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Nilsson, Göran
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Publications (10 of 24) Show all publications
Nilsson, G., Hedberg, P., Leppert, J. & Öhrvik, J. (2018). Basic Anthropometric Measures in Acute Myocardial Infarction Patients and Individually Sex- and Age-Matched Controls from the General Population. Journal of Obesity, Article ID 3839482.
Open this publication in new window or tab >>Basic Anthropometric Measures in Acute Myocardial Infarction Patients and Individually Sex- and Age-Matched Controls from the General Population
2018 (English)In: Journal of Obesity, ISSN 2090-0708, E-ISSN 2090-0716, article id 3839482Article in journal (Refereed) Published
Abstract [en]

We compared weight, height, waist and hip circumferences (hip), body mass index (BMI), and waist-to-hip ratio in acute myocardial infarction (MI) patients and individually sex-and age-matched control subjects from the general population in the catchment area of the patients and predicted the risk of MI status by these basic anthropometric measures. The study cohort comprised 748 patients <= 80 years of age with acute MI from a major Swedish cardiac center and their individually sex- and age-matched controls. The analyses were stratified for sex and age (<= 65/>= 66 years). Risk of MI was assessed by conditional logistic regression. A narrow hip in men >66 years was the single strongest risk factor of MI among the anthropometric measures. The combination of hip and weight was particularly efficient in discriminating men >= 66 years with MI from their controls (area under the receiver operating characteristic (AUROC) curve = 0.82). In men <= 65 years, the best combination was hip, BMI, and height (AUROC = 0.79). In women >= 66 years, the best discriminatory model contained only waist-to-hip ratio (AUROC = 0.67), whereas in women <= 65 years, the best combination was hip and BMI (AUROC = 0.68). A narrow hip reasonably reflects small gluteal muscles. This finding might suggest an association between MI and sarcopenia, possibly related to deficiencies in physical activity and nutrition.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-371133 (URN)10.1155/2018/3839482 (DOI)000451233500001 ()30533220 (PubMedID)
Note

Corrigendum in: Journal of Obesity, Volume 2018, Article ID 3126805, https://doi.org/10.1155/2018/3126805

Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2019-01-17Bibliographically approved
Nilsson, G., Leppert, J., Hedberg, P. O., Rosenblad, A. & Ohrvik, C. J. (2015). Heavy torso and narrow hip means high risk of myocardial infarction in elderly men: findings from a population based case-control study on anthropometric measures. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 29-SEP 02, 2015, London, ENGLAND. European Heart Journal, 36(Suppl. 1), 119-120
Open this publication in new window or tab >>Heavy torso and narrow hip means high risk of myocardial infarction in elderly men: findings from a population based case-control study on anthropometric measures
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2015 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no Suppl. 1, p. 119-120Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-266233 (URN)000361205101436 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 29-SEP 02, 2015, London, ENGLAND
Note

Meeting Abstract: P753

Available from: 2015-11-23 Created: 2015-11-05 Last updated: 2017-12-01Bibliographically approved
Selmeryd, J., Sundstedt, M., Nilsson, G., Henriksen, E. & Hedberg, P. (2014). Impact of left ventricular geometry on long-term survival in elderly men and women. Clinical Physiology and Functional Imaging, 34(6), 442-448
Open this publication in new window or tab >>Impact of left ventricular geometry on long-term survival in elderly men and women
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2014 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 34, no 6, p. 442-448Article in journal (Refereed) Published
Abstract [en]

