| 1. |
- Sjöland, Helen, 1959, et al.
(author)
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Pulmonary embolism and deep venous thrombosis after COVID-19: long-term risk in a population-based cohort study
- 2023
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In: Research and Practice in Thrombosis and Haemostasis. - 2475-0379. ; 7:5
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Journal article (peer-reviewed)abstract
- Background: Venous thromboembolism (VTE) (pulmonary embolism [PE] or deep venous thrombosis [DVT]) is common during acute COVID-19. Long-term excess risk has not yet been established. Objectives: To study long-term VTE risk after COVID-19. Methods: Swedish citizens aged 18 to 84 years hospitalized and/or testing positive for COVID-19 between January 1, 2020, and September 11, 2021 (exposed), stratified by initial hospitalization, were compared to matched (1:5), nonexposed, population-derived subjects without COVID-19. Outcomes were incident VTE, PE, or DVT recorded within 60, 60 to <180, and & GE;180 days. Cox regression was used for evalu-ation, and a model adjusted for age, sex, comorbidities, and socioeconomic markers was developed to control for confounders. Results: Among exposed patients, 48,861 were hospitalized for COVID-19 (mean age, 60.6 years) and 894,121 were without hospitalization (mean age, 41.4 years). Among patients hospitalized for COVID-19, fully adjusted hazard ratios during 60 to <180 days were 6.05 (95% CI, 4.80-7.62) for PE and 3.97 (CI, 2.96-5.33) for DVT compared with that for nonexposed patients with corresponding estimates among those with COVID-19 without hospitalization 1.17 (CI, 1.01-1.35) and 0.99 (CI, 0.86-1.15), based on 475 and 2311 VTE events, respectively. Long-term (& GE;180 days) hazard ratios in patients hospitalized for COVID-19 were 2.01 (CI, 1.51-2.68) for PE and 1.46 (CI, 1.05-2.01) for DVT, while nonhospitalized patients had similar risk as nonexposed patients, based on 467 and 2030 VTE events, respectively. Conclusion: Patients hospitalized for COVID-19 retained an elevated excess risk of VTE, mainly PE, after 180 days, while long-term risk of VTE in individuals with COVID-19 without hospitalization was similar to that in the nonexposed patients.
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| 2. |
- Andréasson, Karin, et al.
(author)
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Body mass index in adolescence, risk of type 2 diabetes and associated complications: A nationwide cohort study of men
- 2022
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In: EClinicalMedicine. - : Elsevier BV. - 2589-5370. ; 46
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Journal article (peer-reviewed)abstract
- Background Obesity is a predominant factor in development of type 2 diabetes but to which extent adolescent obesity influences adult diabetes is unclear. We investigated the association between body mass index (BMI) in young men and subsequent type 2 diabetes and how, in diagnosed diabetes, adolescent BMI relates to glycemic control and diabetes complications. Methods Baseline data from the Swedish Conscript Register for men drafted 1968-2005 was combined with data from the National Diabetes and Patient registries. Diabetes risk was estimated through Cox regression and Kaplan-Meier survival estimates. Relationships between BMI, glycemic control and diabetes complications were assessed through multiple linear and logistic regression. Findings Among 1,647,826 men, 63,957 (3.88%) developed type 2 diabetes over a median follow-up of 29.0 years (IQR[21.0-37.0]). The risk of diabetes within 40 years after conscription was nearly 40% in individuals with adolescent BMI >= 35 kg/m(2). Compared to BMI 18.5-<20 kg/m(2) (reference), diabetes risk increased in a linear fashion from HR 1.18(95%CI 1.15-1.21) for BMI 20-<22.5 kg/m(2) to HR 15.93(95%CI 14.88-17.05) for BMI >= 35 kg/m(2), and a difference in age at onset of 11.4 years was seen. Among men who developed diabetes, higher adolescent BMI was associated with higher HbA1c levels and albuminuria rates. Interpretation Rising adolescent BMI was associated with increased risk of type 2 diabetes diagnosed at a younger age, with poorer metabolic control, and a greater prevalence of albuminuria, all suggestive of worse prognosis. Copyright (C) 2022 The Authors. Published by Elsevier Ltd.
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| 3. |
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| 4. |
- Berg, Christina, 1963, et al.
