| 1. |
- Axelsson, Kristian F, 1973, et al.
(författare)
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Analysis of Comorbidities, Clinical Outcomes, and Parathyroidectomy in Adults With Primary Hyperparathyroidism
- 2022
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Ingår i: Jama Network Open. - : American Medical Association (AMA). - 2574-3805. ; 5:6
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Patients with primary hyperparathyroidism (pHPT) appear to have an increased risk of fractures and other comorbidities, such as cardiovascular disease, although results from previous studies have been inconsistent. Evidence of the association of parathyroidectomy (PTX) with these outcomes is also limited because of the lack of large well-controlled trials. OBJECTIVE To investigate whether untreated pHPT was associated with an increased risk of incident fractures and cardiovascular events (CVEs) and whether PTX was associated with a reduced risk of these outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all patients who were diagnosed with pHPT at hospitals in Sweden between July 1, 2006, and December 31, 2017. Each patient was matched with 10 control individuals from the general population by sex, birth year, and county of residence. The patients were followed up until December 31, 2017. Data analyses were performed from October 2021 to April 2022. MAIN OUTCOMES AND MEASURES The primary outcomes were fractures, CVEs, and death. Cumulative incidence of events was estimated using the 1-minus Kaplan-Meier estimator of corresponding survival function. Cox proportional hazards regression models were used to calculate hazard ratios (HRs). RESULTS A total of 16 374 patients with pHPT were identified (mean [SD] age, 67.5 [12.9] years; 12 806 women [78.2%]), with 163 740 control individuals. The follow-up time was 42 310 person-years for the pH PT group and 803 522 person-years for the control group. Compared with the control group, the pH PT group had a higher risk of any fracture (unadjusted HR, 1.39; 95% CI, 1.31-1.48), hip fracture (unadjusted HR, 1.51; 95% CI, 1.35-1.70), CVEs (unadjusted HR, 1.45; 95% CI, 1.34-1.57), and death (unadjusted HR, 1.72; 95% CI, 1.65-1.80). In a time-dependent Poisson regression model, PTX was associated with a reduced risk of any fracture (HR, 0.83; 95% CI, 0.75-0.93), hip fracture (HR, 0.78; 95% CI, 0.61-0.98), CVEs (HR, 0.84; 95% CI, 0.73-0.97), and death (HR, 0.59; 95% CI, 0.53-0.65). CONCLUSIONS AND RELEVANCE Results of this study suggest that pHPT is associated with increased risk of fractures, CVEs, and death, highlighting the importance of identifying patients with this condition to prevent serious unfavorable outcomes. The reduced risk of these outcomes associated with PTX suggests a clinical benefit of surgery.
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| 2. |
- Axelsson, K. F., et al.
(författare)
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Hip fracture risk and safety with alendronate treatment in the oldest-old
- 2017
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 282:6, s. 546-559
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Tidskriftsartikel (refereegranskat)abstract
- Background. There is high evidence for secondary prevention of fractures, including hip fracture, with alendronate treatment, but alendronate's efficacy to prevent hip fractures in the oldest-old (80 years old), the population with the highest fracture risk, has not been studied. Objective. To investigate whether alendronate treatment amongst the oldest-old with prior fracture was related to decreased hip fracture rate and sustained safety. Methods. Using a national database of men and women undergoing a fall risk assessment at a Swedish healthcare facility, we identified 90 795 patients who were 80 years or older and had a prior fracture. Propensity score matching (four to one) was then used to identify 7844 controls to 1961 alendronate-treated patients. The risk of incident hip fracture was investigated with Cox models and the interaction between age and treatment was investigated using an interaction term. Results. The case and control groups were well balanced in regard to age, sex, anthropometrics and comorbidity. Alendronate treatment was associated with a decreased risk of hip fracture in crude (hazard ratio (HR) 0.62 (0.49-0.79), P < 0.001) and multivariable models (HR 0.66 (0.51-0.86), P < 0.01). Alendronate was related to reduced mortality risk (HR 0.88 (0.82-0.95) but increased risk of mild upper gastrointestinal symptoms (UGI) (HR 1.58 (1.12-2.24). The alendronate association did not change with age for hip fractures or mild UGI. Conclusion. In old patients with prior fracture, alendronate treatment reduces the risk of hip fracture with sustained safety, indicating that this treatment should be considered in these high-risk patients.