Background: Adverse loading conditions and cardiac injury lead to remodelling of the heart into different patterns of left ventricular (LV) geometry. Geometry can be classified into LV hypertrophy (LVH), concentric remodelling (CR) or normal geometry (NG). The prognostic implications of the different geometric patterns have been extensively studied in middle-aged subjects, but data are scarcer for elderly populations. Methods: From a community-based random sample of 75-year-old men and women, subjects with normal LVEF were selected (n = 303). All-cause and cardiovascular mortality was analysed by LV geometry with Cox regression (unadjusted and adjusted for sex, prevalent hypertension, smoking, diabetes and prevalent ischaemic heart disease). Median follow-up time was 9.9 years. Results: Prevalence of CR and LVH was 19% and 17%, respectively. Hazard ratios (HRs) for CR were 0.93 (95% CI 0.54-1.58) for all-cause and 1.13 (0.48-2.65) for cardiovascular mortality. HRs for LVH were 2.01 (1.30-3.10) for all-cause and 3.55 (1.89-6.67) for cardiovascular mortality. As non-proportionality was present in the form of an increasing hazard for LVH, we partitioned the follow-up time at the median event time (approximately 7 years) and performed Cox regression separately within each time period. HRs for LVH during the first period were 1.23 (0.63-2.42) for all-cause and 1.79 (0.69-4.65) for cardiovascular mortality, while HRs for the second period were 3.06 (1.73-5.41) for all-cause and 6.60 (2.82-15.39) for cardiovascular mortality. Conclusion: In this community-based sample of 75-year-old men and women with normal LVEF, LVH was associated with an adverse prognosis during long-term follow-up, whereas CR was not.

Keywords
aged, left ventricular hypertrophy, mortality, ventricular remodelling
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-240232 (URN)10.1111/cpf.12114 (DOI)000345639300004 ()24314203 (PubMedID)
Available from: 2015-01-07 Created: 2015-01-06 Last updated: 2017-12-05Bibliographically approved
Nilsson, G., Hedberg, P. & Ohrvik, J. (2013). Inflammation and the Metabolic Syndrome: Clustering and Impact on Survival in a Swedish Community-Based Cohort of 75 Year Olds. Metabolic Syndrome and Related Disorders, 11(2), 92-101
Open this publication in new window or tab >>Inflammation and the Metabolic Syndrome: Clustering and Impact on Survival in a Swedish Community-Based Cohort of 75 Year Olds
2013 (English)In: Metabolic Syndrome and Related Disorders, ISSN 1540-4196, E-ISSN 1557-8518, Vol. 11, no 2, p. 92-101Article in journal (Refereed) Published
Abstract [en]

Background: High blood concentrations of inflammatory markers, including white blood cell (WBC) count, are closely related to the metabolic syndrome. Both conditions predict dismal survival. We determined prospective associations between mortality and factors derived by a factor analysis of WBC count and the basic components of the metabolic syndrome. Methods and Results: We performed a factor analysis of WBC count and the continuous components of the metabolic syndrome in 196 men and 200 women, comprising 64% of the originally invited 75 year olds from the Swedish city Vasteras. The analysis revealed three factors in men and two in women. The first factor included fasting glucose, high-density lipoprotein cholesterol, triglycerides, and waist circumference in men and in addition WBC count in women. The second factor included diastolic blood pressure and systolic blood pressure in both sexes. In men, the third factor included fasting glucose and WBC count. These factors explained 66% (first factor, 28%; second factor, 23%; third factor, 15%) of the variation in men and 57% (first factor, 34%; second factor, 23%) in women. Prospective associations of the derived factors and all-cause mortality during 10-year follow-up were assessed by Cox regression [hazard ratio (HR)]. The first factor was significantly related to increased mortality in men: HR=1.22 [95% confidence interval (CI) 1.05-1.41; p = 0.008] and women: HR=1.25 (95% CI 1.06-1.48; p = 0.010). Pooling men and women adjusting for established cardiovascular risk factors gave HR= 1.16 (95% CI 1.04-1.29; p = 0.010). In men the third factor was significantly related to mortality; HR= 1.29 (95% CI 1.07-1.57; p = 0.009). Conclusions: A metabolic inflammatory factor and a blood pressure factor were identified. In men, the former was split into a metabolic and an inflammatory factor. Factors including metabolic and inflammatory components were significantly related to 10-year mortality and the relation remained after adjusting for established cardiovascular risk factors.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-198382 (URN)10.1089/met.2012.0100 (DOI)000316300300004 ()
Available from: 2013-04-15 Created: 2013-04-15 Last updated: 2017-12-06Bibliographically approved
Hellden, A., Odar-Cederlof, I., Nilsson, G., Sjoviker, S., Söderström, A., von Euler, M., . . . Bergman, U. (2013). Renal function estimations and dose recommendations for dabigatran, gabapentin and valaciclovir: a data simulation study focused on the elderly. BMJ Open, 3(4), e002686
Open this publication in new window or tab >>Renal function estimations and dose recommendations for dabigatran, gabapentin and valaciclovir: a data simulation study focused on the elderly
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2013 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 4, p. e002686-Article in journal (Refereed) Published
Abstract [en]

