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1.	Al-Majdoub, Mahmoud, et al. (author) Population-level analysis to determine parameters that drive variation in the plasma metabolite profiles 2018 In: Metabolites. - : MDPI AG. - 2218-1989. ; 8:4 Journal article (peer-reviewed)abstract The plasma metabolome is associated with multiple phenotypes and diseases. However, a systematic study investigating clinical determinants that control the metabolome has not yet been conducted. In the present study, therefore, we aimed to identify the major determinants of the plasma metabolite profile. We used ultra-high performance liquid chromatography (UHPLC) coupled to quadrupole time of flight mass spectrometry (QTOF-MS) to determine 106 metabolites in plasma samples from 2503 subjects in a cross-sectional study. We investigated the correlation structure of the metabolite profiles and generated uncorrelated metabolite factors using principal component analysis (PCA) and varimax rotation. Finally, we investigated associations between these factors and 34 clinical covariates. Our results suggest that liver function, followed by kidney function and insulin resistance show the strongest associations with the plasma metabolite profile. The association of specific phenotypes with several components may suggest multiple independent metabolic mechanisms, which is further supported by the composition of the associated factors. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.
2.	Andersson, Susanne, 1957, et al. (author) The association between self-rated health and impaired glucose tolerance in Swedish adults: A cross-sectional study 2013 In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:2, s. 111-118 Journal article (peer-reviewed)abstract Objective. To investigate gender differences in the association between self-rated health (SRH) and impaired glucose tolerance (IGT) in subjects unaware of their glucose tolerance. Design. A cross-sectional population-based study. Setting. The two municipalities of Vara and Skövde in south-western Sweden. Subjects. A total of 2502 participants (1301 women and 1201 men), aged 30–75, were randomly selected from the population. Main outcome measures. IGT was regarded as the outcome measure and SRH as the main risk factor. Results. The prevalence of IGT was significantly higher in women (11.9%) than in men (10.1%), (p = 0.029), as was the prevalence of low SRH (women: 35.4%; men: 22.1%, p = 0.006). Both men and women with low SRH had a poorer risk factor profile than those with high SRH, and a statistically significant crude association between SRH and IGT was found in both men (OR = 2.8, 95% CI 1.8–4.4) and women (OR = 1.5, 95% CI 1.0–2.2, p = 0.033). However, after controlling for several lifestyle factors and biomedical variables, the association was attenuated and remained statistically significant solely in men (OR = 2.3, 95% CI 1.2–4.3). Conclusion. The gender-specific associations found between SRH and IGT suggest that SRH may be a better indicator of IGT in men than in women. Future studies should evaluate the utility of SRH in comparison with objective health measures as a potential aid to health practitioners when deciding whether to screen for IGT and T2DM.
3.	Bollano, Entela, 1970, et al. (author) Early post-transplant elevated pulmonary artery pressure predicts adverse outcome in cardiac recipients. 2020 In: International Journal of Cardiology. Heart & vasculature. - : Elsevier BV. - 2352-9067. ; 26 Journal article (peer-reviewed)abstract To investigate the prognostic value of early post-transplant hemodynamic measurements on 5-year mortality in cardiac recipients (HTx).A right heart catheterization was performed in 290 heart transplantation (HTx) recipients at a one-year post-HTx evaluation. To study the effect of post-HTx hemodynamic variables on 5-year outcome, the cohort was stratified into several subgroups. For right atrial pressure (RAP), mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP), and pulmonary vascular resistance (PVR), patients with values from the upper 10th percentile (high), were compared with those with values from the remaining lower 90th percentile (normal). For cardiac index (CI), patients with values from the lower 10th percentile (low) were compared with those with values from the remaining upper 90th percentile (normal).Death or re-transplantation within 5years after the one-year control occurred in 44 patients (13%). Of those, death or re-HTx was related to graft failure in 20 of cases (45%) and non-cardiac causes in 24 of cases (55%). The risk of death or re-HTx was higher in the subgroup with MPAP above 23mmHg than those equal to or below this value [hazard ratio 3.22, 95% confidence interval (CI) 1.49-6.97; P=0.003]. The association remained significant despite adjustment for several comorbidities. There were no differences in outcome between subgroups stratified with respect to high versus low RAP, PAWP, CI or PVR.Elevated pulmonary artery pressure at a first annual evaluation after HTx was the only hemodynamic variable that predicted impaired outcome in cardiac recipients.
4.	Buschard, Karsten, et al. (author) Sulfatide and Longevity 2022 In: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press (OUP). - 1758-535X. ; 77:9, s. 1715-1716 Journal article (peer-reviewed)
5.	Daka, Bledar, 1976, et al. (author) Association between self-reported alcohol consumption and diastolic dysfunction: a cross-sectional study 2023 In: Bmj Open. - 2044-6055. ; 13:10 Journal article (peer-reviewed)abstract Background and objectives While alcohol consumption is associated with common risk factors for diastolic dysfunction the independent impact of low levels of alcohol consumption on this condition in a community setting is still unclear. Thus, the aim of this study was to explore this association in a representative population sample employing optimal echocardiographic techniques.Background and objectives While alcohol consumption is associated with common risk factors for diastolic dysfunction the independent impact of low levels of alcohol consumption on this condition in a community setting is still unclear. Thus, the aim of this study was to explore this association in a representative population sample employing optimal echocardiographic techniques.Design Cross-sectional observational study in community-based population.Settings, participants and methods Participants between 30 and 75 years of age were consecutively invited to a physical examination, interview, conventional echocardiography, including Tissue Velocity Imaging. Diastolic dysfunction was defined according to the European Society of Cardiology criteria, excluding subjects with ejection fraction <45%, self-reported history of heart failure or atrial fibrillation on ECG. Self-reported alcohol intake using a validated questionnaire was categorised as no intake, low and medium-high intake.Results In total, 500 men and 538 women (mean age 55.4 +/- 13) were successfully examined. Diastolic dysfunction was identified in 16% (79/500) of the men and 13% (58/538) of the women. The multivariable adjusted model revealed a strong and independent association between alcohol intake and diastolic dysfunction. In fact, using no alcohol intake as reference, diastolic dysfunction was independently associated with alcohol consumption in a dose-dependent fashion; low consumption, OR 2.3 (95% CI 1.3 to 4.0) and medium-high consumption OR 3.1 (95% CI 1.6 to 6.2), respectively.Conclusion There was a significant association between alcohol consumption and diastolic dysfunction starting already at low levels that was supported by a dose-dependent pattern. These results need confirmatory studies and are important in public health policies.
6.	Daka, Bledar, 1976, et al. (author) Circulating concentrations of endothelin-1 predict coronary heart disease in women but not in men: A longitudinal observational study in the Vara-Skövde Cohort 2015 In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 15:1 Journal article (peer-reviewed)abstract © 2015 Daka et al.Background: The vasoconstricting peptide endothelin-1 has been proposed to be a marker of cardiovascular disease. Our aim was to investigate whether circulating endothelin-1 levels predict coronary heart disease (CHD) in Sweden. Methods: In 2002-2005, 2816 adult participants (30-74 years) were randomly selected from two municipalities in south-western Sweden. Cardiovascular risk factors and endothelin-1 levels were assessed at baseline, and incident CHD was followed-up in all participants through 2011. After exclusion of 50 participants due to known CHD at baseline and 21 participants because of unsuccessful analysis of endothelin-1, 2745 participants were included in the study. In total, 72 CHD events (52 in men and 20 in women) were registered during the follow-up time. Results: We showed that baseline circulating endothelin-1 levels were higher in women with incident CHD than in women without CHD (3.2 pg/ml, SE: 0.36 vs 2.4 pg/ml, SE: 0.03, p = 0.003) whereas this difference was not observed in men (2.3 pg/ml, SE: 0.16 vs 2.3 pg/ml, SE: 0.04, p = 0.828). An age-adjusted Cox proportional regression analysis showed an enhanced risk of CHD with increasing baseline endothelin-1 levels in women (hazard ratio (HR) = 1.51, 95 % CI = 1.1-2.1, p = 0.015) but not in men (HR = 0.98, 95 % CI = 0.8-1.2, p = 0.854). Furthermore, the predictive value of endothelin-1 for incident CHD in women was still significant after adjustments for age, HOMA-IR, apolipoprotein (apo)B/apoA1 and smoking (HR = 1.53, CI = 1.1-1.2, p = 0.024). Conclusion: Circulating endothelin-1 levels may predict CHD in women.
7.	Daka, Bledar, 1976, et al. (author) Inverse association between serum insulin and sex hormone-binding globulin in a population survey in Sweden 2013 In: Endocrine Connections. - 2049-3614. ; 2:1, s. 18-22 Journal article (peer-reviewed)abstract OBJECTIVES: Obesity is associated with low levels of sex hormone-binding globulin (SHBG). While the reason is not fully understood, we aimed to study the association between serum insulin and levels of SHBG in a random population. DESIGN AND METHODS: Between 2001 and 2005, a random sample of 2816 participants aged 30-74 years were enrolled in a cross-sectional survey in the South-west of Sweden. Fasting blood samples were collected and an oral glucose tolerance test (OGTT) was conducted in all subjects without known diabetes. Diabetes mellitus was defined according to criteria from WHO, and clinical characteristics were used to discriminate between type 1 (T1D) and type 2 diabetes (T2D). Analyses of SHBG were successful in 2782 participants (98%), who thus constituted the current study population. RESULTS: WE FOUND SIGNIFICANT INVERSE ASSOCIATION BETWEEN LEVELS OF SHBG AND FASTING SERUM INSULIN IN BOTH GENDERS (MEN: β=-0.090, P=0.001; women: β=-0.197, P<0.001), which was independent of differences in age and BMI. The associations remained when also differences in fasting plasma glucose were accounted for (men: β=-0.062, P=0.022; women: β=-0.176, P≤0.001). Subjects with T1D exhibited higher levels of SHBG than both T2D (men: δ=15.9nmol/l, P<0.001; women: δ=71.1nmol/l, P<0.001) and non-diabetic subjects (men: δ=15.1nmol/l, P<0.001; women: δ=72.9nmol/l, P<0.001) independent of age, BMI and fasting glucose levels. CONCLUSION: These findings are consistent with high levels of SHBG in T1D, and correspondingly low levels in T2D subjects, suggesting an inhibitory effect of insulin on the SHBG production in the liver.
