| 1. |
- Wamala, Sarah, et al.
(author)
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Lipid profile and socioeconomic status in healthy middle aged women in Sweden
- 1997
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In: Journal of Epidemiology and Community Health. - : BMJ Publishing Group. - 0143-005X .- 1470-2738. ; 51:4, s. 400-407
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Journal article (peer-reviewed)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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| 2. |
- Fridner, Ann, et al.
(author)
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Why don't academic physicians seek needed professional help for psychological distress?
- 2012
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In: Swiss Medical Weekly. - : SMW Supporting Association. - 1424-7860 .- 1424-3997. ; 142:JULY
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Journal article (peer-reviewed)abstract
- PURPOSE: Suicidal thoughts, burnout and other signs of psychological distress are prevalent among physicians. There are no studies concerning help-seeking for psychological distress among university hospital physicians, who face a particularly challenging, competitive work environment. We compare psychologically-distressed university hospital physicians who have not sought needed help with those who have sought such help. We thereby aim to identify factors that may hinder help-seeking and factors that may trigger seeking help. METHODS: Analysis was performed among university hospital physicians reporting recent suicidal thoughts and/or showing other indications of current psychological illhealth. These distressed physicians were a subgroup (42.7%) from the cross-sectional phase I HOUPE study (Health and Organization among University Hospital Physicians in Europe): 366 from Sweden and 150 from Italy. Having sought professional help for depression or burnout was the outcome variable. Multiple logistic regression was performed with socio-demographic factors as covariates. RESULTS: Altogether 404 (78.3%) of these distressed physicians had never sought professional help for depression/burnout. Physicians who were currently involved in medical research, taking night call, surgical specialists, male, or Italian were least likely to have sought help. Physicians who faced harassment at work or who self-diagnosed and self-treated were more likely to have sought help. CONCLUSION: Very few of these university hospital physicians with signs of psychological distress sought help from a mental-health professional. This has implications for physicians themselves and for patient care, clinical research, and education of future physicians. More study, preferably of interventional design, is warranted concerning help-seeking among these physicians in need.
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| 3. |
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| 4. |
- Janszy, I., et al.
(author)
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Alcohol consumption and coronary atherosclerosis progression : The Stockholm female coronary risk angiography study
- 2004
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In: Atherosclerosis. - : Elsevier BV. - 0021-9150 .- 1879-1484. ; 176:2, s. 311-319
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To assess the association of alcohol intake with progression of coronary atherosclerosis. Although moderate drinkers have a lower risk of coronary heart disease than abstainers, the relation of alcohol use and coronary atherosclerosis has not been well studied. METHODS AND RESULTS: In the Stockholm Female Coronary Risk Angiographic Study, we evaluated 103 women, aged 65 years or younger, hospitalized with acute myocardial infarction or unstable angina pectoris who underwent serial quantitative coronary angiography 3-6 months following their index event and repeated an average of 3 years and 3 months (range 2-5 years) later. Individual alcoholic beverage consumption was assessed by a standardized questionnaire. We used mixed model analysis to estimate the effect of alcohol consumption on progression of coronary atherosclerosis, as measured by mean luminal diameter change, controlling for age, smoking, body-mass index, education, physical activity, index cardiac event, menopausal status, diabetes, and history of dyslipidemia. Of the 93 women with complete information on alcohol intake, 14 consumed no alcohol (abstainers), 55 consumed up to 5 g of alcohol per day (light drinkers), and 24 consumed more than 5 g of alcohol per day (moderate drinkers). Coronary atherosclerosis progressed by a multivariate-adjusted average of 0.138 mm (95% confidence interval (CI): 0.027-0.249) among abstainers, 0.137 mm (95% CI: 0.057-0.217) among light drinkers, and -0.054 mm (95% CI: -0.154 to 0.047) among moderate drinkers (P < 0.001). The inverse association persisted in analyses stratified by index event. No beverage type appeared to confer particular benefit. CONCLUSIONS: Among middle-aged women with coronary heart disease, moderate alcohol consumption (over 5 g/day) was protective of coronary atherosclerosis progression.
