| 1. |
- Rawshani, Aidin, 1991, et al.
(författare)
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Severe COVID-19 in people with type 1 and type 2 diabetes in Sweden : A nationwide retrospective cohort study
- 2021
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Ingår i: The Lancet Regional Health. - : Elsevier. - 2666-7762. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Whether infection with SARS-CoV-2 leads to excess risk of requiring hospitalization or intensive care in persons with diabetes has not been reported, nor have risk factors in diabetes associated with increased risk for these outcomes. Methods: We included 44,639 and 411,976 adult patients with type 1 and type 2 diabetes alive on Jan 1, 2020, and compared them to controls matched for age, sex, and county of residence (n=204,919 and 1,948,900). Age- and sex-standardized rates for COVID-19 related hospitalizations, admissions to intensive care and death, were estimated and hazard ratios were calculated using Cox regression analyses. Findings: There were 10,486 hospitalizations and 1,416 admissions into intensive care. A total of 1,175 patients with diabetes and 1,820 matched controls died from COVID-19, of these 53.2% had been hospitalized and 10.7% had been in intensive care. Patients with type 2 diabetes, compared to controls, displayed an ageand sex-adjusted hazard ratio (HR) of 2.22, 95%CI 2.13-2.32) of being hospitalized for COVID-19, which decreased to HR 1.40, 95%CI 1.34-1.47) after further adjustment for sociodemographic factors, pharmacological treatment and comorbidities, had higher risk for admission to ICU due to COVID-19 (age- and sexadjusted HR 2.49, 95%CI 2.22-2.79, decreasing to 1.42, 95%CI 1.25-1.62 after adjustment, and increased risk for death due to COVID-19 (age- and sex-adjusted HR 2.19, 95%CI 2.03-2.36, complete adjustment 1.50, 95%CI 1.39-1.63). Age- and sex-adjusted HR for COVID-19 hospitalization for type 1 diabetes was 2.10, 95%CI 1.72-2.57), decreasing to 1.25, 95%CI 0.3097-1.62) after adjustment. Patients with diabetes type 1 were twice as likely to require intensive care for COVID-19, however, not after adjustment (HR 1.49, 95%CI 0.75-2.92), and more likely to die (HR 2.90, 95% CI 1.6554-5.47) from COVID-19, but not independently of other factors (HR 1.38, 95% CI 0.64-2.99). Among patients with diabetes, elevated glycated hemoglobin levels were associated with higher risk for most outcomes. Interpretation: In this nationwide study, type 2 diabetes was independently associated with increased risk of hospitalization, admission to intensive care and death for COVID-19. There were few admissions into intensive care and deaths in type 1 diabetes, and although hazards were significantly raised for all three outcomes, there was no independent risk persisting after adjustment for confounding factors. (C) 2021 The Authors. Published by Elsevier Ltd.
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| 2. |
- Dudas, Kerstin, 1963, et al.
(författare)
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Differences between acute myocardial infarction and unstable angina: a longitudinal cohort study reporting findings from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA)
- 2013
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to compare risk factors and comorbidities in patients with a first episode of acute coronary syndrome (ACS), being either acute myocardial infarction (AMI) or unstable angina pectoris (UAP). DESIGN: Cross-sectional and prospective. SETTING: The Swedish population. PARTICIPANTS: A total of 145 346 consecutive patients aged 25-105 years included in the Swedish Register of Cardiac Intensive Care Admission (Register of Information and Knowledge about Swedish Heart Intensive Care) and admitted to hospital between 1 January 1996 and 30 June 2009 with a first episode of either AMI or UAP. PRIMARY AND SECONDARY OUTCOME MEASURES: Type of ACS and 1-year outcome. RESULTS: Compared with patients with UAP, AMI patients were more likely to be older; men; and former or current smokers; they were also more likely to have had diabetes and peripheral artery disease, but had lower rates of prior heart failure (HF) and fewer cardioprotective medications on admission. Among patients aged <65 years, 1.4% of men and 1.6% of women with UAP died within 1 year in 2003-2006 compared with 4.2% of men and 3.1% of women AMI patients (multiple-adjusted OR 3.54 (99% CI 2.29 to 5.48) in women and 2.65 (99% CI 2.11 to 3.34) in men). Corresponding proportions in patients aged >/=65 years was 7.5% in men and 7.6% in women with UAP and 21.5% in men and 17.8% in women with AMI. CONCLUSIONS: In patients with a first-time ACS episode, male sex, slightly older age, smoking, diabetes and peripheral arterial disease (PAD), but fewer cardioprotective medications, were major determinants for presenting with AMI. Despite increasingly active treatment in AMI and more inclusive diagnostic criteria in recent years, persistently worse prognosis was observed in AMI patients.