8.	Daka, Bledar, 1976, et al. (author) Low agreement between radio binding assays in analyzing glutamic acid decarboxylase (GAD65Ab) autoantibodies in patients classified with type 2 diabetes. 2009 In: Autoimmunity. - : Informa UK Limited. - 1607-842X .- 0891-6934. ; 42:6, s. 507-14 Journal article (peer-reviewed)abstract Autoantibodies against glutamic acid decarboxylase (GAD65Ab) are used in the classification of diabetes in adults. We assessed the concordance in GAD65 autoantibody levels within subjects between three different GAD65Ab radio binding assays (RBA). Plasma samples from 112 diabetes patients (median age 50 years) initially classified with type 2 diabetes was randomly selected from a local diabetes registry. Coded samples were analyzed with two RBA employing (35)S-labeled GAD65. The first used the pEx9 plasmid (pEx9 RBA), the second employed the pThGAD65 plasmid (pThGAD65 RBA) to label GAD65 by in vitro transcription translation. We also used a commercial kit employing plasmid pGAD17 labelled with (125)I (pGAD17 RBA). Subsequent analyses followed standard procedures. Two different cut-offs for GAD65Ab positivity were used in all three assays. We calculated the correlation, concordance, and agreement between the assays. The proportion of GAD65Ab positivity differed between assays when low cut-offs were used (pEx9 RBA 25%, pThGAD65 RBA 17.9%, and pGAD17 RBA 12.5%, respectively). When high cut-offs were applied, the concordance between the pEx9 RBA and the pThGAD65 RBA was 97.3 while their concordance to the pGAD17 RBA was lower (88.4 and 87.4, respectively). There was a low agreement between both pEx9 RBA and pGAD17 RBA (0.45, 95% CI 0.20-0.70) and between pThGAD65 RBA and pGAD17 RBA (0.43, 95% CI 0.18-0.68). We found discrepancies in determining the GAD65Ab positivity, which constitutes a problem when GAD65Ab are used clinically. Further methodological GAD65Ab assays studies are warranted.
9.	Daka, Bledar, 1976, et al. (author) Low concentrations of serum testosterone predict acute myocardial infarction in men with type 2 diabetes mellitus 2015 In: Bmc Endocrine Disorders. - : Springer Science and Business Media LLC. - 1472-6823. ; 15 Journal article (peer-reviewed)abstract Background: The aim of the present study was to investigate the associations between endogenous testosterone concentrations and the incidence of acute myocardial infarction (AMI) in men and women with and without type 2 diabetes. Methods: The study comprised 1109 subjects >= 40 years of age (mean age 62 +/- 12 years) participating in a baseline survey in Sweden in 1993-94. Information about smoking habits and physical activity was obtained using validated questionnaires. Serum concentrations of testosterone and sex hormone-binding globulin (SHBG) were obtained using radioimmunoassay. Diagnosis of type 2 diabetes was based on WHO's 1985 criteria. Individual patient information on incident AMI was ascertained by record linkage with national inpatient and mortality registers from baseline through 2011. Results: The prevalence of type 2 diabetes at baseline was 10.0 % in men and 7.5 % in women. During a mean follow-up of 14.1 years (+/- 5.3), there were 74 events of AMI in men and 58 in women. In age-adjusted Cox models, a significant inverse association between concentrations of testosterone and AMI-morbidity was found in men with type 2 diabetes (HR = 0.86 CI (0.75-0.98)). In a final model also including waist-to-hip ratio, systolic blood pressure, total cholesterol and active smoking, the association still remained statistically significant (HR = 0.754 CI (0.61-0.92)). Conclusion: Low concentrations of testosterone predicted AMI in men with type 2 diabetes independent of other risk factors. Trials with testosterone investigating the effect regarding cardiovascular outcome are still lacking. Future trials in this field should take into account a modification effect of diabetes.
10.	Daka, Bledar, et al. (author) Low sex hormone-binding globulin is associated with hypertension: a cross-sectional study in a Swedish population 2013 In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 13 Journal article (peer-reviewed)abstract Background: The aim of this study was to investigate the association of sex hormone-binding globulin (SHBG) and hypertension in a Swedish population. Methods: The study is based on a random sample of a Swedish population of men and women aged 30-74 years (n=2,816). Total testosterone, oestradiol and SHBG were measured in 2,782 participants. Free androgen index was then calculated according to the formula FAI=100 x (Total testosterone)/SHBG. Hypertension was diagnosed according to JNC7. Results: In men, but not in women, significant association between SHBG and both diastolic (diastolic blood pressure: beta=-0.143 p<0.001) and systolic blood pressure (systolic blood pressure beta=-0.114 p<0.001) was found. The association was still significant after adjusting for age, body mass index (BMI), homeostatic model assessment insulin resistance (HOMA-IR), triglycerides, high density lipoproteins (HDL) and C-reactive protein (CRP) (diastolic blood pressure: beta=-0.113 p<0.001; systolic blood pressure beta=-0.093 p=0.001). An inverse association was observed between SHBG and hypertension in both men (B=-0.024 p<0.001) and women (B=-0.022 p<0.001). The association was still significant in women older than 50 years after adjustments for age, BMI, physical activity, CRP and alcohol consumption (B=-0.014, p=0.008). Conclusion: In conclusion, these results show a strong association between SHBG and blood pressure independent of major determinants of high blood pressure. This association might be addressed to direct effects of SHBG in endothelial cells through the receptor for SHBG. If this is confirmed by other observational and experimental studies, it might become a new field for the development of therapies for lowering blood pressure.
11.	Diurlin, Sven, et al. (author) Men with impaired glucose tolerance have lower self-rated health than men with impaired fasting glucose 2020 In: Primary Care Diabetes. - : Elsevier BV. - 1751-9918. ; 14:1, s. 40-46 Journal article (peer-reviewed)abstract Aim: Previous studies have shown that individuals with impaired glucose tolerance (IGT) have lower self-rated health than normoglycaemic individuals. The aim of this study was to examine differences in self-rated health between individuals with IGT and those with impaired fasting glucose (IFG) and to consider the potentially mediating effect of physical activity. Methods: In 2002–2005, a total of 2816 individuals were randomly selected for a population-based study in Sweden. All participants performed an oral glucose tolerance test (OGTT). Fasting venous blood samples were drawn, and questionnaires concerning lifestyles were completed. Self-rated health (SRH) and leisure time physical activity (LTPA) were reported on a five-graded and four-graded scale, respectively. A total of 213 individuals with IGT and 129 with IFG were detected. Results: IGT, but not IFG, was associated with low self-rated health. The difference in self-rated health was seen particularly in men when adjusted for age and BMI (OR = 2.13, CI: 1.13–4.02, p = 0.020). The results became insignificant when including physical activity in the model (OR = 1.8, CI: 0.91–3.58, p = 0.094). Conclusion: The low self-rated health adds further weight to the risk profile in men with IGT and stresses the importance of early detection and lifestyle interventions. © 2019
12.	Diurlin, Sven, et al. (author) Persisting prediabetic conditions and glomerular filtration rate - A longitudinal study 2022 In: Primary Care Diabetes. - : Elsevier BV. - 1751-9918 .- 1878-0210. ; 16:4, s. 597-599 Journal article (peer-reviewed)abstract The aim was to explore differences in the development of eGFR in persisting prediabetic conditions. This prospective study including 1327 individuals showed that eGFR decreased more in individuals with persisting IGT than in individuals with persisting IFG. Repeating OGTT and monitoring eGFR might improve the risk estimation in prediabetes.
13.	Eriksson, Maria, et al. (author) Association between low internal health locus of control, psychological distress and insulin resistance. An exploratory study 2023 In: Plos One. - 1932-6203. ; 18:5 Journal article (peer-reviewed)abstract AimTo assess the hypothesis that low internal health locus of control (IHLC) and psychological distress (PD) are associated with insulin resistance. Materials and methodsIn 2002-2005, a random population sample of 2,816 men and women aged 30-74 years participated (76%) in two municipalities in southwestern Sweden. This study included 2,439 participants without previously known diabetes or cardiovascular disease. IHLC was measured by a global scale and PD was measured by the 12-item General Health Questionnaire. Insulin resistance was estimated using HOMA-ir. General linear models were used to estimate differences in HOMA-ir between groups with low IHLC, PD, and both low IHLC and PD, respectively. ResultsFive per cent (n = 138) had both PD and low IHLC, 62 per cent of participants (n = 1509) had neither low IHLC nor PD, 18 per cent (n = 432) had PD, and 15 per cent (n = 360) low IHLC. Participants with both low IHLC and PD had significantly higher HOMA-ir than participants with neither low IHLC nor PD (Delta = 24.8%, 95%CI: 12.0-38.9), also in the fully adjusted model (Delta = 11.8%, 95%CI: 1.5-23.0). Participants with PD had significantly higher HOMA-ir (Delta = 12%, 95%CI: 5.7-18.7), but the significance was lost when BMI was included in the model (Delta = 5.3%, 95%CI:0.0-10.8). Similarly, participants with low IHLC had significantly higher HOMA-ir (Delta = 10.1%, 95%CI: 3.5-17.0) but the significance was lost in the fully adjusted model (Delta = 3.5%, 95%CI: -1.9-9.3). ConclusionsInternal health locus of control (IHLC) and psychological distress (PD) were associated with insulin resistance. Especially individuals with both PD and low IHLC may need special attention.
14.	Eriksson, Maria Christina, 1981, et al. (author) Validation of a single question to measure internal health locus of control in Swedish primary care 2023 In: Scandinavian Journal of Psychology. - 0036-5564 .- 1467-9450. ; 64:5, s. 674-678 Journal article (peer-reviewed)abstract BackgroundBehavioral risk factors are highlighted in the prevention of diabetes and cardiovascular disease. Screening for health locus of control could be a feasible way to better identify individuals who could benefit from preventive behavioral change interventions. The aim of the study was to investigate the correlation between a single question measuring internal health locus of control (IHLC) and the Multidimensional Health Locus of Control Scale (MHLC) and to assess how IHLC relates to the General Self-Efficacy scale (GSE) in a primary care setting. MethodsPrimary care patients, aged 18 and older, attending three primary care centers in southwest Sweden were consecutively asked to anonymously participate in the study. The patients were given a questionnaire and instructed to return the questionnaire in a sealed box in the waiting room. ResultsIn all, 519 patients were included. The correlation between MHLC Internality and IHLC was weak (r = 0.21, p < 0.001). An increase of one point on the internality scale of the MHLC gave an odds ratio of 1.19 (95% CI 1.11-1.28) for reporting high IHLC, and thus a five-point increase gave a doubled likelihood, OR = 2.40, CI 1.67-3.46. The results for the other scales of the MHLC and GSE were similar. ConclusionIn this study, we found weak but statistically significant support for the single-question IHLC as a measure of internal health locus of control. Given that the correlation was weak, we recommend using the MHLC when possible.