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| 3. |
- Hage, Camilla, et al.
(författare)
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The predictive value of inflammatory activity and markers of the adipo-insular axis on restenosis in patients with type 2 diabetes.
- 2011
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Ingår i: Diabetes & Vascular Disease Research. - : SAGE Publications. - 1752-8984 .- 1479-1641. ; 8:2, s. 143-149
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Patients with type 2 diabetes (T2DM) have a high restenosis rate after percutaneous coronary intervention (PCI). This study investigated whether markers of inflammation and the adipo-insular axis associated with T2DM and poor metabolic control were able to predict restenosis after PCI in T2DM patients. Methods and results: The predictive value of traditional and non-traditional risk markers, including IL-1β, IL-6, TNF-α, hsCRP, interferon gamma, leptin, IGF-I, insulin, proinsulin and NT-proBNP, was investigated in 82 patients with T2DM. A re-angiography 6 months after the index percutaneous coronary intervention (PCI) revealed that 43% of the patients had a restenosis. In a multiple regression analysis, the only independent predictors of restenosis were fasting glucose before the PCI and previous myocardial infarction (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.07—1.92; p = 0.015 and OR 8.00, 95% CI 2.49—25.67; p ≤ 0.001, respectively). None of the other markers remained as significant predictors. Conclusion: Fasting glucose prior to the PCI was an independent predictor of restenosis in patients with T2DM while analyses of a variety of markers related to inflammation and the adipo-insular axis did not add any further information.
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| 4. |
- Nilsson, Anna G, 1968, et al.
(författare)
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Type 2 Diabetes Mellitus is Associated with Better Bone Microarchitecture But Lower Bone Material Strength and Poorer Physical Function in Elderly Women - a Population-Based Study.
- 2017
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Ingår i: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. - : Wiley. - 1523-4681. ; 32:5
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Tidskriftsartikel (refereegranskat)abstract
- Type 2 diabetes mellitus (T2DM) is associated with an increased risk of fractures according to several studies. The underlying mechanisms remain unclear, although small case-control studies indicate poor quality of the cortical bone. We have studied a population-based sample of women aged 75-80 in Gothenburg, randomly invited from the population registry. Areal bone mineral density (aBMD) was measured by dual energy x-ray absorptiometry (Hologic Discovery A), bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT; ExtremeCT from Scanco Medical AG), and reference point indentation was performed with Osteoprobe (Active Life Scientific). Women with T2DM (n=99) had higher aBMD compared to controls (n=954). Ultradistal tibial and radial trabecular bone volume fraction (+11% and +15%, respectively), distal cortical volumetric BMD (+1.6% and +1.7%), cortical area (+11.5% and +9.3%), and failure load (+7.7% and +12.9%) were higher in diabetics than in controls. Cortical porosity was lower (mean±SD: 1.5±1.1 vs 2.0±1.7%, p=0.001) in T2DM in the distal radius but not in the ultradistal radius or the tibia. Adjustment for covariates (age, body mass index, glucocorticoid treatment, smoking, physical activity, calcium intake, bone-active drugs) eliminated the differences in aBMD but not in HR-pQCT bone variables. However, bone material strength index (BMSi) by reference point indentation was lower in T2DM (74.6±7.6 vs 78.2±7.5, p<0.01), also after adjustment, and women with T2DM performed clearly worse in measures of physical function (one leg standing: -26%, 30s chair-stand test: -7%, timed up and go: +12%, walking speed: +8%; p<0.05-0.001) compared to controls. In conclusion, we observed a more favorable bone microarchitecture but no difference in adjusted aBMD in elderly women with T2DM in the population compared to non-diabetics. Reduced BMSi and impaired physical function may explain the increased fracture risk in T2DM. This article is protected by copyright. All rights reserved.