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| 5. |
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| 6. |
- Al-Khalili, F, et al.
(author)
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Clinical importance of risk factors and exercise testing for prediction of significant coronary artery stenosis in women recovering from unstable coronary artery disease : The Stockholm Female Coronary Risk Study
- 2000
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In: American Heart Journal. - Karolinska Hosp & Inst, Dept Cardiol, Stockholm, Sweden. Karolinska Hosp & Inst, Dept Thorac Radiol, Stockholm, Sweden. Karolinska Hosp & Inst, Dept Publ Hlth Sci, Div Prevent Med, Stockholm, Sweden. : MOSBY-ELSEVIER. - 0002-8703 .- 1097-6744. ; 139:6, s. 971-978
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Journal article (peer-reviewed)abstract
- Background The objectives of this study were to investigate the relation between coronary risk factors, exercise testing parameters, and the presence of angiographically significant coronary artery disease (CAD) (>50% luminal stenosis) in female patients previously hospitalized for an acute CAD event. Methods and Results All women younger than age 66 years in the greater Stockholm area in Sweden who were hospitalized for acute coronary syndromes during a 3-year period were recruited, Besides collection of clinical parameters, coronary angiography and a symptom-limited exercise test were performed in 228 patients 3 to 6 months after the index hospitalization. The mean age was 56 +/- 7 years. Angiographically nonsignificant CAD (stenosis <50%) was verified in 37% of the patients; significant CAD was found in 63%. The clinical parameters that showed the strongest relation with the presence of significant CAD after adjusting for age were history of myocardial infarction (odds ratio [OR] 4.91, 95% confidence interval [CI] 2.35 to 7.49), history of diabetes mellitus (OR 3.83, 95% Cl 1.63 to 14.31), serum high-density lipoprotein cholesterol <1.4 mmol/L (OR 2.11, 95% Cl 1.20 to 3.72), and waist-to-hip ratio >0.85 (OR 1.78, 95% Cl 1.02 to 3.10). A low exercise capacity and associated low change of rate-pressure product from rest to peak exercise were the only exercise testing parameters that were significantly related to angiographically verified significant CAD (<90% of the predicted maximal work capacity adjusted for age and weight, OR 1.91, 95% CI 1.04 to 3.50). Conclusions In female patients recovering from unstable CAD, exercise capacity was the only exercise testing parameter of value in the prediction of significant CAD. The consideration of certain clinical characteristics and coronary risk factors offer better or complementary information when deciding on further coronary assessment.
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| 7. |
- Al-Khalili, F, et al.
(author)
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Clinical predictors of poor outcome in women recovering from acute coronary syndrome
- 2000
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In: Journal of the American College of Cardiology. - Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. Karolinska Hosp, Dept Publ Hlth Sci, Div Prevent Med, S-10401 Stockholm, Sweden. Karolinska Hosp, Dept Thorac Radiol, S-10401 Stockholm, Sweden. Karolinska Inst, Stockholm, Sweden. : ELSEVIER SCIENCE INC. - 0735-1097 .- 1558-3597. ; 35:2, s. 392A-392A
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Journal article (other academic/artistic)
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| 8. |
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| 9. |
- Al-Khalili, F, et al.
(author)
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Prognostic value of exercise testing in women after acute coronary syndromes (The Stockholm Female Coronary Risk Study)
- 2000
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In: American Journal of Cardiology. - Karolinska Hosp, Dept Cardiol, S-17176 Stockholm, Sweden. Karolinska Hosp, Dept Publ Hlth Sci, Div Prevent Med, S-17176 Stockholm, Sweden. Karolinska Inst, Stockholm, Sweden. : EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. - 0002-9149 .- 1879-1913. ; 86:2, s. 211-213
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Journal article (peer-reviewed)
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| 10. |
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| 11. |
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| 12. |
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| 13. |
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| 14. |
- Daniel, M., et al.