Objectives The thrombin inhibitor dabigatran is mainly excreted by the kidneys. We investigated whether the recommended method for estimation of renal function used in the clinical trials, the Cockcroft-Gault (CG(old)) equation and the estimated glomerular filtration rate (eGFR) modification of diet in renal disease equation 4 (MDRD4), differ in elderly participants, resulting in erroneously higher dose recommendations of dabigatran, which might explain the serious, even fatal, bleeding reported. The renally excreted drugs gabapentin and valaciclovir were also included for comparison. Design A retrospective data simulation study. Participants Participants 65years and older included in six different studies. Main outcome measure Estimated renal function by CG based on uncompensated (old Jaffe' method) creatinine (CG(old)) or by MDRD4 based on standardised compensated P-creatinine traceable to isotope-dilution mass spectrometry, and the resulting doses. Results 790 participants (432 females), mean age (SD) 77.6 +/- 5.7years. Mean estimated creatinine clearance (eCrCl) by the CG(old) equation was 44.2 +/- 14.8ml/min, versus eGFR 59.6 +/- 20.7ml/min/1.73m(2) with MDRD4 (p<0.001), absolute median difference 13.5, 95% CI 12.9 to 14.2. MDRD4 gave a significantly higher mean dose (valaciclovir +21%, dabigatran +25% and gabapentin +37%) of all drugs (p<0.001). With MDRD4 58% of the women would be recommended a full dose of dabigatran compared with 18% if CG(old) is used. Conclusions MDRD4 would result in higher recommended doses of the three studied drugs to elderly participants compared with CG, particularly in women, and thus increased the risk of dose and concentration-dependent adverse reactions. It is important to know which method of estimation of renal function the Summary of Products Characteristics was based on, and use only that one when prescribing renally excreted drugs with narrow safety window. Doses based on recently developed methods for estimation of renal function may be associated with considerable risk of overtreatment in the elderly.

Keywords
Clinical Pharmacology, Geriatric Medicine
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-219178 (URN)10.1136/bmjopen-2013-002686 (DOI)000329809200013 ()
Available from: 2014-02-24 Created: 2014-02-24 Last updated: 2017-12-05Bibliographically approved
Nilsson, G., Rosenblad, A., Hedberg, P. O. & Leppert, J. (2013). Steeper increase of body weight and BMI in acute myocardial infarction patients than in control subjects from the general population: learning from a case control study. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 31-SEP 04, 2013, Amsterdam, NETHERLANDS. European Heart Journal, 34(S1), 148-148
Open this publication in new window or tab >>Steeper increase of body weight and BMI in acute myocardial infarction patients than in control subjects from the general population: learning from a case control study
2013 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no S1, p. 148-148Article in journal, Meeting abstract (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-214371 (URN)10.1093/eurheartj/eht307.P732 (DOI)000327744600539 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 31-SEP 04, 2013, Amsterdam, NETHERLANDS
Available from: 2014-01-09 Created: 2014-01-08 Last updated: 2017-12-06Bibliographically approved
Rosenblad, A., Nilsson, G. & Leppert, J. (2012). Intelligence level in late adolescence is inversely associated with BMI change during 22 years of follow-up: results from the WICTORY study. European Journal of Epidemiology, 27(8), 647-655
Open this publication in new window or tab >>Intelligence level in late adolescence is inversely associated with BMI change during 22 years of follow-up: results from the WICTORY study
2012 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 27, no 8, p. 647-655Article in journal (Refereed) Published
Abstract [en]

