| 1. |
- Wamala, S. P, et al.
(författare)
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Socioeconomic status and determinants of hemostatic function in healthy women
- 1999
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Ingår i: Arteriosclerosis, Thrombosis and Vascular Biology. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, S-14157 Huddinge, Sweden. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Karolinska Hosp, Dept Cariol, S-10401 Stockholm, Sweden. Karolinska Hosp, King Gustaf V Res Inst, Atherosclerosis Res Unit, S-10401 Stockholm, Sweden. : LIPPINCOTT WILLIAMS & WILKINS. - 1079-5642 .- 1524-4636. ; 19:3, s. 485-492
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Tidskriftsartikel (refereegranskat)abstract
- Hemostatic factors are reported to be associated with coronary heart disease (CHD). Socioeconomic status (SES) is 1 of the determinants of the hemostatic profile, but the factors underlying this association are not well known. Our aim was to examine determinants of the socioeconomic differences in hemostatic profile. Between 1991 and 1994, we studied 300 healthy women, aged 30 to 65 years, who were representative of women living in the greater Stockholm area. Fibrinogen, factor VII mass concentration (FVII:Ag), activated factor VII (FVIIa), von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1) were measured. Educational attainment was used as a measure of SES. Low educational level and an unfavorable hemostatic profile were both associated with older age, unhealthful life style, psychosocial stress, atherogenic biochemical factors, and hypertension. Levels of hemostatic factors increased with lower educational attainment. Independently of age, the differences between the lowest (mandatory) and highest (college/university) education in FVII:Ag levels were 41 mu g/L (95% confidence interval [CI] 15 to 66 mu g/L, P=0.001), 0.26 g/L (95% CI, 0.10 to 0.42 g/L, P=0.001) in fibrinogen levels, and 0.11 U/mL (95% CI, 0.09 to 0.12 U/mL, P=0.03) in levels of vWF. The corresponding differences in FVIIa and PAI-1 were not statistically significant. With further adjustment for menopausal status, family history of CHD, marital status, psychosocial stress, lifestyle patterns, biochemical factors, and hypertension, statistically significant differences between mandatory and college/university education were observed in FVII:Ag (difference=34 mu g/L; 95% CI, 2 to 65 mu g/L, P=0.05) but not in fibrinogen (difference 0.03 g/L; 95% CI, -0.13 to 0.19 g/L, P=0.92) or in VWF (difference=0.06 U/mL; 95% CI, -0.10 to 0.22 U/mL, P=0.45). An educational gradient was most consistent and statistically significant for FVII:Ag, fibrinogen, and VWF. Age, psychosocial stress, unhealthful life style, atherogenic biochemical factors, and hypertension mediated the association of low educational level with elevated levels of fibrinogen and vWF. Psychosocial stress and unhealthful life style were the most important contributing factors. There was an independent association between education and FVII:Ag, which could not be explained by any of these factors.
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| 2. |
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| 3. |
- Eriksson, M, et al.
