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- Djupsjo, C, et al.
(författare)
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Preoperative disturbances of glucose metabolism and mortality after coronary artery bypass grafting
- 2020
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Ingår i: Open heart. - : BMJ. - 2053-3624. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- Disturbances of glucose metabolism are important risk factors for coronary artery disease and are associated with an increased mortality risk. The aim was to investigate the association between preoperative disturbances of glucose metabolism and long-term all-cause mortality after coronary artery bypass grafting (CABG).MethodsPatients undergoing a first isolated CABG in 2005–2013 were included. All patients without previously known diabetes underwent an oral glucose tolerance test (OGTT) before surgery. They were categorised as having normal glucose tolerance (NGT), pre-diabetes (impaired glucose tolerance and/or impaired fasting glucose) or newly discovered diabetes. Data were collected from nationwide healthcare registers. Cox regression was used to calculate adjusted HR with 95% CI for death in patients with pre-diabetes and diabetes, using NGT as reference.ResultsIn total, 497 patients aged 40–86 years were included. According to OGTT, 170 (34%) patients had NGT, 219 (44%) patients with pre-diabetes and 108 (22%) patients had newly discovered diabetes. Baseline characteristics were similar between the groups except for slightly higher age among patients with newly discovered diabetes. There were 133 (27%) deaths during a mean follow-up time of 10 years. The cumulative 10-year survival was 77% (69%–83%), 83% (77%–87%) and 71% (61%–79%) in patients with NGT, pre-diabetes and newly discovered diabetes, respectively. There was no significant difference in all-cause mortality between the groups after multivariable adjustment.ConclusionIn this study, patients with pre-diabetes or newly discovered diabetes prior to CABG had similar long-term survival compared with patients with NGT.
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- Anderson, RE, et al.
(författare)
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Only a minority of patients referred for elective coronary artery bypass surgery have risk factors diagnosed and treated according to established guidelines
- 2007
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Ingår i: Diabetes & vascular disease research. - : SAGE Publications. - 1479-1641 .- 1752-8984. ; 4:2, s. 112-6
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Tidskriftsartikel (refereegranskat)abstract
- Patients deserve to be medically optimised for treatment of metabolic risk factors and hypertension before referral for elective coronary artery bypass grafting (CABG). We describe here a prospective study of 347 consecutive patients referred for elective CABG. An oral glucose tolerance test (OGTT) was performed and metabolic risk factors and hypertension were determined pre-operatively. Compliance to treatment guidelines was calculated. From the total of 347 patients, 80 patients (23%) had known and 66 (19%) had previously unknown diabetes. Dysglycaemia (that is, diabetes and pre-diabetes) was found in 194 (73%) of the 267 patients without known diabetes. Among patients with dysglycaemia, 111/274 (41%) received one antihypertensive medication, or none, and blood pressure guidelines were met in 39/274 (14%); statins were being taken by 206 (75%; average dose 23 mg simvastatin) and low-density lipoprotein (LDL)-cholesterol guidelines were met in 43 (16%). In conclusion, diabetes diagnosis and titration of risk factor treatment to guidelines is inadequate even in elective CABG patients. A pre-admission OGTT affords an opportunity to improve care significantly.
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- Bokenberger, K, et al.
(författare)
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Work disability patterns before and after incident acute myocardial infarction and subsequent risk of common mental disorders: A Swedish cohort study
- 2019
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Ingår i: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 9:1, s. 16086-
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated the extent to which work disability patterns including sickness absence and disability pension (SA/DP) before and after acute myocardial infarction (AMI) were associated with subsequent common mental disorders (CMDs) such as depression and anxiety in AMI patients without previous CMD. Total 11,493 patients 26–64 years with incident AMI during 2008–10 were followed up for CMD (measured as antidepressant prescription) through 2013. Four SA/DP trajectory groups during the 3-years pre-AMI and 1-year post-AMI were identified. Hazard ratios (HRs) with 95% confidence intervals for subsequent CMD were estimated in Cox models. Higher pre-AMI SA/DP annual levels (>1–12 months/year) were associated with 40–60% increased CMD rate than the majority (78%) with low increasing levels (increasing up to 1 month/year). Regarding post-AMI findings, constant high (~25–30 days/month) SA/DP levels within the first 3 months was associated with a 76% higher CMD rate, compared to constant low (0 days/month). A gradually decreasing post-AMI SA/DP pattern over a 12-month period suggested protective influences for CMD (HR = 0.80). This is the first study to demonstrate that pre- and post-AMI work disability patterns are associated with subsequent CMD risk in AMI patients. Work disability patterns should be considered as an indicator of AMI prognosis in terms of CMD risk.
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- Dalen, M., et al.
(författare)
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Coronary Artery Bypass Grafting in Women 50 Years or Younger
- 2019
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Ingår i: Journal of the American Heart Association. - : Ovid Technologies (Wolters Kluwer Health). - 2047-9980. ; 8:18
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Tidskriftsartikel (refereegranskat)abstract
- Background-Prior research has shown higher mortality in women with severe coronary artery disease compared with men, particularly in younger patients. It is unknown if this could be attributable to an adverse risk factor profile. Methods and Results-In a population-based cohort study, we included all adults <= 50 years of age (932 women and 4514 men) who underwent coronary artery bypass grafting from 1995 to 2013 from the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register. Following inverse probability of treatment weighting, we investigated differences between women and men. Women had a higher prevalence of cardiovascular risk factors compared with men. There was no difference in early mortality between women and men (unadjusted: 1.3% versus 0.9%; hazard ratio, 1.42; 95% CI, 0.75-2.70; weighted sample: 1.1% versus 1.0%; hazard ratio, 1.10; 95% CI, 0.52-2.30). During a median follow-up time of 11.8 years, in the unweighted population, the risk of death was greater in women compared with men (hazard ratio, 1.34; 95% CI, 1.13-1.58). However, in the weighted sample, the risk of death was not significantly different in women compared with men (hazard ratio, 1.02; 95% CI, 0.83-1.26). Conclusions-Women <= 50 years of age had a higher unadjusted risk of death after coronary artery bypass grafting compared with men, but this was explained by a clustering of cardiovascular risk factors. Female sex per se was not associated with increased mortality or major adverse cardiovascular events. Early mortality was not increased in women compared with men, even though younger women in our study had an increased burden of risk factors known to affect early risk.
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