15.	Hebib, Lana, et al. (author) Life’s Essential 8 is inversely associated with high-sensitivity C-reactive protein 2024 In: Scientific Reports. - : Springer Nature. - 2045-2322. ; 14:1 Journal article (peer-reviewed)abstract Life’s Essential 8 (LE8) is a score that includes modifiable risk factors for cardiovascular disease. Four health behaviors (diet, physical activity, nicotine exposure and sleep health) and four health factors (non-HDL cholesterol, blood glucose, blood pressure and body mass index) are included. These modifiable risk factors promote inflammation, and inflammation is one of the biological mechanisms of cardiovascular disease development. Thus, we examined the relationship between cardiovascular health measured by LE8 and low-grade inflammation measured by high-sensitivity C-reactive protein (hs-CRP) in the cross-sectional population-based Swedish CArdioPulmonary bioImage Study (SCAPIS). The study consisted of 28,010 participants between 50 and 64 years (51.5% women, mean age 57.5 years). All individual LE8 components were assigned a score between 0 (unhealthy) and 100 (healthy) points, and a global score was calculated. The association between LE8 scores and high-risk hs-CRP (defined as > 3.0 mg/L) was analyzed using adjusted logistic regression with spline analyses. There was a strong, dose response and inverse association between LE8 scores and levels of hs-CRP. Thus, those with a low LE8 score (= 50.0 points) had 5.8 higher (95% confidence interval [CI] 5.2–6.4) odds ratio (OR) of having high hs-CRP as compared to those with a high LE8 score (= 80.0 points). In conclusion, our findings show strong inverse associations between LE8 scores and levels of hs-CRP.
16.	Hellgren, Margareta, 1955, et al. (author) Association between body mass index and self-rated health: A Swedish population-based longitudinal study. 2021 In: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 49:4, s. 369-376 Journal article (peer-reviewed)abstract Aims: We aimed to investigate (a) the association between body mass index (BMI) and self-rated health (SRH) and (b) BMI's predicted value for SRH within a representative population in the Skaraborg Project. Methods: This was a longitudinal observational study. A random population of 2816 individuals were included in the study between 2002 and 2005, and a representative sample of these individuals were invited consecutively for a follow-up visit between 2012 and 2014. At follow-up, data from 1327 participants were collected concerning anthropometric variables, blood samples and validated questionnaires regarding lifestyle factors. Results: A significant inverse association was observed between BMI and SRH both at baseline and at follow-up, with all p-values for trend being ⩽0.001 in both men and women. This association was observed even after adjusting for confounders such as co-morbidity, age, sex, education, marital status and lifestyle factors. In addition, the longitudinal analyses showed that BMI at baseline was inversely associated with SRH at follow-up in both sexes (odds ratio (OR)=1.1, confidence interval (CI) 1.02-1.16, p=0.017 in men; and OR=1.1, CI 1.04-1.14, p=0.001 in women). These findings remained in participants whose weight increased (p=0.022) or was stable (p=0.004), while it was not seen in individuals who lost weight over the years (p=0.340). Conclusions: SRH is inversely associated with BMI in Swedish men and women. High BMI predicted low SRH from a longitudinal perspective, independent of co-morbidities, except for individuals who lost weight over the years. This knowledge emphasises the importance of an understanding and empathetic attitude towards these individuals.
17.	Hellgren, Margareta, 1955, et al. (author) C-Reactive Protein Concentrations and Level of Physical Activity in Men and Women With Normal and Impaired Glucose Tolerance: A Cross-Sectional Population-Based Study in Sweden 2016 In: Journal of Physical Activity & Health. - : Human Kinetics. - 1543-3080 .- 1543-5474. ; 13:6, s. 625-631 Journal article (peer-reviewed)abstract Background: We aimed to explore the association between self-reported leisure time physical activity (LTPA) and C-reactive protein (CRP) concentrations in men and women with and without impaired glucose tolerance (IGT). Methods: In a cross-sectional study, a random sample (n = 2,816) was examined with an oral glucose tolerance test, CRP and information about LTPA. Those with IGT or normal glucose tolerance (NGT) and CRP value <= 10 mg/L were selected (n = 2,367) for the study. Results: An inverse association between LTPA and CRP concentrations was observed in the population (P < .001), though, only in men with IGT (P = .023) and in women with NGT. Men with IGT, reporting slight physical activity up to 4 hours a week presented significantly higher CRP concentrations than normoglycemic men (Delta 0.6 mg/L, P = .004). However, this difference could not be found in men with IGT reporting more intense physical activity (Delta 0.01 mg/L, P = .944). Conclusions: Physical inactivity seems to have greater inflammatory consequences for men (vs. women) with IGT. More importantly, although 4 hours of physical activity per week is more than the usual minimum recommendation, an even greater intensity of LTPA appears to be required to limit subclinical inflammation in men with IGT.
18.	Hellgren, Margareta, 1955, et al. (author) Circulating endothelin-1 levels are positively associated with chronic kidney disease in women but not in men: a longitudinal study in the Vara-Skovde cohort 2021 In: Bmc Nephrology. - : Springer Science and Business Media LLC. - 1471-2369. ; 22:1 Journal article (peer-reviewed)abstract Background The vasoconstricting peptide endothelin-1 (ET-1) is associated with endothelial dysfunction. The aim of this paper was to investigate whether circulating ET-1 levels predicts chronic kidney disease (CKD) in a prospective population study. Methods In 2002-2005, 2816 participants (30-74 years) were randomly selected from two municipalities in South-Western Sweden and followed up in a representative sample of 1327 individuals after 10 years. Endothelin-1 levels were assessed at baseline. Outcome was defined as CKD stage 3 or above based on eGFR < 60 mL/min/1.73m(2). Those 1314 participants with successful analysis of ET-1 were further analyzed using binary logistic regression. Results At follow-up, 51 (8%) men and 47 (7,8%) women had CKD stage 3 and above. Based on levels of ET-1 the population was divided into quintiles showing that women in the highest quintile (n = 132) had a significantly increased risk of developing CKD during the follow up period (OR = 2.54, 95% CI:1.19-5.45, p = 0.02) compared with the other quintiles (1-4). The association was borderline significant after adjusted for age, current smoking, alcohol consumption, hypertension, diabetes, BMI, high- sensitive CRP and LDL-cholesterol (OR = 2.25, 95% CI:0.97-5.24, p = 0.06). No significant differences were observed between quintiles of ET-1 and development of CKD in men (NS). Conclusions High levels of ET-1 are associated with development of CKD in women.
19.	Hellgren, Margareta, et al. (author) HbA1c räcker inte vid screening för störd glukosmetabolism - Även glukosbelastning behövs, visar svensk prospektiv epidemiologisk studie. 2015 In: Läkartidningen. - 1652-7518. ; 112 Journal article (peer-reviewed)abstract An HbA1c threshold of ≥42 mmol/mol has been proposed to diagnose prediabetes. The sensitivity, specificity and positive predictive value of the proposed threshold for detection of individuals with prediabetes was examined in a study of 573 randomly selected individuals from Vara and Skövde. In addition, the utility of the FINDRISC questionnaire and of a fasting glucose test in combination with three short questions concerning BMI, heredity for type 2 diabetes and known hypertension was examined. Results from an oral glucose tolerance test were used as reference. The sensitivity of HbA1c and FINDRISC to detect individuals with IGT was 16 and 26 per cent respectively. Questions regarding BMI, heredity and hypertension together with a fasting glucose test yielded a sensitivity of 50%, but a lower specificity and positive predictive value. We conclude that HbA1c inefficiently detected individuals with impaired glucose tolerance and that oral glucose tolerance tests can still preferably be recommended.
20.	Hellgren, Margareta, 1955, et al. (author) Insulin resistance predicts early cardiovascular morbidity in men without diabetes mellitus, with effect modification by physical activity 2015 In: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 22:7, s. 940-949 Journal article (peer-reviewed)abstract Aim: to assess how well insulin resistance predicts cardiovascular disease (CVD) in non-diabetic men and women and to explore the influence of physical activity. Methods: in this prospective study 2563 men and women without diabetes were examined with an oral glucose tolerance test, anthropometric measurements and blood pressure assessment. Questionnaires about lifestyle and physical activity were completed. Insulin resistance was estimated by fasting concentrations of plasma insulin and by HOMA index for insulin resistance. Participants were followed up for cardiovascular morbidity and mortality during an 8-year period, using information from the National Swedish Inpatient and Mortality registers. Results: at follow-up, HOMAir predicted CVD morbidity in males (50 events) and females (28 events) combined (HRage/sex-adj 1.4, 95% CI 1.1-1.7); however, when stratified by gender HOMAir was predictive solely in men (HRage-adj 1.8, 95% CI 1.3-2.4), whereas no association was found in women (HRage-adj 1.1, 95% CI 0.8-1.5). When stratifying the data for high and low physical activity, the predictive value of insulin resistance became stronger in sedentary men (HRage-adj 2.3, 95% CI 1.5-3.4) but was abolished in men performing moderate to vigorous physical activity (HRage-adj 1.0, 95% CI 0.6-1.6). The results remained when step-wise adjusted also for BMI, ApoB/ApoA1 and hypertension, as well as for smoking, alcohol consumption and education. Outcome for fasting plasma insulin was similar to HOMAir. Conclusions: insulin resistance predicts CVD in the general population; however, men may be more vulnerable to increased insulin resistance than women, and physically inactive men seem to be at high risk.
21.	Hellgren, Margareta, 1955, et al. (author) Primary care screening for individuals with impaired glucose metabolism with focus on impaired glucose tolerance 2015 In: Primary Care Diabetes. - : Elsevier BV. - 1751-9918. ; 9:4, s. 261-266 Journal article (peer-reviewed)abstract Aim: To evaluate the utility of three short questions (the Skövde Form) combined with a random plasma glucose, and HbA1c as alternative tools for detection of individuals with impaired glucose metabolism (IGM), and particularly impaired glucose tolerance (IGT).