(author)
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Normal weight adiposity in a Swedish population: how well is cardiovascular risk associated with excess body fat captured by BMI?
- 2015
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In: Obesity Science & Practice. - : Wiley. - 2055-2238. ; 1:1, s. 50-58
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Journal article (peer-reviewed)abstract
- Objective The aim of this study was to examine how well body mass index (BMI) reflects cardiovascular risk associated with excess adiposity in a Swedish population by examining the association between body fat, BMI and cardiovascular risk factors. Methods A total of 3,010 adults participated. Normal weight adiposity was defined as the combination of BMI<25 kg/m2 and percentage body fat ≥35% for women and ≥25% for men. Associations with blood pressure, blood lipids, apolipoproteins and C-reactive protein were analysed in age-adjusted regression models. Results The majority of the individuals with overweight and obesity were correctly classified to adiposity, while a wide range of body fat was observed among the normal weight subjects. In total, 9% of the participants were categorised as normal weight with adiposity. Compared with the normal weight leanness group, participants with normal weight adiposity had higher levels of serum triglycerides, low-density lipoprotein cholesterol, C-reactive protein, apolipoptotein B and the apolipoprotein B/A-I ratio. In normal weight men, adiposity was also associated with higher blood pressure and lower high-density lipoprotein cholesterol. Conclusions Higher percentage of body fat was associated with less favourable risk factor profile even in subjects who were normal weight. Thus, it might be relevant to screen for metabolic risk factors in the upper end of the normal weight category.
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| 5. |
- Berg, Johanna, 1983, et al.
(author)
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Continuing decrease in coronary heart disease mortality in sweden
- 2014
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In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 14:9
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Journal article (peer-reviewed)abstract
- Background: Deaths from coronary heart disease (CHD) have been decreasing in most Western countries over the last few decades. In contrast, a flattening of the decrease in mortality has been recently reported among younger age groups in some countries. We aimed to determine whether the decrease in CHD mortality is flattening among Swedish young adults.Methods: We examined trends in CHD mortality in Sweden between 1987 and 2009 among persons aged 35 to 84 years using CHD mortality data from the Swedish National Register on Cause of Death. Annual percent changes in rates were examined using Joinpoint software.Results: Overall, CHD mortality rates decreased by 67.4% in men and 65.1% in women. Among men aged 35-54 years, there was a modest early attenuation from a marked initial decrease. In the oldest women aged 75-84 years, an attenuation in the mortality decrease was observed from 1989 to 1992, followed by a decrease, as in all other age groups.Conclusions: In Sweden, coronary heart disease deaths are still falling. We were unable to confirm a flattening of the decline in young people. Death rates continue to decline in men and women across all age groups, albeit at a slower pace in younger men since 1991. Continued careful monitoring of CHD mortality trends in Sweden is required, particularly among young adults. © 2014 Berg et al.; licensee BioMed Central Ltd.
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| 6. |
- Berg, Johanna, 1983, et al.
(author)
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Sex differences in survival after myocardial infarction in Sweden, 1987-2010
- 2017
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In: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 103:20, s. 1625-1630
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Journal article (peer-reviewed)abstract
- Objective In this nationwide study, we investigated age-specific and sex-specific trends in sex differences in survival after acute myocardial infarction (AMI), including deaths from coronary heart disease (CHD) that occurred outside hospital. Methods Observational study in Sweden of 28-day and 1-year mortality among 658 110 persons (35.7% women) aged 35-84 years with a first-time CHD event 1987-2010 with data retrieved from the national Swedish death and hospital registries. Results Age-adjusted 28-day case fatality decreased from 23.5% to 8.5% over the period (p<0.05). In hospitalised cases, short-term survival in women aged 35-54 years compared with men of the same age was poorer, not changing appreciably over time (HRs for women relative to men 1.63 (95% CI 1.28 to 2.08) at age 35-54 years and 1.28 (95% CI 1.12 to 1.46) at age 55-64 years in 2005-2010), but after adjustment for comorbidities, differences between men and women were no longer significant (HR 1.25 (95% CI 0.97 to 1.61) and 1.05 (95% CI 0.91 to 1.20)). When CHD deaths outside hospital were included, women had better prognosis regardless of age and period. In patients surviving the first 28 days, age-adjusted 1-year case fatality decreased from 15.3% to 7.7% (p<0.05) for both men and women. After adjustment for comorbidities, no significant sex differences persisted below the age of 75 years in the last period. Female 28day survivors 75-84 years old had a consistently better prognosis than older men. Conclusions The worse short-term outcomes in women <55 years of age hospitalised with AMI did not persist after adjustment for comorbidities. When CHD deaths outside hospital were included, women had consistently better short-term prognosis. In 28-day survivors, women did not fare worse than men when differences in comorbidities were considered.