(author)
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Prevalence of Anxiety and Depression Symptoms in Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries
- 2018
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In: American Journal of Medicine. - : Elsevier BV. - 0002-9343 .- 1555-7162. ; 131:9, s. 1118-1124
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Journal article (peer-reviewed)abstract
- BACKGROUND: Myocardial infarction with non-obstructive coronary arteries is a working diagnosis for several heart disorders. Previous studies on anxiety and depression in patients with myocardial infarction with non-obstructive coronary arteries are lacking. Our aim was to investigate the prevalence of anxiety and depression among patients with myocardial infarction with non-obstructive coronary arteries. METHODS: We included 99 patients with myocardial infarction with non-obstructive coronary arteries together with age- and sex-matched control groups who completed the Beck Depression Inventory and the Hospital Anxiety and Depression Scale (HADS) 3 months after the acute event. RESULTS: Using the Beck Depression Inventory, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (35%) was higher than in healthy controls (9%; P = .006) and similar to that of patients with coronary heart disease (30%; P = .954). Using the HADS anxiety subscale, we found that the prevalence of anxiety in patients with myocardial infarction with non-obstructive coronary arteries (27%) was higher than in healthy controls (9%; P = .002) and similar to that of patients with coronary heart disease (21%; P = .409). Using the HADS depression subscale, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (17%) was higher than in healthy controls (4%; P = .003) and similar to that of patients with coronary heart disease (13%; P = .466). Patients with myocardial infarction with non-obstructive coronary arteries and takotsubo syndrome scored higher on the HADS anxiety subscale than those without (P = .028). CONCLUSIONS: This is the first study on the mental health of patients with myocardial infarction with non obstructive coronary arteries to show that prevalence rates of anxiety and depression are similar to those in patients with coronary heart disease. (C) 2018 Elsevier Inc. All rights reserved.
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| 15. |
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| 16. |
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| 17. |
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| 18. |
- Eriksson, M, et al.
(author)
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Relationship between plasma fibrinogen and coronary heart disease in women
- 1999
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In: 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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Journal article (peer-reviewed)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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| 19. |
- Fridner, Ann, et al.
(author)
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Recent suicidal ideation among female and male university hospital physicians in Sweden (The HOUPE Study) : Associations with work stressors
- 2008
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In: 3rd International Congress of Gender Medicine, Stockholm, Sweden, the 12-14th of September 2008.
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Conference paper (peer-reviewed)abstract
- Background: Suicide rates for physicians are noted to be higher than for the general population, mainly related to high rates among female physicians. Female physicians have been reported to admit to significantly more suicidal thoughts than male physicians. Suicide ideation is a recognized precursor of suicide. The urgent need to examine the reasons for suicide risk among female physicians is underscored by society’s increasing dependence upon this group of health providers. Suicide impacts not only upon the physician’s personal circle, but upon the colleagues, staff and patients alike. We examine the relationship between work stressors and recent suicide ideation among male and female physicians in Sweden.Methods: Cross-sectional questionnaire-based study including the General Nordic Questionnaire for Psychological and Social Factors at Work (QPS-Nordic), Physician Career Path Questionnaire (PCPQ) and the Mehan Suicidal Ideation Scale. The questionnaire was completed by physicians working at the Karolinska University Hospital, Stockholm. Multiple logistic regression was used to identify sets of independent variables showing the strongest association with suicidal ideation within the last 12 months.Results: Altogether 50 of the 385 Swedish female physicians and 42 of the 434 male physicians reported having suicidal thoughts within the last 12 months. Among the female physicians, adjusting for non-significant covariates: age, having a partner and number of children, the two work-related variables associated with suicidal ideation within the last 12 months were: having been subjected to degrading experiences at work (Odds Ratio (OR)=3.11, 95% Confidence Interval (CI) =1.52–6.38) and not having regular meetings to discuss stressful situations at work (OR=2.82, CI=1.04–7.63). Self diagnosis and treatment was also significantly associated with recent suicidal ideation. The same covariates were included for the male physicians, for whom having been subjected to degrading experiences at work was significant (OR=4.25, CI=1.60-11.25).Conclusions: Albeit statistically non-significant, more than the expected number of female physicians compared to males had recent suicidal ideation. Recent suicidal ideation among both male and female physicians in Sweden showed a strong association with an important work stressor: having been subjected to degrading experiences at work. For Swedish female physicians, having meetings to discuss work stressors may be protective.