22.	Herraiz Adillo, Ángel, et al. (author) Life's Essential 8 and carotid artery plaques: the Swedish cardiopulmonary bioimage study 2023 In: Frontiers in Cardiovascular Medicine. - : FRONTIERS MEDIA SA. - 2297-055X. ; 10 Journal article (peer-reviewed)abstract BackgroundTo quantify cardiovascular health (CVH), the American Heart Association (AHA) recently launched an updated construct of the "Life's Simple 7" (LS7) score, the "Life's Essential 8" (LE8) score. This study aims to analyse the association between both CVH scores and carotid artery plaques and to compare the predictive capacity of such scores for carotid plaques.MethodsRandomly recruited participants aged 50-64 years from the Swedish CArdioPulmonary bioImage Study (SCAPIS) were analysed. According to the AHA definitions, two CVH scores were calculated: i) the LE8 score (0, worst CVH; 100, best CVH) and two different versions of the LS7 score [(0-7) and (0-14), 0 indicating the worst CVH]. Ultrasound-diagnosed carotid plaques were classified as no plaque, unilateral, and bilateral plaques. Associations were studied by adjusted multinomial logistic regression models and adjusted (marginal) prevalences, while comparison between LE8 and LS7 scores was performed through receiver operating characteristic (ROC) curves.ResultsAfter exclusions, 28,870 participants remained for analysis (50.3% women). The odds for bilateral carotid plaques were almost five times higher in the lowest LE8 (<50 points) group [OR: 4.93, (95% CI: 4.19-5.79); adjusted prevalence 40.5%, (95% CI: 37.9-43.2)] compared to the highest LE8 (& GE;80 points) group [adjusted prevalence 17.2%, (95% CI: 16.2-18.1)]. Also, the odds for unilateral carotid plaques were more than two times higher in the lowest LE8 group [OR: 2.14, (95% CI: 1.82-2.51); adjusted prevalence 31.5%, (95% CI: 28.9-34.2)] compared to the highest LE8 group [adjusted prevalence 29.4%, (95% CI: 28.3-30.5)]. The areas under ROC curves were similar between LE8 and LS7 (0-14) scores: for bilateral carotid plaques, 0.622 (95% CI: 0.614-0.630) vs. 0.621 (95% CI: 0.613-0.628), P = 0.578, respectively; and for any carotid plaque, 0.602 (95% CI: 0.596-0.609) vs. 0.600 (95% CI: 0.593-0.607), P = 0.194, respectively.ConclusionThe new LE8 score showed inverse and dose-response associations with carotid plaques, particularly bilateral plaques. The LE8 did not outperform the conventional LS7 score, which showed similar ability to predict carotid plaques, especially when scored as 0-14 points. We conclude that both the LE8 and LS7 may be useful in clinical practice for monitoring CVH status in the adult population.
23.	Herraiz-Adillo, Ángel, et al. (author) Life's Essential 8 and Life's Simple 7 in Relation to Coronary Atherosclerosis: Results From the Population-Based SCAPIS Project. 2024 In: Mayo Clinic proceedings. - : Elsevier. - 1942-5546 .- 0025-6196. ; 99:1, s. 69-80 Journal article (peer-reviewed)abstract To examine the associations between the American Heart Association scores ("Life's Essential 8" [LE8] and "Life's Simple 7" [LS7]) and 2 subclinical coronary atherosclerosis indicators: coronary computed tomographic angiography (CCTA)-stenosis and coronary artery calcium (CAC).We included a population-based sample, aged 50 to 64 years, recruited between 2013 and 2018 from the Swedish Cardiopulmonary Bioimage Study (n=24,819, 50.3% women). CCTA-stenosis was graded as no stenosis, stenosis (1%-49%) or severe stenosis (≥50%), whereas CAC was graded as 0, 1 to 99, 100 to 399, or ≥400 Agatston units. Multinomial logistic regression and receiver operating characteristic (ROC) curves were used to study the associations between cardiovascular health scores and subclinical coronary atherosclerosis.Odds ratios (ORs) for CCTA-stenosis and severe CCTA-stenosis between the lowest (<50 points) vs the highest (≥80 points) LE8 group were 4.18 (95% CI, 3.56 to 4.91) and 11.17 (95% CI, 8.36 to 14.93), respectively. For corresponding CAC results, ORs were 3.36 (95% CI, 2.84 to 3.98), 7.72 (95% CI, 6.03 to 9.89), and 14.94 (95% CI, 10.47 to 21.31) for CAC scores of 1 to 99, 100 to 399, and ≥400, respectively. Area under ROC curves for predicting any stenosis were 0.642 (95% CI, 0.635 to 0.649) and 0.631 (95% CI, 0.624 to 0.638, P<.001) for LE8 and LS7, respectively.Our data indicate that LE8 showed a strong, graded, and inverse association with CCTA-stenosis and CAC score. The capacity to predict CCTA-stenosis was comparable between LE8 and LS7, although LE8 had slightly higher prediction capacity of any stenosis. This study provides novel evidence that the LE8 score may be a useful tool for monitoring cardiovascular health.
24.	Herraiz-Adillo, Ángel, et al. (author) Life’s Essential 8 in relation to self-rated health and health-related quality of life in a large population-based sample : the SCAPIS project 2024 In: Quality of Life Research. - : Springer Nature. - 0962-9343 .- 1573-2649. ; 33, s. 1003-1014 Journal article (peer-reviewed)abstract Purpose: To monitor cardiovascular health, in 2022, the American Heart Association (AHA) updated the construct “Life’s Simple 7” (LS7) to “Life’s Essential 8” (LE8). This study aims to analyze the associations and capacity of discrimination of LE8 and LS7 in relation to self-rated health (SRH) and health-related quality of life (HRQoL).Methods: This study from the Swedish CArdioPulmonary bioImage Study (SCAPIS) included 28 731 Swedish participants, aged 50–64 years. Three different scores were derived from the SF-12 questionnaire: 1-item question SRH (“In general, would you say your health is …?”), mental-HRQoL and physical-HRQoL. Logistic regression, restricted cubic splines, and ROC analysis were used to study the associations between the AHA scores in relation to SRH and HRQoL.Results: Compared to those with a LE8 score of 80, participants with a LE8 score of 40 were 14.8 times more likely to report poor SRH (OR: 14.8, 95% CI: 13.0–17.0), after adjustments. Moreover, they were more likely to report a poor mental-HRQoL (OR: 4.9, 95% CI: 4.2–5.6) and a poor physical-HRQoL (OR: 8.0, 95% CI: 7.0–9.3). Area under curves for discriminating poor SRH were 0.696 (95% CI: 0.687–0.704), 0.666 (95% CI: 0.657–0.674), and 0.643 (95% CI: 0.634–0.651) for LE8, LS7 (0–14), and LS7 (0–7), respectively, all p values < 0.001 in the DeLong’s tests.Conclusion: LE8 and LS7 had strong and inverse associations with SRH, mental-HRQoL, and physical-HRQoL, though LE8 had a somewhat higher capacity of discrimination than LS7. The novel LE8, a construct initially conceived to monitor cardiovascular health, also conveys SRH and HRQoL.
25.	Herraiz-Adillo, Ángel, et al. (author) Physical fitness in male adolescents and atherosclerosis in middle age: a population-based cohort study 2024 In: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480. Journal article (peer-reviewed)abstract Objectives To examine the associations between physical fitness in male adolescents and coronary and carotid atherosclerosis in middle age.Methods This population-based cohort study linked physical fitness data from the Swedish Military Conscription Register during adolescence to atherosclerosis data from the Swedish CArdioPulmonary bioImage Study in middle age. Cardiorespiratory fitness was assessed using a maximal cycle-ergometer test, and knee extension muscular strength was evaluated through an isometric dynamometer. Coronary atherosclerosis was evaluated via Coronary Computed Tomography Angiography (CCTA) stenosis and Coronary Artery Calcium (CAC) scores, while carotid plaques were evaluated by ultrasound. The associations were analysed using multinomial logistic regression, adjusted (marginal) prevalences and restricted cubic splines.Results The analysis included 8986 male adolescents (mean age 18.3 years) with a mean follow-up of 38.2 years. Physical fitness showed a reversed J-shaped association with CCTA stenosis and CAC, but no consistent association was observed for carotid plaques. After adjustments, compared with adolescents in the lowest tertile of cardiorespiratory fitness and muscular strength, those in the highest tertile had 22% (OR 0.78; 95% CI 0.61 to 0.99) and 26% (OR 0.74; 95% CI 0.58 to 0.93) lower ORs for severe (>= 50%) coronary stenosis, respectively. The highest physical fitness group (high cardiorespiratory fitness and muscular strength) had 33% (OR 0.67; 95% CI 0.52 to 0.87) lower OR for severe coronary stenosis compared with those with the lowest physical fitness.Conclusion This study supports that a combination of high cardiorespiratory fitness and high muscular strength in adolescence is associated with lower coronary atherosclerosis, particularly severe coronary stenosis, almost 40 years later.
26.	Higueras-Fresnillo, Sara, et al. (author) Associations of psychological factors with atherosclerosis and cardiovascular health in middle-age : the population-based Swedish CArdioPulmonary bioImage study (SCAPIS) 2024 In: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 24:1 Journal article (peer-reviewed)abstract Background: Cardiovascular disease (CVD) is a major global health issue, primarily caused by atherosclerosis. Psychological factors may play a role in the development and progression of CVD. However, the relationship between psychological factors and atherosclerosis is complex and poorly understood. This study, therefore, aimed to examine the association of psychological factors with (i) coronary and carotid atherosclerosis and (ii) cardiovascular health according to Life’s Essential 8, in a large Swedish cohort.Methods: This study utilized data from the Swedish CArdioPulmonary bioImage Study (SCAPIS), a large population-based project including individuals aged 50 to 65 years. Several psychological factors were analysed: general stress, stress at work, financial stress, major adverse life events, locus of control, feeling depressed, and depression. Coronary atherosclerosis was assessed as the degree of stenosis by coronary computed tomography angiography (CCTA) and coronary artery calcification (CAC) scores. Carotid atherosclerosis was examined using ultrasound. In addition, cardiovascular health was examined using the Life’s Essential 8 concept created by the American Heart Association, which includes four health behaviors and four health factors. Associations were examined through binomial logistic regression (atherosclerosis variables) and linear regression (Life’s Essential 8).Results: A total of 25,658 participants were included in the study. The presence of financial stress, higher locus of control, and depression was weakly associated with increased odds of CCTA stenosis, CAC ≥ 1 and the presence of carotid plaques (all odds ratios: 1.10–1.21, 95% CI: 1.02–1.32) after adjusting for sex, age, and study site. However, these associations were attenuated and not statistically significant after additional adjustments for socioeconomic factors and health behaviors. Conversely, we observed inverse associations between the worst category for all psychological factors and cardiovascular health according to Life’s Essential 8 score (all standardized β-Coefficient ≤-0.033, p < 0.001).Conclusion: While there were no strong and consistent associations between psychological factors and atherosclerosis, the consistent associations of psychological factors with cardiovascular health by Life’s Essential 8 may have relevance for future CVD risk. However, further studies are needed to elucidate the long-term effects of psychological factors on atherosclerosis development and cardiovascular health.