(författare)
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Relationship between plasma fibrinogen and coronary heart disease in women
- 1999
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Ingår i: Arteriosclerosis, Thrombosis and Vascular Biology. - Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. Karolinska Hosp, Dept Clin Chem, S-10401 Stockholm, Sweden. Karolinska Inst, Natl Inst Psychosocial Factors & Hlth, Stockholm, Sweden. Deaconess Hosp, Inst Prevent Cardiovasc Dis, Boston, MA USA. : LIPPINCOTT WILLIAMS & WILKINS. - 1079-5642 .- 1524-4636. ; 19:1, s. 67-72
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Tidskriftsartikel (refereegranskat)abstract
- Plasma fibrinogen is an independent risk factor for coronary heart disease (CHD) in men; however, its role in women is less clear. We examined the ability of plasma fibrinogen to predict CHD in a community-based, case-control study of women aged 65 years or younger living in the greater Stockholm area. Cases were all patients hospitalized for an acute coronary event between February 1991 and February 1994. Controls were randomly selected from the city census and were matched to cases by age and catchment area. Plasma fibrinogen was measured 3 to 6 months after hospitalization by using a fibrinogen assay based on fibrinogen polymerization time measurement. Of the 292 consecutive cases, 110 (37%) were hospitalized for an acute myocardial infarction and 182 (63%) for angina pectoris. The mean age+/-SD in both patients and controls was 56+/-7 years. Mean levels of plasma fibrinogen in patients and controls were 3.66+/-0.81 and 3.25+/-0.64 g/L (P<0.0001), respectively. The age-adjusted odds ratio (OR) for CHD in the highest versus the lowest quartile of plasma fibrinogen was 6.0 (95% confidence interval [CI], 3.5 to 10.4). After adjustment for age, cigarette smoking, body mass index, systolic blood pressure, total cholesterol, high density lipoprotein cholesterol, triglycerides, and educational level, the OR was 3.0 (95% CI, 1.6 to 5.5). Further adjustment for C-reactive protein yielded the same result. In both premenopausal and postmenopausal women, the multivariate adjusted ORs were 7.0 (95% CI, 1.8 to 28.3) and 2.1 (95% CI, 1.0 to 4.4), respectively. These results provide evidence that plasma fibrinogen is associated with an excess risk of CHD in women.
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| 4. |
- Horsten, M, et al.
(författare)
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Psychosocial factors and heart rate variability in healthy women.
- 1999
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Ingår i: Psychosomatic Medicine. - : Ovid Technologies (Wolters Kluwer Health). - 0033-3174 .- 1534-7796. ; 61:1, s. 49-57
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study was conducted to investigate associations between psychosocial risk factors, including social isolation, anger and depressive symptoms, and heart rate variability in healthy women. METHODS: The study group consisted of 300 healthy women (median age 57.5 years) who were representative of women living in the greater Stockholm area. For the measurement of social isolation, a condensed version of the Interpersonal Support Evaluation List was used and household size assessed. Anger was measured by the anger scales previously used in the Framingham study and depressive symptoms by a questionnaire derived from Pearlin. Health behaviors were measured by means of standard questionnaires. From 24-hour ambulatory electrocardiographic monitoring, both time and frequency domain measures were obtained: SDNN index (mean of the SDs of all normal to normal intervals for all 5-minute segments of the entire recording), VLF power (very low frequency power), LF power (low frequency power), HF power (high frequency power), and the LF/HF ratio (low frequency by high frequency ratio) were computed. RESULTS: Social isolation and inability to relieve anger by talking to others were associated with decreased heart rate variability. Depressive symptoms were related only to the LF/HF ratio. Adjusting for age, menopausal status, exercise and smoking habits, history of hypertension, and BMI did not substantially change the results. CONCLUSIONS: These findings suggest heart rate variability to be a mediating mechanism that could explain at least part of the reported associations between social isolation, suppressed anger, and health outcomes.
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| 5. |
- Horsten, M, et al.
(författare)
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Social relations and the metabolic syndrome in middle-aged Swedish women
- 1999
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Ingår i: Journal of Cardiovascular Risk. - Karolinska Inst, Novum, Div Prevent Med, Dept Publ Hlth Sci, S-14157 Huddinge, Sweden. Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA USA. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : LIPPINCOTT WILLIAMS & WILKINS. - 1350-6277 .- 1473-5652 .- 1741-8267 .- 1741-8275. ; 6:6, s. 391-397
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Tidskriftsartikel (refereegranskat)abstract
- Background Both social isolation and the metabolic syndrome are independently associated with greater than normal cardiovascular risk. Design A population-based cross-sectional study of middle-aged Swedish women. Methods The study group consisted of 300 healthy women (aged 31-65 years) who were representative of women living in the greater Stockholm area. Social isolation was measured by using a condensed Version of the Interpersonal Support Evaluation List. Health behaviours were assessed and a full serum-lipid-level and haemostatic profile was obtained by standardized methods, The metabolic syndrome was defined as the presence of two or more of these components: fasting serum level of glucose greater than or equal to 7.0 mmol/l, arterial blood pressure greater than or equal to 160/90 mmHg, fasting serum level of triglycerides greater than or equal to 1.7 mmol/l or high-density lipoprotein < 1.0 mmol/l, or both, and central obesity (waist:hip ratio > 0.85 or body mass index > 30 kg/m(2), or both), Results After adjustment for age, menopausal status, educational level, smoking, exercise habits and consumption of alcohol, the risk ratio for the metabolic syndrome for women in the lower compared with women in the upper social-support quartile was 3.5 (95% confidence interval 1.1-11.4), whereas that of women in the two middle quartiles was 2.2 (95% confidence interval 0.67-7.2; P for trend 0.02). Conclusions Social isolation was associated with the metabolic syndrome for these middle-aged women. The findings suggest that the metabolic syndrome and its components may be mediators of the reported association between social isolation and cardiovascular disease, (C) 1999 Lippincott Williams & Wilkins.