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| 7. |
- Berg, Johanna, 1983, et al.
(author)
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Symptoms of a first acute myocardial infarction in women and men.
- 2009
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In: Gender medicine : official journal of the Partnership for Gender-Specific Medicine at Columbia University. - : Elsevier BV. - 1878-7398. ; 6:3, s. 454-62
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Journal article (peer-reviewed)abstract
- BACKGROUND: Many studies have compared women and men for symptoms of acute myocardial infarction (AMI), but findings have been inconsistent, largely because of varying inclusion criteria, different study populations, and different methods. OBJECTIVE: The purpose of this study was to analyze gender differences in symptoms in a well-defined, population-based sample of women and men who experienced a first AMI. METHODS: Information on symptoms was collected from the medical charts of all patients with a first AMI, aged 25 to 74 years, who had taken part in the INTERGENE (Interplay Between Genetic Susceptibility and Environmental Factors for the Risk of Chronic Diseases) study. INTERGENE was a population-based research program on risk factors for cardiovascular disease. Medical charts were reviewed for each patient to determine the symptoms of AMI, and the prevalence of each symptom was compared according to sex. RESULTS: The study included 225 patients with a first AMI: 52 women and 173 men. Chest pain was the most common symptom, affecting 88.5% (46/52) of the women and 94.8% (164/173) of the men, with no statistically significant difference between the sexes. Women had significantly higher rates of 4 symptoms: nausea (53.8% [28/52] vs 29.5% [51/173]; age-adjusted odds ratio [OR] = 2.78; 95% CI, 1.47-5.25), back pain (42.3% [22/52] vs 14.5% [25/173]; OR = 4.29; 95% CI, 2.14-8.62), dizziness (17.3% [9/52] vs 7.5% [13/173]; OR = 2.60; 95% CI, 1.04-6.50), and palpitations (11.5% [6/52] vs 2.9% [5/173]; OR = 3.99; 95% CI, 1.15-13.84). No significant gender differences were found in the proportions of patients experiencing arm or shoulder pain, diaphoresis, dyspnea, fatigue, neck pain, abdominal pain, vomiting, jaw pain, or syncope/lightheadedness. No significant differences were found in the duration, type, or location of chest pain. The medical charts listed numerically more symptoms in women than in men; 73.1% (38/52) of the women but only 48.0% (83/173) of the men reported >3 symptoms (age-adjusted OR = 3.26; 95% CI, 1.62-6.54). CONCLUSIONS: Chest pain is the most common presenting symptom in both women and men with AMI. Nausea, back pain, dizziness, and palpitations were significantly more common in women. Women as a group displayed a greater number of symptoms than did men.
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| 8. |
- Björck, Lena, 1959, et al.
(author)
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Absence of chest pain and long-term mortality in patients with acute myocardial infarction
- 2018
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In: Open Heart. - : BMJ. - 2053-3624. ; 5:2
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Journal article (peer-reviewed)abstract
- Objective Chest pain is the predominant symptom in patients with acute myocardial infarction (AMI). A lack of chest pain in patients with AMI is associated with higher in-hospital mortality, but whether this outcome is sustained throughout the first years after onset is unknown. Therefore, we aimed to investigate long-term mortality in patients hospitalised with AMI presenting with or without chest pain. Methods All AMI cases registered in the SWEDEHEART registry between 1996 and 2010 were included in the study. In total, we included 172 981 patients (33.5% women) with information on symptom presentation. Results Patients presenting without chest pain (12.7%) were older, more often women and had more comorbidities, prior medications and complications during hospitalisation than patients with chest pain. Short-term and long-term mortality rates were higher in patients without chest pain than in patients with chest pain: 30-day mortality, 945 versus 236/1000 person-years; 5-year mortality, 83 versus 21/1000 person-years in patients <65 years. In patients >= 65 years, 30-day mortality was 2294 versus 1140/1000 person-years; 5-year mortality, 259 versus 109/1000 person-years. In multivariable analysis, presenting without chest pain was associated with an overall 5-year HR of 1.85(95% CI 1.81 to 1.89), with a stronger effect in younger compared with older patients, as well as in patients without prior AMI, heart failure, stroke, diabetes or hypertension. Conclusion Absence of chest pain in patients with AMI is associated with more complications and higher short-term and long-term mortality rates, particularly in younger patients, and in those without previous cardiovascular disease.