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| 20. |
- Fridner, Ann, et al.
(author)
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The pivotal role of work environment for the mental health of female and male physicians
- 2010
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Conference paper (peer-reviewed)abstract
- Aim/Setting: To examine the relationship between the work environment and mental health among 327 female and 402 male Swedish physicians from the HOUPE study (Health and Organization among University Hospital Physicians) and for whom complete data were available. Methods: The work environment was assessed by individual items and by validated scales from the Questionnaire for Psychological and Social Factors at Work (QPS-Nordic). Using the additive General Health Questionnaire (GHQ-12), MOLBI (exhaustion and disengagement scales) and the Mehan Suicidal Ideation Scale, we constructed a combined outcome variable reflecting mental health as: below the median on the scales and no recent suicidal thoughts. Results: Forty-seven (14.4%) female and seventy-nine (19.7%) male physicians were positive for the outcome variable reflecting mental health. Healthy Work Organization, Work Support in Tough Situations and Control over Workpace each showed significant associations being positive for the outcome variable. This was the case for both the female and male physicians, after adjusting for non-significant covariates: age, number of children and civil status. Male physicians had more control over their workpace than females (p < 0.0001). Factors significantly, inversely associated with the outcome variable included role conflict, recent degrading experiences, performing tasks in conflict with personal values, having night call duty, and work demands interfere with family life (both genders), and for the male physicians only, home demands interfering with work. Conclusions: For these female and male physicians, the work environment plays a pivotal role in mental health, and therefore merits much more attention than it has heretofore received.
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| 21. |
- Gustafsson Sendén, Marie, et al.
(author)
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What makes physicians go to work while sick : A comparative STUDY of Sickness presenteeism in four European countries (HOUPE)
- 2013
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In: Swiss Medical Weekly. - : SMW Supporting Association. - 1424-7860 .- 1424-3997. ; 143
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Journal article (peer-reviewed)abstract
- QUESTIONS UNDER STUDY: Sickness presenteeism is common in the health sector, especially among physicians, leading to high costs in terms of medical errors and loss in productivity. This study investigates predictors of sickness presenteeism in university hospitals, which might be especially exposed to competitive presenteeism. The study included comparisons of university hospitals in four European countries. METHODS: A cross-sectional survey analysis of factors related to sickness behaviour and work patterns in the field of academic medicine was performed among permanently employed physicians from the HOUPE (Health and Organisation among University Physicians Europe) study: (Sweden n = 1,031, Norway n= 354, Iceland n = 242, Italy n = 369). The outcome measure was sickness presenteeism. RESULTS: Sickness presence was more common among Italian physicians (86%) compared with physicians in other countries (70%-76%). Country-stratified analyses showed that sickness presenteeism was associated with sickness behaviour and role conflicts in all countries. Competition in the form of publishing articles was a predictor in Italy and Sweden. Organisational care for physician well-being reduced sickness presenteeism in all countries. CONCLUSION: Sickness presenteeism in university hospitals is part of a larger behavioural pattern where physicians seem to neglect or hide their own illness. Factors associated with competitive climate and myths about a healthy doctor might contribute to these behaviours. Importantly, it is suggested that managers and organisations should work actively to address these questions since organisational care might reduce the extent of these behaviours.
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| 22. |
- Horsten, M, et al.
