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- Gulliksson, Mats, et al.
(author)
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Hazard Function and Secular Trends in the Risk of Recurrent Acute Myocardial Infarction : 30 Years of Follow-Up of More Than 775 000 Incidents
- 2009
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In: Circulation: Cardiovascular Quality and Outcomes. - 1941-7713. ; 2:3, s. 175-185
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Journal article (peer-reviewed)abstract
- Background—The incidence of a first acute myocardial infarction (AMI) has fallen considerably during the last decades. However, no previous studies have analyzed the underlying hazards function of experiencing a recurrent AMI, and none has analyzed the change of risk for a recurrent AMI over the last 3 decades. Methods and Results—The study was based on the Swedish national myocardial infarction register. The register contained more than 1 million AMI events. After exclusion of events occurring in subjects younger than 20 or older than 84 years and events with uncertain first AMI status, 775 901 events occurring between 1972 and 2001 remained for analysis. During the study period, the risk of a new event among survivors of a previous AMI decreased sharply during the first 2 years after the previous event, had its minimum after 5 years, and then increased slowly again. The risk for a recurrent AMI during the first year after a previous event was fairly stable over the years until the late 1970s and then decreased by 36% in women and 40% in men until the late 1990s, irrespective of age and AMI number, mirroring the incidence decrease over the years for primary events. Conclusions—The risk of a recurrent AMI event was highly dependent on time from the previous event, a novel finding which may affect risk scoring. There were strong secular trends toward diminishing risk for a recurrent AMI in recent years, even when other outcome affecting variables were taken into account.
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- Gulliksson, Mats, et al.
(author)
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Psychosocial factors during the first year after a coronary heart disease event in cases and referents : Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM)
- 2007
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In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261 .- 1471-2261. ; 7, s. 36-
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Journal article (peer-reviewed)abstract
- BACKGROUND: A large number of studies have reported on the psychosocial risk factor pattern prior to coronary heart disease events, but few have investigated the situation during the first year after an event, and none has been controlled. We therefore performed a case-referent study in which the prevalence of a number of psychosocial factors was evaluated. METHODS: Three hundred and forty-six coronary heart disease male and female cases no more than 75 years of age, discharged from hospital within the past 12 months, and 1038 referents from the general population, matched to the cases by age, sex and place of living, received a postal questionnaire in which information on lifestyle, psychosocial and quality of life measures were sought. RESULTS: The cases were, as expected, on sick leave to a larger extent than the referents, reported poorer fitness, poorer perceived health, fewer leisure time activities, but unexpectedly reported better social support, and more optimistic views of the future than the referents. There were no significant case-referent differences in everyday life stress, stressful life events, vital exhaustion, depressive mood, coping or life orientation test. However, women reported less favourable situations than men regarding stressful life events affecting others, vital exhaustion, depressive mood, coping, self-esteem, sleep, and symptom reporting, and female cases reported the most unfavourable situation of all groups. CONCLUSION: In this first controlled study of the situation during the first year after a CHD event disease and gender status both appeared to be determinants of psychological well-being, with gender status apparently the strongest. This may have implications for cardiac rehabilitation programmes.
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- Gulliksson, Mats, et al.
(author)
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Randomized Controlled Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients With Coronary Heart Disease Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM)
- 2011
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In: Archives of Internal Medicine. - : American Medical Association (AMA). - 0003-9926 .- 1538-3679. ; 171:2, s. 134-140
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Journal article (peer-reviewed)abstract
- Background: Psychosocial factors are independently associated with increased risk of cardiovascular disease(CVD) morbidity and mortality, but the effects of psychosocial factor intervention on CVD are uncertain. We performed a randomized controlled clinical trial of cognitive behavioral therapy (CBT) to measure its effects on CVD recurrence. Methods: The study included 362 women and men 75 years or younger who were discharged from the hospital after a coronary heart disease event within the past 12 months. Patients were randomized to receive traditional care (reference group, 170 patients) or traditional care plus a CBT program (intervention group, 192 patients), focused on stress management, with 20 two-hour sessions during 1 year. Median attendance at each CBT session was 85%. Outcome variables were all-cause mortality, hospital admission for recurrent CVD, and recurrent acute myocardial infarction. Results: During a mean 94 months of follow-up, the intervention group had a 41% lower rate of fatal and non-fatal first recurrent CVD events (hazard ratio [95% confidence interval], 0.59 [0.42-0.83]; P=.002), 45% fewer recurrent acute myocardial infarctions (0.55 [0.36-0.85]; P=.007), and a nonsignificant 28% lower all-cause mortality (0.72 [0.40-1.30]; P=.28) than the reference group after adjustment for other outcome-affecting variables. In the CBT group there was a strong dose-response effect between intervention group attendance and outcome. During the first 2 years of follow-up, there were no significant group differences in traditional risk factors. Conclusions: A CBT intervention program decreases the risk of recurrent CVD and recurrent acute myocardial infarction. This may have implications for secondary preventive programs in patients with coronary heart disease.