27.	Higueras-Fresnillo, Sara, et al. (author) Associations of psychological factors with atherosclerosis and cardiovascular health in middle-age: the population-based Swedish CArdioPulmonary bioImage study (SCAPIS) 2024 In: BMC Public Health. - : BMC. - 1471-2458. ; 24:1 Journal article (peer-reviewed)abstract Background Cardiovascular disease (CVD) is a major global health issue, primarily caused by atherosclerosis. Psychological factors may play a role in the development and progression of CVD. However, the relationship between psychological factors and atherosclerosis is complex and poorly understood. This study, therefore, aimed to examine the association of psychological factors with (i) coronary and carotid atherosclerosis and (ii) cardiovascular health according to Life's Essential 8, in a large Swedish cohort. Methods This study utilized data from the Swedish CArdioPulmonary bioImage Study (SCAPIS), a large population-based project including individuals aged 50 to 65 years. Several psychological factors were analysed: general stress, stress at work, financial stress, major adverse life events, locus of control, feeling depressed, and depression. Coronary atherosclerosis was assessed as the degree of stenosis by coronary computed tomography angiography (CCTA) and coronary artery calcification (CAC) scores. Carotid atherosclerosis was examined using ultrasound. In addition, cardiovascular health was examined using the Life's Essential 8 concept created by the American Heart Association, which includes four health behaviors and four health factors. Associations were examined through binomial logistic regression (atherosclerosis variables) and linear regression (Life's Essential 8). Results A total of 25,658 participants were included in the study. The presence of financial stress, higher locus of control, and depression was weakly associated with increased odds of CCTA stenosis, CAC >= 1 and the presence of carotid plaques (all odds ratios: 1.10-1.21, 95% CI: 1.02-1.32) after adjusting for sex, age, and study site. However, these associations were attenuated and not statistically significant after additional adjustments for socioeconomic factors and health behaviors. Conversely, we observed inverse associations between the worst category for all psychological factors and cardiovascular health according to Life's Essential 8 score (all standardized beta-Coefficient <=-0.033, p < 0.001). Conclusion While there were no strong and consistent associations between psychological factors and atherosclerosis, the consistent associations of psychological factors with cardiovascular health by Life's Essential 8 may have relevance for future CVD risk. However, further studies are needed to elucidate the long-term effects of psychological factors on atherosclerosis development and cardiovascular health.
28.	Higueras-Fresnillo, Sara, et al. (author) Low prevalence of ideal cardiovascular health in the general Swedish population: Results from the Swedish CArdioPulmonary bioImage Study (SCAPIS) 2023 In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 51:4, s. 527-530 Journal article (peer-reviewed)abstract The aim of the current study was to examine the prevalence of ideal cardiovascular health (iCVH) in the general Swedish middle-aged population. To address this aim, we utilised data from the Swedish CArdioPulmonary bioImage Study (SCAPIS) which is a large Swedish population-based study (N=30,154) that combined comprehensive state-of-the-art imaging technology with clinical examinations and included all iCVH components. A total iCVH score was calculated as the number of iCVH metrics at an ideal level for the seven components and classified as: ideal (> 5 ideal components), intermediate (3-4 ideal components) and poor (<= 2 ideal components). Our results showed that only 18.2% of the population reached ideal status (i.e. > 5 components at the ideal level), whereas 51.9% were classified as intermediate status and 29.9% as poor status of iCVH. Women had a higher prevalence of iCVH status (23.9% vs. 12.0%) and a lower prevalence of poor iCVH status (23.5% vs. 36.8%). Our data may serve as benchmarks for future national and international comparisons and motivate efforts to promote cardiovascular health in the general population, given the strong link between iCVH with all-cause and cardiovascular disease mortality and morbidity.
29.	Korduner, Johan, et al. (author) Galectin-4 levels in hospitalized versus non-hospitalized subjects with obesity: the Malmo Preventive Project 2022 In: Cardiovascular Diabetology. - : Springer Science and Business Media LLC. - 1475-2840. ; 21:1 Journal article (peer-reviewed)abstract Background Obesity is strongly associated with the development of cardiovascular disease (CVD). However, the heterogenous nature of obesity in CVD-risk is still poorly understood. We aimed to explore novel CVD biomarkers and their possible association with presumed unhealthy obesity, defined as hospitalized subjects with obesity (HO). Methods Ninety-two proteins associated with CVD were analyzed in 517 (mean age 67 +/- 6 years; 33.7% women) individuals with obesity (BMI >= 30 kg/m(2)) from the Malmo Preventive Project cohort, using a proximity extension array technique from the Olink CVD III panel. Individuals with at least one recorded hospitalization for somatic disease prior to study baseline were defined as HO phenotypes. Associations between proteins and HO (n = 407) versus non-hospitalized subjects with obesity (NHO, n = 110), were analyzed using multivariable binary logistic regression, adjusted for traditional risk factors. Results Of 92 analyzed unadjusted associations between biomarkers and HO, increased levels of two proteins were significant at a false discovery rate < 0.05: Galectin-4 (Gal-4) and insulin-like growth factor-binding protein 1 (IGFBP-1). When these two proteins were included in logistic regression analyses adjusted for age and sex, Gal-4 remained significant. Gal-4 was independently associated with the HO phenotype in multivariable logistic regression analysis (OR 1.72; CI95% 1.16-2.54). Post-hoc analysis revealed that this association was only present in the subpopulation with diabetes (OR 2.26; CI95% 1.25-4.07). However, an interaction analysis was performed, showing no significant interaction between Gal-4 and prevalent diabetes (p = 0.16). Conclusions In middle-aged and older individuals with obesity, increased Gal-4 levels were associated with a higher probability of HO. This association was only significant in subjects with diabetes only, further implying a role for Gal-4 in diabetes and its complications.
30.	Larsson, Charlotte A, et al. (author) Clusters of AMI risk factors and their association with left ventricular hypertrophy: A population-based study within the Skaraborg Project, Sweden. 2013 In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 168:6, s. 5416-5421 Journal article (peer-reviewed)abstract OBJECTIVES: Risk factors for acute myocardial infarction (AMI) are known to cluster and to be differently distributed in men and women. The aim of this study was to sex-specifically explore clusters of acknowledged AMI risk factors by factor analysis, and to study whether such clusters are associated with left ventricular hypertrophy (LVH), used as a subclinical measure of CHD. METHODS: In 2001-2005, 2328 subjects (30-74years) were randomly selected from two municipalities in Sweden (participation-rate 76%) and were assessed with regard to cardiovascular risk factors; 852 participants also had an echocardiographic examination performed. RESULTS: Factor analysis identified three identical factors in men and women. WHR, HOMA-ir, systolic blood pressure, and ApoB/ApoA1 loaded significantly on the principal "metabolic factor", leisure-time physical activity and self-rated health loaded significantly on the "vitality factor", and smoking and alcohol consumption loaded significantly on the "addiction factor". The metabolic factor was associated with LVH in both men (P<0.001) and women (P<0.001), whereas the addiction factor was associated with LVH solely in men (P=0.002). CONCLUSIONS: The consistent pattern in the clustering of acknowledged AMI risk factors suggests common underlying mechanisms in both men and women. However, whereas the metabolic factor was paramount in both men and women in the association with LVH, the addiction factor had an impact solely in men. As LVH often precedes AMI, a deeper understanding of risk factors for LVH, including consideration of the supposed sex differences, can be useful in order to explore prevention strategies for AMI. © 2013.
31.	Lenander, Cecilia, et al. (author) Tioårsuppföljning av Nationella forskarskolan i allmänmedicin : [120 Swedish PhD candidates in general practice have been admitted to the Swedish National Research School in General Practice during the first 10-year period] 2022 In: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 119 Journal article (peer-reviewed)abstract Since the start of the Swedish National Research School in General Practice, 120 Swedish PhD candidates in general practice have been admitted to the school, out of whom 89 during the first 10-year period. We have evaluated the academic achievements of the 53 (60%) PhD candidates that finished their thesis 2011-2020 by a questionnaire and bibliometric data collected from the Web of Science Core Collection. The questionnaire was answered by 52 (98%) and showed that 45 (87%) had continued with research work after their dissertation. Ten (19%) had done a post doc and four (8%) had become associate professors, out of whom one (2%) was a full professor. We found 519 peer-reviewed scientific publications authored by the alumni. The co-authors of these publications were affiliated all around the world, mainly in Sweden, followed by Australia and Germany. The National Research School will continue to strive towards increased quality of primary care research.
32.	Lindblad, Ulf, 1950, et al. (author) The 10-year incidence of hypertension across blood pressure categories in a population-based cohort in southwestern Sweden 2021 In: Bmc Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 21:1 Journal article (peer-reviewed)abstract Background To explore the determinants of incident hypertension, and especially the impact of baseline blood pressure categories, in a representative Swedish population. Methods A 10-year longitudinal study of residents aged 30-74. Blood pressures were measured and categorized according to ESH guidelines with optimal blood pressure < 120/80 mmHg, normal 120-129/80-84 mmHg, and high normal 130-139/85-89 mmHg. Incident hypertension was defined as ongoing treatment or three consecutive blood pressure readings >= 140/ >= 90 mmHg (one or both) at follow-up, while those with >= 140 and/or >= 90 mmHg at only one or two visits were labelled as unstable. After excluding subjects with hypertension, ongoing blood pressure lowering medication or a previous CVD event at baseline, 1099 remained for further analyses. Results Sixteen (2.6%) subjects with optimal baseline blood pressure had hypertension at follow up. Corresponding numbers for subjects with normal, high normal and unstable blood pressure were 55 (19.4%), 50 (39.1%) and 46 (74.2%), respectively. Compared with subjects in optimal group those in normal, high normal and unstable blood pressure categories had significantly higher risk to develop manifest hypertension with odds ratios OR and (95% CI) of 7.04 (3.89-12.7), 17.1 (8.88-33.0) and 84.2 (37.4-190), respectively, with adjustment for age, BMI and family history for hypertension. The progression to hypertension was also independently predicted by BMI (p < 0.001), however, not by age. Conclusions Subjects with high normal or unstable blood pressure should be identified in clinical practice, evaluated for global hypertension risk and offered personalized advice on lifestyle modification for early prevention of manifest hypertension and cardiovascular disease.