(author)
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Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women - The Stockholm Female Coronary Risk Study
- 2000
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In: European Heart Journal. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, Stockholm, Sweden. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA USA. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : W B SAUNDERS CO LTD. - 0195-668X .- 1522-9645. ; 21:13, s. 1072-1080
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Journal article (peer-reviewed)abstract
- Aims Several studies have reported that women with coronary heart disease have a poorer prognosis than men. Psychosocial factors, including social isolation and depressive symptoms have been suggested as a possible cause. However. little is known; about these factors and their independent predictive value in women. Therefore, we investigated the prognostic impact of depression, lack of social integration and their interaction in the Stockholm Female Coronary Risk Study. Methods and Results Two hundred and ninety-two women patients aged 30 to 65 years and admitted for an acute coronary event between 1991 and 1994, were followed for 5 years from baseline assessments, which were performed between 3 and 6 months after admission. Lack of social integration and depressive symptoms, assessed at baseline by standardized questionnaires, were associated with recurrent events. including cardiovascular mortality, acute myocardial infarction and revascularization procedures (percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). Adjusting for age, diagnosis at index event. symptoms of heart failure, diabetes mellitus, high density lipoprotein (HDL) cholesterol, history of hypertension, systolic blood pressure, smoking, sedentary lifestyle, body mass index, and severity of angina pectoris symptoms. the hazard ratio associated with low (lowest quartile) as compared to high social integration (upper quartile) was 2.3 (95% CI 1.2-4.5) and the hazard ratio associated with two or more (upper three quartiles) as compared to one or no depressive symptoms was 1.9 (95% CI 1.02-3 6). Conclusions The presence of two or more depressive symptoms and lack of social integration independently predicted recurrent cardiac events in women with coronary heart disease. Women who were free of both these risk factors, had the best prognosis. (C) 2000 The European Society of Cardiology.
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| 23. |
- Horsten, M, et al.
(author)
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Psychosocial factors and heart rate variability in healthy women.
- 1999
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In: Psychosomatic Medicine. - : Ovid Technologies (Wolters Kluwer Health). - 0033-3174 .- 1534-7796. ; 61:1, s. 49-57
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Journal article (peer-reviewed)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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| 24. |
- Horsten, M, et al.
(author)
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Social relations and the metabolic syndrome in middle-aged Swedish women
- 1999
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In: 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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Journal article (peer-reviewed)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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| 25. |
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| 26. |
- Janszky, I., et al.
(author)
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Heart rate variability in long-term risk assessment in middle-aged women with coronary heart disease : The Stockholm Female Coronary Risk Study
- 2004
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In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 255:1, s. 13-21
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Journal article (peer-reviewed)abstract
- Objectives. Low heart rate variability (HRV) is associated with poor prognosis after acute coronary events in men. In women, the prognostic impact is not well documented. The objective of this study was to assess the long-term predictive power of HRV on mortality amongst middle-aged women with coronary heart disease (CHD). Design, Settings and Subjects. Consecutive women below 65 years hospitalized for an acute coronary syndrome during a 3-year period in Stockholm were examined for cardiovascular prognostic factors including HRV, and followed for a median of 9 years. An ambulatory 24-h electrocardiograph was recorded during normal activities, 3-6 months after hospitalization. SDNN index (mean of the standard deviations of all normal to normal intervals for all 5-min segments of the entire recording) and the following frequency domain parameters were assessed: total power, high-frequency (HF) power, low-frequency (LF) power, very-low frequency (VLF) power and LF/HF ratio. Using Cox proportional hazards regression, the hazard ratios (HR) for each 25% decrease of the HRV parameters were assessed. Results. After controlling for the independent, significant predictors of mortality amongst the clinical variables, the following HRV parameters were found to be significant predictors of all-cause mortality: SDNN index [HR 1.56, 95% confidence intervals (CI) 1.19-2.05], total power (HR 1.21, 95% CI 1.08-1.35), VLF power (HR 1.22, 95% CI 1.09-1.36), LF power (HR 1.18 95%, CI 1.07-1.30) and HF power (HR 1.18, 95% CI 1.05-1.33). The results were essentially the same when cardiovascular mortality was used as end-points. The HRV parameters were stronger predictors of mortality in the first 5 years following the index event. Conclusion. Low HRV is a predictor of long-term mortality amongst middle-aged women with CHD when measured 3-6 months after hospitalization for an acute coronary syndrome, even after controlling for established clinical prognostic markers.
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| 27. |
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| 28. |
- Koertge, J C, et al.