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| 6. |
- Norlund, L, et al.
(författare)
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Reference intervals for the glomerular filtration rate and cell-proliferation markers : serum cystatin C and serum beta 2-microglobulin/cystatin C-ratio
- 1997
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Informa UK Limited. - 0036-5513 .- 1502-7686. ; 57:6, s. 463-470
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Tidskriftsartikel (refereegranskat)abstract
- Recent studies have indicated that serum and plasma cystatin C are better markers for glomerular filtration rate (GFR) than serum creatinine, ubiquitously used for this purpose. To fully exploit the value of serum and plasma cystatin C as GFR markers, reliable age and sex-correlated reference intervals are required. The present study comprised cystatin C determinations in plasma and sera from 259 individuals from a well-defined area in the southernmost part of Sweden. From demographic lists two men and two women were randomly selected from each one-year birth cohort above 20 years of age. No sex differences were found for plasma and serum cystatin C, whereas an increase in the cystatin C levels with age was noted, corresponding to the known age-related decrease in GFR. The following reference intervals are recommended for practical clinical use: S-Cystatin C (both sexes): 20-50 years, 0.70-1.21 mg l-1 and 50+ years, 0.84-1.55 mg l-1. The same samples were also used for determination of beta 2-microglobulin levels in order to calculate reference intervals for the beta 2-microglobulin/cystatin C-ratio, which is a more distinct marker for cell proliferation, particularly lymphoproliferation, than is the serum level of beta 2-microglobulin alone, since the ratio should be virtually uninfluenced by GFR. The beta 2-microglobulin/cystatin C-ratios were uninfluenced by sex and age and 1.45-2.43 is recommended as the serum reference interval for practical clinical use. Serum creatinine was determined in the same samples and the creatinine level was found to be strongly influenced by sex and weakly by age.
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| 7. |
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| 8. |
- Orth-Gomer, K, et al.
(författare)
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Social relations and extent and severity of coronary artery disease - The Stockholm Female Coronary Risk Study
- 1998
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Ingår i: European Heart Journal. - Karolinska Inst, Novum, Dept Publ Hlth Sci, Div Prevent Med, S-14157 Huddinge, Sweden. Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Boston, MA USA. Univ Texas, Sch Med, Div Cardiol, Houston, TX USA. Karolinska Hosp, Dept Thorac Med, S-10401 Stockholm, Sweden. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : W B SAUNDERS CO LTD. - 0195-668X .- 1522-9645. ; 19:11, s. 1648-1656
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Tidskriftsartikel (refereegranskat)abstract
- Aims Social relations have been repeatedly linked to coronary heart disease in men, even after careful control for standard risk factors. Women have rarely been studied and results have not been conclusive. We investigated the role of social support in the severity and extent of coronary artery disease in women. Methods and Results One hundred and thirty-one women, aged 30 to 65 years, who were hospitalized for an acute coronary event and were included in the Stockholm Female Coronary Risk Study, were examined with computer assisted quantitative coronary angiography. Angiographic measures included presence of stenosis greater than 50% in at least one coronary artery (severity) and the number of stenoses greater than 20% within the coronary tree (extent). Social factors included two measures of social support, which were previously shown to predict coronary disease in prospective studies of men. After adjustment for age, lack of social support was associated with both measures of coronary artery disease. With further adjustment for smoking, education, menopausal status, hypertension, high density lipoprotein and body mass index, the risk ratio for stenosis greater than 50% in women with poor as compared to those with strong social support was 2.5 (95% confidence interval 1.2 to 5.3; P=0.003). Also, women with poor social support had more stenoses obstructing at least 20% of the coronary lumen with multivariate adjustment, but the difference from women with strong support was only of borderline significance (P=0.09). Conclusion The findings suggest that lack of social support contributes to the severity of coronary artery disease in women, independent of standard risk factors.