33.	Molvin, John, et al. (author) A diabetes-associated genetic variant is associated with diastolic dysfunction and cardiovascular disease. 2020 In: ESC heart failure. - : Wiley. - 2055-5822. ; 7:1, s. 345-353 Journal article (peer-reviewed)abstract Although the epidemiological association between Type 2 diabetes and congestive heart failure (CHF) as well as cardiovascular disease (CVD) is well established, associations between diabetes-related single-nucleotide polymorphisms (SNPs), CHF, and CVD have been surprisingly inconclusive. Our aim is to examine if 43 diabetes-related SNPs were associated with prevalent diastolic dysfunction assessed by echocardiography and incident CVD and/or CHF.We genotyped 43 SNPs that previously reported genome-wide significant associations with Type 2 diabetes, in 1444 subjects from the population-based Malmö Preventive Project-Re-examination Study (MPP-RES) (mean age 68 years; 29% women, 36% prevalent diabetes) (discovery cohort) and in 996 subjects from the VARA cohort (mean age 51 years, 52% women, 7% prevalent diabetes) (replication cohort). Multivariable logistic regression was assessed. Genetic variants that reached significant association with diastolic dysfunction in both cohorts were then analysed for association with incident CVD/CHF in a larger sample of the MPP-RES cohort (3,407 cases and 11,776 controls, median follow up >30 years) using Cox regression analysis. A common variant at the HNF1B [major allele (T) coded, also the risk allele for diabetes] was the only SNP associated with increased risk of prevalent diastolic dysfunction in both the discovery [MPP-RES; odds ratio (OR) 1.21, P = 0.024), and the replication cohort (VARA; OR 1.38, P = 0.042]. Cox regression analysis showed that carriers of the T-allele of rs757210 had an increased risk of future CVD (HR 1.05, P = 0.042). No significant association was seen for incident CHF.The diabetes susceptibility locus HNF1B is associated with prevalent diastolic dysfunction in two independent Swedish cohorts as well as incident cardiovascular disease.
34.	Molvin, John, et al. (author) Exploration of pathophysiological pathways for incident atrial fibrillation using a multiplex proteomic chip. 2020 In: Open heart. - : BMJ. - 2053-3624 .- 2398-595X. ; 7:1 Journal article (peer-reviewed)abstract Atrial fibrillation (AF) is the most common arrhythmia and associated with increased morbidity and mortality. Its increasing prevalence calls for novel biomarkers to identify underlying pathophysiological mechanisms as well as patients at risk.Plasma samples from 1694 individuals from the Swedish population-based Malmö Preventive Project (mean age 69.5 years; 29.3% female; mean follow-up time 9.7±3.1 years) were analysed with the Olink proximity extension assay CVD III panel consisting of 92 proteins to identify proteins associated with incident AF or atrial flutter, referred to as incident AF. Incident cases of AF (n=278) were retrieved by linkage to the registers. Participants were followed until the first episode of AF or until censoring by death or emigration. Bonferroni-corrected multivariable Cox regression models adjusted for known risk factors were used to explore possible associations of the 92 proteins and incidence of AF.Multivariable Cox regression analyses of 11 proteins associated with incident AF (mean follow-up time 9.7±3.1 years) after Bonferroni correction confirmed N-terminal pro-B-type natriuretic peptide (HR per 1 SD increment (95% CI) 1.80 (1.58 to 2.04); p=1.2×10-19) as risk marker of incident AF. Further, matrix metalloproteinase-2 (1.22 (1.07 to 1.39); p=0.002) and osteopontin (1.27 (1.12 to 1.44); p=2.7×10-4) were associated with incident AF at follow-up independently of traditional risk markers and NT-proBNP.In a general Swedish population, we confirmed the well-known association of NT-proBNP with incident AF and also identified matrix metalloproteinase-2 and osteopontin as novel risk markers for incident AF, independently of traditional risk factors and NT-proBNP.
35.	Molvin, John, et al. (author) Proteomic exploration of common pathophysiological pathways in diabetes and cardiovascular disease 2020 In: ESC Heart Failure. - : Wiley. - 2055-5822. ; 7:6, s. 4151-4158 Journal article (peer-reviewed)abstract Aims The epidemiological association between diabetes and cardiovascular disease is well established, but the pathophysiological link is complex and multifactorial. We investigated seven proteins, previously linked to incident diabetes mellitus, and their association with cardiovascular disease and mortality. Methods and results Plasma samples from 1713 individuals from the Swedish population-based Malmo Preventive Project (mean age 67.4 +/- 6.0 years; 29.1% women) were analysed with a proximity extension assay panel. Seven proteins [scavenger receptor cysteine rich type 1 protein M130 (CD163), fatty acid-binding protein 4 (FABP4), plasminogen activator inhibitor 1 (PAI), insulin-like growth factor-binding protein 2 (IGFB2), cathepsin D (CTSD), galectin-4 (GAL4), and paraoxonase-3 (PON3)] previously shown to be associated with incident diabetes were analysed for associations with all-cause mortality (ACM), cardiovascular mortality (CVM), incident coronary events (CEs), and incident heart failure (HF). After exclusion of prevalent cases of respective outcome, proteins that met Bonferroni-corrected significance were analysed in multivariable Cox regression models. Significant associations were identified between five proteins [GAL4 (hazard ratio; 95% confidence interval: 1.17-1.41), CTSD (1.15-1.37), CD163 (1.09-1.30), IGFBP2 (1.05-1.30), and FABP4 (1.04-1.29)] and ACM and four proteins [GAL4 (1.38-1.56), CTSD (1.14-1.43), CD163 (1.09-1.36), and IGFBP2 (1.03-1.35)] with CVM. Three proteins [GAL4 (1.14-1.57), CTSD (1.12-1.50), and FABP4 (1.05-1.55)] were significantly associated with incident CE and two [GAL4 (1.03-1.54) and CTSD (1.01-1.46)] were associated with incident HF after adjusting for traditional risk factors including N-terminal pro-brain natriuretic peptide. Conclusions In a general Swedish population, four proteins previously shown to be associated with diabetes were associated with ACM and CVM. Three proteins were associated with incident CE. Finally, GAL4 and CTSD displayed novel associations with incident HF and were the only proteins associated with all outcomes.
36.	Molvin, John, et al. (author) Using a Targeted Proteomics Chip to Explore Pathophysiological Pathways for Incident Diabetes-The Malmo Preventive Project 2019 In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 9:1 Journal article (peer-reviewed)abstract Multiplex proteomic platforms provide excellent tools for investigating associations between multiple proteins and disease (e.g., diabetes) with possible prognostic, diagnostic, and therapeutic implications. In this study our aim was to explore novel pathophysiological pathways by examining 92 proteins and their association with incident diabetes in a population-based cohort (146 cases of diabetes versus 880 controls) followed over 8 years. After adjusting for traditional risk factors, we identified seven proteins associated with incident diabetes. Four proteins (Scavenger receptor cysteine rich type 1 protein M130, Fatty acid binding protein 4, Plasminogen activator inhibitor 1 and Insulin-like growth factor-binding protein 2) with a previously established association with incident diabetes and 3 proteins (Cathepsin D, Galectin-4, Paraoxonase type 3) with a novel association with incident diabetes. Galectin-4, with an increased risk of diabetes, and Paraoxonase type 3, with a decreased risk of diabetes, remained significantly associated with incident diabetes after adjusting for plasma glucose, implying a glucose independent association with diabetes.
37.	Moradi, Faraidoun, et al. (author) Health perspectives among Halabja’s civilian survivors of sulfur mustard exposure with respiratory symptoms—A qualitative study 2019 In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:6 Journal article (peer-reviewed)abstract Background In 1988, Halabja came under heavy chemical warfare attack using chemicals such as sulfur mustard (SM). Thousands of survivors of SM exposure in the city today live with multiple health complaints, such as severe, long-lasting respiratory symptoms; but their perceptions of health have never been adequately researched. We aimed to explore current major health concern topics in civilian survivors with long-term respiratory symptoms. Method Sixteen subjects (f:m10:6, mean age 45.5 years (range 34–67)) were interviewed. Study participants were recruited in 2016 via a purposive sampling strategy among civilian survivors of chemical warfare in the city of Halabja in Kurdistan-Iraq. A qualitative research design was applied including semi-structured, face-to-face interviews. Data was analyzed using systematic text condensation. Results The analysis yielded fourteen themes related to: (1) General health: all participants described a deterioration in physical and psychological health, following the SM exposure, foremost involving respiratory symptoms, fatigue, sleeping disorders, ocular problems, depressive symptoms, and anxiety; (2) Quality of life: most notably, they reported a limited family life, limited social relations, lack of work ability, and concern about their financial situation. Moreover, many lived in constant fear of a renewed attack; (3) access to health care services: all participants reported that they had no, or only poor, access to health care services and limited access to specialist care, and all reported lack of financial resources to obtain treatment. Conclusions The post-exposure somatic and psychosocial effects such as respiratory symptoms of CWA are plausible contributor to poor general health and quality of life among survivors. We conclude that multidisciplinary interventions are needed to tackle the biopsychosocial complications in survivors of SM exposure to minimize further health damage in the future, as well as to promote their health-related quality of life.
38.	Moradi, Faraidoun, et al. (author) Respiratory function after 30+years following sulfur mustard exposure in survivors in Sweden 2024 In: FRONTIERS IN MEDICINE. - 2296-858X. ; 11 Journal article (peer-reviewed)abstract Background Sulfur mustard (SM) exposure causes acute and chronic respiratory diseases. The extent of small airway dysfunction (SAD) in individuals exposed to SM is unclear. This study evaluated and compared SAD in SM-exposed and SM-unexposed participants using noninvasive lung function tests assessing small airway function.Methods This retrospective cohort study involved SM-exposed (n = 15, mean age: 53 +/- 8 years) and SM-unexposed (n = 15, mean age: 53 +/- 7 years) Kurdish-Swedish individuals in Sweden. Small airway resistance and reactance were assessed using impulse oscillometry (IOS). Nitrogen (N2) multiple breath washout (MBW) was employed to assess lung ventilation heterogeneity. The gas-exchanging capacity of the lungs was assessed using the diffusing capacity of the lungs for the carbon monoxide (DLCO) test. Lung function outcomes were reported as absolute values and z-scores. Group comparisons were performed using the Mann-Whitney U test.Results No statistically significant differences in age, height, or body mass index were observed between the two groups. IOS showed significantly increased small airway resistance, while N2MBW exhibited significantly increased global and acinar ventilation heterogeneity in SM-exposed individuals compared to that in unexposed individuals. SAD was identified in 14 of 15 SM-exposed individuals, defined as at least one abnormal IOS difference between resistance at 5 and 20 Hz (R5-R20) and/or area of reactance (AX) or N2MBW lung's acinar zone (Sacin), and DLCO adjusted to the alveolar volume (DLCO/VA) outcome. Of these 14 individuals, only 5 demonstrated concordant findings across the IOS and N2MBW tests.Conclusion Exposure to SM was positively associated with long-term impairment of respiratory tract function in the small airways in the majority of the previously SM-exposed individuals in the present study. Furthermore, both IOS and N2MBW should be employed to detect SAD in SM-exposed survivors as they provide complementary information. Identifying and characterizing the remaining pathology of the small airways in survivors of SM exposure is a first step toward improved treatment and follow-up.
