatic symptoms, sleep disturbances and an evaluation of overall life satisfaction. Results Combined cardiovascular events did not differ and occurred in 30.8% and 29.3% of metoprolol and verapamil treated patients respectively. Total mortality in metoprolol and verapamil treated patients was 5.4 and 6.2%, respectively. Cardiovascular mortality was 4.7% in both groups. Non-fatal cardiovascular events occurred in 26.1 and 24.3% of metoprolol and verapamil-treated patients, respectively. Psychosomatic symptoms and sleep disturbances were significantly improved in both treatment groups. The magnitudes of change were small and did not differ between treatments. Life satisfaction did not change on either drug. Withdrawals due to side effects occurred in 11.1 and 14.6%, respectively. Conclusion This long term study indicates that both drugs are well tolerated and that no difference was shown on the effect on mortality, cardiovascular end points and measures of quality of life.
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