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| 3. |
- Giang, Kok Wai, 1984, et al.
(författare)
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Long-term trends in the prevalence of patients hospitalized with ischemic stroke from 1995 to 2010 in Sweden
- 2017
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 12:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective The prevalence of stroke is expected to increase partly because of prolonged life expectancy in the general population. The objective of this study was to investigate trends in the prevalence of patients hospitalized with ischemic stroke (IS) in Sweden from 1995-2010. The Swedish inpatient and cause-specific death registries were used to estimate the absolute numbers and prevalence of patients who were hospitalized with and survived an IS from 1995-2010. The overall number of IS increased from 129,418 in 1995 to 148,778 in 2010. In 1995, the prevalence of IS was 189 patients per 10,000 population. An increase in overall prevalence was observed until 2000, and then it remained stable, followed by a decline with an annual percentage change of (APC)-0.8% (95% CI -1.0 to 0.6) and with a final prevalence of 199 patients per 10,000 population in 2010. The prevalence of IS in people aged <45 years increased from 6.4 in 1995 to 7.6 patients per 10,000 population in 2010, with an APC of 2.1% (95% CI 0.9 to 3.4) from 1995-1998 and 0.7% (95% CI 0.6-0.9) from 1998-2010. Among those aged 45-54 years, the prevalence rose through the mid to late 1990s, followed by a slight decrease (APC:-0.7%, 95% CI -1.1 to -0.4) until 2006 and then remained stable with a prevalence of 43.8 patients per 10,000 population in 2010. Among >= 85 years, there was a minor decrease (APC: -0.3%, 95% CI -0.5 to -0.1) in overall prevalence after 2002 from 1481 to 1453 patients per 10,000 population in 2010. The overall prevalence of IS increased until 2000, but then remained stable followed by a slight decline. However, the prevalence of IS in the young increased through the study period. The absolute number of IS survivors has markedly increased, mainly because of demographic changes.
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| 4. |
- Lindgren, Martin, et al.
(författare)
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Physical activity pattern, cardiorespiratory fitness, and socioeconomic status in the SCAPIS pilot trial — A cross-sectional study
- 2016
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Ingår i: Preventive Medicine Reports. - : Elsevier BV. - 2211-3355. ; 4, s. 44-49
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Tidskriftsartikel (refereegranskat)abstract
- Living in a low socioeconomic status (SES) area is associated with an increased risk of cardiovascular events and all-cause mortality. Previous studies have suggested a socioeconomic gradient in daily physical activity (PA), but have mainly relied on self-reported data, and individual rather than residential area SES. This study aimed to investigate the relationships between residential area SES, PA pattern, compliance with PA-recommendations and fitness in a Swedish middle-aged population, using objective measurements. We included 948 individuals from the SCAPIS pilot study (Gothenburg, Sweden, 2012, stratified for SES, 49% women, median age: 58years), in three low and three high SES districts. Accelerometer data were summarized into intensity-specific categories: sedentary (SED), low (LIPA), and medium-to-vigorous PA (MVPA). Fitness was estimated by submaximal ergometer testing. Participants of low SES areas had a more adverse cardiovascular disease risk factor profile (smoking: 20% vs. 6%; diabetes: 9% vs. 3%; hypertension: 38% vs. 25%; obesity: 31% vs. 13%), and less frequently reached 150min of MVPA per week (67% vs. 77%, odds ratio [OR]=0.61; 95% confidence interval [95% CI]=0.46–0.82), from 10-minute bouts (19% vs. 31%, OR=0.53, 95% CI=0.39–0.72). Individuals in low SES areas showed lower PA levels (mean cpm: 320 vs. 348) and daily average MVPA (29.9 vs. 35.5min), and 12% lower fitness (25.1 vs. 28.5mL×min−1×kg−1) than did those in high SES areas. Reduced PA and fitness levels may contribute to social inequalities in health, and should be a target for improved public health in low SES areas.
