| 31. |
- Eliasson, Mats, et al.
(författare)
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The disparity between long-term survival in patients with and without diabetes following a first myocardial infarction did not change between 1989 and 2006 : an analysis of 6,776 patients in the Northern Sweden MONICA Study
- 2011
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Ingår i: Diabetologia. - : SpringerLink. - 0012-186X .- 1432-0428. ; 54:10, s. 2538-2543
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis: Long-term survival after myocardial infarction(MI) has improved in the population, but data ondiabetic patients is lacking. We analysed survival for up to18 years after a first MI in patients with or without diabetesMethods: The Northern Sweden MONICA MyocardialInfarction Registry was linked to the Cause-of-DeathRegistry for a total of 6,776 patients, 25–64 years of age,with a first MI during 1989–2006. Prehospital deaths wereincluded. Follow-up ended on 30 August 2008.Results: Sixteen per cent had diabetes. Median follow-uptime was 6.8 years, and the study included 50,667 patientyears.One third of the non-diabetic patients died vs half ofthe diabetic patients. Median survival for non-diabetic menwas 227 months and for diabetic men 123 months.Corresponding figures for the non-diabetic and diabeticwomen were 222 and 81 months respectively. Men withdiabetes had an age-adjusted HR for all-cause mortality of 1.56 (95% CI 1.39, 1.79) vs men without diabetes. Mortality risk was higher among diabetic women, HR1.97 (1.62, 2.39) (diabetes × sex interaction, p=0.03). Survival increased for three consecutive cohorts and washigher in non-diabetic patients for all durations of follow-upand in all three cohorts. The interaction of diabetes x cohortwas not significant over time (p=0.5) and HRs did notdiffer either.Conclusions/interpretation Long-term survival after a firstMI is markedly lower in diabetic patients, especially amongwomen, over an 18-year observation time. Althoughsurvival has improved in diabetic patients, the effect ofdiabetes upon mortality has not diminished.
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| 32. |
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| 33. |
- Engeset, Dagrun, et al.
(författare)
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Fish consumption and mortality in the European Prospective Investigation into Cancer and Nutrition cohort
- 2015
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Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 1573-7284 .- 0393-2990. ; 30:1, s. 57-70
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Tidskriftsartikel (refereegranskat)abstract
- Fish is a source of important nutrients and may play a role in preventing heart diseases and other health outcomes. However, studies of overall mortality and cause-specific mortality related to fish consumption are inconclusive. We examined the rate of overall mortality, as well as mortality from ischaemic heart disease and cancer in relation to the intake of total fish, lean fish, and fatty fish in a large prospective cohort including ten European countries. More than 500,000 men and women completed a dietary questionnaire in 1992-1999 and were followed up for mortality until the end of 2010. 32,587 persons were reported dead since enrolment. Hazard ratios and their 99 % confidence interval were estimated using Cox proportional hazard regression models. Fish consumption was examined using quintiles based on reported consumption, using moderate fish consumption (third quintile) as reference, and as continuous variables, using increments of 10 g/day. All analyses were adjusted for possible confounders. No association was seen for fish consumption and overall or cause-specific mortality for both the categorical and the continuous analyses, but there seemed to be a U-shaped trend (p < 0.000) with fatty fish consumption and total mortality and with total fish consumption and cancer mortality (p = 0.046).
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| 34. |
- Engström, Karin, et al.
(författare)
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Evaluation of the impact of genetic polymorphisms in glutathione-related genes on the association between methylmercury or n-3 polyunsaturated long chain fatty acids and risk of myocardial infarction : a case-control study
- 2011
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Ingår i: Environmental Health. - : BioMed Central (BMC). - 1476-069X. ; 10:33
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Tidskriftsartikel (refereegranskat)abstract
- Background: The n-3 polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, which are present in fish, are protective against myocardial infarction. However, fish also contains methylmercury, which influences the risk of myocardial infarction, possibly by generating oxidative stress. Methylmercury is metabolized by conjugation to glutathione, which facilitates elimination. Glutathione is also an antioxidant. Individuals with certain polymorphisms in glutathione-related genes may tolerate higher exposures to methylmercury, due to faster metabolism and elimination and/or better glutathione-associated antioxidative capacity. They would thus benefit more from the protective agents in fish, such as eicosapentaenoic+docosahexaenoic acid and selenium. The objective for this study was to elucidate whether genetic polymorphisms in glutathione-related genes modify the association between eicosapentaenoic+docosahexaenoic acid or methylmercury and risk of first ever myocardial infarction. Methods: Polymorphisms in glutathione-synthesizing (glutamyl-cysteine ligase catalytic subunit, GCLC and glutamyl-cysteine ligase modifier subunit, GCLM) or glutathione-conjugating (glutathione S-transferase P, GSTP1) genes were genotyped in 1027 individuals from northern Sweden (458 cases of first-ever myocardial infarction and 569 matched controls). The impact of these polymorphisms on the association between erythrocyte-mercury (proxy for methylmercury) and risk of myocardial infarction, as well as between plasma eicosapentaenoic+docosahexaenoic acid and risk of myocardial infarction, was evaluated by conditional logistic regression. The effect of erythrocyte-selenium on risk of myocardial infarction was also taken into consideration. Results: There were no strong genetic modifying effects on the association between plasma eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury and risk of myocardial infarction risk. When eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury were divided into tertiles, individuals with GCLM-588 TT genotype displayed a lower risk relative to the CC genotype in all but one tertile; in most tertiles the odds ratio was around 0.5 for TT. However, there were few TT carriers and the results were not statistically significant. The results were similar when taking plasma eicosapentaenoic+docosahexaenoic acid, erythrocyte-selenium and erythrocyte-mercury into account simultaneously. Conclusions: No statistically significant genetic modifying effects were seen for the association between plasma eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury and risk of myocardial infarction. Still, our results indicate that the relatively rare GCLM-588 TT genotype may have an impact, but a larger study is necessary for confirmation.