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- Gulliksson, Mats, 1954-
(author)
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Studies of Secondary Prevention after Coronary Heart Disease with Special Reference to Determinants of Recurrent Event Rate
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Objectives. The first aim was to examine the effects of secondary prevention with a focus on determinants in the risk of recurrent coronary heart disease (CHD). The second aim was to analyse the effects of a cognitive behavioural therapy (CBT) intervention on the risk of recurrent cardiovascular disease (CVD) and to investigate the psychosocial situation of CHD patients. Material and methods. Papers I and II were based on the Swedish Acute Myocardial Infarction Statistics Register, 1969 to 2001: 775,901 events in 589,341 subjects. Papers III and IV were based on The Secondary Prevention in Uppsala Primary Care project (SUPRIM), a randomized controlled clinical trial in 362 CHD patients. Results. The risk of a recurrent acute myocardial infarction (AMI) event was highly dependent on time from the previous event, with the greatest risk immediately after an AMI event. In addition, sex, age, and AMI number influenced the general risk level. Furthermore, there has been a major decline in recurrence risk over 30 years, and there were considerable geographical differences in risk, best explained by residential area population density, with a high recurrent AMI risk in areas with the lowest and the highest population densities, and the lowest risk in areas with moderate population density. Disease status and sex were determinants of psychological well-being the first year after a CHD event. Sex seemed to be the stronger determinant. The CBT intervention focused on stress management during one year in patients with CHD. There was significantly improved outcome in the intervention group on recurrent CVD and recurrent AMI during a 9 year follow up. A dose-response relationship was demonstrated between attendance rate at intervention group meetings and outcome, the higher the attendance rate the better the outcome. Conclusions. The risk of a recurrent AMI event was dependent on time from the previous event, with major improvement seen in recent decades. Regional differences were best explained by population density. Female CHD patients were at high risk concerning well-being after a coronary event, which deserves special attention. The CBT intervention for CHD patients improved outcomes concerning the risk of recurrent CVD and AMI events.
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| 9. |
- Norlund, Fredrika, et al.
(author)
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Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease : A sub-analysis from the SUPRIM trial
- 2017
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In: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 24:9, s. 917-925
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Journal article (peer-reviewed)abstract
- Background:The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) was a randomized controlledtrial of a group-based cognitive behavioural therapy stress management programme for patients with coronary heartdisease. The project was successful in reducing the risk of fatal or non-fatal first recurrent cardiovascular events. The aimof this study was to analyse the effect of cognitive behavioural therapy on self-rated stress, somatic anxiety, vitalexhaustion and depression and to study the associations of these factors with the reduction in cardiovascular events.Methods:A total of 362 patients were randomly assigned to intervention or usual care groups. The psychologicaloutcomes were assessed five times during 24 months and analysed using linear mixed models. The mediating roles of theoutcomes were analysed using joint modelling of the longitudinal and time to event data.Results:The intervention had a positive effect on somatic anxiety (p<0.05), reflecting a beneficial development overtime compared with the controls. Stress, vital exhaustion and depression did not differ between the groups over time.Mediator analysis suggested that somatic anxiety may have mediated the effect of treatment on cardiovascular events.Conclusions:The intervention had a small positive effect on somatic anxiety, but did not affect stress, vital exhaustionor depression in patients with coronary heart disease. Somatic anxiety was associated with an increased risk of cardio-vascular events and might act as a partial mediator in the treatment effect on cardiovascular events. However, themechanisms between the intervention and the protective cardiovascular outcome remain to be identified.
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| 10. |
- Olsson, Erik, 1967-, et al.
(author)
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The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary disease : results from the SUPRIM-trial
- 2018
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In: Upsala Journal of Medical Sciences, Supplement. - : Uppsala Medical Society. - 0300-9726 .- 0300-9734 .- 2000-1967. ; 123:3, s. 167-173
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Journal article (peer-reviewed)abstract
- Background: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) is a prospective randomized controlled trial of a group-based cognitive behavioral therapy (CBT) stress management program for coronary heart disease (CHD) patients. The intervention reduced the risk of fatal or non-fatal first recurrent cardiovascular (CV) events. The aim of the present study was to analyze if the positive effects of the CBT program on clinical outcomes could have been mediated by changes in biomarkers for inflammation.Methods: Altogether 362 patients with CHD were randomly assigned to intervention or usual care. The inflammatory biomarkers (VCAM-1, TNF-R1, TNF-R2, PTX3, and hs-CRP) were serially assessed at five time points every six months from study start until 24 months later, and analyzed with linear mixed models.Results: Baseline levels of the inflammatory markers were near normal, indicating a stable phase. The group-based CBT stress management program did not significantly affect the levels of inflammatory biomarkers in patients with CHD. Three out of five (VCAM-1, TNF-R2, and PTX3) inflammatory biomarkers showed a slight increase over time in both study groups, and all were positively associated with age.Conclusion: Group-based CBT stress management did not affect biomarkers for inflammation in patients with CHD. It is therefore unlikely that inflammatory processes including these biomarkers were mediating the effect the CBT program had on the reduction in CV events. The close to normal baseline levels of the biomarkers and the lack of elevated psychological distress symptoms indicate a possible floor effect which may have influenced the results.Keywords: Biomarkers, CBT, CHD, inflammation, stress management
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