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| 5. |
- Wallander, Märit
(författare)
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Acute myocardial infarction and glucose abnormalities : novel risk markers and characteristics
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: There is a strong relationship between abnormal glucose tolerance (AGT) and the occurrence of an acute myocardial infarction (AMI). The identification of novel risk markers and pathophysiological disease characteristics may add important information to our understanding of the reasons for the disease pattern and thereby open the door to new therapeutic opportunities in this high-risk group of patients. Aims: 1. To characterise patients with AMI and newly discovered AGT as regards their beta-cell function (Study I); 2. To investigate the long-term reliability of the early classification of glucose perturbations by means of an oral glucose tolerance test (OGTT) in patients with AMI without previously known glucose abnormalities (Study II); 3. To investigate the potential relationships between novel risk markers from the IGF-I system and the adipokines and future cardiovascular events and glucose tolerance in patients with AMI with and without glucose abnormalities (Studies III-V). Studies I-III and V: A total of 181 AMI patients (the GAMI study: 125 men, 56 women; mean age 63.5 ± 9.4 years) were enrolled and 168 of them were classified by means of an OGTT before hospital discharge as having normal glucose tolerance (NGT, n=55), impaired glucose tolerance (IGT, n=58) or type 2 diabetes (n=55). Classifications were repeated three and 12 months thereafter. Age- and gender-matched subjects from the background population served as controls (n=185, 127 men, 58 women; mean age 64.4 ± 9.2 years). Beta-cell function was quantified as the insulinogenic index (IGI) 30 minutes after the glucose load. The associations between levels of IGF-I, IGF binding proteins 1 and 3 (IGFBP-1, IGFBP-3), leptin, adiponectin, glucose metabolism and future cardiovascular events were studied. The studies revealed that patients with AMI and AGT have reduced beta-cell function compared with patients with AMI and NGT (Study I). These patients can be detected and reliably classified from a long-term perspective using an OGTT when they are discharged from the coronary care unit (Study II). Furthermore, patients with AMI and glucose abnormalities have lower levels of IGF-I compared with patients with NGT and controls (Study III). Moreover, high levels of leptin on the first morning after the AMI are associated with the presence of AGT at discharge and with a more serious long-term prognosis (Study V). Study IV: In the DIGAMI 2 trial, 1,253 patients with AMI and type 2 diabetes were randomised to one of three study arms receiving: a) a 24-hour insulin-glucose infusion followed by subcutaneous insulin-based, long-term glucose control, b) the same initial treatment followed by glucose-lowering treatment according to local practice or c) glucose-lowering treatment according to local practice. The main objective, to compare total mortality and morbidity between these management strategies, revealed no significant differences between the treatment groups regarding the primary (total mortality) or the secondary (mortality, non-fatal MI or stroke) endpoints. A total of 575 of the DIGAMI 2 patients participated in a biochemistry programme with repeated blood sampling during 12 months of follow-up. In these 575 patients, the associations between IGF-I, IGFBP-1 and future cardiovascular events were studied. A high level of IGFBP-1 at admission was a strong predictor of cardiovascular mortality and morbidity. Conclusion: Glucose abnormalities in patients with AMI without previously known type 2 diabetes are related to impaired beta-cell function. These patients can be detected with an OGTT as early as day 4-5 after the AMI and the classification of the glucometabolic state is reliable in a long-term perspective. Furthermore, low levels of IGF-I are related to glucose abnormalities, while high levels of leptin are related to both glucose abnormalities and the subsequent prognosis in AMI patients without previously known type 2 diabetes. Moreover, high levels of IGFBP-1 are related to morbidity and mortality in patients with AMI and established type 2 diabetes. These findings add important information and will hopefully lead to studies aimed at improving management strategies and risk assessments in these patient groups.
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