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| 35. |
- Eriksson, Jan W., et al.
(författare)
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Hydrochlorothiazide, but not Candesartan, aggravates insulin resistance and causes visceral and hepatic fat accumulation : the mechanisms for the diabetes preventing effect of Candesartan (MEDICA) Study
- 2008
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Ingår i: Hypertension. - : American Heart Association. - 0194-911X .- 1524-4563. ; 52:6, s. 1030-1037
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Tidskriftsartikel (refereegranskat)abstract
- Treatment with angiotensin II receptor blockers is associated with lower risk for the development of type 2 diabetes mellitus compared with thiazide diuretics. The Mechanisms for the Diabetes Preventing Effect of Candesartan Study addressed insulin action and secretion and body fat distribution after treatment with candesartan, hydrochlorothiazide, and placebo. Twenty-six nondiabetic, abdominally obese, hypertensive patients were included in a multicenter 3-way crossover trial, and 22 completers (by predefined criteria; 10 men and 12 women) were included in the analyses. They underwent 12-week treatment periods with candesartan (C; 16 to 32 mg), hydrochlorothiazide (H; 25 to 50 mg), and placebo (P), respectively, and the treatment order was randomly assigned and double blinded. Intravenous glucose tolerance tests and euglycemic hyperinsulinemic (56 mU/m(2) per minute) clamps were performed. Intrahepatic and intramyocellular and extramyocellular lipid content and subcutaneous and visceral abdominal adipose tissue were measured using proton magnetic resonance spectroscopy and MRI. Insulin sensitivity (M-value) was reduced following H versus C and P (6.07+/-2.05, 6.63+/-2.04, and 6.90+/-2.10 mg/kg of body weight per minute, mean+/-SD; P
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| 36. |
- Eriksson, Maria A., 1965-, et al.
(författare)
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Leptin levels are not affected by enalapril treatment after an uncomplicated myocardial infarction, but associate strongly with changes in fibrinolytic variables in men
- 2020
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Taylor & Francis. - 0036-5513 .- 1502-7686. ; 80:4, s. 303-308
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Tidskriftsartikel (refereegranskat)abstract
- Leptin, an adipocyte-derived hormone, is involved in the regulation of body weight and is associated with obesity-related complications, notably cardiovascular disease (CVD). A putative link between obesity and CVD could be induction of plasminogen activator inhibitor-1 (PAI-1) synthesis by leptin. In this study, we hypothesized that the beneficial effect of the angiotensin-converting enzyme inhibitor (ACE(i)) enalapril on PAI-1 levels is mediated by effects on leptin levels. The association between leptin and components of the fibrinolytic system was evaluated in a non-prespecified post hoc analysis of a placebo-controlled randomized, double-blind trial where the effect of the ACE(i) enalapril on fibrinolysis was tested. A total of 46 men and 37 women were randomized to treatment with enalapril or placebo after (median 12 months) an uncomplicated myocardial infarction. At baseline, the participants were stable and had no signs of congestive heart failure. Leptin and fibrinolytic variables (mass concentrations of PAI-1, tissue plasminogen activator (tPA) and tPA-PAI complex) were measured at baseline, and after 10 days, 6 months and 12 months. Enalapril treatment did not change leptin levels, which increased significantly during 1 year of follow-up (p = .007). Changes in leptin levels were strongly associated with changes of tPA mass (p = .001), tPA-PAI complex (p = .003) and of PAI-1 (p = .006) in men, but not in women. Leptin levels are not influenced by treatment with an ACE(i). In contrast, leptin associates strongly with changes in fibrinolytic variables notably with a sex difference, which could be of importance for obesity-related CVD.
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| 37. |
- Eriksson, Marie, et al.
(författare)
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Comparison of blood pressure measurements between an automated oscillometric device and a Hawksley random-zero sphygmomanometer in the northern Sweden MONICA study.