(author)
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Vital exhaustion in relation to lifestyle and lipid profile in healthy women
- 2003
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In: International Journal of Behavioral Medicine. - : LAWRENCE ERLBAUM ASSOC INC. - 1070-5503 .- 1532-7558. ; 10:1, s. 44-55
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Journal article (peer-reviewed)abstract
- "Vital exhaustion," characterized by fatigue, irritability, and demoralization, precedes new and recurrent coronary events. Biological mechanisms explaining this association are not fully understood. The objective was to investigate the relationship between vital exhaustion, lifestyle, and lipid profile. Vital exhaustion, smoking, body mass index (BMI), alcohol consumption, exercise capacity, and serum lipids were determined in 300 healthy women, aged 56.4 +/- 7.1 years. No statistically significant associations were found between vital exhaustion and lifestyle variables. Divided into quartiles, vital exhaustion was inversely related to high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 in a linear fashion after adjustment for age, BMI, exercise capacity, and alcohol consumption. A multivariate-adjusted vital exhaustion-score in the top quartile, as compared to one in the lowest, was associated with 12% lower HDL-C and 8% lower apolipoprotein A1 (p < .05). In conclusion, alterations in lipid metabolism may be a possible mediating mechanism between vital exhaustion and coronary heart disease. The impact of lifestyle variables was weak.
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| 29. |
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| 33. |
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| 34. |
- Orth-Gomér, K., et al.
(author)
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Marital stress worsens prognosis in women with coronary heart disease : The Stockholm female coronary risk study
- 2000
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In: Journal of the American Medical Association (JAMA). - : American Medical Association. - 0098-7484 .- 1538-3598. ; 284:23, s. 3008-3014
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Journal article (peer-reviewed)abstract
- Context: Psychosocial stress has been associated with incidence of coronary heart disease (CHD) in men, but the prognostic impact of such stress rarely has been studied in women. Objective: To investigate the prognostic impact of psychosocial work stress and marital stress among women with CHD. Design and Setting: Population-based, prospective follow-up study conducted in the city of Stockholm, Sweden. Participants: A total of 292 consecutive female patients aged 30 to 65 years (n = 279 working or cohabiting with a male partner) who were hospitalized for acute myocardial infarction or unstable angina pectoris between February 1991 and February 1994. Patients were followed up from the date of clinical examination until August 1997 (median, 4.8 years). Main Outcome Measures: Recurrent coronary events, including cardiac death, acute myocardial infarction, and revascularization procedures, by marital stress (assessed using the Stockholm Marital Stress Scale, a structured interview) and by work stress (assessed using the ratio of work demand to work control). Results: Among women who were married or cohabiting with a male partner (n = 187), marital stress was associated with a 2.9-fold (95% confidence interval [CI], 1.3-6.5) increased risk of recurrent events after adjustment for age, estrogen status, education level, smoking, diagnosis at index event, diabetes mellitus, systolic blood pressure, smoking, triglyceride level, high-density lipoprotein cholesterol level, and left ventricular dysfunction. Among working women (n = 200), work stress did not significantly predict recurrent coronary events (hazard ratio, 1.6; 95% CI, 0.8-3.3). Conclusions: Our results indicate that marital stress but not work stress predicts poor prognosis in women aged 30 to 65 years with CHD. These findings differ from previous findings in men and suggest that specific preventive measures be tailored to the needs of women with CHD.
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| 35. |
- Orth-Gomer, K, et al.
(author)
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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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In: 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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Journal article (peer-reviewed)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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- Wamala, S.P, et al.
(author)
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Education and the metabolic syndrome in women
- 1999
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In: 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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Journal article (peer-reviewed)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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| 43. |
- Wamala, S.P, et al.