The objective of this population-based retrospective cohort study was to examine the association between intelligence (IQ) at late adolescence and changes in body mass index (BMI) during 22 years of follow-up until 40 years of age, taking education level into account. Data from 5,286 males born 1950–1959 who had participated in the Westmannia Cardiovascular Risk Factors Study at 40 years of age and attended the Swedish military conscription examination between the ages of 17 and 22 were used. From a mean age of 18 years until follow-up at 40 years of age, BMI increased with a mean (95 % confidence interval (CI)) of 4.36 (4.28–4.43) kg/m2, equalling 0.20 kg/m2 per year. The difference in BMI change between IQ levels was strongly statistically significant (P < 0.001), with a strictly inverse relationship between IQ and BMI change. The lowest IQ level (<74) had a mean (95 % CI) BMI increase of 5.19 (4.63–5.74) kg/m2, equalling 0.24 kg/m2 per year, compared with 3.73 (3.40–4.07) kg/m2, equalling 0.17 kg/m2 per year, for the highest IQ level (>126). Education level also had a strictly inverse relationship with BMI change. After adjusting for confounding variables, including education level, IQ still had a strictly inverse relationship to BMI change, with all IQ levels < 111 having a significantly larger BMI change than IQ > 126 (P < 0.01 for all levels). Education level at 40 years of age but not at 18 years of age had a significant association with BMI change after adjusting for IQ.

Keywords
Body mass index, Cohort study, Conscription, Education, IQ, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-183234 (URN)10.1007/s10654-012-9713-7 (DOI)000308966900007 ()
Available from: 2012-10-25 Created: 2012-10-23 Last updated: 2017-12-07Bibliographically approved
Rosenblad, A., Leppert, J. & Nilsson, G. (2012). Maternal age at childbirth is associated with changes in smoking status between late adolescence and early middle age: results from 22 years of follow-up. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 25-29, 2012, Munchen, GERMANY. European Heart Journal, 33(Suppl 1), 615-615
Open this publication in new window or tab >>Maternal age at childbirth is associated with changes in smoking status between late adolescence and early middle age: results from 22 years of follow-up
2012 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no Suppl 1, p. 615-615Article in journal, Meeting abstract (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-183065 (URN)10.1093/eurheartj/ehs282 (DOI)000308012404488 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 25-29, 2012, Munchen, GERMANY
Available from: 2012-10-22 Created: 2012-10-22 Last updated: 2017-12-07Bibliographically approved
Venskutonyte, L., Ryden, L., Nilsson, G. & Ohrvik, J. (2012). Mortality prediction in the elderly by an easily measured metabolic index. Diabetes & Vascular Disease Research, 9(3), 226-233
Open this publication in new window or tab >>Mortality prediction in the elderly by an easily measured metabolic index
2012 (English)In: Diabetes & Vascular Disease Research, ISSN 1479-1641, Vol. 9, no 3, p. 226-233Article in journal (Refereed) Published
Abstract [en]

Objective: Hyperglycaemia enhances the risk of cardiovascular events and death, while high-density lipoprotein cholesterol (HDLc) is protective. Information on these associations among the elderly population is scanty. We applied a cardiometabolic risk index (CMRI) based on HDLc and fasting plasma glucose (FPG) in an elderly Swedish population.

Methods: In total, 432 75-year-olds were followed for 10-year mortality. The impact of risk factors on survival was analysed using Cox regression.