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| 9. |
- Wamala, Sarah, et al.
(författare)
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Lipid profile and socioeconomic status in healthy middle aged women in Sweden
- 1997
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group. - 0143-005X .- 1470-2738. ; 51:4, s. 400-407
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Tidskriftsartikel (refereegranskat)abstract
- Study objective - To examine the relationship between socioeconomic status (SES) and full lipid profile in middle aged healthy women. Participants - These comprised 300 healthy Swedish women between 30 and 65 years who constitute the control group of the Stockholm female coronary risk study, a population based, case-control study of women with coronary heart disease (CHD). The age matched control group, drawn from the census register of greater Stockholm, was representative of healthy Swedish women aged 30-65 years. Five measures of SES were used; educational level, occupation, decision latitude at work, annual income, and size of house or apartment. Main results - Swedish women with low decision latitude at work, low income, low educational level, blue collar jobs, and who were living in small houses or apartments had an unhealthy lipid profile, suggesting an increased risk of CHD. Part of this social gradient in lipids was explained by an unhealthy lifestyle, but the lipid gradients associated with decision latitude at work and annual income were independent of these factors. Decision latitude, educational level, and annual income had the strongest associations with lipid profile. These associations were independent of age, menopausal status, smoking, sedentary lifestyle, alcohol consumption, obesity, excess abdominal fat, and unhealthy dietary habits. Of the lipid variables, low high density lipoprotein cholesterol (HDL) levels were most consistently associated with low SES. Conclusions - Decision latitude at work was the strongest SES predictor of HDL levels in healthy middle aged Swedish women, after simultaneous adjustment for other SES measures, age, and all lifestyle factors in the multivariable regression model.
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| 10. |
- Wamala, S.P, et al.
(författare)
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Education and the metabolic syndrome in women
- 1999
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Ingår i: Diabetes Care. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, Stockholm, Sweden. Univ Michigan, Sch Publ Hlth, Dept Epidemiol, Ann Arbor, MI 48109 USA. Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA USA. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : AMER DIABETES ASSOC. - 0149-5992 .- 1935-5548. ; 22:12, s. 1999-2003
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE - The main objective was to examine the association between the metabolic syndrome and socioeconomic position las indicated by education) among women, RESEARCH DESIGN AND METHODS - The study sample comprised healthy women (aged 30-65 years) in Sweden who were representative of the general population in a metropolitan area. Socioeconomic position was measured by educational level (mandatory [less than or equal to 9 years], high school, or college/university). The metabolic syndrome was defined as the presence of two or mon: of the following components: 1) fasting plasma glucose level greater than or equal to 7.0 mmol/l; 2) arterial blood pressure greater than or equal to 160/90 mmHg; 3) fasting plasma triglycerides greater than or equal to 1.7 mmol/l and/or HDL cholesterol <1.0 mmol/l; and 4) central obesity (waist-to-hip ratio >0.85 and/or BMI >30 kg/m(2)), RESULTS - After adjustment for age, the risk ratio for the presence of the metabolic syndrome comparing the lowest (less than or equal to 9 years) with the highest (college/university) education was 2.7 (95% CI 1.1-6.8)1 This association persisted after controlling for menopausal status, family history of diabetes, and behavioral risk factors. CONCLUSIONS - Low education is associated with increased risk for metabolic syndrome in middle-aged women. These findings show that not only are women with low socioeconomic position at increased risk for individual risk factors that are associated with cardiovascular disease and type 2 diabetes, they are also at increased risk for the metabolic clustering of risk factors.
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