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| 9. |
- Björck, Lena, 1959, et al.
(author)
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Body mass index in women aged 18 to 45 and subsequent risk of heart failure.
- 2020
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In: European journal of preventive cardiology. - : Oxford University Press (OUP). - 2047-4881 .- 2047-4873. ; 27:11, s. 1165-1174
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Journal article (peer-reviewed)abstract
- The incidence of heart failure (HF) is decreasing in older ages, but increasing rates have been observed among younger persons in Sweden. Therefore, we investigated the relationship between risk of hospitalization for HF and body mass index (BMI).This was a prospective registry-based cohort study. We included 1,374,031 women aged 18-45 years (mean age 27.9 years) who gave birth during 1982-2014, and were registered in the Medical Birth Register. Information on hospitalization because of HF was collected through linkage to the National Inpatient Register.Compared to women with a BMI of 20-<22.5kg/m2, women with a BMI of 22.5-<25.0 had a hazard ratio (HR) of 1.24 (95% confidence interval (CI), 1.10-1.39) for HF after adjustment for age, year, parity, baseline disorders, smoking, and education. The HR (95% CI) increased to 1.56 (1.36-1.78), 2.39 (2.05-2.78), 2.82 (2.43-3.28), and 4.51 (3.63-5.61) in women with a BMI of 25-<27.5, 27.5-<30, 30-<35, and ≥35kg/m2, respectively. The multiple-adjusted HRs (95% CI) associated with risk of HF per one-unit increase in BMI in women with a BMI≥22.5kg/m2 ranged from 1.01 (0.97-1.06) for HF related to valvular disease to 1.14 (1.12-1.15) for coronary heart disease, diabetes, or hypertension.Increasing body weight was strongly associated with the risk of early HF in women. Compared with lean women, the risk for HF started to increase at high-normal BMI levels, and was nearly five-fold in women with a BMI≥35kg/m2.
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| 10. |
- Björck, Lena, 1959, et al.
(author)
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Body weight in midlife and long-term risk of developing heart failure-a 35-year follow-up of the primary prevention study in Gothenburg, Sweden
- 2015
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In: Bmc Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 15
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Journal article (peer-reviewed)abstract
- Background: This study aimed to determine whether midlife obesity predicts heart failure (HF) over an extended follow-up into old age. Methods: We studied 7495 men (from a population sample of 9,998 men) without HF, who were 47-55 years old when investigated in 1970 to 1973. All participants were followed up for 35 years, or until death, using the Swedish National Inpatient Register (IPR) and the Cause of Death Register. Over follow-up, 1855 men (24.7%) were discharged from hospital or died with a diagnosis of HF. Results: There was a strong relation between obesity and future risk of HF, which was accentuated over the last years of the long follow-up. After adjusting for age, the risk of HF increased stepwise with increasing body mass index (BMI), even in those with a normal BMI (22.5-24.9) The subdistribution hazard ratio (SHR) was 1.20 (95% CI: 1.02-1.39) in men with a normal BMI, 1.29 (95% CI: 1.11-1.50) for a BMI of 25-27.49, 1.50 (95% CI: 1.27-1.77) for a BMI of 27.5-29.99, and 1.62 (95% CI: 1.33-1.97) for a BMI >30. After adjusting for, age, smoking, occupational class, and physical activity, the results were unchanged. Conclusion: Obesity in midlife is strongly related to the long-term risk of developing HF extending into old age where the risk is highest. Even normal body weight (BMI <25) was related to an increased risk of developing HF during life. Because overweight and obesity are largely preventable, our findings further emphasize the importance of public health interventions against the development of obesity.
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