Results: HDLc (mmol/1; median and interquartile range) was 1.6 (1.3-2.0) in women and 1.4 (1.2-1.5) in men, while FPG was 5.9 (5.5-6.6) and 5.9 (5.5-6.5). Some 89 persons were at high risk according to CMRI, and 163 persons died. FPG was related to mortality in women (HR: 95% CI: 1.23; 1.10-1.37) and there was a similar trend in men (1.08; 1.00-1.17; p = 0.061). Increasing HDLc was protective in men (0.38; 0.19-0.77) but not in women (0.77; 0.45-1.29). CMRI was related to mortality in both genders even after adjustment for established risk factors (1.79; 1.14-2.79; p = 0.011).

Conclusions: The CMRI helps identify elderly subjects at risk and may serve as a cost-effective risk prediction tool.

Keywords
Cardiometabolic risk, elderly, fasting glucose, gender, HDL cholesterol, survival
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-179930 (URN)10.1177/1479164111434317 (DOI)000306940800008 ()
Available from: 2012-08-27 Created: 2012-08-27 Last updated: 2012-08-27Bibliographically approved
Nilsson, G., Hedberg, P. & Öhrvik, J. (2011). Survival of the fattest: unexpected findings about hyperglycaemia and obesity in a population based study of 75-year-olds. BMJ Open, 1(1), Article ID e000012.
Open this publication in new window or tab >>Survival of the fattest: unexpected findings about hyperglycaemia and obesity in a population based study of 75-year-olds
2011 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 1, no 1, article id e000012Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To study the relationship between body mass index (BMI) and mortality among 75-year-olds with and without diabetes mellitus type 2 (DM) or impaired fasting glucose (IFG).

DESIGN: Prospective population-based cohort study with a 10-year follow-up.

PARTICIPANTS: A random sample of 618 of the 1100 inhabitants born in 1922 and living in the city of Västerås in 1997 were invited to participate in a cardiovascular health survey; 70% of those invited agreed to participate (432 individuals: 210 men, 222 women).

OUTCOME MEASURES: All-cause and cardiovascular mortality.

RESULTS: 163 of 432 (38%) participants died during the 10-year follow-up period. The prevalence of DM or IFG was 41% (35% among survivors, 48% among non-survivors). The prevalence of obesity/overweight/normal weight/underweight according to WHO definitions was 12/45/42/1% (14/43/42/1% among survivors, 9/47/42/2% among non-survivors). The hazard rate for death decreased by 10% for every kg/m(2) increase in BMI in individuals with DM/IFG (HR 0.91, 95% CI 0.86 to 0.97; p=0.003). After adjustment for sex, current smoking, diagnosed hypertension, diagnosed angina pectoris, previous myocardial infarction and previous stroke/transient ischaemic attack, the corresponding decrease in mortality was 9% (HR 0.92, 95% CI 0.86 to 0.99; p=0.017). These findings remained after exclusion of individuals with BMI<20 or those who died within 2-year follow-up. In individuals without DM/IFG, BMI had no effect on mortality (HR 1.01, 95% CI 0.95 to 1.07; p=0.811). The HR for BMI differed significantly between individuals with and without DM/IFG (p interaction=0.025). The increased all-cause mortality in individuals with DM/IFG in combination with lower BMI was driven by cardiovascular death.

CONCLUSION: High all-cause and cardiovascular mortality was associated with lower BMI in 75-year-olds with DM/IFG but not in those without DM/IFG. Further studies on the combined effect of obesity/overweight and DM/IFG are needed in order to assess the appropriateness of current guideline recommendations for weight reduction in older people with DM/IFG.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-246269 (URN)10.1136/bmjopen-2010-000012 (DOI)000208638000006 ()22021724 (PubMedID)
Available from: 2015-03-04 Created: 2015-03-04 Last updated: 2017-12-04Bibliographically approved
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