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| 5. |
- Mandalenakis, Zacharias, 1979, et al.
(författare)
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Atrial natriuretic peptide as a predictor of atrial fibrillation in a male population study. The Study of Men Born in 1913 and 1923
- 2014
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 171:1, s. 44-48
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial fibrillation is one of the most common arrhythmias in clinical practice and it is often diagnosed after a complication occurs. The study aimed to evaluate the predictive value of atrial natriuretic peptide (ANP) for atrial fibrillation in a male population-based study. Methods and results: This study is a part of the "Study of Men Born in 1913 and 1923", a longitudinal prospective cohort study of men, living in the city of Gothenburg in Sweden. A population-based sample of 528 men was investigated in 1988 when they were aged 65 years (n = 134) and 75 years (n = 394), and they were followed up for 16 years. Blood samples were collected from all 528 men at baseline and plasma ANP levels were analyzed by radioimmunoassay. Hazard ratios were estimated by competing-risk regression analysis. One hundred five participants were excluded because of a prior diagnosis of atrial fibrillation, congestive heart failure, severe hypertension, or severe chronic renal insufficiency. Of the remaining 423 participants, 90 men were diagnosed with atrial fibrillation over the 16-year follow-up. In multivariable analysis, men in the two highest quartiles of ANP levels had a significantly higher risk for atrial fibrillation compared with men in the lowest ANP quartile. The adjusted ratio was 3.14 (95% CI 1.59-6.20) for the third ANP quartile and 3.36 (95% CI 1.72-6.54) for the highest quartile of ANP level. Conclusions: In this population-based longitudinal study, we found that elevated ANP levels at baseline predicted atrial fibrillation during a follow-up time of 16 years.
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| 6. |
- Novak, Masuma, 1969, et al.
(författare)
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Occupational status and incidences of ischemic and hemorrhagic stroke in Swedish men: a population-based 35-year prospective follow-up study
- 2013
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Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 0393-2990 .- 1573-7284. ; 28:8, s. 697-704
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Tidskriftsartikel (refereegranskat)abstract
- This study examined variations in stroke incidence across occupational classes over a 35-year follow-up period. We analyzed a random population-based sample of 6,994 men aged 47-56 years at baseline without prior history of stroke. Standardized incidence rates, subdistribution hazard ratios (SHRs) from competing risk regressions and cumulative incidence were calculated, after accounting for risk of death attributed to causes other than stroke. A total of 1,442 strokes were identified over the 35-year period with crude incidences of 5.50 (ischemic) and 1.16 (hemorrhagic) per 1,000 person-years. In the whole group, occupational class was not associated with either ischemic or hemorrhagic stroke. However, older men (>/=51 years at baseline) with unskilled manual occupations had a significantly lower risk of ischemic stroke than those with high officials (referent). No association between occupation and stroke of either type was detected for men younger than 51 years. There was an inverse and graded risk of death from causes other than stroke; men in high official positions had the lowest cumulative risk and unskilled manual workers had the highest risk (P < 0.0001). The association between occupation and ischemic stroke in older men persisted after accounting for competing risks of death (SHR 0.62; 95 % CI 0.46-0.84). In conclusion, low socioeconomic status was not associated with an increased risk of incident hemorrhagic or ischemic stroke. Older men with the lowest occupational status i.e. unskilled manual had a significantly lower risk of ischemic stroke, even after controlling for other risk factors and competing risks of death.