39.	Moradi, Faraidoun, et al. (author) The impact of sulfur mustard on quality of life and mental health in Kurdish survivors in Sweden, thirty years after exposure 2022 In: Health and Quality of Life Outcomes. - : Springer Science and Business Media LLC. - 1477-7525. ; 20:1 Journal article (peer-reviewed)abstract Background: The Iraqi state used chemical warfare agents (CWAs) like sulfur mustard (SM) in al-Anfal genocide in the present-day Kurdistan Region of Iraq. In addition to somatic injuries, exposure to CWAs causes biopsychosocial complications. We investigated the long-term impact of SM exposure on quality of life (QoL) and depression severity in Kurdish survivors resettled in Sweden. Methods: This is a case-control study, where subjects exposed to SM (n = 18, mean age 51.3 years, 50% women) and sex- and age-matched nonexposed subjects (n = 30, mean age 48.7 years, 47% women) of Kurdish residents in Sweden. Data were collected through in-person interviews based on the RAND 36-item Short Form Health Survey to assess QoL and the Montgomery-Asberg Depression Rating Scale-self assessment (MADRS-S) to investigate the presence and the gravity of depressive symptoms. Results: The SM-exposed group had a significantly lower QoL than the nonexposed group (p < 0.001). Also, the overall mean MADRS-S scores among the SM-exposed group, corresponding to moderate depression, were higher than the scores of the nonexposed (22 points (p) vs. 9 p, p < .001). Overall, the participants within the exposed group reported worse mental than physical well-being 36p and 32p, respectively. Within the SM-exposed group, there was no gendered-related difference neither in terms of depression severity nor for QoL, but the groups were small. Conclusion: Individuals exposed to SM had worse QoL and a higher level of depressive severity compared with nonexposed individuals three decades after exposure, indicating the importance of increased clinician knowledge, guidelines, and an approach to assess and respond to the exposed groups' biopsychosocial needs. These findings indicate that those exposed to SM might need early identification of mental illnesses and more support to promote QoL.
40.	Myftiu, S., et al. (author) Clinical profile and management of patients with incident and recurrent acute myocardial infarction in Albania - A call for more focus on prevention strategies 2017 In: Zdravstveno Varstvo. - : Walter de Gruyter GmbH. - 0351-0026. ; 56:4, s. 236-243 Journal article (peer-reviewed)abstract Background. The clinical profile of acute myocardial infarction (AMI) patients reflects the burden of risk factors in the general population. Differences between incident (first) and recurrent (repeated) events and their impact on treatment are poorly described. We studied potential differences in the clinical profile and in-hospital treatment between patients hospitalised with an incident and recurrent AMI. Methods. A total of 324 patients admitted in the Coronary Care Unit of 'Mother Teresa' hospital, Tirana, Albania (2013-2014), were included in the study. Information on AMI type, complications and risk factors was obtained from patient's medical file. Logistic regression analyses were used to explore differences between the incident and recurrent AMIs regarding clinical profile and in-hospital treatment. Results. Of all patients, 50 (15.4%) had a prior AMI. Compared to incident cases, recurrent cases were older (P=0.01), more often women (P=0.01), less educated (P=0.01), and smoked less (P=0.03). Recurrent cases experienced more often heart failure (HF) (OR=2.48; 95% CI: 1.31-4.70), impaired left ventricular ejection fraction (OR=1.97; 95% CI: 1.05-3.71), and multivessel disease (OR=6.32; 95% CI: 1.43-28.03) than incident cases. In-hospital use of beta-blockers was less frequent among recurrent compared to incident cases (OR=0.45; 95% CI: 0.24-0.85), while no statistically significant differences between groups were observed regarding angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, statin, aspirin or invasive procedures. Conclusion. A more severe clinical expression of the disease and underutilisation of treatment among recurrent AMIs are likely to explain their poorer prognosis compared to incident AMIs. © 2017 National Institute of Public Health, Slovenia.
41.	Olausson, Josefin, 1983, et al. (author) Endothelin-1 as a predictor of impaired glucose tolerance and type 2 diabetes - A longitudinal study in the Vara-Skovde Cohort 2016 In: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 113, s. 33-37 Journal article (peer-reviewed)abstract We addressed whether endothelin-1, a marker of endothelial dysfunction, predicts impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) in a population study in south-western Sweden. Follow-up after 9.7 years showed an association between circulating endothelin-1 levels at baseline and development of IGT/T2DM in women but not in men.
42.	Osmancevic, Amar, et al. (author) High C-reactive protein is associated with increased risk of biochemical hypogonadism: a population-based cohort study 2022 In: Endocrine Connections. - : Bioscientifica. - 2049-3614. ; 11:7 Journal article (peer-reviewed)abstract Context: Obesity seems to decrease levels of testosterone. It is still unknown what role inflammation plays in the secretion of testosterone in men. Objective: The objective is to study the association between levels of C-reactive protein and testosterone and its role in predicting biochemical hypogonadism in men. Design: This was a longitudinal observational study between 2002 and 2014 in Sweden. Patients or other participants: At the first visit, a random population sample of 1400 men was included, and 645 men fulfilled a similar protocol at a 10-year follow-up visit. After exclusion, 625 men remained to be included in the final analyses. Main outcome measure(s): Serum concentrations of testosterone and C-reactive protein (CRP) were measured at both visits. Bioavailable testosterone was calculated. Biochemical hypogonadism was defined as total testosterone levels <8 nmol/L. Results: At the first visit and in the longitudinal analyses, a strong association was found between high levels of CRP and low levels of calculated bioavailable testosterone even after adjustments for age, waist-hip ratio, hypertension, smoking, type 2 diabetes, and leisuretime physical activity (B = -0.31, 95% CI -0.49 to -0.13, P = 0.001, B = -0.26, 95% CI -0.41 to -0.11, P = 0.001). Similarly, increase with one s. d. in CRP was associated with increased risk of having hypogonadism after adjustment in the final model (odds ratio (OR) 1.76, 95% CI 1.12-2.78, P = 0.015, OR 1.80, 95% CI 1.16-2.78, P =0.008). Conclusions: In this representative cohort of men in southwestern Sweden, high levels of CRP were longitudinally associated with low concentrations of calculated bioavailable testosterone and increased risk of biochemical hypogonadism.
43.	Osmancevic, Amar, et al. (author) The Association between Inflammation, Testosterone and SHBG in men: A cross-sectional Multi-Ethnic Study of Atherosclerosis 2023 In: Clinical Endocrinology. - 0300-0664 .- 1365-2265. ; 99:2, s. 190-197 Journal article (peer-reviewed)abstract ContextEarlier studies have investigated the role of obesity-related inflammation and endogenous sex hormones in men. The role of interleukin-6 (IL-6) and C-reactive protein (CRP) with testosterone and sex hormone binding globulin (SHBG) levels in men is still debated. ObjectiveTo investigate the independent association between levels of high sensitivity CRP (hsCRP) and IL-6 with endogenous sex hormones in men. DesignCross-sectional observational study using data from the Multi-Ethnic Study of Atherosclerosis. Patients or Other ParticipantsA community-based sample of 3212 men aged 45-84 years was included. After exclusions, 3041 men remained for the analyses. Main Outcome Measure(s)Serum concentrations of testosterone, SHBG, hsCRP, IL-6, and sTNFR were measured from the baseline exam. Multivariable linear regressions were used to examine the association of inflammatory markers with sex hormones. ResultsAn inverse association was found between levels of hsCRP and levels of testosterone and SHBG, even after adjustment for confounders and IL-6 (Total Testosterone; B = -0.14, Bioavailable Testosterone; B = -0.06, and SHBG; B = -0.66). Similar results were found for IL-6, although a positive association was found for SHBG (B = 0.95). Notably, an inverse association was found for IL-6 with bioavailable testosterone in African Americans and Hispanic Americans aged 45-54 years. No associations were found for sTNFR and endogenous sex hormones. ConclusionOur results indicate that inflammatory markers have independent associations with levels of testosterone (total and bioavailable) and furthermore, appear to associate differently with SHBG levels.
44.	Ottarsdottir, Kristin, et al. (author) Cardiometabolic Risk Factors and Endogenous Sex Hormones in Postmenopausal Women: A Cross-Sectional Study 2022 In: Journal of the Endocrine Society. - : The Endocrine Society. - 2472-1972. ; 6:6 Journal article (peer-reviewed)abstract Context: it is uncertain which cardiovascular risk factors are associated with sex hormone levels in postmenopausal women. Objective: This work aimed to investigate the association between cardiometabolic risk factors and sex hormones in a cross-sectional, observational population study. Methods: In this Swedish population study, participants were physically examined from 2002 to 2004, and endogenous sex hormones were analyzed by liquid chromatography-tandem mass spectrometry. Women aged 55 years or older with estradiol levels below 20 pg/mL and not using any hormonal therapy were eligible for inclusion in the study (N = 146). Variable selection and bootstrap stability analyses were performed and linear regression models presented, with each of the 8 hormones as outcome variables. Results: Body mass index (BMI) was positively associated with estradiol (beta = 0.054, P < .001), but negatively associated with 17-alpha-hydroxyprogesterone (beta = -0.023, P = .028). Waist-to-hip ratio (WHR) was negatively associated with dihydrotestosterone (beta = -2.195, P = .002) and testosterone (beta = -1.541, P = .004). The homeostatic model assessment of insulin resistance was positively associated with androstenedione (beta = 0.071, P = .032), estradiol (beta = 0.091, P = .009), estrone (beta = 0.075, P = 0.009), and 17-alpha-hydroxyprogesterone (beta = 0.157 P = .001). Age was positively associated with testosterone (6 = 0.017, P = .042). C-reactive protein showed an inverse association with progesterone (beta = -0.028, P = .037). Lower low-density lipoprotein cholesterol was associated with higher estradiol levels (beta = -0.093, P = .049), whereas lower triglycerides were associated with higher concentrations of dihydrotestosterone (beta = -0.208, P = .016). Conclusion: In postmenopausal women, WHR was strongly inversely associated with androgens, while BMI was positively associated with estrogens.
