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Effects of degree of urbanisation in the risk of recurrent acute myocardial infarction: more than 775,000 incidents followed for 30 years
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
Nordic School of Public Health, Gothenburg, Sweden.
National Board of Health and Welfare, Centre for Epidemiology, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
(English)Manuscript (preprint) (Other academic)
Keyword [en]
acute myocardial infarction, recurrence, regional variation, co-morbidity epidemiology
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:uu:diva-107360OAI: oai:DiVA.org:uu-107360DiVA: diva2:228903
Note
Pek 2Available from: 2009-08-07 Created: 2009-08-07 Last updated: 2011-08-15Bibliographically approved
In thesis
1. Studies of Secondary Prevention after Coronary Heart Disease with Special Reference to Determinants of Recurrent Event Rate
Open this publication in new window or tab >>Studies of Secondary Prevention after Coronary Heart Disease with Special Reference to Determinants of Recurrent Event Rate
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
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:nbn:se:uu:diva-107347 (URN)978-91-554-7577-2 (ISBN)
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

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Gulliksson, MatsSvärdsudd, Kurt F

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