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| 7. |
- Parén, Pär, et al.
(författare)
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Association of diuretic treatment at hospital discharge in patients with heart failure with all-cause short- and long-term mortality: A propensity score-matched analysis from SwedeHF
- 2018
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 257, s. 118-124
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Diuretics are recommended for treating congestive symptoms in heart failure (HF). The short- and long-term prognostic effects of diuretic treatment at hospital discharge have not been studied in randomized clinical trials or in a Western world population. We aimed to determine the association of diuretic treatment at discharge with the risk of short-and long-term all-cause mortality in real-life patients in Sweden with HF irrespective of EF. Methods and results: From a Swedish nationwide HF register 26,218 patients discharged from hospital were included in the present study. A total of 87% of patients were treated with and 13% were not treated with diuretics at hospital discharge. In a 1:1 propensity score-matched cohort of 6564 patients, the association of diuretic treatment at hospital discharge with the risk of 90-day all-cause mortality was neutral (HR 0.89, 95% CI 0.74–1.07, p = 0.21) whereas the risk of long-term all-cause mortality (median follow-up: 2.85 years) was increased (HR 1.15, 95% CI 1.06–1.24, p < 0.001). Conclusion: Diuretic treatment at hospital discharge was not associated with short-term mortality whereas it was associated with increased long-term mortality. Although we accounted for a wide range of clinical features, measured or unmeasured factors could still explain this increase in risk. However, our results suggest that diuretic treatment at hospital discharge may be regarded as a marker of increased long-term mortality.
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| 8. |
- Redfors, Petra, et al.
(författare)
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Living alone predicts mortality in patients with ischemic stroke before 70 years of age: a long-term prospective follow-up study
- 2016
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Ingår i: BMC neurology. - : Springer Science and Business Media LLC. - 1471-2377 .- 1471-2377. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Living alone is associated with increased mortality after myocardial infarction but little data is available about whether this applies to prognosis after stroke. We aimed to examine the association between living situation and long-term mortality in patients with ischemic stroke and a control group, and to explore whether this association is modified by patient gender. METHODS: This is a prospective case-control study of 600 patients with ischemic stroke before 70 years of age and 600 age- and sex-matched controls who have been included in the Sahlgrenska Study on Ischemic Stroke. Mortality data were collected through national registers and medical records. We used Cox regression models for identifying predictors of mortality. RESULTS: In the entire sample, mean age was 57 years, proportion of males 64 %, proportion living alone 28 %, and median follow-up 8.6 years. Mortality rates were 36 % among patients living alone, 17 % among cohabitant patients, 15 % among controls living alone, and 9 % among cohabitant controls. Living alone was an independent predictor of all-cause mortality in cases after adjustment for stroke severity, stroke subtype, and vascular risk factors including physical activity, alcohol consumption, and socioeconomic status. A significant interaction was found between gender and living situation; the adjusted hazard ratio for mortality was 3.47 (95 % Confidence Interval 2.13-5.65) in male patients living alone, whereas no significant association was observed in women. Living alone was also a predictor of vascular mortality among cases and of all-cause mortality among controls. CONCLUSIONS: Living alone is associated with increased long-term mortality after ischemic stroke in men. Further prospective studies are needed to confirm the observed gender difference and to identify modifiable factors underlying this increased risk.
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| 9. |
- Rosengren, Annika, 1951, et al.