45.	Ottarsdottir, Kristin, et al. (author) Longitudinal associations between sex hormone-binding globulin and insulin resistance 2020 In: Endocrine Connections. - : Bioscientifica. - 2049-3614. ; 9:5, s. 418-425 Journal article (peer-reviewed)abstract Purpose: We aimed to investigate the association between SHBG and the homeostatic model assessment of insulin resistance (HOMA-Ir) in men and women in a prospective observational study. Methods: The Vara-Skovde cohort is a random population of 2816 participants living in southwestern Sweden, aged 30-74. It was recruited between 2002 and 2005, and followed up in 2012-2014. After excluding participants on insulin therapy or hormone replacement therapy, 1193 individuals (649 men, 544 women) were included in the present study. Fasting blood samples were collected at both visits and stored in biobank. All participants were physically examined by a trained nurse. SHBG was measured with immunoassay technique. Linear regressions were computed to investigate the association between SHBG and HOMA-Ir both in cross-sectional and longitudinal analyses, adjusting for confounding factors. Results: The mean follow-up time was 9.7 +/- 1.4 years. Concentrations of SHBG were significantly inversely associated with log transformed HOMA-Ir in all groups with estimated standardized slopes (95% CI): men: -0.20 (-0.3;-0.1), premenopausal women: -0.26 (-0.4;-0.2), postmenopausal women: -0.13 (-0.3;-0.0) at visit 1. At visit 2 the results were similar. When comparing the groups, a statistically significant difference was found between men and post-menopausal women (0.12 (0.0;0.2) P value = 0.04). In the fully adjusted model, SHBG at visit 1 was also associated with HOMA-Ir at visit 2, and the estimated slopes were -0.16 (-0.2;-0.1), -0.16 (-0.3;-0.1) and -0.07 (-0.2;0.0) for men, premenopausal and postmenopausal women, respectively. Main conclusion: Levels of SHBG predicted the development of insulin resistance in both men and women, regardless of menopausal state.
46.	Ottarsdottir, Kristin, et al. (author) The association between serum testosterone and insulin resistance: a longitudinal study 2018 In: Endocrine Connections. - : Bioscientifica. - 2049-3614. ; 7:12, s. 1491-1500 Journal article (peer-reviewed)abstract The objective of this study was to investigate whether there is a bidirectional association between testosterone concentrations and insulin resistance, in a prospective population study. A random population sample of 1400 men, aged 30-74, was examined in 2002-2005 in southwestern Sweden and followed up in 2012-2014 (N=657). After excluding subjects without information on sex hormones and insulin resistance, 1282 men were included in the baseline study. Fasting measurements of plasma glucose, insulin and hormones were performed. Insulin resistance was defined using HOMA-Ir. Mean age at baseline was 47.3 +/- 11.4 years. From the follow-up survey 546 men were included, mean age 57.7 +/- 11.6 years. Low concentrations of total testosterone at baseline were significantly associated with high IogHOMA-Ir at follow-up in a multivariable model including age, waist-hip ratio, physical activity, alcohol intake, smoking, LDL, CRP, hypertension, diabetes and logHOMA-Ir at baseline as covariates (beta = -0.096, P = 0.006). Similar results were observed for bioavailable testosterone. Men within the lowest quartile of total testosterone at baseline had significantly higher IogHOMA-Ir at follow-up than other quartiles (Q1 vs Q2 P = 0.008, Q1 vs Q3 P = 0.001, Q1 vs Q4 P = 0.052). Multivariable analysis of the impact of insulin resistance at baseline on testosterone levels at follow-up revealed no significant associations regarding testosterone concentrations (beta = -0.003, P = 0.928) or bioavailable testosterone (beta = -0.006, P = 0.873), when adjusting for baseline concentrations of total testosterone, age, waist-hip-ratio, LDL, CRP, physical activity, alcohol intake, smoking, hypertension and diabetes. Low testosterone concentrations at baseline predicted higher insulin resistance at follow-up, but high insulin resistance at baseline could not predict low testosterone at follow-up.
47.	Privsek, E., et al. (author) Epidemiological and clinical implications of blood pressure measured in seated versus supine position 2018 In: Medicine. - : Ovid Technologies (Wolters Kluwer Health). - 0025-7974. ; 97:31 Journal article (peer-reviewed)abstract The evidence concerning how posture influences blood pressure is not consistent. The aim of this cross-sectional study was to consider the clinical and epidemiological implications of blood pressure measured in seated versus supine position, and to investigate the impact of age, sex, body mass index (BMI), and diabetes on these differences. This study included 1298 individuals (mean age 58.6 +/- 11.8 years) from the Vara-Skovde cohort at the 10 years' follow-up visit in 2014. Physical examination included blood pressure measurements in seated and supine position. Self-reported information on diabetes status, hypertension, ongoing medication, leisure time physical activity, and smoking habits were obtained. Linear regression models accounted for differences in age, sex, BMI, and known diabetes. Both systolic and diastolic blood pressure were significantly higher in the seated position [1.2mm Hg, P<.001, 95% confidence interval (95% CI) 0.79-1.54 and 4.2mm Hg, P<.001, 95% CI 4.08-4.71, respectively]. The prevalence of high blood pressure in seated position was higher (19.9%) than in supine position (13.5%). Linear regression analysis showed that age (beta=-0.215, P<.001) and diabetes (beta=-0.072, P=.012) were associated with smaller differences in postural diastolic blood pressure and BMI (beta=0.124, P<.001) with greater difference. This study showed substantial postural differences in blood pressures measured in office. Measuring blood pressure in the supine position shows lower blood pressure readings when compared with the seated position. Clinicians should be aware of how age, BMI, and diabetes influence these differences.
48.	Privšek, Ernest, et al. (author) Epidemiological and clinical implications of blood pressure measured in seated versus supine position 2018 In: Medicine. - 1536-5964. ; 97:31, s. 11603-11603 Journal article (peer-reviewed)abstract The evidence concerning how posture influences blood pressure is not consistent. The aim of this cross-sectional study was to consider the clinical and epidemiological implications of blood pressure measured in seated versus supine position, and to investigate the impact of age, sex, body mass index (BMI), and diabetes on these differences.This study included 1298 individuals (mean age 58.6 ± 11.8 years) from the Vara-Skövde cohort at the 10 years' follow-up visit in 2014. Physical examination included blood pressure measurements in seated and supine position. Self-reported information on diabetes status, hypertension, ongoing medication, leisure time physical activity, and smoking habits were obtained. Linear regression models accounted for differences in age, sex, BMI, and known diabetes.Both systolic and diastolic blood pressure were significantly higher in the seated position [1.2 mm Hg, P < .001, 95% confidence interval (95% CI) 0.79-1.54 and 4.2 mm Hg, P < .001, 95% CI 4.08-4.71, respectively]. The prevalence of high blood pressure in seated position was higher (19.9%) than in supine position (13.5%). Linear regression analysis showed that age (β = -0.215, P < .001) and diabetes (β = -0.072, P = .012) were associated with smaller differences in postural diastolic blood pressure and BMI (β = 0.124, P < .001) with greater difference.This study showed substantial postural differences in blood pressures measured in office. Measuring blood pressure in the supine position shows lower blood pressure readings when compared with the seated position. Clinicians should be aware of how age, BMI, and diabetes influence these differences.
49.	Szaló, Gábor, 1982, et al. (author) Impaired artery elasticity predicts cardiovascular morbidity and mortality- A longitudinal study in the Vara-Skövde Cohort. 2023 In: Journal of human hypertension. - : Springer Nature. - 1476-5527 .- 0950-9240. ; 38, s. 140-5 Journal article (peer-reviewed)abstract It is still debated whether arterial elasticity provides prognostic information for cardiovascular risk beyond blood pressure measurements in a healthy population. To investigate the association between arterial elasticity obtained by radial artery pulse wave analysis and risk for cardiovascular diseases (CVD) in men and women. In 2002-2005, 2362 individuals (men=1186, 50.2%) not taking antihypertensive medication were included. C2 (small artery elasticity) was measured using the HDI/Pulse Wave CR2000. Data on acute myocardial infarction or stroke, fatal or non-fatal, was obtained between 2002-2019. Cox- regression was used to investigate associations between C2 and future CVD, adjusting for confounding factors such as age, sex, systolic blood pressure, heart rate, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), LDL- cholesterol, CRP (C-Reactive Protein), alcohol consumption, smoking and physical activity. At baseline, the mean age of 46±10.6 years and over the follow-up period, we observed 108 events 70 events in men [event rate: 5.9%], 38 in women [event rate: 3.2%]. In the fully adjusted model, and for each quartile decrease in C2, there was a significant increase in the risk for incident CVD by 36%. (HR=1.36, 95% CI: 1.01-1.82, p=0.041). The results were accentuated for all men (HR=1.74, 95% CI: 1.21-2.50, p=0.003) and women over the age of 50 years (HR=1.70, 95% CI: 0.69-4.20). We showed a strong and independent association between C2 and CVD in men. In women after menopause, similar tendencies and effect sizes were observed.
50.	Szalo, Gabor, et al. (author) Longitudinal association between leisure-time physical activity and vascular elasticity indices 2021 In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 21:1 Journal article (peer-reviewed)abstract AimWe investigated the association between levels of leisure-time physical activity and vascular stiffness in a longitudinal observational study from a representative Swedish population.MethodA total of 2816 randomly selected individuals were examined at visit 1 (2002-2005, Men=1400). After a mean follow-up of 9.71.4 years, a representative sample of 1327 of the original participants were re-examined at visit 2. After excluding subjects with hypertension at baseline, 761 participants were included in the longitudinal analyses. Leisure-time physical (LTPA) activity was self-reported and dichotomized as high or low (level 3, 4 and level 1, 2, respectively). Large Arterial Elasticity Index (LAEI) and Small Arterial Elasticity Index (SAEI) were measured using the HDI/Pulse Wave (TM) CR2000. Multivariable general linear models were used to investigate the differences in changes SAEI and LAEI based on LTPA levels.ResultsAt visit 1, and after adjustment for possible confounders, participants in the high LTPA group had better small artery elasticity (SAEI) (SAEI in low-level LTPA: 7.89 +/- 0.11, SAEI in high-level LTPA: 8.32 +/- 0.15, Delta SAEI: 0.42, CI: 0.07-0.78; p=0.020). SAEI decreased between the two assessments (Visit 1: SAEI 8.01 +/- 3.37 ml/mmHg; Delta SAEI: 1.4, CI 1.2-1.6, p<0.001). Participants with a higher LTPA at visit 1 had significantly better SAEI at visit 2 (SAEI: 0.44, CI 0.03-0.85, p=0.037). No significant associations were observed between LAEI and LTPA after adjustments.Conclusions High LTPA predicted higher small arterial compliance at visit 2 suggesting that positive effects of LTPA on arterial elasticity persists over time.

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