- 2012
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Ingår i: Blood Pressure Monitoring. - 1359-5237 .- 1473-5725. ; 17:4, s. 164-170
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Hawksley random-zero sphygmomanometer (random-zero) has been used widely in epidemiological observation studies. This study compares blood pressure measurements using the random-zero with measurements using an automated oscillometric device and suggests a correction of the automated oscillometric measurements to enable comparisons of blood pressure levels over time.METHODS: The northern Sweden MONICA population survey 2009 included 1729 participants, 853 men and 876 women, 25-74 years old. Blood pressure was measured using both random-zero and an automated oscillometric device in all participants. The Omron M7 digital blood pressure monitor was used for automated oscillometric measurements. A linear mixed model was used to derive a formula to adjust the automated oscillometric readings.RESULTS: Automated oscillometric measurements of systolic blood pressure were generally lower than random-zero measurements in women [oscillometric mean 122.1 mmHg (95% confidence interval: 121.0-123.2) versus random-zero mean 124.4 mmHg (123.5-125.5)], whereas automated oscillometric measurements of systolic blood pressure were generally higher than random-zero measurements in men [oscillometric 131.1 mmHg (130.0-132.2) versus random-zero 129.0 mmHg (127.9-130.1)]. For diastolic blood pressure, automated oscillometric measurements were higher in both women [oscillometric 79.9 mmHg (79.2-80.5) versus random-zero 76.7 mmHg (76.0-77.4)] and men [oscillometric 83.1 mmHg (82.4-83.8) vs. random-zero 81.2 mmHg (80.6-81.9)]. The difference also varied with age and order of measurement. Adjustment of the automated oscillometric measurements using mixed model regression coefficients produced estimates of blood pressure that were close to the random-zero measurements.CONCLUSION: Blood pressure measurements using an automated oscillometric device differ from those with random-zero, but the oscillometric measurements can be adjusted, on the basis of sex, age and measurement order, to be similar to the random-zero measurements.
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| 38. |
- Eriksson, Marie, et al.
(författare)
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Greater decreases in cholesterol levels among individuals with high cardiovascular risk than among the general population : the northern Sweden MONICA study 1994 to 2014
- 2016
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 37:25, s. 1985-1992
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Decreasing cholesterol levels in Western populations is the main reason for decreasing mortality due to coronary heart disease. Our aim was to analyze trends in cholesterol levels in the population during a period of 20 years in relation to previous cardiovascular disease (CVD), other cardiovascular risk factors, and socioeconomic status.METHODS AND RESULTS: A total of 4546 women and 4349 men aged 25-74 years participated in five population-based surveys in the Northern Sweden MONICA Study between 1994 and 2014 (participation rate 76.8-62.5%). Total cholesterol levels decreased from 6.2 mmol/L (95% confidence interval, CI, 6.1-6.2) in 1994 to 5.5 mmol/L (CI 5.4-5.5) in 2014. The decrease was more pronounced in elderly vs. younger participants (1.0 vs. 0.5 mmol/L). In 2014, participants with previous CVD, diabetes, or hypertension had lower cholesterol levels than the general population, whereas their levels were higher or similar to the general population in 1994. The use of lipid-lowering drugs increased markedly and was used by 14.3% in 2014. Previously described differences in cholesterol levels between participants with obesity and normal weight, and between those with and without university education, diminished, or vanished over time.CONCLUSION: Cholesterol levels decreased by 0.7 mmol/L over 20 years with no sign of abating. The improvement occurred in all age and gender groups but more prominently among those at high risk of ischaemic heart disease.
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| 39. |
- Eriksson, Marie, et al.
(författare)
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Large improvements in major cardiovascular risk factors in the population of northern Sweden : the MONICA study 1986–2009
- 2011
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 269:2, s. 219-231
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. The incidence of cardiovascular disease has declined rapidly in Sweden since the 1980s. We explored changes in major cardiovascular risk factors in northern Sweden between 1986 and 2009.Design. Since 1986, six population surveys have been carried out in northern Sweden using procedures of the World Health Organization MONICA project. The population age range was 25–64 years in 1986 and 1990, and 25–74 years from 1994. Trends were analysed using generalized linear models.Results. A total of 10 586 subjects were included in the surveys. Blood pressure decreased by 4.9/3.9 mmHg in women and 1.8/1.5 mmHg in men aged 25–64 years between 1986 and 2009. In men and women aged 65–74 years, the decrease was 12.6/6.1 mmHg between 1994 and 2009. From 1994, the use of blood pressure‐lowering drugs increased, particularly among the older subgroup. The prevalence of smoking halved between 1986 and 2009; 11% of women and 9% of men were smokers in 2009. Cholesterol levels decreased by 0.9 mmol L−1 in the younger age group (25–64 years), and the use of lipid‐lowering agents increased from 1994. Among subjects aged 25–64 years, one in five was obese in 2009, which was twice as many as in 1986, and body mass index (BMI) increased by 1.5 kg m−2, corresponding to an increase in weight of 4 kg. There was no further increase in BMI from 2004. The prevalence of diabetes did not change between 1986 and 2009. The proportion that received a university education increased markedly in all age groups, especially in women, during the study period.Conclusions. Significant improvements were observed in major cardiovascular risk factors in northern Sweden between 1986 and 2009.
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| 40. |
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