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Studies of Secondary Prevention after Coronary Heart Disease with Special Reference to Determinants of Recurrent Event Rate
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2009. , 86 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 472
Keyword [en]
Coronary heart disease, myocardial infarction, epidemiology, population, prevention, recurrence, psychosocial factors, social support, gender, regional variation, co-morbidity
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:uu:diva-107347ISBN: 978-91-554-7577-2 (print)OAI: oai:DiVA.org:uu-107347DiVA: diva2:228829
Public defence
2009-09-18, Enghoffsalen, ingång 50, Akademiska sjukhuset, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2009-08-28 Created: 2009-08-06 Last updated: 2009-08-28Bibliographically approved
List of papers
1. Hazard Function and Secular Trends in the Risk of Recurrent Acute Myocardial Infarction: 30 Years of Follow-Up of More Than 775 000 Incidents
Open this publication in new window or tab >>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 (English)In: Circulation: Cardiovascular Quality and Outcomes, ISSN 1941-7713, Vol. 2, no 3, 175-185 p.Article in journal (Refereed) Published
Abstract [en]

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.

 

 

 

Keyword
myocardial infarction, epidemiology, population, prevention
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-107364 (URN)10.1161/CIRCOUTCOMES.108.802397 (DOI)000276074000008 ()
Note
Pek 1Available from: 2009-08-07 Created: 2009-08-07 Last updated: 2011-08-15Bibliographically approved
2. Effects of degree of urbanisation in the risk of recurrent acute myocardial infarction: more than 775,000 incidents followed for 30 years
Open this publication in new window or tab >>Effects of degree of urbanisation in the risk of recurrent acute myocardial infarction: more than 775,000 incidents followed for 30 years
(English)Manuscript (preprint) (Other academic)
Keyword
acute myocardial infarction, recurrence, regional variation, co-morbidity epidemiology
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-107360 (URN)
Note
Pek 2Available from: 2009-08-07 Created: 2009-08-07 Last updated: 2011-08-15Bibliographically approved
3. 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)
Open this publication in new window or tab >>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)
Show others...
2007 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 7, 36- p.Article in journal (Refereed) Published
Abstract [en]

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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-13892 (URN)10.1186/1471-2261-7-36 (DOI)18031575 (PubMedID)
Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-11Bibliographically approved
4. A randomized controlled trial of cognitive behavioral therapy versus standard treatment on recurrent cardiovascular events in coronary heart disease
Open this publication in new window or tab >>A randomized controlled trial of cognitive behavioral therapy versus standard treatment on recurrent cardiovascular events in coronary heart disease
Show others...
(English)Manuscript (preprint) (Other academic)
Keyword
coronary heart disease, randomized controlled trial, cognitive behavioral therapy, epidemiology, secondary prevention
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-107361 (URN)
Available from: 2009-08-07 Created: 2009-08-07 Last updated: 2011-08-15Bibliographically approved

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