(author)
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Job stress and the occupational gradient in coronary heart disease risk in women - The Stockholm Female Coronary Risk Study
- 2000
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In: Social Science and Medicine. - Karolinska Inst, Div Prevent Med, Dept Publ Hlth Sci, Stockholm, Sweden. Harvard Univ, Sch Publ Hlth, Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA 02115 USA. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : PERGAMON-ELSEVIER SCIENCE LTD. - 0277-9536 .- 1873-5347. ; 51:4, s. 481-489
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Journal article (peer-reviewed)abstract
- Recent studies of men have shown that job stress is important in understanding the occupational gradient in coronary heart disease (CHD), but these relationships have rarely been studied in women. With increasing numbers of women in the workforce it is important to have a more complete understanding of how CHD risk may be mediated by job stress as well as other biological and behavioural risk factors. The objective of this study was to examine the occupational gradient in CHD risk in relation to job stress and other traditional risk factors in currently employed women. We used data from the Stockholm Female Coronary Risk Study, a population based case-control study, comprising 292 women with CHD aged 65 years or younger and 292 age-matched healthy women (controls). An inversely graded association was observed between occupational class and CHD risk. Compared with the highest (executive/professional), women in the lowest occupational class (semi/unskilled) had a four-fold (95% CI 1.75-8.83) increased age-adjusted risk for CHD, Simultaneous adjustment for traditional risk factors and job stress attenuated this risk to 2.45 (95% CI 1.01-6.14). Neither job control nor the Karasek demand-control model of job stress substantially explained the increased CHD risk of women in the lowest occupational classes. It is likely that lower occupational class working women face multiple and sometimes interacting sources of work and non-work stress that are mediated by behavioural and biological factors that increase their CHD risk. (C) 2000 Elsevier Science Ltd. All rights reserved.
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| 44. |
- Wamala, S.P, et al.
(author)
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Short stature and prognosis of coronary heart disease in women
- 1999
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In: Journal of Internal Medicine. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, S-14157 Huddinge, Sweden. Karolinska Hosp, Dept Cardiol, Stockholm, Sweden. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA USA. : WILEY. - 0954-6820 .- 1365-2796. ; 245:6, s. 557-563
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Journal article (peer-reviewed)abstract
- Objectives. To investigate the effect of short stature on prognosis following an acute event of coronary heart disease (CHD) in women. Setting. All women who were hospitalized for an acute event of CHD in any of the 10 cardiology clinics in greater Stockholm were investigated for the first time in the Stockholm Female Coronary Risk Study between 1991 and 1994, and were followed until August 1997 for recurrent coronary events. Design. A follow-up study of women with either acute myocardial infarction (AMI) or unstable angina pectoris, Median follow-up period was 4.8 years. Subjects. A total of 292 Swedish women, aged 65 years or younger. Main outcome measures. Recurrent AMI, death from CHD or revascularization procedure (percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). Results. Independent of the confounding effects of other risk factors of clinical importance for CHD (age, socioeconomic status, menopausal status, index event, congestive heart failure, angina severity, diabetes, hypertension, smoking, triglycerides and HDL cholesterol), the shortest 25% of women (<160 cm) had a 2.1-fold (95% CI = 1.0-4.4) increased rate of developing adverse cardiac events (cardiovascular death, recurrent AMI or revascularization procedure) compared with the tallest 25% (>165 cm). In addition, an increased rate was observed for each 10 cm difference in height (hazard ratio = 1.7, 95% CI = 1.4-2.7). Similar results were observed when analysing each outcome separately. Conclusions. These data indicate that short stature is a strong predictor of poor prognosis after an acute coronary event in women, independent of socioeconomic status and other risk factors for CHD.
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| 45. |
- Wamala, S. P, et al.
(author)
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Socioeconomic status and determinants of hemostatic function in healthy women
- 1999
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In: 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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Journal article (peer-reviewed)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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| 46. |
- Wamala, Sarah, et al.
(author)
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Potential explanations for the educational gradient in coronary heart disease : A population-based case-control study of Swedish women
- 1999
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In: American Journal of Public Health. - : American Public Health Association Inc.. - 0090-0036 .- 1541-0048. ; 89:3, s. 315-321
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Journal article (peer-reviewed)abstract
- Objectives. This study examined the association between educational attainment and coronary heart disease (CHD) and the factors that may explain this association. Methods. This population-based case-control study included 292 women with CHD who were 65 years, or younger and 292 age-matched controls. Results. Compared with the adjusted odds ratio for CHD associated with college education, the age-adjusted odds ratio associated with mandatory education (≤9 years) was 1.87 (95% confidence interval [CI]=1.23, 2.84) and the odds ratio for high school education was 1.35 (95% CI=0.81, 2.25) (P for trend <.01). The odds ratio for mandatory education was reduced by 82%, to 1.16 (95% CI=0.69, 2.09), after adjustment for psychosocial stress, unhealthy lifestyle patterns, hemostatic factors, hypertension, and lipids. Conclusions. Much of the increased risk of CHD in women with low education appears to be linked to psychosocial stress and lifestyle factors. Hemostatic factors, lipids, and hypertension also contribute to a lesser extent. These factors may be considered in strategies geared to reducing socioeconomic inequalities in cardiovascular health.