(författare)
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Twenty-Four-Year Trends in the Incidence of Ischemic Stroke in Sweden From 1987 to 2010
- 2013
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Ingår i: Stroke. - 0039-2499. ; 44:9, s. 2388-93
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The incidence of stroke in Sweden increased between 1989 and 2000 among people aged 65 years are lacking. METHODS: Through the Swedish Hospital Discharge and Cause of Death registries, we identified all cases of nonfatal and fatal ischemic stroke (IS) among people aged 18 to 84 years during 1987-2010 in Sweden. RESULTS: Of the 391 081 stroke cases identified, 1.6% were 18 to 44 years, 16.7% were 45 to 64 years, and 81.7% were 65 to 84 years. Among people aged 18 to 44 years, there was a continuous increase in the incidence of stroke of 1.3% (95% confidence interval, 0.8%-1.8%) per year for men and 1.6% (1.0%-2.3%) per year for women. Among men and women aged 45 to 64 years, slightly declining rates were observed from the late 1990s, with a mean annual decrease of 0.4% (0.1%-0.7%) among men and 0.6% (0.2%-1.0%) among women. Among men aged 65 to 84 years, a decrease of 3.7% in IS (3.4%-4.0%) per year was observed from the late 1990s. This was more marked in women, where an initial decrease of 2.5% (2.1%-2.9%) per year was followed by an accelerated decrease of 5.1% (4.4%-5.8%) after 2005. Mortality from IS decreased markedly in all age groups.Conclusions-The incidenceof IS in elderly people in Sweden is now decreasing, whereas the decline in IS incidence in the middle-aged people is much less steep. The increasing incidence of stroke in the young, particularly if carried forward to an older age, is concerning.
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| 10. |
- Rödjer, Lars, 1975, et al.
(författare)
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Self-reported leisure time physical activity : a useful assessment tool in everyday health care.
- 2012
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 12:1, s. 693-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The individual physical activity level is an independent risk factor for cardiovascular disease and death, as well as a possible target for improving health outcome. However, today's widely adopted risk score charts, typically do not include the level of physical activity. There is a need for a simple risk assessment tool, which includes a reliable assessment of the level of physical activity. The aim of this study was therefore, to analyse the association between the self-reported levels of physical activity, according to the Saltin-Grimby Physical Activity Level Scale (SGPALS) questionnaire, and cardiovascular risk factors, specifically focusing on the group of individuals with the lowest level of self-reported PA.METHODS: We used cross sectional data from the Intergene study, a random sample of inhabitants from the western part of Sweden, totalling 3588 (1685 men and 1903 women, mean age 52 and 51). Metabolic measurements, including serum-cholesterol, serum-triglycerides, fasting plasma-glucose, waist circumference, blood pressure and resting heart rate, as well as smoking and self-reported stress were related to the self-reported physical activity level, according to the modernized version of the SGPALS 4-level scale.RESULTS: There was a strong negative association between the self-reported physical activity level, and smoking, weight, waist circumference, resting heart rate, as well as to the levels of fasting plasma-glucose, serum-triglycerides, low-density lipoproteins (LDL), and self-reported stress and a positive association with the levels of high-density lipoproteins (HDL). The individuals reporting the lowest level of PA (SGPALS, level 1) had the highest odds-ratios (OR) for having pre-defined levels of abnormal risk factors, such as being overweight (men OR 2.19, 95% CI: 1.51-3.19; women OR 2.57, 95 % CI: 1.78-3.73), having an increased waist circumference (men OR 3.76, 95 % CI: 2.61-5.43; women OR 2.91, 95% CI: 1.94-4.35) and for reporting stress (men OR 3.59, 95 % CI: 2.34-5.49; women OR 1.25, 95% CI: 0.79-1.98), compared to the most active individuals, but also showed increased OR for most other risk factors analyzed above.CONCLUSION: The self-reported PA-level according to the modernized Saltin-Grimby Physical Activity Level Scale, SGPALS, is associated with the presence of many cardiovascular risk factors, with the most inactive individuals having the highest risk factor profile, including self-reported stress. We propose that the present SGPALS may be used as an additional, simple tool in a routine risk assessment in e.g. primary care, to identify inactive individuals, with a higher risk profile.
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