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| 47. |
- Wamala, SP, et al.
(author)
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Potential explanations for the educational gradient in coronary heart disease: a population-based case-control study of Swedish women
- 1999
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In: American journal of public health. - : American Public Health Association. - 0090-0036 .- 1541-0048. ; 89:3, s. 315-321
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Journal article (peer-reviewed)abstract
- OBJECTIVES: This study examined the association between educational attainment and coronary heart disease (CHD) and the factors that may explain this association. METHODS: This population-based case-control study included 292 women with CHD who were 65 years or younger and 292 age-matched controls. RESULTS: Compared with the adjusted odds ratio for CHD associated with college education, the age-adjusted odds ratio associated with mandatory education (< or = 9 years) was 1.87 (95% confidence interval [CI] = 1.23, 2.84) and the odds ratio for high school education was 1.35 (95% CI = 0.81, 2.25) (P for trend < .01). The odds ratio for mandatory education was reduced by 82%, to 1.16 (95% CI = 0.69, 2.09), after adjustment for psychosocial stress, unhealthy lifestyle patterns, hemostatic factors, hypertension, and lipids. CONCLUSIONS: Much of the increased risk of CHD in women with low education appears to be linked to psychosocial stress and lifestyle factors. Hemostatic factors, lipids, and hypertension also contribute to a lesser extent. These factors may be considered in strategies geared to reducing socioeconomic inequalities in cardiovascular health.
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| 48. |
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| 49. |
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| 50. |
- Weidner, G, et al.
(author)
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Cardiovascular reactivity to mental stress in the Stockholm Female Coronary Risk Study
- 2001
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In: Psychosomatic Medicine. - SUNY Stony Brook, Dept Psychol, Stony Brook, NY 11794 USA. Univ Educ, Dept Hlth Psychol, Schwabisch Gmund, Germany. Karolinska Inst, Dept Prevent Med, Stockholm, Sweden. Karolinska Inst, Dept Cardiol, Stockholm, Sweden. Karolinska Hosp, S-10401 Stockholm, Sweden. Univ Stockholm, Student Hlth Ctr, Stockholm, Sweden. : LIPPINCOTT WILLIAMS & WILKINS. - 0033-3174 .- 1534-7796. ; 63:6, s. 917-924
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Journal article (peer-reviewed)abstract
- Objective: This study evaluated the ability of mental stress testing to discriminate between women with and without CHD, and among women with different disease manifestations, taking into account history of hypertension and beta -blocker use. Methods: Analyses were based on data from a community-based case-control study of women aged 65 years or younger. The study group consisted of 292 women who were hospitalized for an acute event of CHD, either AMI or unstable AP in Stockholm between 1991 and 1994. Controls were matched to cases by age and catchment area. Cardiovascular reactivity and emotional response to an anagram task solved under time pressure were measured 3 to 6 months after hospitalization. Results: Patients reacted with smaller increases in heart rate (4 bpm) than their controls (7 bpm). Results for the rate-pressure product were similar. Cardiovascular reactions did not distinguish patients with AP from those with AML History of hypertension (present in 50% of patients and 11% of controls) was related to enhanced diastolic blood pressure reactivity. Patients on beta -blockers (66%) had lower heart-rate levels throughout testing, but did not differ in their cardiovascular stress reactions when compared with the remaining participants. Conclusions: Women with heart disease have somewhat lower heart-rate responses to stress than healthy age-matched controls. History of hypertension is related to enhanced diastolic blood pressure reactivity to mental stress in both patients and controls.
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